“You’re young — it will happen eventually.”

“Miscarriages aren’t uncommon. Don’t worry.”

“It wasn’t really a baby yet.”

“Maybe you should consider adopting.”

Even when spoken sincerely, these “words of wisdom” are not necessarily the most appropriate or comforting to a couple who has experienced an early pregnancy loss. According to counseling experts working with this population, having a miscarriage during the first 20 weeks of pregnancy is just as traumatic as any other loss and should be recognized and validated by the couple, their family and friends.

“With early pregnancy loss, or during the first trimester, there is really nothing tangible, so as a result, society tends to make comments downplaying the loss. It’s a sorrow that often goes unacknowledged, and, many times, couples feel that they don’t have a right to grieve or feel the way that they feel,” says American Counseling Association member Valorie Thomas, a Licensed Marriage and Family Therapist and Mental Health Counselor in Florida.

Thomas knows this silent sorrow firsthand. Of her nine pregnancies, she was able to carry only one child full term. Now she draws from her own struggles to have children to help other couples longing for a family.

“Many couples feel that they need permission to grieve. I just really wanted to help other women and couples to go through the grieving process,” she says. Using therapeutic rituals, Thomas guides couples as they grieve not only for the baby they lost, but also for their dreams of what they thought their future would be like with that child.

“Couples experiencing one or more miscarriage often have the same emotional experience as those couples that have difficulty conceiving — the same sense of loss of control, helplessness and desperation,” she says. “It’s a biological, psychological, social and spiritual crisis that affects all aspects of an individual and couple’s functioning.”

Individual, shared reactions

Most counselors know that men and women experience and cope with death differently, but Thomas says these reactions must be explained and presented to the couple as normal. Reactions to the loss may also differ because of personal coping styles, initial levels of desire to have a child and cultural beliefs.

Some common reactions among women include:

  • Depression
  • Higher levels of distress
  • A sense of loss of control
  • Guilt/blaming themselves
  • Talking constantly about the loss
  • Reaching out for social support from friends or family

Common reactions among men include:

  • Buffering themselves against feelings of powerlessness and uncertainty
  • Tending not to speak of the loss
  • Rationalizing
  • Pursuing action or wanting to try again too soon
  • Engaging in denial and distance or avoiding their partner
  • Feeling helpless that they cannot fix the problem
  • Blaming their partner

Together, couples may experience anger, shock or disbelief. Thomas says couples may withdraw from friends or family members who have children and will commonly go through spiritual questioning — “Why did this happen to us?” “Are we not good enough to be parents?” “Is God punishing us?”

“The spiritual aspect, to me, is so significant no matter what the religious background,” Thomas says. “You have to make sense of the loss spiritually. You have to figure out how this fits into your story as a couple. It’s about helping them make sense of what has happened and strengthening them as a couple.”

She notes that an early pregnancy loss changes the relationship permanently. If one or both of the individuals avoid the grieving process, she cautions that it can paralyze the couple’s ability to communicate and problem solve effectively. It also may hinder sexual intimacy and enjoyment.

“They often find themselves stuck and unable to move on. They need to recognize and validate their loss and find a way to say goodbye to their dream of having this particular baby,” Thomas says. “Once a woman finds out that she is pregnant, that emotional attachment begins. They start thinking about what their baby will be like, the child’s future and how the baby will interact within the family.” She adds that if the couple has seen their baby on a sonogram or heard the heartbeat, the sense of loss is even greater, yet they are left with only a fuzzy black-and-white photo or a hospital bracelet as proof of what they once had.

Helping couples grieve

To help couples move through the grieving process, Thomas suggests marking the loss of the child with a “life-cycle ritual,” a planned set of actions acknowledging the passing of the baby. The ritual provides couples the chance to collaborate and construct a symbolic experience to reflect on their loss and share their vulnerabilities with each other. The process of designing the ritual can foster communication, understanding and a sense of peace within the couple, Thomas says.

“When creating a ritual experience, it is important to ask the couple if this is something they desire to do,” she says. “You can suggest that it has been helpful to other couples who have experienced an early loss. This discussion can then lead to determining what the couple needs most from the experience.”

The counselor’s role in this process is to listen to each partner’s story about his or her loss and identify individual and relational strengths and coping skills, Thomas says. These strengths can then be used to help the couple create their own ritual.

She suggests having each partner explore the following questions:

  • What individual strengths have helped you cope with losses in the past?
  • What individual strengths do you possess that get you through difficult times?
  • What are three of your strongest assets as a couple that have helped you through life challenges?

Thomas offers suggestions for each step of the creation process if couples are receptive to the idea of creating a ritual.

Step 1: Purpose of the ritual

What does the ritual mean to you both?

  • Validates the existence of their baby
  • Marks the pregnancy as real
  • Marks the passing of the child
  • Allows the couple to move on
  • Allows the couple to come to terms with their early pregnancy loss

What do you hope to gain from the experience?

  • Closure
  • A forum to grieve the loss of the child
  • Recognition that the baby’s spirit has passed on to another place
  • Taking a step toward accepting the loss

Step 2: Identifying symbolic articles relevant to the loss

What are some special articles that you want to include in your ritual? What does each symbolize?

  • Appointment card
  • Sonogram photo
  • Mother’s journal
  • Candle
  • Baby blanket, toy or clothing
  • A family article, photo or cultural item
  • Religious jewelry or trinket

Step 3: Creating the symbolic action or gesture to be carried out during the ritual

What actions speak to you as a couple as a form of recognizing the loss? (Through this action, Thomas says, a couple can connect themselves, their partner, and their family and friends to their baby.)

  • Lighting a candle
  • Playing a song
  • Reading a letter composed by the parents to the baby
  • Reading a poem
  • Planting a tree or flower

Step 4: Creating a specific plan

The counselor should ask the following questions to help the couple prepare logistically for the ritual.

  • How will the event take place?
  • When will it occur?
  • Where will it be performed?
  • Who will be present?
  • Who will contact family members and friends (if included)?
  • How will the ritual be concluded?

Thomas adds that some couples may choose to involve close family members and friends, while other may decide to perform the ritual privately. The couple also needs to consider the possibility that some family members may not be receptive to the idea of a life-cycle ritual and discuss how to cope if that occurs. “They need to be selective when choosing who will be there and who will be the most supportive of them,” Thomas says. She adds that by discussing and exploring the couple’s preferences while designing the ritual, counselors can also help them use their individual and relational strengths and guide them as they mend their bond with each other.

Thomas notes that some couples may want to conduct a ritual but not plan out all the specific details. “They may just have an idea, but they don’t know when they will be ready to actually do the ritual,” she says. “It may be a spontaneous event that they share when the time is right. It will happen when they are ready. They are in therapy to move forward, so just allow them to evolve. It’s important not to push them.”

After the ritual

After the ritual experience, Thomas says it is important for counselors to explore how things may have changed for the couple. She suggests asking the following questions:

  • What has changed between the two of you as a result of creating this ritual together?
  • What have you learned about yourself and the way you grieve?
  • What have you learned about your partner?
  • What strengths have you become aware of in yourself and in your partner as a result of this experience?
  • What do you think your baby would say to you now that you have honored and remembered him or her?

“This is usually a pretty powerful session,” she says. “This experience has helped them create or rewrite their story as a couple. They came in with one story, not knowing what to do with this loss, and they leave with an understanding of how this event fits into their story. It has a special place within their lives and relationship.”

Helping a couple or individual address issues through the use of their “story” is the primary technique used in narrative therapy. Like Thomas, Donna Gibson, president of the Association for Assessment in Counseling and Education, has used narrative therapy in the past when helping couples through the grief of early pregnancy loss.

Several years ago, Gibson moved out of state and, because of the lack of licensure parity, needed to complete an additional internship. She chose to work with a grief counselor specifically assigned to a hospital maternity ward. This position is rare, Gibson says, because most hospitals employ few grief counselors, and those that do usually assign these counselors to the hospital as a whole rather than designating them for one specific area.

“I worked with a counselor who was only seeing couples who had either lost a child preterm, had stillbirths or had made the decision to terminate the pregnancy due to genetic complications. We also worked with couples who were experiencing infertility,” says Gibson, now a counselor educator at the University of South Carolina. “It was a very enlightening experience because I never before had dealt with that level of grief. It was stressful at times because we were considered a front-line person responding to the family.”

Gibson describes narrative therapy as a postmodern form of treatment in which the individual or couple directs the course of counseling and how they interpret the struggles with which they are dealing. Through this storytelling, she says, couples can come to terms with their loss and forge a stronger relationship with each other.

“I have them tell me their dreams they had for this baby — all the details. The humor they first found (when they learned of the pregnancy) and, now, the sadness they are experiencing. They tell me their story and talk about all of these aspects in the dreams that they created,” Gibson says. “Then I help them rewrite or retell the story focusing on the present and how this has changed their lives. It’s important to get them to recognize that their dream has to be modified, not necessarily lost, even though they lost the baby. The dream can still live if it’s modified, and they are the ones to modify it.”

Gibson adds that miscarriages and early pregnancy losses are not that uncommon, but many couples suffer privately because the subject is painful to talk about or because many people consider it taboo to discuss such issues as infertility. “The problem is that we don’t talk about it in our society,” she says. “As counselors, we need to be comfortable talking about this.”

Barb Fehrman has made it her job to get comfortable discussing the subject. After her pregnancy complications, she decided to change careers and become a Licensed Professional Counselor dedicated to helping couples cope with loss and infertility. The private practitioner uses her experiences with fertility drugs, injections, insemination procedures and pregnancy losses, and her eventual successes, to connect with clients.

Coming from a large Roman Catholic family, Fehrman says her pregnancy complications shattered the family portrait she had envisioned. The lack of support she felt during her own grieving process motivated her to become a counselor in this field. She says it’s important for couples to talk about what has happened and decide how they want to mark the loss and significant dates associated with the loss, such as the baby’s original due date and Mother’s Day. She encourages couples to use whatever medium seems natural to them, be it journaling, preparing a ritual, painting or any other creative expression, and then helps them follow through with the grieving process.

Considering family and friends

American Counseling Association member Valorie Thomas provides the following suggestions to help couples communicate with family and friends after a pregnancy loss.

  • Friends and family usually respond well to a specific request when they otherwise wouldn’t know what to say or do. Let others know that you need help.
  • Respect your need to talk and be heard, and choose good listeners who care about you. It is vital that you reach out to others during this sad time.
  • Plan how you will phrase your loss to colleagues and acquaintances in
  • a simple, brief manner. Respect your need to decline discussing details you don’t want to share.
  • Consider telling those close to you who are pregnant or have small children that it will be difficult for you to socialize with them for a while. If you feel it is too difficult to attend celebrations, send your regrets. Relatives and friends who care for you will probably understand.
  • In addition, the following suggestions can be offered to the couple’s family and friends:
  • Acknowledge their sorrow and validate their feelings.
  • Give them permission to express their grief.
  • Let the couple know it is OK for them to be sad and express their feelings around you. This will allow them to grieve naturally.
  • Offer support by asking if there is anything you can do. For example, provide meals or help with the care of their other children.
  • Ask if it is OK for you to check on them periodically. It is assuring to know that family and friends are there to support them in the coming months.
  • Ask them out or invite them over and enjoy just “hanging out” and being together.
  • Be aware that being around children or someone who is pregnant may be very difficult for the couple at this time. Give them permission to choose not to attend baby showers or children’s birthday celebrations.
  • Acknowledge that they may have emotional reactions on the anniversary of the due date of their baby or the date of the loss. Be especially sensitive to their needs at these times.

— Angela Kennedy