My husband, Peter, sat in a chair watching me pace a small, sterile room. I was supposed to be lying on the examination table, but I needed to move.
In the days leading up to our appointment, every time I felt a cramp, I went to the bathroom expecting to see blood. When my daily morning sickness briefly subsided, I assumed it was because I had miscarried. For weeks, I battled to fit into my regular pants every morning, jumping up and down to try to get them on. But I refused to unpack my maternity clothes that were stored in the basement.
I was bracing myself for the worst-case scenario because I didn’t want to be hurt again. This was based on experience.
A year prior, we learned through an ultrasound that our baby had passed when I was 12 weeks pregnant. After I underwent a dilation and curettage procedure, also known as a D&C, to remove our baby, the surgeon offered minimal guidance. “You can return to work tomorrow and start trying for another baby in a month.”
I was sitting on a hospital bed, drowsy from Ativan and ibuprofen. My mind and body had barely registered what had just happened.
It seemed like she was offering us a simple, almost elegant solution to our grief: just make another baby.
Many women are led to believe that a new pregnancy will erase a prior miscarriage, but this narrative risks dismissing the emotional pain, and consequently women’s mental health, as a result.
Due to many factors, such as a lack of societal awareness and social stigma, women’s emotional experiences after a miscarriage can be dismissed by family, friends or their medical providers. That risk goes beyond comfort; if anxiety or depression after a miscarriage goes untreated, it can persist into subsequent pregnancies or develop into a mood disorder.
Up to half of all pregnancies, like mine last year, end in miscarriage. Each person’s experience is different, but it is not uncommon to endure anxiety and depression after a pregnancy loss.
After a miscarriage, women report feelings of guilt, low self-esteem and an increase in suicidal thoughts, among other symptoms. In the months following a miscarriage, half of women experience depressive symptoms and almost a quarter struggle with moderate to severe anxiety. One in six women who lose a baby due to a miscarriage or ecoptic pregnancy (when the fertilized egg implants outside of the uterus) endure long-term symptoms of post-traumatic stress.
It made me question my ability to carry a healthy pregnancy, sparking an anxiety to quickly get pregnant again
Many women face societal or family pressure to get pregnant again. In my case, my miscarriage made me question my ability to carry a healthy pregnancy, sparking an anxiety to quickly get pregnant again.
After our miscarriage, I was often awakened to the image of our still baby on the ultrasound screen in the middle of the night. Those nightmares lasted for weeks. Luckily, I was seeing a therapist who helped me work through these intrusive thoughts as well as the sadness I was facing.
However, for many women in the US, reliable, affordable access to mental health support is hardly a reality.
The Affordable Care Act (ACA), enacted in 2010, mandated coverage of mental health care, decreasing the rate of uninsured women (ages 18 to 24) by 39% in eight years. But more than 10 million women, particularly of low income, were still uninsured in 2017. One in six women did not successfully obtain mental health care because of their inability to pay, according to the 2017 Kaiser Women’s Health Survey.
Up to 80% of women who experience a prenatal loss will become pregnant again. A year after our miscarriage, I am in the third trimester of a healthy pregnancy. This hardly means I am out of the woods, in terms of my mental health: women who have miscarried suffer from higher rates of anxiety and depression during a subsequent pregnancy than women who have not miscarried and are at a higher risk of experiencing postpartum depression.
I was overjoyed when I discovered I was pregnant again. But at some point, I realized the surgeon’s advice was misleading: unfortunately, the simple advice of just making another baby did not resolve my grief. As we approach our due date, the sadness from our loss coexists with the joy of this new pregnancy.
Concerned about the coronavirus, I switched to a midwife for my prenatal appointments to avoid being in a hospital and for more hands-on care. At my first visit, we sat discussing my medical history, each wearing face masks. At the end of the appointment, she covered my stomach with lubricating jelly and placed a doppler on my belly.
The loud sound of a healthy heartbeat reverberated against the walls. The midwife placed her hand on my arm as tears rolled down my cheeks.
“We can listen a little longer, if you’d like,” she said. And we did.