How Does Pregnancy After Loss Affect Perinatal Mental Health
Even though pregnancy loss is fairly common, especially in the first trimester, and is a physiological process, the grief and mental health ramifications can be life-long. If you have an early pregnancy loss before 12 weeks, many haven’t even told anyone they are pregnant and thus go through the release and grief process alone, compounding the mental health issues. So the question is, how exactly does pregnancy loss affect one’s mental health in the subsequent pregnancy?
The prevalence of PTSD one month after pregnancy loss was as high as 25%, with 34% of those with increased chances of depression. At four months, the rates of PTSD had fallen to 7%, but the rates of depression stayed the same, and the depression rates fell very slowly over the next few years.¹ In addition to this, a study done on anxiety and prenatal attachment in subsequent pregnancy after loss showed that those with a history of loss had greater risk of anxiety and less chance of prenatal attachment during pregnancy.² It’s been coined as “emotional cushioning”³, the emotional barrier you place between yourself and your unborn baby as if protecting yourself in case of another loss. The trauma and grief appear to be longreaching, affecting not only your mental state, but attachment to other children born after your loss.
To better understand how pregnancy loss affects the next pregnancy, I created an anonymous online survey with questions about their mental health in the next pregnancy, specific things that helped them, if they felt connected to that baby, if they felt capable of parenting that baby, and if their mental health got better or worse after the birth, among others.⁴ I received 84 responses in less than 3 days, all from online friends, their friends, and groups they shared the survey in. Of all the responses, all had had a pregnancy loss and either were currently pregnant again or had a pregnancy following that loss. 60% said that their grief from loss made their mental state worse during the pregnancy, mostly from fear of another loss, but it lessened after the live birth for 40% of those. One said, “I think I needed to fully grieve the babies I didn't carry full term in order to fully love the next baby that I did carry full term.” One question asked if they trusted their ability to parent the baby, 75% said yes, and a response in particular said, “Yes and no, I trust my ability as a parent but I also question myself more and have more anxiety.”
Two of the more intense questions dealt with thoughts of self-harm and suicide during their pregnancy after loss, and in both questions, around 11% had considered both. Because it’s anonymous and clumped together in the report, I don’t know if they were the same 10% of people, but it’s still a fairly high number to me. This shows me that pregnancy after loss isn’t just worry, fear, and emotional cushioning, it’s also a serious mental health concern that may make some people consider harming themselves along with suicide, and possibly act on it. As practitioners, whether doulas, midwives, or even just friends and family, we should be aware of this when working with or talking to those pregnant after loss.
Another interesting aspect of the survey showed that for more than 90% of those that responded, two things helped their fear and anxiety during pregnancy more than anything else: frequent ultrasounds and getting past the gestation of their previous loss. The fact that ultrasounds were the most common way for them to feel safe showed that they needed that outside validation of a growing baby that had more chance to survive through pregnancy and birth than the one before. Some were considered more high risk and under the care of Maternal Fetal Medicine Doctors, but even those with low risk pregnancies after a single loss still had the extra monitoring of their pregnancy just to keep their anxiety under control.
Pregnancy should be a time of excitement and joy, if the pregnancy is planned and wanted, and in many cases of pregnancy after loss the baby is not only planned but very much wanted. Perinatal mental health issues stemming from the loss make this time not a joyous and exciting one for many, and instead it’s a time filled with anxiety, depression, and emotional detachment. Considering one in four people have experienced a pregnancy loss, that is a lot of people going through a very probable mental health crisis during their next pregnancy, one where many don’t get the support they need because they feel guilt from the last loss, guilt to be pregnant again, or even shame that they don’t deserve this baby if they have untreated PTSD or severe anxiety or depression from their loss. We need to make sure we are aware of their history, the signs of anxiety and depression during pregnancy, and that we have the resources available to refer them for more help if they need it.
Resources:
Engelhard, Iris M. Posttraumatic Stress Disorder after Pregnancy Loss. https://www.sciencedirect.com/science/article/pii/S0163834301001244
Armstrong, Deborah. Pregnancy After Perinatal Loss, The Relationship Between Anxiety and Prenatal Attachment. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1552-6909.1998.tb02609.x
Arsenault, Denise. Emotional Cushioning in Pregnancy After Perinatal Loss. https://www.tandfonline.com/doi/full/10.1080/02646838.2010.513115
Pearson, Kayce. Pregnancy After Loss Questionnaire Responses. https://docs.google.com/spreadsheets/d/1mMY5SNyuc7OyVlDo3s8Y8rzcj-rIzn3XSYPhEg_8a0w/edit?usp=sharing