Miscarriage, Fetal Anomaly and Demise Support

Like a medical history form, this emotional triage form is designed to help you identify how you are doing emotionally and spiritually.

It can’t give you definitive answers — no form can! — but it might help you better understand what you are feeling and what support you might need.

1. How are you feeling? People experience a wide range of emotions in this situation (circle all that apply).

• Helpless
• Confused
• Relieved
• Angry
• Trapped
• Worried
• Supported
• Stressed
• Sad
• Guilty
• Ashamed
• Grateful
• Alone
• Numb
• Afraid

Putting specific words to each emotion you are feeling can help you figure out how to take care of yourself. If you are feeling helpless, for example, what can you do to feel more in control? If you are feeling worried or guilty, how can you find more information to ease your mind? 

2. How do you see yourself? There are some factors in a person's life that make it easier or harder when dealing with traumatic life experiences. Circle the statements that feel more true than false about you.

A.

• I suffer from depression or a diagnosed personality disorder*
• I am easily overwhelmed
• There is a lot going on in my life
• I don’t have anyone to talk about difficult things with
• I often make bad choices and hurt myself and others
• I haven’t told anyone about my decision
• My family/friends are critical and judgmental of my decision
• I have lost a pregnancy in the past
• I felt completely connected to this pregnancy
• I have felt like this wasn’t real or it couldn’t be happening to me
• I do not know how to deal with my feelings
• I have thought about hurting myself*
• I don’t know what I’m going to do to make it through this experience*

B. 

• I feel good about myself
• I am confident in my ability to do what is right for me
• I am able to show compassion for myself
• I am emotionally stable
• I am emotionally mature
• I have supportive family/friends who I rely on
• I feel safe telling family/friends about my decision

If you circled more factors in A, you may need more support during this difficult time. If you circled anything with an *, we strongly encourage you to seek professional help immediately. If you circled more factors in B, you may also need support, but you are starting from a position of strength. Check out some ideas under the “Finding Professional Help” tab.

3. What are some of your beliefs? A person’s beliefs about abortion may affect their ability to feel emotionally healthy when they are facing a termination of a wanted pregnancy due to fetal anomaly.

A.

• I am sad but feel safe in my decision
• I believe that sometimes abortion is the best choice
• I personally know someone who has had an abortion
• I know God understands my decision
• My religious community has supportive resources for families in my situation 

B.

• I believe abortion is murder
• I am not sure if I made the right decision
• I feel guilty and ashamed for having the abortion
• I think God will punish me for terminating my pregnancy
• I am never going to be able to forgive myself
• I think I am a bad parent and person for making this decision
• I think others will judge me because of my decision
• I am never going to get over the loss of my pregnancy

If more of the statements you circled were in B, we encourage you to look under the “Discovering Religious and Spiritual Resources” tab. There are a set of options representing most religious traditions that can help you find a place of acceptance and healing.

Some people prefer to work through their grief process after suffering a pregnancy loss on their own.

Healing is a process, and it can be helpful to figure out what healing will look like for you. These resources aim to soothe and support the complex feelings you’re experiencing, allowing you to take on your healing process in an individualized manner.

• The Burden of Choice by Georgina Pearson — This book consists of collected stories from couples facing a diagnosis of abnormalities during pregnancy, dedicated to the pregnancies they have lost, with the intention of supporting anyone dealing with a similar decision. All profits of this book are donated to the national charity ARC, which provides support and information for bereaved couples dealing with fetal anomalies. On their website, you will find additional literature and downloadable reading materials, including: partner support/guidance, how to talk about your experience with family/friends, and deciding to begin another pregnancy.

• A Time to Decide, A Time to Heal by Molly Minnick MSW, Kathleen Delp ACSW, and Mary Ciotti MD — This book was designed for couples making difficult decisions about their pregnancies. It provides professional suggestions for coping with grief, as well as direct advice from couples who have terminated a pregnancy due to a fetal anomaly. A quick and easy read, it's divided into clear chapters including: the hospital experience, couples healing together, the days and weeks after, and your next pregnancy.

• Unspeakable Losses: Understanding the Experience of Pregnancy Loss, Miscarriage, and Abortion by Kim Kluger-Bell — This book is recommended for women enduring pregnancy loss, as well as for their supportive networks. It is filled with in-depth stories of pregnancy loss, providing solid and practical advice on healthy coping strategies, along with mourning rituals and services. Written by a therapist specializing in the psychodynamics of reproductive crises, readers recommend this self-help manual for those seeking out both comfort and support.

Asking for outside help is not a sign of weakness or an inability to cope with your emotions.

It requires courage and bravery to seek out support when you need it most. Listen to your heart, mind, and body. What are they telling you? If you have questioned whether or not you need professional support during this time, do not hesitate to reach out to those who wish to help.

If you find yourself unable to eat or sleep and are crying uncontrollably, around the clock, SIX WEEKS after the procedure, immediately seek out professional, medical support. These physical symptoms are associated with severe depression and require medical intervention.

Professionals are here to aid you through your grieving process. You can choose between in-person help (therapist), or a national talk line with trained counselors on the phone.

In-Person Help

A good therapist is nonjudgmental, accepting, and patient. Sometimes finding the right therapist for you can be a daunting task.

There are many types of professionals able to assist you with your emotional health needs. All of these therapists provide mental health services but each brings different training, experience, insights, and character to the table. Keep in mind that titles don’t mean everything. It is important to seek out the medical professional who is best qualified to assist your personal and unique emotional needs.

How to Find a Therapist 

• Asking for Referrals – Trusted friends, family, and coworkers can be a great place to start when searching for a therapist. Their therapist can provide a referral to a professional who is an expert in the specific support that you are seeking.

• The Internet – Reliable websites require a minimum of professional qualifications to be listed. Solid search engines provide you with information regarding the professional’s qualifications, what areas of expertise they may have, how long they’ve been in practice, as well as contact information, where their office is located, office hours, and whether or not they accept your insurance. Once you have found a few therapists who seem to fit your needs, Google them yourself. Often you can get a sense of who they are by what they write or what is written about them. Just keep in mind that many good, well-qualified therapists are not on the web. Not finding them there is not a reason to rule them out.

• Use Resources at Work – Many places of employment have what’s called an Employee Assistance Program (EAP). The purpose of EAPs is to provide emotional support and counseling for employees in complete privacy (it is run by people outside your company) and as part of the employee’s benefit package. Usually, you would see a counselor at the EAP for a set number of sessions (no charge to you) and if you want to continue, they will refer you to a therapist in the community who will accept your insurance.

Resources to Access

These sites provide an advanced search tab that allows you to filter therapists according to: gender, age group specialty, services they specialize in, treatment expertise, and the specific area in which you are seeking support. This way, your results are narrowed to therapists in your area, who are well versed in the specific support you are seeking out.

• goodtherapy.org/find-therapist.html
• networktherapy.com/directory/find_therapist.asp
• therapists.psychologytoday.com/rms/

The following two sites also filter doctors according to insurance and location, so that if you wish to go through your insurance plan, you can locate therapists within your network.

• doctor.com/find-a-doctor
• insiderpages.com 

Talk Lines

If you do not wish to seek out in-person counseling, there are a number of free talk lines available so that you may discuss your emotional concerns from the comfort and privacy of your own home.

• All Options (formerly Backline) is a national talk line for women making or having made a pregnancy decision. (1.888.493.0092)
• Connect & Breathe is an after-abortion, non-judgmental talk line. (1.866.647.1764)
• Faith Aloud trained counselors are clergy of various religious faiths: Roman Catholic, Jewish, Unitarian Universalist, Protestant Christian, and Buddhist. Persons of no particular religious faith are equally welcome to receive services (1.888.717.5010). You will reach a voicemail. Leave your first name and phone number; a counselor will call back.

• Imagine Counseling has phone counseling and decision-making tools provided by therapist Charlotte Taft, specializing in pre-and post-abortion trauma (505.490.2084).

It is important to take care of your physical health too. Your body, mind, and heart all need time to recover from this experience.

Below you will find after-care information, which was provided to you at the clinic. Additionally, we have provided a list of suggested self-care practices to help maintain a strong and healthy body after your initial recovery from surgery, and genetic counseling information, which may give you the information you need to make your decision about future pregnancies.

Taking Care of Yourself After an Abortion

Most people have no problems after abortion. Here are general instructions about what to expect and how to take care of yourself after the procedure. We’ve also included instructions for handling an emergency if one occurs.

Plan on relaxing. Don’t drive if you had any sedation. Most people return to their normal activities the next day, but do not do hard work or exercise for several days to a week. This includes swimming, lifting heavy things, bicycling, or jogging. Fill and take any prescriptions you may have been given for antibiotics, pain medication, or other medication. 

• Bleeding – Some vaginal bleeding is normal after the abortion. It may be different than your period. It is also normal to have no bleeding, spotting that lasts up to six weeks, heavy bleeding for a few days, or bleeding that stops and starts again. Call us right away if you soak two or more maxi pads an hour for two hours.

• Cramping – You may have cramps. Use a heating pad or hot water bottle, take pain medication (like Tylenol or Motrin), and rest.

• Sex – Don’t put anything in your vagina (like tampons) or have sex for one week after the procedure. You can get pregnant again within two weeks of the procedure.

• Your Next Period – When your next period will come depends on the birth control method you use. If you are not using birth control, you should have a period by eight weeks after the abortion. If you are not using birth control and you don’t have a period eight weeks after the abortion, call the health center.

• Breast Care – For some people, their breasts will begin to produce milk as a natural consequence of no longer being pregnant. Your breasts may become enlarged, hard, and painful, and you might be slightly feverish. Your milk will dry up on its own within a few days. Relieving a small amount of milk can relieve some discomfort and will not prolong milk production. Rest and cold compresses may help to relieve pain. Be sure not to restrict your fluid intake.

Worried About Something

Our doctors are experts in post-operative care and our staff is always available to you in case of a problem. If you have a complication after your procedure, we will take care of you. During normal business hours, call 1.888.743.7526. In an emergency situation, if the health center is not open for regular business, call the answering service at 1.800.608.6960. A licensed staff person and physician are on call 24 hours a day, 7 days a week.

Call us immediately at the phone numbers listed below, or if you are unable to reach us, go to the nearest emergency room if you:

1. Soak two maxi pads an hour for two hours

2. Have abdominal pain or cramps that you cannot relieve with pain medication

3. Have a fever of 100.4 degrees F or higher

4. Have an unpleasant smelling vaginal discharge or drainage

5. Have signs of a continuing pregnancy

While a follow-up appointment usually is not necessary, we would like to see you if you feel it is important for any reason. If this is the case, please make an appointment in 2–3 weeks at one of our family planning offices.

Exercise Ideas

As your body recovers, get it moving. Exercise is scientifically proven to improve your mood and release tension, stress, and sadness.

• Yoga. A great way to create a calm center and inner peace. Try this at home or at a studio to help build strength, flexibility, and relieve stress.

• Boxing. Group classes are a great way to find motivation and rid your body and mind of tension and anger. Take up boxing and sweat your way to a healthier, more relaxed body and mind.

• Hiking. It allows you to enjoy the outdoors, experience new places, and enjoy family and friends — all while getting a great workout. Sierra Club courses offer weekly classes and organized hikes in many regions.

• Go on Groupon or Living Social to find great deals on exercise packages like Pilates classes, boot camps by the beach, and a wide variety of organized exercise classes. 

Genetic Counseling

• National Society of Genetic Counselor's provides a directory to help patients locate genetic counseling services. Genetic Counselors can be searched by State, City, Counselor's Name, Work Setting, Type of Specialty, or Zip Code.

• Making Sense Of Your Genes: A Guide To Genetic Counseling, is a publication put forth by the nonprofit Genetic Alliance and provides general information about genetic counseling, tips on how to prepare for an appointment, and details about different specialties in the field.

Some people find themselves struggling with questions and religious and spiritual concerns when dealing with the aftermath of termination due to fetal anomaly.

Below is a list of websites to help encourage you toward a place of acceptance, understanding, and healing.

• The Religious Coalition for Reproductive Choice offers many spiritual and religious resources for individuals facing contradictions within their religious faith and personal lives. State affiliates of the organization may offer counseling and referrals to clergy. This site has been recommended by a variety of individuals, from a multitude of religious faiths, for those struggling with religious concerns about and after abortion.

• Catholics for Choice is for pro-choice Catholics and takes a stand on all kinds of reproductive freedom. If you are Catholic and struggling with the aftermath of your abortion due to fetal anomaly, this website offers information to help support both your religious faith and personal freedoms concerning your individual health. They publish the magazine Conscience, as well as other helpful literature.

• WATER is a global network, an educational and spiritual space, and a center for dialogues on feminism, faith, and justice. WATER connects activists, religious leaders, students, scholars, and allies who are using feminist religious values to create social change and discuss the issues women face within our culture.

• Guided Meditation creates a safe, supportive, nurturing space in which you can be present with all of your thoughts and feelings, working to validate and empower your individual choices. It was developed to help encourage spiritual understanding by helping you find empowerment and peace with your choices, and with yourself during difficult times.

Who you tell and how you tell is for you to decide.

Some people feel they are unable to tell the truth, due to fear of judgment and criticism. However, many have found that when they do not tell the whole truth to their trusted loved ones, they do not receive the kind of support they really need.

Research has shown that talking openly about your experience with trusted loved ones is a vital part of the recovery process. If you are worried about how your family and friends may react to your experience, invite them to visit this website so they may gain a better understanding of what you are going through. 

Telling Your Children

The amount of detail you share will depend on their age and how much they know about pregnancy and birth. Use simple terms, like, “The baby wasn’t able to keep growing.” Saying things like, “We lost the baby,” or “The baby is sleeping,” can be confusing to children, so try to be honest.

Telling them the truth helps relieve their anxiety, because children often recognize that you are sad or upset and wonder if it’s their fault. Consider getting a book for children on death and loss to help you and your child with this conversation.

Children may also grieve. Watch for behavior changes and encourage questions. It may help to find another trusted adult in their lives to speak with them as well. If your child attends school or playgroup, don’t be afraid to inform their teacher of your loss so they understand and can support your child.

You may also feel a mixture of emotions regarding your children. You might feel overprotective or resentful of their health. You may experience less patience with them or feel indifferent about them during your recovery. None of these reactions are unusual or wrong but may be confusing or shameful for you. Be kind to yourself and know that these emotions are likely temporary.

Telling Grandparents

Your own parents may find it difficult to cope with your loss. They are facing their own loss, as well as your grief during this emotionally difficult time. Due to generational differences, it may be difficult to speak openly with your or your partner’s parents as they may not be used to the same degree of open communication.

Additionally, deeply held religious beliefs could make it more difficult to share your experience with them. They may not know what to say or how to comfort you. Once again, time, honesty, and the security in knowing you are healthy and loved will help encourage understanding and healing.

Telling Co-Workers and Acquaintances

Being honest and talking openly about your experience does not mean that everyone needs to know about it. But for people who knew you were pregnant, it is often helpful to have a simple statement ready if they ask, or if you feel like they need to know. It can be as simple as, “I lost the pregnancy. Thank you for your support during this difficult time.”

You may choose to tell someone in person, if your relationship is close and you want emotional support, hugs, and comfort. For some people, it might be easier to send emails so you can inform them of your loss and tell them how they can best support you (for example, whether you would prefer not to talk about it, or whether you would like to). You can also ask a friend to spread the word; tell them the message you would like to communicate and let them pass it on.

Reactions May Vary

Be prepared for a wide variety of responses to your news. Not everyone is comfortable with grief and loss, and many people won’t know what to say. Here are a few responses to be prepared for:

• No response. Sometimes people shut down or avoid you. Know that for many, it’s just that they don’t know what to say or do, and they don’t want make your pain worse.

• Downplaying your loss. Sometimes people say incredibly stupid things, like, “At least it happened early,” or “It’s not like losing a 10-year-old.” Know that most of them mean this in support, even if it doesn’t feel that way to you.

• Clichés: “It happened for a reason.” “I know how you feel.”

• Sharing stories: Many people, when they share their experience, find out how many of their family and friends have had a similar experience. Sometimes it feels supportive (“I’ve been there and you will get through this.”) and sometimes competitive (“Oh, yeah? Well, guess what happened to me.”)

How you respond is up to you — whether you prepare a snappy comeback, or smile and walk away, or grit your teeth and move on. Your first priority, however, should be to take care of yourself.

Resources

Antenatal Results and Choices is a group in England that publishes a set of brochures tailored to telling loved ones about your loss, including fathers, grandparents, and children.

Grief is the process of remembering, not forgetting.

Many families have found creating tangible memories to be helpful and comforting as they grieve the loss of their pregnancy. Rituals and keepsakes that speak to your personal experience can help bring about closure for those who wish to say goodbye. Below, we have included a handful of ideas that other families have used to honor the pregnancy.

Memorial Ideas

• Write a goodbye letter

• Hold a memorial service

• Plant a tree or name a star

• Find a pendant that is two halves of a heart. Wear one and bury the other. 

• Do something for a child in need; volunteer or lend a helping hand.

• Give a gift to a child or an organization

• Create a memory box. You might include items you'd prepared for the birth, like booties, albums, stuffed animals, plus sympathy cards from friends and family, and any other memorial items you may have.

• Create a blog or memorial site

Some people and families find important dates, like their expected due date or the anniversary of their loss, to be especially meaningful. You might create a ritual like burning a candle throughout the day of your intended delivery date, or asking friends and family to burn a candle in honor of your pregnancy.

It is never too late or too soon to reach out to others who have been in your same shoes.

While no two individuals will endure the loss of their pregnancy the same way, many women have found it helpful and healing to share their feelings and experience with other women who have lost a pregnancy. If you wish to share your story, someone who wishes to listen and will understand what you are going through is waiting for you to reach out.

Below is a list of online support networks for grieving mothers. Websites have been organized according to the specific topic.

• Ending a Wanted Pregnancy is a support website for parents ending a pregnancy after prenatal or maternal medical diagnosis. You'll find other couples sharing their stories and offering their support, Q&As, and general information.
• Abortion Care Network is a driving force behind the movement to de-stigmatize the abortion experience, while offering support and training to the abortion care community. This network is recommended for those interested in taking part in the larger movement to make abortion an understood and accepted aspect of women’s equal right to health.
• Abortion Conversation Project’s mission is to challenge the polarization that characterizes the abortion conversation, lessen the stigmatization of abortion, and promote speaking and listening with empathy, dignity, and resilience about even the most difficult aspects of abortion. On this website, you will find ways to work through the complicated and conflicting dynamics surrounding abortion and what you can do for yourself and others facing the reality of abortion stigma.

Partners may struggle to understand, accept, and express their feelings during this time.

It is important to remember that you too have experienced a loss and are entitled to the same processes of grief. You may feel as though you have to remain strong for your partner by not letting your true feelings show.

Do your best to talk openly with your partner, to express your feelings and concerns during this time. You too need time to adjust and heal from this experience. Do not be afraid to ask for outside support if needed. Below are a handful of resources available to partners grieving the loss of their pregnancy.

• Men and Abortion was developed to give men who are dealing with abortion a safe space to express and share their feelings about their individual situation. Research has found that most men wish to be more involved in their partner's emotional experience with abortion, yet are unsure how to express their feelings and fears concerning the experience. This site offers a thorough discussion and advice for men affected by an abortion experience.

• Antenatal Results and Choices (ARC) allows you to directly access the publication put forth by the nonprofit organization. The help offered in this book is for men, based on their work with men in these situations. It talks about some of the emotions other men have felt, and gives advice on how to cope, based on their experiences.