This is a paper I wrote for my Introduction to Counselling class about the miscarriages. I have removed all parenthetical references so future students can learn as much as I did by doing their own research. This paper was difficult to write because this is a situation that many people face.
INTRODUCTION
Pregnancy is a beautiful thing and God chose to bring about his plan of salvation by having Jesus Christ be born a natural, human birth to a woman in Bethlehem. How precious is that the marriage union is the coming together of two people to become one and how much more important is blessing of this union that can be given by God is the gift of a child. Unfortunately, for a variety of reasons, a pregnancy is not always successful and sometimes result in the loss of a pregnancy.
One only has to be a part of a local church congregation to hear the stories of hurt and trauma that can come from the loss of a child through miscarriage. This is often devastating to the family as their hopes of having a child are suddenly taken from them. And yet, this common experience shared by many couples is sometimes called the “silent grief” because they feel alone and unable to share how they are feeling with those around them.
The importance of this topic is simple. As God’s people are hurting, God’s people must step in to bring them comfort. A death in the womb is no different from an elderly person and often hurts an equal amount, although the outward appearance may be different. Pastors and lay people alike must be prepared to face this issue alongside their congregation and be ready and equipped to navigate this crushing time in a couple’s life.
DEFINITIONS / DESCRIPTIONS / INCIDENCE / SYMPTOMS / WARNING SIGNS
When approaching an issue with such a heavy emotional tie, it is imperative that the terms used to describe the issue are correct. For the purpose of this paper, miscarriage will only refer to “spontaneous miscarriage”, that is to say, a miscarriage that is not induced through medical practice, such as an abortion. The miscarriage of a fetus happens between 50-75% of all conceptions abort instantaneously and generally go unnoticed by the woman as they are expelled through normal menstrual cycle. This paper will discuss a miscarriage that the woman is aware of from a western perspective.
The definition of a spontaneous miscarriage, hereafter referred to just as a miscarriage, is defined as the loss of a doctor diagnosed pregnancy prior to 20 weeks of gestation, with a fetal weight of under 500 grams. These miscarriages occur in 15-20% of all diagnosed pregnancies. The miscarriage is not the death of a fetus, but rather, when it is expelled or removed and unable to survive outside of the womb on its own. These events are incredibly common, yet 55% of Americans think that they are a rare event, and this misconception can make couples feel alone in this common struggle. Over half a million women in the United States miscarriage each year, and this event can often be unexpected and physically traumatic. Although this is a common experience, it is not trivial and for most women is the loss of not only a future child, but everything that comes from that such as motherhood, preparing the room, and dreams of the child’s future.
Around 80% of miscarriages happen in the first trimester and there are many causes that can create a terminated pregnancy. Since the death of the fetus precedes the miscarriage, many of the reasons for miscarriage are directly related to the cause of the death of the fetus and over half of miscarriages are caused by chromosomal abnormalities. The most frequent chromosomes to be affected are 13, 16, 18, 21, or 22. The second most common reasons is abnormal infant development.
There are many clear symptoms that signify that a miscarriage is about to occur or has already happened. The most visible symptom is vaginal bleeding, during early pregnancy. Besides spotting, any sort of bleeding is a strong indicator that something is wrong. It may be heavy or light, constant or on and off. Be especially aware if there is pain associated with it. The third indicator is pain the belly, lower back or pelvis. The fourth and final symptom is the passage of tissue through the vagina. No treatment is required for a miscarriage unless there is very heavy blood loss, a fever, or a sign of infection. Unfortunately, the patient will have to stay the course until the miscarriage is completed, and this can be deeply traumatic.
THEORETICAL PERSPECTIVES
There are no named theories specifically outlining the repercussions and effects of a miscarriage on a woman and her. Although what causes the loss of a pregnancy is well documented in the scientific literature, it is rarely talked about among common people, and this has created a stigma around the issue. Although the majority of research is focused on the medical field it is still under examined, and it is researched even less in the humanities and social sciences.
PSYCHOLOGICAL PERSPECTIVES
There are many psychological perspectives that a counsellor must keep in mind while walking with a client through a sudden loss of pregnancy. The first portion of this section will focus on women, followed by men, who are often ignored when it comes to clinical studies of mental health after miscarriage.
After a miscarriage, a woman goes through a wide range of emotions. When women were examined using the “Hospital Anxiety Depression Scale”, it was found that women more often experienced anxiety than depression, in some cases lasting up to 12 weeks, but can last into the long-term.
A pregnancy can often shape a woman’s identity into one of being an expecting mother. A miscarriage takes this identity away from the woman very unexpectedly and can negatively impact a way a woman views herself. For many women who have a wanted pregnancy, a miscarriage is not just a biological event. The ability to reproduce is central to many people’s identity, not just a woman’s. It removes the experience of being able to participate in the most basic aspect of life. This loss can sometimes be because of the loss of the baby, but more often than not also is grieving the loss of the relationship the mother had with the baby. Society can sometimes downplay the role a woman plays and removes her agency, and can view her as a bystander who cannot control what is happening to her. Pregnancy is not merely a biological act. Women are pregnant for a reason, and unlike animals, these purposes are not to spread their genes to the next generation. Even if a pregnancy was unexpected and unwanted, there is a significant bond made between the mother and child as the baby heavily relies on the mother and the mother feels the weight of this responsibility. A miscarriage can have a strong negative effect on the marriage relationship, relationships with friends, and other children that have already been born.
Although depression was not found to be the leading emotion, depression also plays a large part in the process. Symptoms of depression are significantly higher in patients who have had a miscarriage compared to pregnant woman. A contributing factor to the level of depression was if the woman had any children. Depression symptoms declined in relation to the number of children the woman had previously had. The data suggests if a woman already has a child, a miscarriage is easier to bear. Patients who do not have children are more likely to show depressive behaviors and women who have children almost seem to have a protective shield from experiencing depression.Another contributing factor to the level of depression is the length of gestation. The further a woman is into the gestational period, the higher the risk and severity of depression.
Another important factor to take into consideration is if the woman has experienced previous miscarriages. Recurrent miscarriage is defined as three or more consecutive pregnancy losses and occurs to around 1-3% of couples. These couples are at a higher risk of pregnancy complications such as stillbirth, intrauterine growth restriction, and the baby being born prematurely. The amount of data that is available to counsel couples who have had several miscarriages is small, but there is reassurance that once the woman goes beyond the first trimester the success rate of pregnancy goes up and they can expect to be able to have a live birth. Some mental illness can also affect a woman’s experience while going through a pregnancy loss. Women who have bipolar disorder are at a great risk of intense postpartum experience.
Women are not the only ones who are affected by the sudden loss of a pregnancy, as this major life event affects the father as well. The addition of a new baby is a stressor on a family, but the majority of research has been done on the effect on women and men’s have been mostly ignored. Men experience a deep felt loss following the miscarriage of a child and feel unable to talk about these feelings with their family and friends. In a typical miscarriage, the man’s role is traditionally viewed as the support for the mother, so they are unlikely to see support for themselves. In order to cope, men often seek out avoidance coping mechanisms. Men feel stress during a normal pregnancy due to the change of their role in the relationship, but after a miscarriage additional depression will be added on top of what they are feeling. These feelings can last over a year after the miscarriage in some cases. Unfortunately, men are now more than ever being encouraged to take part in the child-bearing process with little to no research on the consequences of this. Although the impact on a man after a miscarriage is less than that of a woman, there is still significant psychological distress caused by it.
THEOLOGICAL PERSPECTIVES
As mentioned above, pregnancy has played an important role in the history of God’s people. Christians believe that God plays an integral part in the conception and formation of a fetus as so poetically said by the Psalmist in Psalm 139. God creates our innermost being and knits us together in the womb. Our days are ordained by God and written into his book before we were ever conceived.
God’s commandment throughout the Old Testament is to be fruitful and multiply, and God often promises children to barren women. These children then grow to become mighty servants of the Lord such as Hannah and Samuel (1 Samuel 1-2) and Sarah and Isaac (Genesis 16). God promises to the Israelites in Exodus 23 that people will no longer be barren or miscarry. Knowing all of this and still having a miscarriage can be a hard blow to withstand in an already traumatic time.
Wesleyans believe that a child cannot go to hell until they reach an age of accountability where they can understand the basic tenants of the Gospel. This means that a miscarried baby goes to heaven, regardless of the religious tendencies of the parents. This can bring great comfort to a grieving family as well as a hope of being united with them again.
Another theological perspective to remember is that Christians believe that life begins at conception whereas in the secular world, life is defined by laws and varies country to country. Since life begins at conception, there is not a cut off period in which a miscarriage is not a big deal. This view of life that believe that life starts at conception may cause some trouble considering 50-75% of pregnancy abort within a few days of conception and the woman never knows that they are pregnant.
ISSUES THAT MAY IMPACT DYNAMICS OF THE COUNSELLING RELATIONSHIP
There are several issues that can affect the counselling relationship with regards to helping a couple work through a miscarriage. Firstly, it is important to know whether or not this is their first miscarriage. As seen through the psychological section of this paper, whether or not this is the first miscarriage a couple has had can have a significant impact on their level of stress, anxiety, and depression.
Another thing that can deeply impact the counselling relationship is if the counselor has gone through a miscarriage themselves. Since this is such a traumatic event, a counselor must have come to terms fully with their own trauma before they can treat someone else. This will not only be healthier for the client, but also for the counselor. By going through something and dealing with it in a healthy way a counselor will be more able to understand the emotions the couple is going through and be able to process them with the client and offer healthy advice. The death of a fetus can give deep traumatic loss and contribute to grief and this struggle is often done alone in silence. A miscarriage can result in a sense of failure and guilt caused by being unable to carry the pregnancy, even though cause does not fall on the woman in a personal sense.
A third thing that can impact the counselling relationship is a person’s religious convictions. Even secular people will often look past their own hold religious views and cultural views to find peace in the tragedy that they are experiences. Knowing that in this time people are looking for answers can open the door to a Christian worldview and allow the counseling dynamic to become more pastoral instead of straight clinical.
A fourth item to consider is the length of time that has passed since the miscarriage has happened. Women most need support immediately following the miscarriage, but having support on special days such as anniversaries of the event.
RECOMMENDED COUNSELING INTERVENTIONS, METHODS, AND RESOURCES
Miscarriages happen to many couples so it would make sense that there are high levels of support available to a grieving couple, but this is not the case. Unlike with a death of a person who has been born or even a death of a child that happens later in the pregnancy, there are not many services available to help people through this. Many women feel a high level of dissatisfaction with the professional support that is available .
The fact of the matter is that a vast majority of women, up to 95% feel that some kind of post miscarriage support was important and 91% of women would have possibly wanted to have support following their miscarriage. The best time to receive this support is immediately after the diagnosis , as doing this too early would be uncomfortable and doing it too late will be too far from the event. This follow-up should happen within a few days or weeks at most. It is also wise to check in on specific times, such as anniversaries or a new pregnancy.
Women also feel that their medical appointment is insufficient for giving the information they desire in order to help in the healing process. They felt most frustrated by the lack of the psychological impacts that a miscarriage would have on them and their family. In general, the longer the hospital stay, the more satisfied a woman is with the information she receives.
One of the most often sought out strategies of coping after a miscarriage is seeking out information, followed by discussing this with others, participating in internet communities, reading about miscarriage, and talking to other women who had experienced a pregnancy loss. On the contrary, very few people reached out to psychology professionals after this event. The main reason that many women did not seek out this help was due to an appearance that it wasn’t available to them.
With this information the course of action for helping a couple who has gone through miscarriage is abundantly clear. A couple needs only two things in order to traverse a pregnancy loss in a healthy way, and the first is information. Without having concrete medical and psychological information, there is not a way that a woman and her partner can feel fully informed about what has happened. If people know what is coming, then fear plays a smaller role. Having information available to the client will help them to realize that they are not alone in this struggle and that many people go through it. It does not the be the silent struggle any longer. If a couple knows what to expect with a miscarriage they can grow to be prepared for the waves of trauma that can happen at seemingly random times after the initial shock has worn off.
The second thing that couples need is support. As with any traumatic experience, going through it with people can make it easier to cope with. There is a great resource online called “Barren to Beautiful” which shares testimonies from a Christian perspective and encourages women to submit their own stories. This online community has offered healing and support to countless people and offers community that may be hard to find elsewhere due to the stigma that is attached to miscarriage. Open and frank support is crucial to healing.
USING THE COMMUNITY OF FAITH
The community of faith, from a Christian perspective, can be greatly beneficial to the healing after a miscarriage. This can be done in several ways.
One of the most common is through small group ministry. As a woman is integrated into a small group her network of support grows and she will be able to have people who can go through this traumatic events together. If a church has a culture of vulnerability, the couple will hopefully know of others who have had a similar experience who can give them comfort in this time.
Another powerful way to support people through the community of faith is giving those who are having this struggle a platform in which they can share their feelings. An example of this would be a testimony that is shared afterwards. This has a two-fold effect on people as the person who has had the miscarriage gets help through expression and this expression helps others who maybe be silently struggling in the pews.
Another important role that church plays in the season of miscarriage is constantly pointing the couple to the truths found in God’s word. There are countless examples of women in the scriptures who were barren and God spoke to them personally to ease their pain. Outside of direct examples, the Bible is full of encouragement for the broken hearted, the downtrodden, and the lonely. God is with people as they grieve the loss of the unborn child and is in control of every situation, even if we feel as if everything is spinning out of control. Finding peace and rest can only fully be found through God, so a Church must constantly be pointing the couple to this reality.
SUMMARY OF KEY POINTS
Miscarriage, although painful, is a very common occurrence in the life of a woman. Many miscarriages, around 50-70%, happen at the time of fertilization and go unnoticed by a woman. A miscarriage is the loss of a clinically diagnosed pregnancy that is less than 20 weeks into the gestational period, and occur in 15-20% of all pregnancies. Although these events are very common, most people think that they are rare, which leads people to struggling through these traumatic events alone.
The symptoms are almost exclusively external with the appearance of abnormal vaginal blood as well as pain in the stomach and pelvic area, but this depends on the length of the gestation. Although this is a common problem, there are no named theories about miscarriages and very little research has been done outside of the medical field.
The most common psychological effect of a miscarriage is anxiety followed by depression. A miscarriage can also lead to a woman having a distorted view of their identity and self-worth. This means that a miscarriage is not merely just a biological event and it’s affects are far reaching. The effects can lead to problems within a marriage, and change the way a couple interacts with friends and family.
Depression is a major factor and is more intense when it is a woman’s first pregnancy. Women find it more difficult to bear a loss of pregnancy when it is their first because it removes hope from them that they may never have a child. The length of gestation can also impact the level of depression, as the further a woman is into the pregnancy, the greater sense of loss. Men are also affected by this loss, but traditional research has only focused on the trauma of the women.
Theologically, life begins at conception, and God plays an integral role in the development of a fetus, forming them and making a plan for their lives. Wesleyans hold a view of the age of accountability, so knowing that an unborn child goes to heaven can bring deep comfort to a grieving family.
Miscarriages have always been an issue that brought me deep sadness due to the loss of life that is experienced as well as the pain I have seen in so many people who have been unable to have children, so this paper has been very helpful to help me understand both the medical, psychological, and spiritual aspects of a miscarriage. My mother experienced a miscarriage between my brother and I, and it affects her to this day, even though not as much as it used to. This summer, my boss at Wesleyan Headquarters took me to lunch with his wife. Halfway into the meal, he told me that they had suffered a miscarriage. I was unable to hold back tears as I saw the pain that they had gone through, and I didn’t know what to say. Miscarriages have happened to many people who have been close to
There are things that we must do when counselling people who have gone through a miscarriage, and bursting into tears is not the right thing to do. We must come alongside those who are hurting and provide loving support by pointing them to God, with whom their child is now in eternity with. A counsellor must be intentional and answer any questions that they can, and refer the client to a medical professional so that they can get the medical answers that they require to feel well informed as information can deeply help the healing process.
A counselor must avoid making the woman feel guilty about a pregnancy loss because these are feelings she may already be feeling. A miscarriage and do much harm to someone’s self-worth and identity, so it is important to use language that is free of blame.
Overall, there has been a lack of help available to those who have suffered pregnancy loss, and as we go out into the church and beyond after Kingswood, we will face this issue, so being well equipped to face it and walk alongside those who are hurting is essential.
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