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An estimated 30 percent to 60 percent of conceptions end in a loss and many occur before a person knows that they are pregnant. The Center for Disease Control, 2012, determined that the loss of a pregnancy up to 20 weeks is considered a miscarriage.

Still births occur after a 20-week gestational period of time. The classifications of still births are as follows: Early (20 to 27 weeks); Late (28 to 38 weeks); Still birth (37 weeks or later).

The causes of still births include genetic or structural problems of the fetus; problems with the placenta or umbilical cord; certain conditions in the woman such as uncontrolled diabetes, preeclampsia or obesity; growth restriction, which occurs when the fetus cannot get proper nutrition, and bacterial infections.

All too often, early miscarriages are dismissed or minimized by others. Well intended statements such as, "It wasn't meant to be," or, "Did you think of adoption?" often confuse the parents or deepen their grief. Women may feel isolated when others do not grasp the significance of the loss. The lack of needed support can deepen the emotional pain. What often hurts the most is when others urge the woman to "move on" and tell them "it is time to stop grieving."

It is important to remember that grieving is not restricted to the mother. Fathers can grieve the loss just as intensely as mothers. In a two-year study of 2,823 women who experienced a miscarriage or a live birth, 15 percent suffered from clinical depression.

The following reflect the multiple effects that may occur with the loss of a pregnancy.

1. Physical: Loss of appetite, fatigue, weakness.

2. Emotional: Sadness, anxiety, anger, feelings of helplessness.

3. Cognitive: Preoccupation, confusion, disbelief, magical thinking.

4. Behavioral: Restlessness, sleeplessness, social withdrawal, searching, crying.

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5. Spiritual: Questioning beliefs, anger at God, searching for meaning.

Women question themselves when a pregnancy ends. Grieving couples search for answers to questions that cannot be explained. Mothers often wonder if they lifted something too heavy, mishandled a stressful situation, or if the former use of a contraceptive agent may have caused the miscarriage. Some causes of a miscarriage include chromosomal abnormalities, structural abnormalities, endocrine problems and cervical abnormalities.

Losing a baby in a late pregnancy is a traumatic experience for most couples and for women, the shock and pain can be tremendous. As a result, many women develop anxiety and depression. Self-blame compounds grief many experience. Most couples will question the medical treatment that they and the baby received because they want to know that all procedures were performed correctly.

Tragically, after months of planning for the delivery, baby showers, the purchasing of furniture for the nursery, excited parents, in-laws and well-wishers can all compound the loss of a late-stage pregnancy. For the parents, it is not only the loss of a pregnancy that hurts so much; it is the loss of a future life they had planned and hoped for and all the joy that life would bring. Magically, we believe that if we do everything correctly, life will unfold just as we have planned. But, this belief is not facing reality and if we accept that the loss of life is a part of life, in time, we can recover.

Dr. Lynda M. Gantt, Ph.D., is a licensed marriage and family therapist in Santa Maria.

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