Anna Glezer, MD, reproductive psychiatrist

“[If] I were to start a file on things nobody tells you about until you’re right in the thick of them, I might begin with miscarriages. A miscarriage is lonely, painful, and demoralizing almost on a cellular level. When you have one, you will likely mistake it for a personal failure, which it is not.” — Michelle Obama in her memoir, Becoming

Almost a fourth of all pregnancies end in miscarriage. While common, having one can be an isolating and stigmatized experience. Along with that, hormonal changes afterward can elevate symptoms of depression and anxiety.  We sat down with reproductive psychiatrist Anna Glezer, MD, to learn more about how best to take care of ourselves and our mental health during this time, when to reach out to a professional, and how they can help.   

Miscarriage is common (almost 1 in 4 women). Yet, it can feel like an extremely isolating and stigmatized experience. Why aren’t more people talking about it? 

There are a number of factors that perpetuate the stigma and isolation. The first is that because so few women have talked about this, the silence in itself tells others that there is something shameful about this experience, which is quite wrong. Many people feel there is something wrong with them or their bodies, and that makes it hard to reach out. Interestingly, most everyone who does share their experience then feels good that they did because they learn how common the experience actually is. 

What are the hormonal changes that happen that can affect your mental health? How long can symptoms last? 

The hormonal changes are those that begin right at the start of pregnancy, and are different depending on how far along you were when you lost your baby. The hormonal changes of pregnancy can contribute to feelings of anxiety and depression, and when the grief of a loss is layered on top of that, the symptoms can worsen. There is no answer to how long the symptoms last because each loss is very individual and depends on your life circumstances and how you think and feel about your situation. Some women are able to process a loss within a few weeks, while others need months or even longer to grieve and reflect. 

What about women who have had repeat miscarriages? Is there a higher risk of mental health issues? 

Repeated loss can take a toll on a woman’s mental well-being. Many of the negative thoughts (like, “There’s something wrong with me”) can blossom and spiral. Feelings of hopelessness and helplessness can set in. That is why support, counseling and treatment can be so valuable during this type of experience. 

How can I best support my mental health after a miscarriage? When do I know if I should reach out to a professional? How can I find someone who specializes in grief, loss, and fertility?

First off, let go of guilt and blame, and let yourself grieve.

Ensure you have a support network. This means reaching out to family, friends, or organizations with online support for processing and moving forward after a loss, such as Tommy’s, http://nationalshare.org,  We also love following Jennifer Zucker, PhD, creator of the #ihadamiscarriage campaign @ihadamiscarriage on Instagram.

It could also mean working with a professional therapist who specializes in grief, loss, and fertility.

If symptoms of depression, anxiety, and mental distress are severe and impact daily functioning, seeing a physician for medication management is an important step.

How important is it for both partners to work through a loss together or understand the  others unique experience and grieving process?

Every person grieves in their own way. For some this is sharing, for others it is more reflective. It is important for each partner to have the opportunity to grieve and process in a way that is most beneficial to them. In some cases, those ways align and both individuals can process together, and in others, they do not, so it’s important for each partner to understand how the other is processing. 

How can you best support a friend or family member who has experienced a miscarriage? 

One of the most helpful things is to provide a supportive space for the loved one — giving them an opportunity to grieve, letting them take the lead on how to help, and providing validation for their experience without platitudes.