By Teresa Hicks
Pregnancy loss affects individuals and families in complex ways physically, emotionally and psychologically.
Candace Knight, PhD, RN, FAAN (BSN 1997, PhD 2013), Associate Professor at the University of Alabama at Birmingham School of Nursing and Director of the Nurse-Family Partnership of Greater Alabama, which send specially trained nurses into communities around Alabama regularly visiting moms-to-be, starting early in the pregnancy and continuing after the baby is born with the goal of improving pregnancy outcomes and child health and development, discusses the different forms of pregnancy loss, common misconceptions and how health care providers can offer compassionate support during and after loss.
The different forms of pregnancy loss
Pregnancy loss refers to the loss of a pregnancy at any stage and may be described in several clinical and non-clinical ways. One of the most common forms of pregnancy loss is miscarriage, which refers to the loss of a pregnancy up to 20 weeks’ gestation.
“Early pregnancy loss occurs most often during the first trimester, within the first 12 weeks of pregnancy,” Knight said. “It is estimated that up to 31% of all pregnancies end in miscarriage during the first trimester, although only about 10% of these losses are recognized clinically. Less than 1% of miscarriages occur during the second trimester.”
While miscarriage typically occurs within the uterus, some pregnancy losses develop differently, such as ectopic pregnancy.
“This occurs when the embryo implants outside the uterus, most often in the fallopian tube, and may also be referred to as a tubal pregnancy,” Knight said. “This type of pregnancy loss can be life-threatening due to the risk of fallopian tube rupture and internal abdominal hemorrhage.”
Pregnancy loss can also occur later in gestation. Stillbirth, also known as intrauterine fetal demise, refers to the death or loss of a fetus after 20 weeks’ gestation, in which the fetus is delivered with no signs of life present. According to Centers for Disease Control’s fetal mortality data, the U.S. stillbirth rate for all births was 5.45 per 1,000 births in 2022 and 10.01 per 1,000 births among non-Hispanic Black women.
Grief following pregnancy loss
Emotionally, women may experience a wide range of responses following a loss.
“Sadness and tears may come and go without a clear trigger,” Knight said. “Shock and confusion are common, especially when there were no prior signs of complications or when a person was unaware they were pregnant before the loss occurred. Some patients report feelings of numbness, anger or jealousy when seeing other pregnant women or babies.”
Guilt is another common emotional response to pregnancy loss.
“Many women wonder if they did something to cause the loss,” Knight said. “Feelings of loneliness are common, particularly when others close to them have not experienced loss and may struggle to understand the depth of grief.”
Knight says pregnancy loss can also trigger other mental health concerns, such as anxiety and depression, or worsen pre-existing mental health conditions.
Misconceptions about grief after pregnancy loss
Grief following pregnancy loss is often misunderstood, even by health care providers and family members. One common misconception is that certain phrases offer reassurance when they may instead invalidate a parent’s grief.
“Statements such as ‘you can always try again’ or ‘at least you already have a child,' often minimize the loss and fail to acknowledge the grief,” Knight said. “While these types of statements may be well-intended, they often do not acknowledge the grief of losing a child or the hopes and dreams that a parent may have had for that child, no matter how early the loss occurred.”
Another misconception is that grief is less intense following early pregnancy loss.
“While this may be true for some, the emotional impact of loss varies widely and depends on individual circumstances,” Knight said. “Factors such as recurrent miscarriage, infertility, or feelings of guilt can make an early loss just as devastating as a later one.”
An often unspoken reality is that some women may feel relief following a pregnancy loss, particularly if the pregnancy was unplanned or undesired.
“These feelings can also be accompanied by guilt or shame, making it essential for providers to approach each scenario without making assumptions about how a woman should feel,” Knight said.
Fathers and partners in the grieving process
Fathers and partners may not experience the physical aspects of pregnancy loss, but the emotional impact can be profound and may lead to mental health challenges such as anxiety or depression, according to Knight.
“Speaking directly to fathers and partners about their experience and feelings is important,” Knight said. “Though they may experience loss differently and may be less vocal about their grief, their experience is no less important.”
Sharing support resources specifically created for fathers is an important way to ensure fathers and partners feel seen and validated in their experience.
When additional grief support may be needed
Grief counseling or participation in a support group can offer valuable tools following a pregnancy loss. Being surrounded by others with shared experiences can be therapeutic, though some women may hesitate to seek support due to fears of not being understood.
While many individuals can navigate grief with time and support, there are situations in which immediate mental health care is necessary.
“Immediate mental health support is critical if a woman is experiencing thoughts of harming herself,” Knight said. “In these situations, call 911 or the Suicide and Crisis Lifeline at 988.”
Another resource is the National Maternal Mental Health Hotline, available by calling or texting 1-833-852-6262 (1-833-TLC-MAMA).
“Other signs to seek support include persistent negative thoughts about oneself, excessive worry, feelings of isolation, flashbacks related to the loss, panic attacks, nightmares, difficulty sleeping, intrusive thoughts, trouble concentrating, or overwhelming fears.”
How nurses can offer support
Nurses play a vital role in supporting individuals and families after pregnancy loss.
“Effective responses begin with approaching each patient with dignity, respect and without personal bias,” Knight said. “It may be comforting for women to hear that they are not alone, their feelings are valid, and they are truly being heard. Also, encouraging mental health grief support as a normal part of healing, addressing both emotional and physical well-being, is essential.”
Nurses may gently offer language such as: ‘Would you be open to talking with a counselor or joining a grief support group? Many women find comfort in hearing from others who have had similar experiences. Even a few sessions with a grief counselor can help process the heavy emotions you may be feeling.”
Lastly, helping women connect to supportive care or assisting with scheduling an appointment can be beneficial to reduce barriers to care.