Grief after miscarriage, stillbirth or neonatal death
Grief for a baby who died in pregnancy, at birth or soon after. There may be few or no memories to grieve with, no funeral, and a world that did not know the baby existed, while the body may still be acting as if the pregnancy goes on.
What drives it
The loss is of a future more than a past: a name, a room, a due date, the parent the person was about to become. Useful for identification because the grief is often hidden or played down (‘at least it was early’), and partners may grieve on different timetables, which can read as one of them not caring.
How it shows
Work
Going back to work the next week because nobody there knew about the pregnancy. Being unable to go to a colleague’s baby shower, or the due date passing in the middle of a quarterly review.
Relationships
One partner wants to talk about the baby and the other wants to try again or not mention it. Relatives who say ‘you can have another’.
Self
Notice the dates you still count: the due date, the week it would have been. Notice whether you hold the grief to a smaller size because of how early it was.
What tells it apart
Post-traumatic stress disorder (PTSD): Grief is more likely sadness and longing for the baby. Post-traumatic stress after a loss may add replaying the scan or the hospital room, startle, and avoiding the places involved.
Intuitive and instrumental grieving (Martin and Doka): When one partner cries and talks and the other stays busy, it may be two grieving styles, and it can look like one of them not caring. The lower rates of post-traumatic stress in partners say little about whether they grieve.
Major depression: Grief tends to come in waves tied to the baby and to dates. Low mood that colors everything for weeks, with loss of interest and self-loathing, may be depression, which Farren’s study also found raised at one month.
A test
Ask what the person had already imagined: a name, a room, a date. The more of that future was already built, the more the grief may be about the future, even after a very early loss.
Questions to carry
- Which date for the baby have I been counting toward?
- Where have I made this grief smaller than it is?
Go deeper
- Read: The Other Side of Sadness, George A. Bonanno, 2009, revised 2019. Written for readers by a psychologist who has followed bereaved people for years. He questions the idea that grief moves through set stages and argues that most people come through a loss with more resilience than expected. Much of it rests on his own group's studies.
How strong the research is
moderate. About 15% of recognized pregnancies end in miscarriage, some 23 million a year worldwide (Quenby and colleagues, Lancet, 2021). In 737 women after early pregnancy loss at three London hospitals (Farren and colleagues, 2020), 29% had post-traumatic stress symptoms at one month and 18% at nine months, and at one month anxiety and depression were higher than in women whose pregnancies continued. A study of partners from the same London clinics (Ultrasound in Obstetrics and Gynecology, 2020) found post-traumatic stress in 7% at one month and about 4% at nine months, from 102 and then 70 partners. These were screening questionnaires and not diagnoses, from one city.
Where it comes from
John Kennell, Marshall Klaus and colleagues, The mourning response of parents to the death of a newborn infant, New England Journal of Medicine, 1970 (every one of 20 mothers mourned, even when the baby lived an hour)