Guide to Navigating Miscarriage

By Co-Founder Hilary Metcalfe

Losing a pregnancy can be one of the most heartbreaking experiences. Whether it was a planned pregnancy or a surprise, the sudden loss of a life growing inside of you can come with a  range of emotions, from numbness, grief and sadness to anger, shame and guilt. 

Miscarriage is a special type of grief that can be difficult to understand and cope with.

It may be more challenging to come to terms with a loss that others may not understand, potentially leaving many who lose a pregnancy feeling unprepared and isolated. This guide is based on my own loss experience, what I learned and what helped me most. It aims to provide comfort, support, and practical advice to help you navigate this difficult journey. 

1. Your Body, Hormones & Health 
2. Understanding the Silence and Anger  
3. On Empathy Misses and Guiding Others 
4. Non-linear grieving
5. Exercise and Movement
6. Community and Sisterhood 
7. The Significance of Rituals 
8. Finding Meaning 

My Story 

Coming out of a 15-year marriage and starting my life anew at 35 years old, I decided to release the idea of ever becoming a mum. I was dating again for the first time since I was a teenager. I didn’t want my ticking biological clock rushing me to ‘settle down’. 

But then, I met Kees for whom having children was very important. He decided I was the woman he wanted to build a family with and I felt the same way. At age 37, after almost a year of trying with a form of Endometriosis and low ovarian reserve, I fell pregnant. We were ecstatic, having defied the scary statistics.

I could not contain myself and told anyone and everyone! 

I was just starting The SABI and aware of the conflict women felt in sharing their news in what is often a wary but exciting first 12 weeks of pregnancy. I knew the risks: 1 in 4 pregnancies is likely to end in a loss. Between fears about missed career opportunities, letting the pregnancy “settle” in the safe zone or fear of loss, we keep quiet for a myriad of reasons. And yet, I decided I would talk openly about my pregnancy. It’s a time I wanted to share! 

But at our 13-week scan, we learned the baby no longer had a heartbeat. I had a silent miscarriage possibly 2 weeks prior. The ultrasound technician informed me matter of factly, that I would probably start bleeding within hours. It wasn’t the movie version where a woman wakes up in a pool of blood and then cries a bit, though this may be how it is for some, early on. I had a mini birth, complete with my water breaking and passing my baby after hours of contractions. 

My body mostly recovered after a couple of weeks though it took 3 months or so for the pregnancy hormones (and first-trimester symptoms like nausea and the mild hangover feeling) to abate and feel like myself again. 

But, I learnt, the heart takes longer to heal.

1. Your Body, Hormones & Health 

Pregnancy loss is a traumatic event and grief can trigger higher and prolonged levels of stress hormones including cortisol and adrenaline, which if left unresolved can contribute to depression or anxiety. According to a 2016 study in the Journal of Human Reproduction:

Women who experience miscarriage are at higher risk of anxiety, postnatal or postpartum depression and Post Traumatic Stress Disorder (PTSD) in the months following a miscarriage. 

Grief and stress suppress the immune system, making you more susceptible to illness and infection in the days and months following miscarriage. Many often face hormonal fluctuations, irregular periods, hot flashes and mood swings. It can take months to reset. 

The physical and emotional effects of miscarriage on your health and well-being are often more complex than any medical solution can offer. Your support system, community (physically and online), and personal self-care are fundamental for the healing and recovery process. 

And yet, in several studies between 2013 and 2017, women commonly reported that following their miscarriage, they felt socially isolated, stigmatised, ashamed, and received inadequate emotional support socially, and from medical caregivers who may even be dismissive of what you are going through. 

This echoed my experience and probably resonates with most women reading now.

2. Understanding the Silence and Anger  

After the first wave of condolences, most people around me were at a loss for what to say, so they more often said nothing. This sometimes made me angry. Anger is a stage of grief and can arise from the lack of control we feel over our situation, the loss, and the perceived failure of our bodies. 

I even felt anger at other women who had a miscarriage because they “had not prepared me for this”. Many only revealed that it had happened to them long after it happened to me. After my anger subsided, I realised painfully, that even in cases when I did know they had miscarried (I was in my twenties at the time, but still), I had not reached out to them, offered enough hugs, or continued to ask how they were despite the awkwardness of it…for the exact same reasons most people avoided me. 

As award-winning author Julia Bueno explores in her book “The Brink of Being: Talking About Miscarriage", miscarriage is taboo and often not talked about openly. This silence can lead to a lack of empathy towards those experiencing it. People often do not know what to say or may worry about saying or doing the wrong thing. This can cause them to withdraw or avoid the person altogether, leaving the grieving person feeling isolated and unsupported. 

It may be the norm, but it doesn’t make it right. 

It places the burden of processing the loss and even helping others to navigate their response to your loss on the grieving mother or couple. It may be the norm, but it doesn’t make it right. And yet, accepting isolation or living in silence does not offer you support or community in your grief or allow others to be there for you the way you may really need them to be. 

At least you know you can get pregnant! 

3. On Empathy Misses and Guiding Others 

From well-meaning comments like “At least you know you can get pregnant!” or “Everything happens for a reason!” and “It’s just so common, it happens all the time, like with so-and-so I know”, going through a miscarriage can be a minefield of insensitivities. This is partly why many people choose not to share early pregnancy news or avoid the topic of their loss altogether. No response to grief should ever begin with “at least”. 

Empathy can help us process grief. It involves more than just feeling sorry for someone.

Why does it seem so hard? People struggle with their own discomfort or fear around the topic of death and loss, and there may even be judgement surrounding pregnancy grief. This makes it difficult for them to engage in conversations about miscarriage or offer meaningful support. 

Ultimately, holding space for someone grieving a miscarriage requires empathy, understanding, and a willingness to listen without judgement. With that discomfort can come a strong desire to “fix” which although well-intended, is not real empathy. Human emotion researcher and author Brene Brown, PhD has found empathy is essential for grief healing. 

In her book "Rising Strong," Brown discusses the connection between empathy and grief. It allows us to feel understood and supported by others, to process and move forward. It involves more than just feeling sorry for someone. True empathy requires us to put ourselves in another person's shoes and feel what they are feeling. 

She identifies sympathy (also known as an empathy miss) as looking down on a person in a deep, dark hole and remarking, “wow that hole is deep! I feel sorry for you. I know you’ll get out of it though”. Whereas empathy is more like throwing down a rope and sitting in the hole next to them for a bit (ensuring you can always climb back out). It involves being present with the person and offering support without trying to fix the situation or offer platitudes.

Making requests and asking for help 

I found that when I gave people guidance and made specific requests, taking responsibility and ownership over the process, others were better able to support me and even appreciated the guidance. It is tough to do, especially at first as it requires vulnerability on your part when you may be feeling raw already. But in every interaction where I tried it, or even did so after the fact, I was pleasantly surprised. It almost always resulted in me feeling more authentic, closer to them and them to me. 

By engaging in this way, you are practising compassion for them and for yourself. We are not mind readers, even those who may know you well and love you deeply, like family, friends or even a partner. But you can assist them in supporting you in the process. As Psychologist Dr. Phil McGraw says in his Life Strategies Book, we teach others how to treat us and asking for what we need provides clarity, leads to more authentic exchanges and is often empowering.

4. Non-linear Grieving

After you have dealt with telling who you needed or wanted to tell, it may still be a bumpy road. Grieving is a complex and deeply personal experience that is not linear. It is often described as occurring in stages, such as denial, anger, bargaining, depression, and acceptance, first explored by American-Swiss psychiatrist, Dr. Elisabeth Kübler-Ross, in her book ‘On Death and Dying’. 

Grief after a miscarriage usually follows a similar pattern – sometimes in order, sometimes rearranged, and sometimes not complete with all stages. You may move through the stages, or back and forth, at your own pace. If you are in a stage you already went through, it does not mean you have “regressed”. There is no wrong order.

Emotions are like water, they will always find a way through. 

Whether it is sadness, anger, or loneliness, it’s important to feel your feelings. It is common for many grieving people (as I did) to fall into avoidance, for example by becoming hyper-focused on getting pregnant again. They may even fall pregnant soon after and pour themselves into the excitement of expecting. 

Avoidance of grief can result in higher levels of anxiety during the next pregnancy due to fears over the potential for loss. In a 2010 Maternal and Child Health Journal study (8), women who had miscarriages or stillbirths were found to have a higher chance of developing PND or PPD, postnatal, or postpartum depression. 

Pushing feelings away does not allow us to skip them over, but can sometimes compound them, leading to outbursts, meltdowns or other mental health repercussions later because emotions are like water, they will always find a way through. 

If this feels familiar and overwhelming, a therapist or grief counsellor may be of great assistance.

5. Exercise & Movement

Exercise and movement can be helpful for coping with grief as it allows us to express what we may struggle to voice. It also reduces stress and improves well-being. In 2021, this UK study found that grief outcomes such as anxiety and depression, and psychological well-being were improved through physical activity. 

I found it’s best not to think of it as a to-do, but rather an opportunity to help your body express what you may be stuck in releasing, physically. I will dive in during a later blog into some of the best exercises for releasing emotion. The key is to identify a type of movement that feels manageable and enjoyable and be patient with yourself as you navigate the grieving process.

6. Community and Sisterhood 

Community and sisterhood amongst women can be deeply cathartic and powerful. Building a solid support network, and identifying the friends I felt safest with on this topic were among my best resources.

I found the most solace from women who had been there before in a few trusted friends and miscarriage support groups online, like via the Peanut App or Reddit forums. Additionally, I found a good support network across social media for instance via Ella Rose, whose podcast, virtual sisterhood and online event The Joy of Sunflowers offers everything from other mothers' stories to expert guidance. With time, my goal is to build out an element of our Conscious Collective at The SABI to become an informative and healing resource for women who have gone through miscarriage. For now, I have started pulling together a series of books and apps that helped me in our Resources Section. If there are great ones I have missed, let us know. We will review and add them. 

7. The Significance of Rituals 

As part of our process, my partner Kees gifted me a beautiful necklace that is in the shape of an irregular egg. I wear it daily and kiss it often, sending my baby love whenever I feel the loss and sadness. It helps me express and release my grief, making it tangible somehow through this little ritual. 

Rituals can be a powerful way to honour your feelings and find meaning in your grief. Consider creating a ritual that helps you remember and honour your baby, such as planting a tree, creating a memorial, a piece of jewellery or something tangible, such as a beautiful rock you find on a walk. Writing can be especially cathartic, like a letter to the baby or your past or future self. Find something that speaks to you by trying them out.

I also went through a process in the weeks and months following of reconnecting with myself, giving thanks to my body for the process I had been through. It was tough. There was a lot of blame. I took myself for a healing massage during which I meditated and cried throughout. I took moments in the shower to thank my body for creating this little soul that I would love forever. 

I tried, wherever possible, to find a physical ritual, during which I focused on shedding the blame and learning self-love again. I found the process of preparing and drinking a nourishing infusion that also helped me balance my post-miscarriage hormones, or treating my body to a layer of goodness carved out a time to connect with how I was feeling emotionally and physically. We often forget and ignore the importance of physical rituals to heal the mind. For me, it was key in getting through long and painful days. 

8. Finding Meaning and Other Tools

There is a sixth stage of grief recently added to Dr. Elisabeth Kübler-Ross’ work via her collaboration with author and grief expert David Kessler. It is often referred to as “finding meaning”. According to Kessler, finding meaning can occur at any point during the grieving process. 

He suggests it can help us move forward in our grief and ultimately lead to a sense of peace and acceptance. This doesn't mean that you forget about your loss or that you stop grieving, but that you are able to find meaning in your loss and move forward with your life. You may reach a place of acceptance, and you may not, but giving yourself time and exercising self-compassion is important and helpful in the process.

Here are a few suggestions for tools that may be helpful. I found that some poems offered a more gratifying, instant and thought-provoking read than longer-form books on grief. See what resonates with you and try different things in your different stages. 

Poetry:

• "The Grieving" by Rupi Kaur
• "What the Living Do" by Marie Howe
• "The Journey" by Mary Oliver

Books:

1. "The Healing Power of Grief" by Therese A. Rando
2. "Miscarriage: Women Sharing from the Heart" by Marie Allen and Shelly Marks
3. "The Courage to Grieve" by Judy Tatelbaus

ABOUT HILARY 

Hilary is the Co-Founder of the SABI, a Holistic Nutritionist, natural, whole foods Chef, product developer and advocate for women getting to know their bodies, cycles and selves better. Born in Los Angeles, California and raised in Baja California, Mexico, she now lives in Amsterdam, The Netherlands with her partner and her dog, Flint.  

HORMONAL & PROUD

Created as a brand to help women navigate the toughest moments in pregnancy, childbirth, postpartum — and practically every stage of life, the SABI aims to change the narrative around our hormones from one of taboo, embarrassment and loneliness, to awareness and even pride. Much more than a wellness brand, SABI offers a carefully crafted line of products to carry you through your hormonal journey; a set of rituals, supportive tools, and ancient herbal remedies that have been tested time and again by women and now, backed by medicine. SABI is a blend of science and nature conceived by women who have experienced the joys and deep implications of bringing a child into the world, the pains of a heavy and difficult period, miscarriage and difficulty conceiving.

Here is an invitation to get to know your body and its cycles better and to really understand what is going on inside. Learn to use your hormonal cycle to your advantage no matter your stage of life, and know that you can always support and balance your hormone levels. Look for the right sources of information, know that there is help, and know that you’re supported.

SOURCES

1. Farren, J., Jalmbrant, M., Ameye, L., Joash, K., Mitchell-Jones, N., Tapp, S., & Timmerman, D. (2016). Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study. Human Reproduction Update, 22(3), 278-286. doi: 10.1093/humupd/dmv054 https://pubmed.ncbi.nlm.nih.gov/26744531/

2. Murray-Davis, B., McDonald, S. W., Reime, B., Hutton, E. K., & Tough, S. C. (2016). Experiences of pregnant women who have experienced adversity and social marginalization: A systematic review and qualitative evidence synthesis. Psychology & Health, 31(11), 1376-1391. https://doi.org/10.1080/08870446.2016.1208823

3. Bhattacharya, S. (2017). A qualitative study on the psychological experiences of women after miscarriage. Journal of Women's Health Care, 6(2), 1000382. https://doi.org/10.4172/2167-0420.1000382

4. Kramer, R., & Kakuma, R. (2013). The paradox of social support in miscarriage: A review. BMC Pregnancy and Childbirth, 13, 1-8. https://doi.org/10.1186/1471-2393-13-1

5. Evans, J., Heron, J., Francomb, H., Oke, S., & Golding, J. (2001). Cohort study of depressed mood during pregnancy and after childbirth. BMJ, 323(7307), 257-260. doi: 10.1136/bmj.323.7307.257

6. Harville, E. W., Xiong, X., Buekens, P., & Pridjian, G. (2010). Elucidating the early signal: Use of a survey to determine factors associated with postpartum depression in a high-risk Louisiana population. Maternal and Child Health Journal, 14(3), 405-414. doi: 10.1007/s10995-009-0445-2

7. Klier, C. M., Geller, P. A., & Ritsher, J. B. (2002). Affective disorders in the aftermath of miscarriage: A comprehensive review. Archives of Women's Mental Health, 5(4), 129-149. doi: 10.1007/s00737-002-0171-6