MERRY CHRISTMAS!

THE EFFECT OF MISCARRIAGE ON MENTAL HEALTH

A woman who has miscarried is at a higher risk of anxiety and depression than a woman who never miscarried¹. The response of a woman to a miscarriage is, however, dependent on the context within which the miscarriage happened. It is therefore important to recognise and treat each woman as an individual: expecting every woman who has a miscarriage to develop mental health issues is as remiss as assuming every woman who has a miscarriage gets over it easily and without help.

When assessing a woman after a pregnancy loss, it is important, as a health care professional, to be able to distinguish between a grief reaction (which is normal) and a depression reaction (which is pathological).

According to a study on grief and depression after a miscarriage, grief usually proceeds as shock à preoccupation with the deceased à resolution².

Central emotions in grief are sadness, loneliness and a sense of emptiness². Central emotions in depressions are dejection, guilt, discouragement, despair and the usual physical disturbances (i.e. sleep and appetite disturbances)².

Basically, if you talk to a woman who has just suffered a pregnancy loss and she reports feeling weepy all the time, thinking about the baby and wondering why it happened, with sadness increased any time she is faced with reminders of the pregnancy, she is going through a normal coping mechanism. She is obsessed with the baby she lost.

If, however, you talk to a woman after a pregnancy loss and she feels dejected, cannot cope with day-to-day tasks, feels irritable, restless and anxious, she may need professional help to deal with coping. She is obsessed with negative feelings.

This study also found that an ambivalent attitude towards the pregnancy usually resulted in a depression reaction to the loss of the pregnancy². This shows one cannot assume that just because the pregnancy was not planned or maybe not even wanted then the woman will be fine when it is over.

Multiple potential meanings can be attributed to a miscarriage¹. It is a part of our duty of care to ensure that the meanings attributed to the miscarriage by our patients do not result in an inability to cope with the loss. Health, after all, encompasses physical, mental and social wellbeing and we should strive for that.

REFERENCES.

1.       Swanson K M, “Research-based practice with women who have had miscarriages”, Journal of Nursing Scholarship, Vol 31(4), pp339-345, 1999.

2.      Beutel M, Deckardt R, von Rad M, Weiner H, “Grief and Depression after miscarriage: their separation, antecedents and course”, Psychosomatic Medicine, Vol 57(6), pp517-526, 1995.