Most women are stable enough to be discharged within a few hours of treatment for the miscarriage. The patient may bleed for up to two weeks and her menstrual period will return within four to six weeks.
Although a woman physically recovers from a miscarriage quickly, psychological recovery in general may take a long time. Miscarriage is a heart wrenching loss and emotions may range from anger to despair. How short a time the foetus lived in the womb may not matter for the feeling of loss. Reports include being overwhelmed with crushing, breath-taking grief and still others feel that they may be suffering punishment for something they did wrong or that they have failed as women. It has been determined that 7% of women four months after a miscarriage will have Post-Traumatic Stress Disorder and women who had a miscarriage were 2.5 times more likely than controls to develop a Major Depressive Disorder.
Apart from depression and anxiety, a study conducted in Norway compared the guilt felt by women who have an induced abortion with the guilt felt by women after a miscarriage. When confounding variables were taken into account there was no statistically significant difference between the two groups on the index of guilt/shame. This would give insight into the perception women have about themselves and their perceived roles where the termination of a pregnancy, whether planned or spontaneous, still results in feelings of guilt and shame.
Miscarriage therefore results in a myriad of emotions. However, frequently mismatches occur between how a miscarriage is experienced and how people think it ought to be experienced. Hence the actual emotional experience of the loss comes as a rude shock to the woman.
The biggest challenge facing women after a loss is the response or lack of response from others. Members of her healthcare team and of her social circle usually tend to avoid discussing the issue of the miscarriage. This may be because the subject is too painful or the people do not know what to say or are afraid of saying the wrong thing. However, the parents suffering this loss need to feel validated in their grief; they need to know that their babies, feelings and losses are real. For women, depression is one of the most common mental health problems they face when changes and losses become too difficult to bear. This makes a prompt and effective response by the healthcare provider essential as a preventive measure. The doctor should therefore consider a counselling session or at least an opportunity to discuss her feelings about the loss before discharge or at follow-up; this may facilitate healing.
SOURCES
1. A. N. Broen, T. Moum, A. S. Bodtker and O. Ekeberg, “Psychological Impact of Miscarriage versus Induced Abortion: A 2-year Follow-up Study”, Journal of Psychosomatic Medicine 66:265-271, 2004.
2. S. Dubovsky, “Predicting Severe Grief After Miscarriage”, Summary &Comment, Journal Watch Women’s Health, April 1st 1997.
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