Pregnancy loss

The break of the attachment to the unborn child and the resulting grief and bereavement is an appropriate starting point for understanding the psychological reactions to pregnancy loss.

MISCARRIAGE

Miscarriage is the most common complication of pregnancy. There is consensus in the literature that ‘distress’ commonly follows spontaneous miscarriage. However, there is considerable disagreement between studies regarding the intensity and nature of this distress (for example, grief versus depression), its duration and what factors predict its intensity and duration. Some authors have argued that health professionals devalue the significance of miscarriage for the women involved, underestimate its emotional impact and fail to provide much-needed support. In contrast, others state that ‘the overzealous may interfere with the healthy resilience that enables most people to get over an early miscarriage without becoming psychiatrically disturbed’.

Many authors have advocated that women should be routinely assessed after miscarriage and offered counselling. In a randomised controlled trial assessing debriefing after miscarriage, Lee et al. were unable to demonstrate any positive effect upon emotional adaptation. Debriefing can even have negative effects for some couples by interfering with their adaptive suppression and distraction. The beneficial component of debriefing seems to be the detailed explanation of events. This can, however, only be provided by the obstetric staff involved and is unavailable from the counsellor.