DIGEST - Volume 9, Issue 1

7 TPC Digest M iscarriage is the loss of a pregnancy that occurs so early that the embryo or fetus is not viable outside the womb. Sometimes miscarriage occurs before a woman even knows she is pregnant. It is estimated that 20%–50% of all pregnancies end in miscarriage, usually because of chromosomal abnormalities, making it the most common early pregnancy complication. Risk of miscarriage declines as a pregnancy progresses, with most occurring in the first 13 weeks and 75% occurring in the first 17 weeks of gestation. One out of every four women will experience a first trimester miscarriage during her lifetime. In a recent survey assessing public perception of miscarriage in the United States, most participants were mistaken in their beliefs about both the prevalence and causes of miscarriage. Counselors are very likely to work with clients who have experienced miscarriage. There is, however, a notable lack of research focused on this common life span event, which can be viewed as a systemic barrier to the development of clinical competence related to pregnancy loss—an isomorphic reflection of the lack of awareness, customs, conversations, and resources related to the experience of miscarriage in our culture. As such, counselors may inadvertently neglect this area in their psychotherapeutic work. Clinicians who utilize an ecological approach to understanding clients are less likely to ignore or minimize the many complex and nuanced systemic variables influencing clients’ biopsychosocial experiences related to miscarriage. It is important for counselors to: (a) be aware of the possibility of serious and persistent distress related to miscarriage, (b) thoroughly assess clients around this topic, despite cultural norms of either not mentioning or minimizing pregnancy loss, and (c) have knowledge of the myriad of risk and protective factors around this issue, as well as recommended strategies for working with such clients. Women vary in their responses to miscarriage. Some women feel relief upon learning that an unplanned pregnancy will not continue, and others consider miscarriage a minimal obstacle to overcome. Many women experience grief after miscarriage, which is often complicated by non-supportive responses within their microsystems. One study from 2015 reported that women who had personally experienced a miscarriage and men whose partners had one endorsed feelings of guilt (47%), having done something wrong (41%), isolation (41%), and shame (28%), as well as a belief they could have done something to prevent the loss (38%). Although grief following early pregnancy loss mirrors other grief responses in intensity and duration, it is unique in its focus on the demise of an anticipated future rather than on memories of the past, leaving the griever to create a narrative of this ambiguous loss. Half of women grieving after pregnancy loss report clinically significant psychological distress, including symptoms of anxiety, depression, substance misuse, and post-traumatic stress. Predictors of acute and persistent symptoms after an early pregnancy loss include pre-existing mental health diagnoses, childlessness, and dissatisfaction with health care received. Dissatisfied patients cite providers’ attitudes and failure to convey awareness, empathy, compassion, information, and suggestions for follow-up related to the emotional impact of miscarriage. During clinical encounters with women who have experienced miscarriage, acknowledgment and validation of the experience is of utmost importance. Therapeutic exploration of the meaning of the loss, both to the individual client and within broader developmental, relational, cultural, spiritual, political, and economic contexts can facilitate client understanding and growth. Research is needed to further examine women’s experiences of miscarriage and the processes and outcomes of miscarriage-specific counseling interventions. Future scholarly and clinical endeavors on this important topic may ultimately improve awareness, visibility, knowledge, resources, and care for the many women who endure miscarriages during their lifetimes. Jennifer L. Rogers, NCC, is an assistant professor at Wake Forest University. Jamie E. Crockett, NCC, is an assistant professor at Wake Forest University. Esther Suess, NCC, is a counselor at the Mood Treatment Center in Winston-Salem, NC. Correspondence can be addressed to Jennifer Rogers, P.O. Box 7406, Winston-Salem, NC 27109, rogersjl@wfu.edu. Miscarriage Jennifer L. Rogers, Jamie E. Crockett, Esther Suess An Ecological Examination |