One minute you’re painting the nursery, choosing babygrows and planning the baby shower… and then you’re not. Nature can be cruel, especially when it comes to starting a family. Unless you’re one of the one in four women who have experienced a miscarriage (according to HealthXchange.sg), you might be surprised to learn that miscarriage is anything but rare. The reason for this is that it still isn’t spoken about, says perinatal mental health counsellor Silvia Wetherell of Alliance Counselling.

“There is a stigma around it. As soon as women start talking to each other though, they will find out that so many women are grieving in silence,” she adds.

Women often blame themselves after pregnancy loss, even if their doctor tells them it’s not their fault, says Wetherell, who also helps run the Pregnancy and Infant Loss Support Group Singapore. “I’ve heard all kinds of things – maybe I stood too long, maybe I had a cold drink when I was too heaty, maybe I walked too far,” she adds.

As human beings, we are hardwired to find a cause, says Wetherell. “This is the first time women have no control over their lives. They can influence the environment by eating well or not smoking, but they can’t fix this.”

Miscarriage can be triggered by many things that we have no control over, says Dr Sue Smith, a family GP at the International Medical Clinic. “It could be due to chromosomal (genetic) abnormality, imbalance in hormones, infections, and some medications.”

The healing process

When a woman loses a baby, it’s as if a rug has been pulled out from underneath her. Her identity and dreams for the future have abruptly disappeared. Psychologist and fertility counsellor Tanja Faessler-Moro at Counselling Connectz says that couples can experience an abstract as well as physical loss: “The abstract loss can be the loss of not being able to start a family, of not ‘belonging’ to the baby-parent group of their friends, of not gifting their parents with a grandchild, or being a mother or father,” she explains.

If a woman suffers a miscarriage in Singapore, she can take sick leave, which can be up to 14 days, and if her baby is stillborn, she is eligible for full maternity leave. This is 16 weeks of paid maternity leave if her child is a Singapore citizen, and 12 weeks maternity leave if the baby is a foreign national. But this is only the beginning of the healing process.

Faessler-Moro says that people who have suffered a miscarriage can feel very lonely. While a network of family and friends may surround them in the first days or weeks after the loss, they are usually still trying to process it for a long time after that.

“For those women and men who are still trying to process their loss, it’s really hard and lonely,” she says. “Each loss is perceived differently. Some people can grieve for a couple of days, others need weeks, if not months or even years. “People often ask us for how much longer they might continue to grieve, and we unfortunately need to tell them that there is no ‘one size fits all’ recipe to it. It takes what it takes,” adds Faessler-Moro.

Overcoming as a couple

Communication is key for couples who have experienced a loss. When a couple have lost a baby, they can deal with it differently. “With early pregnancy, while a woman is feeling as if she is still struggling with it, a man can appear as if he’s already over it,” says Wetherell. “Men tend to recover pretty quickly. They will also get busy and choose not to talk about what happened. This can create a lot of disconnection between the couple.”

Wetherell says that late-term losses can be traumatic for the partner. “Not only are they losing the baby, but they are watching their wife in extreme distress,” she says. “The partner will often repress their feelings to be strong for the woman. They will also have different coping strategies – they may drink more or work late, which is why it is important to see a counsellor and keep the communication open.”

While some couples heal by trying for another baby, others may take two years to recover. Dr Smith says the length of time it takes to heal physically depends on how advanced the pregnancy was, and if there were any complications. The length of time it takes to heal mentally also differs dramatically. “The first period after a miscarriage will be at four to six weeks, and you ovulate about two weeks before this, so you could actually get pregnant again very quickly,” says Dr Smith. “It is important to wait until (you are) emotionally and psychologically ready, irrespective of when it might be physically safe.”

Dr Smith says that women can increase their chances of a healthy pregnancy by taking folic acid (400mcg daily in the first 12 weeks of pregnancy); ensuring they don’t have any infections and have good reproductive health; managing any maternal health conditions such as diabetes or hypothyroidism; and making sure they don’t take any medicine that can harm the foetus. Women who have suffered miscarriage also need to be aware of their anxiety levels when they are trying for another baby, say the experts.

“Women can become very anxious and superstitious, and a lot of that anxiety will carry into postpartum if they don’t get help,” Wetherell explains. If you know of someone who has lost a baby, Wetherell says that you shouldn’t try and provide reassurance as it makes people feel invalidated. “Say I am so sorry. I am here if you want to talk,” she says. “Be aware of the due date, first birthday, and send supportive messages. Be mindful and make room.”