While most pregnancies result in the birth of a healthy baby, up to 15% of births result in a miscarriage, and another 1-2% of women have a late pregnancy loss before delivery (stillbirth) or an early infant death in the first month after birth. While we know these losses can be devastating for families, there have not been many formal studies examining whether women with stillbirth or early infant death are at high risk for clinical mental health disorders, particularly anxiety disorders. Mental health problems like anxiety can have serious health effects on these women, and these disorders are often not properly recognized, diagnosed, or treated.
Assessing Anxiety Risk in Women Who Have Faced Pregnancy Loss
Since stillbirth and early infant death (“perinatal death“) are often traumatic experiences, my team and I wanted to measure how frequently women with these losses developed symptoms of mental health disorders on top of their grief. We worked with the Michigan Department of Community Health to survey 900 women in Michigan who had a perinatal death (stillbirth or early infant death), and 500 women who had given birth to a healthy live infant. We asked these women about how they were coping with these experiences, and assessed their mental health symptoms.
My team and I also made sure to take into account outside factors which could influence the risk of anxiety disorders: a woman might have clinical depression or past mental health disorders, limited social support from friends and family, or partner violence, among other problems. We included those details in the analysis so we could see if anxiety was due to the perinatal loss or if it could be explained by one of these other factors.
Pregnancy Loss Can Double the Risk of Clinically-Significant Anxiety Disorders
Our study showed that even when we considered all of these other risks, mothers with a perinatal death were still twice as likely as non-bereaved mothers to have symptoms of Social Anxiety Disorder and Generalized Anxiety Disorder nine months after their loss. However, they were not any more likely to have Panic Disorder or Obsessive-Compulsive Disorder.
Sadly, of all the women who met criteria for any of these anxiety disorders, only about a quarter were getting any type of treatment (such as counseling, medication, group therapy, or other treatment). This percentage highlights a critical shortcoming and indicates a current lack of proper care for women who have faced pregnancy loss. Recognizing that women with stillbirth and infant death can also be at higher risk for some anxiety disorders can help us develop ways to better help women who have a loss.
What You Can Do to Cope with Pregnancy Loss
- Find the time and space to heal. Recovering from an experience like this takes time. Finding time and space to grieve is critical, and healing is different for everyone. Large life changes, like a move or a new job, may not be the best idea immediately following a pregnancy loss when your life may feel upside down. You and your partner may cope with grief in different ways, and this is also normal.
- Create memories of your baby. Some families may receive items from the hospital to help them remember their baby—locks of hair, footprints, a cap the baby wore, or photos. Other families choose to have a memorial or remembrance service after a loss or have a family gathering on the anniversary. Finding a way to help others who have been through this experience may be therapeutic, like through donations to research or to funds to help bereaved families. On an anniversary, you may choose to plant a tree or a garden. Even if you didn’t do any of these things when your baby died, you can still go back, even years later, to make memories which may offer comfort in difficult times.
- Consider visiting a healthcare professional if you are struggling and don’t feel you have adequate support from family or friends. Don’t be afraid to ask for help from your family doctor, obstetrician, or midwife, or to use mental health resources such as a therapist or psychiatrist. Some women may find support in their church or from a religious leader. It is normal to have intense symptoms of anxiety and depression after losing a baby, but if these symptoms are not gradually improving over time or if you find yourself thinking seriously about hurting yourself or planning for suicide, it’s very important to let your health team know immediately or seek out a counselor who can help you process your grief.
- Expect your grief to intensify at certain times. Most women report that grief symptoms worsen around key anniversary dates such as the baby’s expected due date, the anniversary of the birth, holidays, or meaningful family events. Seeing other babies or going to baby showers may be difficult. You may think your grief is better and then find that something triggers an intense outpouring of emotions – this is normal and something most women experience. It does not mean you are not “coping” with your grief or even that you are clinically depressed or struggling with a clinical anxiety disorder.
- Be prepared for the fact that other people may not know what to say to you or may be afraid that talking about your baby will make you think about your loss. This is particularly common in the months and years after the loss or in a next pregnancy. You can help friends and family support you by letting them know directly what is helpful to you. If it helps you to share memories of your baby or to talk about your feelings when it’s a hard day, say that. Guide people by explaining that they don’t have to “fix” anything, but it just helps when they can be with you and be caring, even if they don’t feel like they know exactly the right thing to say.
- Consider on-line support, whether it is information about loss or a peer support group, an on—line support group or chat room, or educational information. This allows you to connect with other mothers who may have been through similar experiences, and women who use these sites report that communicating with other parents helps them to realize they are not alone. These are some useful places to start:
- National Share Pregnancy & Infant Loss Support: information, resources, support groups, Facebook closed on-line support group.
- First Candle: a nonprofit which offers support to parents with infant death.
- March of Dimes: medical information and emotional support resources.
- Still Birth Alliance: International Stillbirth Alliance provides links to research and news about stillbirth prevention.
Gold KJ, Boggs ME, Muzik M, Sen A. Anxiety disorders and obsessive compulsive disorder nine months after perinatal loss. Gen Hosp Psych, 2014;36(6):650-4.
Katherine J. Gold, M.D., M.S.W., M.S., is an Assistant Professor at the University of Michigan, specializing in Family Medicine and Obstetrics & Gynecology. With board certification in family medicine, she completed fellowships in research training and holds Master's degrees in Social Work and Health Services Research. Her research centers on mental health, bereavement, and stillbirth prevention, exploring outcomes for families after infant death, bereavement training for health professionals, and mental health during pregnancy and postpartum.