Understanding and managing the emotional reactions to a miscarriage.

The experience of loss following a miscarriage tends not to be recognized or validated by many key people in a woman's life, including her physician. Surveys of patient satisfaction following miscarriage indicate a high percentage of anger and dissatisfaction with the medical care received. The main complaints center on physician insensitivity and lack of opportunity to discuss the personal significance of the loss. Satisfaction was highest when there was a follow-up appointment soon after the loss, at which time answers to the almost universally asked questions of why the miscarriage occurred and whether it would happen again were addressed, and sufficient time was allowed to focus on the patient's feelings. The most likely emotions to be present relate to a relatively brief period of loss characterized by grief, dysphoria, and anxiety. The risk of a more intense or longer lasting distress is likely to occur if the woman strongly desired the pregnancy, waited a long time to conceive, has no living children, had elective abortions or other losses in the past, had few warning signs that a loss might occur, experienced the loss relatively late in the pregnancy, has little social support, or has a history of coping poorly. When there is an elevated level of distress, it tends to take the form of depressive and anxiety disorders, often accompanied by feelings of guilt and worries about future reproductive competence. In addition to validating the significance and nature of the patient's feelings, a physician can help the patient develop rituals to facilitate grieving and plan for anticipated, stressful occasions.