Responses after a miscarriage or ectopic pregnancy

Tommy’s guest blog, 31/05/2017, by Dr Jessica Farren, Dr Maria Jalmbrant and Professor Tom Bourne

Researchers from Tommy’s National Centre for Miscarriage Research in Imperial College London last year published findings that link early miscarriage and ectopic pregnancy to post traumatic stress disorder (PTSD).

You can read more about this research here

We asked Dr Jessica Farren, a key researcher on this project, how to tell if someone you love is suffering from PTSD.

Dr Farren has taken time out of her busy schedule to join up with psychologist Dr Maria Jalmbrant and Tommy’s Professor Tom Bourne to give us this list of symptoms to look out for.

How can I tell if my friend is suffering from Post-Traumatic Stress Disorder?

Miscarriage and ectopic pregnancy affect every couple differently, but often result in a sad and difficult time for those affected.

Up until now, there hasn’t been much focus on the need for emotional support in addition to physical treatment.

Due perhaps to the fact that people often choose or are told not to talk about pregnancies before 12 weeks, losses in this time are regularly ‘brushed under the carpet’ and dealt with in private. 

However, recent research, led by Professor Bourne, and supported by Tommy’s, has suggested that a large number of women experience symptoms of anxiety and depression, and even of post-traumatic stress, following a loss. 

Tommy’s wants to ensure much wider recognition of this potential emotional impact, and what can be done to support sufferers.  

Many women and partners will describe a period of bereavement following a loss, in some ways similar to the loss of a loved one.  

These are some very common symptoms that may be expected to get better over a relatively short period of time (around 2-4 weeks):

• A whole spectrum of emotions that can change by the day – sadness, disbelief, anger, frustration, guilt, shame.
• Frustration, anger or irritability at others, who may seem insensitive.
• Jealousy of, or alienation from, friends or other women who are pregnant.
• Reminders of events (certain dates or places associated with the loss) triggering feelings of sadness, anger or distress after the time of the loss.
• Anxiety and worry about subsequent pregnancies. Couples may worry about the ability to conceive, the risk of a further loss, or find that they are more anxious throughout a subsequent pregnancy.

It is important to recognise that, while the above symptoms are common and in many ways considered ‘normal’, there is also a risk that these symptoms may not improve over long periods of time.

Symptoms may also have a prolonged impact on people's day to day life.

These are some symptoms you may recognise which could indicate that more formal assessment and treatment is needed:

• A strong sense of hopelessness or worthlessness.
• Always feeling tense or wound up, or finding it difficult to relax.
• Frequently getting frightening feelings like something bad is about to happen, or being plagued by worrying thoughts.
• Sleeping much more than usual, or having difficulty falling and staying asleep.
• Losing interest or enjoyment in activities or hobbies.
• Difficulty concentrating on things at work or at home.
• Flashbacks or nightmares about the events surrounding the loss.  Thoughts or images may intrude when they’re not wanted.
• Actively avoiding anything (like places or people) that might be a reminder of the loss, or trying to avoid thinking or talking about it.
• Withdrawing from friends or family.
• Struggling to keep up with a daily routine, either at work or at home.
• Having distressing symptoms over a period of more than two weeks that are not improving.
• Suicidal thoughts. Sometimes the emotional consequences can be so severe that they may lead someone to consider taking their own life. This is a situation that requires urgent medical assessment and treatment and we encourage seeking help via an emergency appointment at a GP, or via A&E.

How can I support a loved one through a loss?

Whilst everyone’s experience is different, many people appreciate hearing that they are not alone, and that the early pregnancy loss is not their fault. Telling your loved one that you are aware of their distress and willing to listen when they are ready is also helpful.

It’s so easy to feel like you might unintentionally say the wrong things – and this will sometimes keep you away – but don’t let it.

The last thing they need to be right now is alone.

It’s often tempting to try and say things to ‘minimise’ the loss such as telling them that they can always try again, or that they should be grateful it was early.

However, comments like this are often feel extremely hurtful, and can even make the person feel like they don’t have a ‘right’ to be grieving.

It is better to listen and be there for support, rather than trying to guide how they should feel.

More support

If you feel that your loved one is not coping, and especially if they are showing any of the symptoms above, you should seek help.

This can be from:

- Their GP - who may ultimately need to refer them for specialist. This should generally be the first port of call.

- Tommy’s - they can speak to a midwife free of charge from 9am-5pm Monday to Friday on: 0800 0147 800 or email [email protected]. 

- The Miscarriage Association  - a charity that offers support. Their helpline is open 9am-4pm Monday to Friday on 01924 200 799). They can also be contacted at [email protected].

-The Ectopic Pregnancy Trust - a charity that offers support following ectopic pregnancies. Their helpline can be accessed by calling 020 7733 2653, leaving a message if they are unable to take your call, or by mailing [email protected].

More information

If you want to learn more about this research, you can read about the link between early miscarriage and ectopic pregnancy and PTSD here.

If you’re struggling to cope after a baby loss in the family, our information and support pages on miscarriage may be of some help or comfort.

You can also read stories from those who’ve suffered miscarriages and spoken out about their experience in our online Book of #misCOURAGE as if can be comforting to know that you are not alone.

We hope this has been helpful.

With thanks to Dr Jessica Farren, Dr Maria Jalmbrant and Professor Tom Bourne for taking the time to put this piece together.