The month of October is National Pregnancy and Infant Loss Awareness Month and is dedicated to honoring women and families who have suffered a loss during pregnancy or infancy. The goal of pregnancy and infant loss awareness month is to raise awareness and provide support for grieving families. 

Pregnancy loss is a broad term which includes many different kinds of losses. For example, Recurrent Pregnancy Loss (RPL) is defined as the loss of two or more clinical pregnancies (ASRM, 2012) and has been shown to have a tremendous impact on a woman’s emotional well-being, as well as that of her partner’s (Voss et al., 2020). Affected women are at risk for developing chronic grief, depression, anxiety, stress, lower quality of life, obsessive-compulsive disorder, and PTSD (Chen et al., 2018; Tavoli et al., 2018; Voss et al., 2020). Yet, there is so much we can do to support women and families struggling with RPL to help mitigate these negative effects and facilitate better medical and psychological outcomes.

As a Licensed Psychologist who specializes in treating the psychological effects of pregnancy loss and often works with women and couples struggling with recurrent pregnancy loss, below, I share three things I often wish that affected women and their partners knew at the beginning of their journey (or at any time in the process!). 

I also chatted with Dr. Moragianni, MD, MSc, FACOG, Medical Director of Johns Hopkins Fertility Center, and Assistant Professor, Division of Reproductive Endocrinology and Infertility at Johns Hopkins University School of Medicine, about three things that she wishes patients affected by RPL would know.

Three things women and couples affected by RPL should know from a psychological, emotional well-being perspective:

1. Every loss needs to be grieved. The loss of a wanted pregnancy no matter how early on in the pregnancy can be devastating. Each loss is real and needs to be grieved. Oftentimes, parents, understandably, feel so much pressure to achieve a healthy pregnancy that they don't take the time to stop and grieve each pregnancy or baby that was lost. This can lead to compounded unresolved grief that can be harder to process and work through later on. Take the time to grieve as an individual parent and as a couple.

2. Some Conflict or Tension in Relationships is Normal. Recurrent pregnancy loss and infertility are extremely stressful situations that often lead to conflict or tension in relationships with your romantic partner. In heterosexual relationships, often men and women have different ways of dealing with grief and stress that interferes with communication and intimacy and leads to a sense of disconnection just when you need your partner the most for support, understanding, and comfort. Couples counseling can help you and your partner communicate about the feelings and experiences you are going through so that you feel like you are going through this difficult situation together and are not so alone.

3. Some Anxiety during Pregnancies after Loss is Normal. Women experiencing recurrent pregnancy loss are constantly vacillating between yet another devastating loss and being pregnant again and fearing yet another potential loss. Some women feel as if there is something wrong with them for feeling anxious during a subsequent pregnancy and not “just relaxing” and “enjoying the pregnancy more,” as others often advise them. Feeling anxious during pregnancies after loss is an understandable reaction to the trauma and grief that so often characterizes the experience of RPL and is a sign of the woman’s attachment to her unborn baby. Women during pregnancies after loss need support and a place to process the trauma and the grief that they have been through in order to move forward in a way that makes space for both the current baby and those she has lost. 

Three things women and couples affected by RPL should know from a medical perspective:

1. You are not alone. “It’s more common than you think — and you’re not alone. RPL affects about 1–2% of couples trying to conceive. While each loss is deeply personal, know that you're not isolated in this experience, and there are well-established ways to evaluate and treat it,” says Dr. Moragianni. 

2. There is often no single answer as to “why is this happening?” and that’s O.K. “There’s often no single cause — and that doesn’t mean there’s no hope.
   In over half of RPL cases, no clear cause is found even after a full workup. That can be frustrating, but many couples in this group still go on to have healthy pregnancies — often with minimal intervention,” explains Dr. Moragianni.

3. Help is available. “A thorough medical evaluation matters — and timing is key.
   If you've had two or more losses, it's worth talking to a specialist. We look at hormonal, anatomical, genetic, and immunologic factors — because addressing even subtle issues can make a difference in future outcomes,” writes Dr. Moragianni.