There’s no way to sugar coat it — having a kid in America is exceptionally difficult. Not only is the country’s maternal mortality rate….CONTINUE READING...CONTINUE READING
one of the worst among industrialized nations but there is also zero federally mandated paid parental leave policy, a concerning lack of affordable child care
, and an infinitesimal regard for the physical and mental health of parents after you leave the hospital. Yet many pregnancy journeys don’t end with giving birth. In a system that is already fraying at the seams, that means that incomplete pregnancy aftercare is an essential, and often overlooked, component for healing, both mentally and physically.
Incomplete pregnancy is an umbrella term that covers miscarriage and elective termination. For context, the American College of Obstetricians and Gynecologists
estimates that 26 percent of all pregnancies end in miscarriage. That number doesn’t include abortions, whether medical abortion, vacuum aspiration, dilation and evacuation, or induced labor, which The Guttmacher Institute totaled
as 930,160 in 2020 (although this data is significantly harder to tally, for obvious reasons). This equates to well over two million people per year who have experienced an incomplete pregnancy, many of whom are left with little information about how to care for their bodies or mental health after the fact.
“[The conversation around] women’s health and birthing people’s health still has so much missing from it,” says Sunita Osborn
, PsyD, MA. “In some ways, it feels like we’re still attached to this idea where there’s certain parts of the [pregnancy] story we’re allowed to talk about, and certain parts of the story are taboo, stigmatized, and are not to be discussed.”
Luckily, there has been a noticeable narrative shift happening around pregnancies that don’t end with a baby as companies begin to cater to this largely ignored demographic. Resources such as aftercare kits for people who have experienced incomplete pregnancy are becoming more widely available, and advocates for people in all stages of pregnancy (including post-miscarriage or abortion) are increasingly vocal.
While the postpartum period — defined as immediately after delivery until the body has “returned to its pre-pregnant state” — is six to eight weeks
(though there is still no federally mandated parental leave policy) there’s little discussion around the recovery timeline following an incomplete pregnancy. Even if you don’t ultimately give birth, your body is likely to experience a range of physical and hormonal changes as a result of the initial pregnancy.
The type of physical aftercare you’ll need can vary depending on how far along you were in your pregnancy. The farther along you are, the longer these hormones can have an effect on your body, according to Jasmine Pedroso
, MD MPH FACOG, OB/GYN, including hormonal and physiological changes like nausea, fluid retention, dysgeusia (a decrease in the ability to taste), and breast tenderness, among others.
She explains: “Typically after a full-term pregnancy, the hormone changes last about six weeks, but can last beyond a year. After an early pregnancy loss or termination, these changes are shorter in duration, typically two to four weeks.” In this event, Dr. Pedroso says these effects can include irregular bleeding, cramping, and mood changes, all of which typically resolve over the aforementioned two to four weeks.
An incomplete pregnancy also carries with it significant effects on your mental health. Per Dr. Osborn: “The mental impact [of an incomplete pregnancy] can [include] a wide range of emotional and internal reactions, from sadness, depression, anxiety, anger, grief, relief, confusion. It can all be there in one day and the cycle back and forth.” She adds that in the case of a miscarriage, the impact of losing the pregnancy may impact a person’s sense of identity.
“[I might think] if I can’t have a healthy pregnancy, does this make me less of a woman? It may even unearth pieces of yourself that you didn’t realize you had until they were shattered and confronted and disrupted.”
Recently, a new category of products that attempts to address the physical and psychological effects of an incomplete pregnancy has popped up. Brands like Frida
and Bodily
now provide pre-made packages filled with supplies that you might need after a miscarriage or termination. “After experiencing two unexpected pregnancy losses myself, we felt it was important to address this isolating and physically challenging time in a woman’s life with the same thoughtfulness and sensitivity as we do for [people] who leave a hospital with a baby, especially in light of how similar some of the needs are,” says Frida CEO Chelsea Hirschhorn
, who founded the brand in 2014. She explains that vaginal bleeding and uterine pain or cramping are symptomatic of almost all post-pregnancy experiences, complete or not, and how “an overnight menstrual pad sometimes doesn’t cut it when it comes to ensuring a comfortable recovery.” She designed the Frida Recovery Kit for Incomplete Pregnancies
($34.99) with these shortcomings in mind. It’s stocked with four pairs of disposable underwear, six ultra-absorbent maxi pads, and an upside-down peri bottle for easy cleansing in the shower and after going to the bathroom.
Bodily also provides a core kit
of products to help people recover from miscarriage, including remembrance bracelets, a turmeric blend, a support book for pregnancy loss that includes “tools … on how to cope and communicate about your loss alongside messages of support,” and a copy of Dr. Osborn’s The Miscarriage Map: What To Expect When You’re No Longer Expecting
($90). The brand includes suggestions for items to add to the kit based on what trimester you were in, including mesh underwear ($14 for 5), maxi pads ($7.50 for 14), and breast pads ($24 for 4, $36 for 6).
In order to offset the lack of emotional or mental health support people may experience post-incomplete pregnancy Hirschhorn vowed to improve the otherwise patchwork physical recovery plan at home through Frida’s products. “The recovery kit is our promise to support women going through all phases of recovery, regardless of how their pregnancy journey ended.”
While having a kit like these on hand can be helpful in at-home aftercare, it is still advisable to follow up with your OB/GYN to make sure that your recovery is on track and everything is normal from a physical standpoint. “Those kits are thoughtful and empathetic additional resources for women during a very difficult time,” says Lisa Masterson MD, a board-certified OB/GYN in Santa Monica, California. “[But] they aren’t a substitute for the care and attention that a women’s physician or health care team should provide. It is important that we anticipate the needs of women both physically
and emotionally during and after [miscarriage or termination], but each woman’s needs as an individual need to be addressed as well. Some may have a good support system and others might benefit from outside referrals.”
Losing a pregnancy or deciding to terminate are immeasurably complicated on both a physical and mental level, which is why having the support of a caregiver who understands these types of incomplete pregnancies can be so valuable.
“I always tell my [miscarriage] clients that they’re not just mourning the loss of something that was eight weeks in your experience; you’re mourning the loss of a system that you’ve carried with you for years, decades, even if you didn’t necessarily [realize it],” Dr. Osborn explains, referencing the story of parenthood that we start learning when we’re kids. “That can be really disorienting, particularly with early miscarriage
.” She adds that even people who choose an elective abortion are often experiencing a life-changing impact on different domains of their life, from beliefs about themselves, the world, their family, and their identity. A professional caregiver can, at the very least, ensure that you’re receiving all of the information you need to know before, during, and after.
A full-spectrum doula can provide that support. You may be familiar with birth doulas, but the general role of a doula
is to provide informational, emotional, and practical support to clients going through a vast number of life changes — including abortions. “There’s a lot of charged feelings around it given the relationship of our culture to abortion,” says Vicki Bloom
, a full-spectrum doula who consults with clients completing abortions both in-person and over the phone before, during, and after their experience. “We need to be able to meet that person where they are and help them get comfort, mentally and physically.”
For example, since someone undergoing an elective termination with a medical professional is often awake, Bloom says a full spectrum doula may help them with breathing techniques to manage their pain or to serve as a distraction during the procedure. For abortions performed at home, the pregnant person may often be alone and can contact a hotline to speak with a trained caregiver for support. “If they’re doing [a medication abortion] at home, they may have questions, or they may just need somebody to talk to in that context because [it will take] a longer period of time. We just want to be there with the person, for whatever they need during that experience,” she explains.
Bloom has occasionally worked with people experiencing miscarriages as well. “In some cases, they might be completing a spontaneous miscarriage at home, and want support during that experience,” she says. “In others, a birth client may experience loss of the pregnancy, and the doula may have to pivot to provide support for that new reality. Finally, some in-clinic abortion clients seek out the procedure because of an incomplete miscarriage causing a medical issue, and any doula working in that context will eventually see a case like this.” Bloom adds that because of the nature of the work, the vast majority of full-spectrum doulas work as volunteers or on a pay-what-you-can donation basis. (You can search for doulas near you here.)
Making sure that her clients have adequate care after her time with them is also of utmost importance to Bloom, since not everyone has a sympathetic group of people around them to lean on. “For example, when I’m doing work with the medication abortion hotline
, I’m not physically there with that person but I can say something like, ‘Can somebody in your life bring you an ice cream sundae?’ That would [prompt] the person into thinking, ‘Oh yeah, I know my sister would be comfortable with me asking that.’Helping that person figure out what’s going to help them can be a very powerful tool.”
Losing a pregnancy or choosing to no longer be pregnant has never received the same amount of airtime as healthy, happy births in this country, but the experts all hope that the tide is turning now that discussions around miscarriage
and abortion aren’t quite as taboo as they once were. Still, that doesn’t necessarily make these types of conversations — or taking necessary time away from obligations to heal — easier to navigate.
“When we don’t have other people who are sayingyes, this happened to me too, then I’m not going to feel like I can actually share this, which is really scary,” says Dr. Osborn. “All of those painful thoughts can be a breeding ground for shame. [But] more and more people are sharing stories about their experiences of loss, which I think is amazing.”
Although there are countless aspects of the American health care system that can make dealing with medical situations more frustrating, there is one sliver of decency: a little known provision in the Family and Medical Leave Act (FMLA)
gives eligible workers the right to take up to 12 weeks of “unpaid leave to care for their own serious health conditions, among other purposes,” without the risk of losing their job. These “serious health conditions” can include some miscarriages, though the FMLA classifies a miscarriage as the natural loss of a fetus before 20 weeks’ gestation and will not guarantee protection for those who have either lost a pregnancy after that time period or elected to terminate. What’s more: The culture of shame surrounding incomplete pregnancy often means that someone will ignore these protections and still continue to work — if they’re aware of them at all. A poll by InHerSight
, a data analytics firm that studies women in the workplace, found that out of 1362 people, only 23 percent knew that this protection existed, only 3 percent were informed by their employer that they had the right to take time off, and 91 percent took zero days off following a miscarriage. Onlythree percentof those polled took more than three weeks away from work to recover.
“Speaking personally, I had two D&C surgeries that [required] a day off of work plus additional follow-up appointments,” says Dr. Osborn. “Even if you have lower levels of medical intervention necessary, there are likely still doctor appointments that you have to attend to ensure that the pregnancy loss is progressing as needed. Having to use sick leave or PTO for these can feel like adding salt to the wound — just one more thing you’ve lost.”
She explains that while pregnancy loss can feel extremely disempowering, taking time for yourself gives you the power to choose what feels best
, and most healing, day by day. For some, that can look like attending a team meeting because being around coworkers feels revitalizing; for others, taking a few days away from work to watch TV or sink into a hot bath might sound better.
Per Dr. Osborn: “While there should be no shame in admitting you need time to recover, both physically and mentally, we may decide that something must be wrong with us if we need support, care, and time to heal. Thus, if you experience shame, which is both painful and painfully normal after pregnancy loss, allow yourself to question where [that] is coming from and what support you would wish for your own loved ones after they experience loss.”
With aftercare resources increasing and the culture of shame surrounding incomplete pregnancy gradually fading (thanks in large part to people opening up about their own stories of loss), these experiences that were once so heavily stigmatized are now a recognizable chapter in the journey of pregnancy — the ones that don’t always end with a baby….CONTINUE READING
