Infertility, Miscarriage, and Neonatal LossYearning for children and the heartbreak associated with infertility, miscarriage, stillbirth, and neonatal loss can be devastating and take a significant toll on the mental health and wellbeing of women and their partners.
Infertility: Infertility is defined as a condition where a women is unable to become and/or stay pregnant after one year of trying to conceive. There are many possible causes for infertility, and for some women, determining the exact cause my be difficult. Being unable to determine the cause of infertility, or to have a diagnosis or identified cause delayed, undergoing rigorous testing, etc. can contribute to even more distress. Sometimes the treatments for infertility can be incredibly painful, expensive, and stressful. For some, the process of trying to conceive may take years, intensive medical testing and interventions, and create a rollercoaster of emotions ranging from hope, to devastation, to helplessness, to anger, to anticipation, etc., all of which can take a toll on relationships, physical health, and mental health. Grieving the loss of an imagined, planned, or expected child and/or family and the dreams and hopes associated with that child may require processing of significant grief. Miscarriage, Recurrent Pregnancy Loss, and Stillbirths: Miscarriage is usually defined as the loss of a baby before the 20th week of pregnancy. A stillbirth is usually defined as the loss of a baby at or after 20 weeks of pregnancy. The agony of losing a baby during pregnancy can have a significant impact on mental health. Some women who experience miscarriages and repeated pregnancy losses may develop anxiety and apprehension about future pregnancies for fear of losing another baby. Medical interventions required to aid in the loss may contribute to anxiety and trauma reactions. Neonatal Loss: Neonatal loss usually encompasses the loss of a baby post-pregnancy within the first 28 days of life. For some parents, the cause of the loss is unknown, or there are delays in determining what caused the loss of their child. This experience can contribute to significant trauma, anxiety, grief reactions, and emotional distress. |
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How Infertility, Miscarriage, and Neonatal Loss can Impact Mental Health
A wide range of mental health issues may worsen or develop when confronted with infertility, miscarriage, stillbirth, or neonatal loss.
Grief Reactions and Related Disorders: Symptoms might include identity disruption (e.g., feeling as though part of oneself has died; feeling a loss of sense of self or sense of ones purpose), denial or disbelief about the loss, avoidance of reminders about the loss, intense emotional pain (e.g., anger, shame, bitterness, deep sorrow, hopelessness), difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future, trying to conceive again), intense feelings of loneliness and aloneness, emotional numbness, feeling that life is meaningless, loss of a sense of direction, loss of a sense of certainty and control over ones future and life, etc.
Depression: Symptoms of depression include persistent sad, anxious, or “empty” mood; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in hobbies or activities; decreased energy, fatigue, or being “slowed down”; difficulty concentrating, remembering, or making decisions; difficulty sleeping, early-morning awakening, or oversleeping; appetite and/or weight changes; thoughts of death or dying; restlessness or irritability; aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.
Anxiety Disorders such as Generalized Anxiety Disorder and Panic Disorder:
Generalized Anxiety Disorder (GAD), is defined as frequent excessive anxiety and worry. In association with the worry, the individual may experience feeling restless or keyed up, being easily fatigued, difficulty concentrating or having your mind go blank, irritability, muscle tension, and sleep disturbance. Individuals with GAD tend to be hyperfocused on possible catastrophes that can happen in the future ("what if?").
Panic Disorder is characterized by recurrent and sometimes unexpected and out-of-the-blue panic attacks. These panic attacks often feel as though they are coming out of the blue and can sometimes even occur while someone is asleep. Panic attacks are episodes of intense fear and anxiety, with symptoms such as pounding heart, heart palpitations, fast heart rate, sweating, trembling or shaking, shortness of breath, smothering sensations, feeling of choking, chest pain, nausea, stomach distress, feeling dizzy or lightheaded, feeling weak or faint, and feelings of unreality or of having an "out of body experience." Symptoms may include a feeling of dread or that something terrible is about to happen. Because panic attacks are so distressing, individuals with Panic Disorder often worry about having them and avoid things that they believe to be triggers of their panic attacks. Panic Disorder is essentially a catastrophic misinterpretation of interocepive cues, or in other words, the individual is afraid of being afraid. They interpret their physical symptoms (normal parts of the flight-fight-freeze system) as meaning something catastrophic and horrible is about to happen (e.g., having a heart attack, fainting, going crazy, losing control, etc.).
Posttraumatic Stress Disorder (PTSD): PTSD is a disorder where an individual endures a traumatic event, usually involving a significant threat of death or serious injury. For some women, the nature in which the baby is lost, medical complications, medical emergencies, surgical complications, and/or medical interventions may create a situation where the women's life or health is seriously threatened.
Individuals with PTSD re-experience the event in an intrusive and distressing manner (i.e., flashbacks, nightmares, upsetting memories, emotional or physical reactivity when confronted with reminders of the event). In order to cope, a person with PTSD may make attempts to avoid remembering trauma by refusing to think or feel in relation to the event or to be in situations that remind him/her/them of the event. Consequently, negative thoughts and/or feelings develop or become enhanced; such as blaming oneself for what happened, having negative thoughts about the self, others, and the world, feeling isolated, struggling to enjoy activities, and difficulty experiencing positive emotion. Lastly, a person’s arousal and reactivity changes, which can manifest as hypervigilance, irritability or aggression, risky or destructive behavior, trouble sleeping and/or concentrating, or heightened startle response.
Grief Reactions and Related Disorders: Symptoms might include identity disruption (e.g., feeling as though part of oneself has died; feeling a loss of sense of self or sense of ones purpose), denial or disbelief about the loss, avoidance of reminders about the loss, intense emotional pain (e.g., anger, shame, bitterness, deep sorrow, hopelessness), difficulty moving on with life (e.g., problems engaging with friends, pursuing interests, planning for the future, trying to conceive again), intense feelings of loneliness and aloneness, emotional numbness, feeling that life is meaningless, loss of a sense of direction, loss of a sense of certainty and control over ones future and life, etc.
Depression: Symptoms of depression include persistent sad, anxious, or “empty” mood; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in hobbies or activities; decreased energy, fatigue, or being “slowed down”; difficulty concentrating, remembering, or making decisions; difficulty sleeping, early-morning awakening, or oversleeping; appetite and/or weight changes; thoughts of death or dying; restlessness or irritability; aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment.
Anxiety Disorders such as Generalized Anxiety Disorder and Panic Disorder:
Generalized Anxiety Disorder (GAD), is defined as frequent excessive anxiety and worry. In association with the worry, the individual may experience feeling restless or keyed up, being easily fatigued, difficulty concentrating or having your mind go blank, irritability, muscle tension, and sleep disturbance. Individuals with GAD tend to be hyperfocused on possible catastrophes that can happen in the future ("what if?").
Panic Disorder is characterized by recurrent and sometimes unexpected and out-of-the-blue panic attacks. These panic attacks often feel as though they are coming out of the blue and can sometimes even occur while someone is asleep. Panic attacks are episodes of intense fear and anxiety, with symptoms such as pounding heart, heart palpitations, fast heart rate, sweating, trembling or shaking, shortness of breath, smothering sensations, feeling of choking, chest pain, nausea, stomach distress, feeling dizzy or lightheaded, feeling weak or faint, and feelings of unreality or of having an "out of body experience." Symptoms may include a feeling of dread or that something terrible is about to happen. Because panic attacks are so distressing, individuals with Panic Disorder often worry about having them and avoid things that they believe to be triggers of their panic attacks. Panic Disorder is essentially a catastrophic misinterpretation of interocepive cues, or in other words, the individual is afraid of being afraid. They interpret their physical symptoms (normal parts of the flight-fight-freeze system) as meaning something catastrophic and horrible is about to happen (e.g., having a heart attack, fainting, going crazy, losing control, etc.).
Posttraumatic Stress Disorder (PTSD): PTSD is a disorder where an individual endures a traumatic event, usually involving a significant threat of death or serious injury. For some women, the nature in which the baby is lost, medical complications, medical emergencies, surgical complications, and/or medical interventions may create a situation where the women's life or health is seriously threatened.
Individuals with PTSD re-experience the event in an intrusive and distressing manner (i.e., flashbacks, nightmares, upsetting memories, emotional or physical reactivity when confronted with reminders of the event). In order to cope, a person with PTSD may make attempts to avoid remembering trauma by refusing to think or feel in relation to the event or to be in situations that remind him/her/them of the event. Consequently, negative thoughts and/or feelings develop or become enhanced; such as blaming oneself for what happened, having negative thoughts about the self, others, and the world, feeling isolated, struggling to enjoy activities, and difficulty experiencing positive emotion. Lastly, a person’s arousal and reactivity changes, which can manifest as hypervigilance, irritability or aggression, risky or destructive behavior, trouble sleeping and/or concentrating, or heightened startle response.
How Do You Treat The Mental Health Consequences of Infertility, Miscarriage, and Neonatal Loss?
Grief Counseling: Grief counseling aims to provide a safe place for an individual to intellectually and emotionally process the loss. This may look different for a individual who is grieving the loss of being able to conceive due to infertility versus individuals who have experiences a pregnancy loss or neonatal loss.
Cognitive-Behavioral Therapy:
Couples Counseling:
Cognitive-Behavioral Therapy:
Couples Counseling:
OakHeart Infertility, Miscarriage, and Neonatal Loss Providers
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What is infertility and why do I need to be aware? Infertility is technically the inability to become pregnant after 1 year of unprotected, timed intercourse due to either female or male reproductive issues. However, let’s be a little more inclusive with this definition. It can also apply to those individuals who are able to achieve pregnancy consistently, but are unable to sustain that pregnancy to term. According to a survey by the CDC, 1 in 8 couples have trouble getting pregnant or sustaining that pregnancy. This has become a far more widespread issue than most are aware. While some couples are able to treat their infertility through medication alone given through their general OB/GYN, many need to seek treatment through a Reproductive Endocrinologist (RE) at a specialized clinic...(to read more, click on the link above).
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