After Ending a Pregnancy ~ Ripples of Pain

By Jane Brody

Parents who have experienced the joy of bringing a healthy child into the world can hardly imagine the pain of losing a baby, even one not close to being born. I have a friend who suffered three miscarriages, another whose baby died in utero when she was eight months pregnant and a third whose baby was alive at the start of labor but was stillborn.

The pain that accompanies such losses is shared by those who feel compelled to terminate wanted pregnancies after learning through amniocentesis that the fetus is seriously abnormal.

Last Christmas, relatives of mine, who had been so excited about being pregnant that they framed their first sonogram photos, learned from amniocentesis at 17 weeks that their unborn child had multiple severe abnormalities. They decided to end the pregnancy. In an attempt to assuage the pain of losing a much-wanted baby they called Hope, the couple held a memorial service.

The mother wrote: "It was our ignorance for believing that all pregnancies led to a healthy baby. It was my arrogance for believing that since I had the best medical care, took prenatal vitamins even before and during my pregnancy, never took drugs, never smoked cigarettes and drank about half a glass of wine a year, that our baby would be safe. We wanted her and longed for her so badly that it physically hurt. Why couldn't I just donate an arm or a leg? I couldn't give her up. Hope taught me how it is to feel a mother's love. It is the sweetest love of all. Someday, we will try again because we have known the joy of creating and carrying a life inside us. The gift of carrying this miracle is worth the risk of pain."

Intense Emotions

The families and friends of people who have been through this experience often fail to appreciate the intense emotions it evokes, and typically say well-meaning but inappropriate things like, "You'll get pregnant again." This is like telling a widow "You'll marry again." Researchers have reported that many couples experience serious psychological consequences after such a pregnancy, including marital conflict, grief, anger, guilt and a strong need for counseling and support. Some are reluctant to attempt another pregnancy and, when one does occur, it can be accompanied by further pain.

In the May/June issue of The Journal of Obstetric, Gynecologic and Neonatal Nursing, Dr. Pam Rillstone and Dr. Sally A. Hutchinson report that once parents have "faced the unimaginable in their previous pregnancy, subsequent pregnancies are not full of joy but instead become racked with fear and uncertainty."

Dr. Rillstone, an assistant professor at Jacksonville University School of Nursing, and Dr. Hutchinson, a nursing professor at the University of Florida Health Science Center in Jacksonville, interviewed 15 women and 9 partners experiencing a pregnancy after ending a previous one that was abnormal. The anguish these parents suffered after the lost pregnancy resurfaced during the later one, they found.

Before parents could even talk about a current pregnancy, they needed to review the intense, extreme pain of the previous one. Nearly all the parents said the anguish had a rippling effect throughout their lives and was unlikely ever to go away. They described the diagnosis of fetal abnormality as an unexpected assault, "like someone taking a two-by-four and just smashing you up the side of the head," one parent called it. Another described it as "an unbelievable shock because you don't consider things like this are going to happen." And one man called it "the blackest time I've ever been in, like falling into a bottomless well where there was no light."

Still, most parents did not want to forget what had happened. My relatives had the baby's remains cremated and placed in a specially decorated box along with all the notes, letters and mementos people had sent; the box is kept in their bedroom.

But some parents were reluctant to talk about their experience because of the stigma that surrounds the topic of abortion. So when they most needed support, many parents felt isolated. As one said, "There is a time early on when you think you're the only person in the world who's ever been through something so terrible." Another said: "I think in our minds there would be judging, but also we wouldn't get that sympathy and we definitely needed it. We lost a child."

Common among the parents interviewed was a loss of innocence, a feeling of helplessness and a sense that somehow they were less than whole. Their devastation affected their relationships with others, including each other, although ultimately, the researchers reported, "most parents talked about how surviving the experience made their relationship stronger."

The parents had a hard time believing misfortune would not strike again. One said, "The numbers don't mean squat once you've been the one in how many thousand people that this will happen to." Now sensitized to a negative outcome, parents tended to hold back and not become as emotionally involved in a subsequent pregnancy. Instead they encased themselves in "emotional armor" to have the strength and courage needed "to face the possibility of another termination decision," the researchers found. Many delayed becoming attached to the baby in a later pregnancy until they felt confident that everything would be O.K. And while in the previous pregnancy they dared to dream and hope for the perfect child, now they only wanted a living child.

Hope's mother, for example, had envisioned her as "a fabulous baby, precocious 2-year-old, adventurous child, challenging teen and growing up with many of her father's qualities -- generous, kind-hearted, beautiful inside and out. I hoped that she would get some of my qualities too. I had already pictured her birth, pool parties, mother/daughter shopping escapades, graduation day, and her wedding. I planned my entire life with her in it."

The Vulnerable Feeling

After becoming pregnant again, most of the parents interviewed by the nurses chose to keep the pregnancy a secret until tests showed that the baby appeared normal. Some even had difficulty acknowledging the pregnancy to themselves, and the prospect of being reassured by other people that everything would be O.K. this time made it more difficult to tell others about the pregnancy.

The researchers wrote, "Unknowing people sometimes pried, leaving parents hurting and vulnerable." Many parents felt comfortable only when discussing their current pregnancy with health professionals, and they greatly appreciated the extra hand-holding and more frequent sonograms and doctor visits they received. Also helpful was connecting with others who had been through similar experiences, through support groups organized by hospitals, or on the Internet. One such Web site is

The researchers emphasized that it is crucial for others -- family members, friends and health professionals alike -- to recognize the mental anguish that nearly always follows a medically prompted decision to end a pregnancy and to avoid making dismissive comments (like "it's a good thing you were able to find out about the abnormality before the baby was born") and giving false reassurances that it won't happen again.

It is better to simply express sympathy, and to tell them that they will be in your thoughts.

Copyright 2001 The New York Times Company


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