Mental Health After Miscarriage, Pregnancy Loss, Termination, Stillbirth, & Infant Death

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  • Perinatal loss is an unexpected, traumatic, and life-changing event (Caccitore, 2013; Gold, Leon, Boggs, & Sen, 2016; Kersting & Wagner, 2012).

  • It can cause severe distress (Gold, Leon, Boggs, & Sen, 2016) presenting as depression, anxiety, obsessive compulsive disorder, social phobia, post-traumatic stress, and suicidal ideations (Caccitore, 2013; Caccitore, Schnebly, & Froen, 2008; Gold, Boggs, Muzik, & Sen, 2014; Gold & Johnson, 2014; Hutti, 2004).

  • Bereaved mothers have 4 times greater odds of depressive symptomatology and 7 times increased odds of post-traumatic stress disorder than non-bereaved mothers (Gold, 2016).

  • Women pregnant after stillbirth had a higher prevalence of anxiety and depression compared with women with a previous live birth. Looking at the postpartum period, women who had experienced a stillbirth continued to be at greater risk for anxiety than women who had not experienced a stillbirth (Gravensteen et. al., 2018).

  • The existence of mental health problems is also an added risk factor for poor fetal outcomes during a subsequent pregnancy (Gold, Leon, Boggs, & Sen, 2016) and can negatively affect the attachment to this child (Gaudet, Sejourne, Camborieux, Rogers, & Chabrol, 2010; Hutti, 2004).

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  • After this type of loss, a mother’s values, beliefs, and spirituality can be challenged.

  • The experience of death at birth is an existential dilemma (Uren & Wastell, 2002).

  • The mother’s assumptive world is jeopardized (Uren & Wastell, 2002) and things that once had meaning to her no longer do.


  • The death of an infant impairs a mother’s day-to-day functioning (Kersting & Wagner, 2012; Jaffe, 2014).

  • Mothers report changed appetite and sleep patterns, decreased social participation, decreased marital satisfaction, and increased isolation (Caccitore, Froen, & Killian, 2013; Caccitore, Schnebly, & Froen, 2008; Kersting & Wagner, 2012).

  • This type of loss frequently affects her professional career and relationships with workplace colleagues (Caccitore, 2013; Jaffe, 2014).


  • Perinatal loss leads to the deconstruction of motherhood and role confusion (Caccitore, 2013).

  • Society does not recognize this type of death, and without a live baby in her arms, the mother has lost her maternal identity (Caccitore, 2013). This is also known as disenfranchised grief.

  • There is social pressure to forget the baby who died, move on, and try to have other children (Caccitore, 2013).

  • Perinatal loss also carries a stigma with it, leaving these mothers to feel shame and guilt (Caccitore, 2013; Kersting & Wagner, 2012).

  • Women report a discrepancy between the intensity of their grief and the extent to which they are allowed to express it (Uren & Wastell, 2002).


Altounji, D., Morgan, H., Grover, M., Daldumyan, S., & Secola, R. (2012). A self-care retreat for pediatric hematology oncology nurses. Journal of Pediatric Oncology Nursing, 30(1), 18-23.

Azri, S. & Ilse, S. (2015). The Prenatal Bombshell. Lanham, Maryland: The Rowman & Littlefield Publishing Group.

Boyle, F. M., Vance, J. C., Najman, J. M., & Thearle, M. J. (1996). The mental health impact of stillbirth, neonatal death or SIDS: Prevalence and patterns of distress among mothers. Social Science and Medicine, 43(8), 1273-1282.

Brin, D. J. (2004). The use of rituals in grieving for a miscarriage or stillbirth. Women & Therapy, 27(3/4), 123-132.

Centers for Disease Control and Prevention (2016). Infant Mortality. Retrieved from

Centers for Disease Control and Prevention (2017). Facts about Stillbirth. Retrieved from

Cacciatore, J. (2007). Effects of support groups on post traumatic stress responses in women experiencing stillbirth. Omega, 55(1), 71-90.

Caccitore, J. (2013). Psychological effects of stillbirth. Seminars in Fetal & Neonatal Medicine, 18(2), 76-82. doi: 10.1016/j.siny.2012.09.001

Caccitore, J. & Bushfield, S. (2007). Stillbirth: The mother’s experience and implications for improving care. Journal of Social Work in End-of-Life & Palliative Care, 3(3), 59-79.

Caccitore, J., Froen, J. F., & Killian, M. (2013). Condemning self, condemning other: Blame and mental health in women suffering stillbirth. Journal of Mental Health Counseling, 35(4), 342-359.

Caccitore, J., Schnebly, S., & Froen, J. F. (2008). The effects of social support on maternal anxiety and depression after stillbirth. Health and Social Care in the Community. doi : 10.1111/j.1365-2524.2008.00814.x

Cote-Arsenault, D. & Mahlangu, N. (1999). Impact of perinatal loss on the subsequent pregnancy self: Women’s experiences. Journal of Obstetric, Gynecologic & Neonatal Nursing, 28(3), 274-282.

Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health. (2015). Stillbirth Collaborative Research Network. Retrieved from

Gaudet, C., Sejourne, N., Camborieux, L., Rogers, R., & Chabrol, H. (2010). Pregnancy after perinatal loss: association of grief, anxiety and attachment. Journal of Reproductive and Infant Psychology, 28(3), 240-251.

Gold, K. J., Leon, I., Boggs, M. E., & Sen. A. (2016). Depression and posttraumatic stress symptoms after perinatal loss in a population-based sample. Journal of Women’s Health, 25(3), 263-269.

Gold, K. J., Boggs, M. E., Muzik M. & Sen, A. (2014). Anxiety disorders and obsessive compulsive disorder 9 months after perinatal loss. General Hospital Psychiatry, 36, 650-654.

Gold, K. J. & Johnson, T. R. B. (2014). Maternal mental health outcomes after perinatal death. Obstetrics & Gynecology (abstract).

Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, Ekeberg Ø (2018). Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: A prospective study. BMC Pregnancy Childbirth, 18(1): 41. doi: 10.1186/s12884-018-1666-8.

Hutti, M.H. (2005). Social and professional support needs of families after perinatal loss. Journal of Obstetric Gynecologic, and Neonatal Nursing, 34(5), 630-638.

Jaffe, J. (2014). The reproductive story: Dealing with miscarriage, stillbirth, or other perinatal demise. In D.L. Barnes (ed.), Women’s reproductive mental health across the lifespan (pp. 159-176). New York: Springer.

Jaffe, J. & Diamond, M.O. (2011). Reproductive trauma: Psychotherapy with infertility and pregnancy loss clients. Washington, D.C.: American Psychological Association.

Kersting, A. & Wagner. B. (2012). Complicated grief after perinatal loss. Dialogues in Clinical Neuroscience, 14(2), 197-194.

MacDorman, M. F. & Gregory, E. C. W. (2015). Fetal and perinatal mortality: United States, 2013. National Vital Statistics Report, 64(8).

Uren, T. H. & Wastell, C. A. (2002). Attachment and meaning-making in perinatal bereavement. Death Studies, 26(4), 279-308.