Pregnancy loss might be the most common experience nobody wants to talk about. As a therapist, this is what I’ve learned counseling couples through a miscarriage.

I work as a psychotherapist, but even I couldn’t escape postpartum depression as a new mom. After what I went through, it became a bit of a mission to hold a space in my practice where new parents could stand up to depression, anxiety, and the judgments of others.

I started reaching out to obstetricians, and the referrals started coming in. Except the people coming to me weren’t mostly new parents with babes in arms. Over and over, I’d hear, “Dr. So-and-so said I should call you … I had a miscarriage and I’m having a really hard time.”

It turns out, pregnancy loss might be the most common experience nobody knows about. Until it happens. And then a woman, and often a couple, has to live it.

More than once, a client has said, “I wish I’d understood this a little bit before.” So, with deep appreciation for each person who has opened their wounded hearts over a cup of tea in my office, here are five things I learned while counseling couples through the loss of their unborn child.

Miscarriage: I’ve come to despise the word itself. It literally means “carried wrong.” Starting from the diagnosis in the doctor’s office, there’s already an implication that something went wrong and that it could’ve gone right. It also ignores the deeply personal and individual experience of pregnancy loss. I’ve become very aware of referring to whatever language comes to the person as they talk about their experience:

  • your loss
  • your baby
  • the child you didn’t get to know

“At least … ” Meaning well, people say all kinds of things to try to dissuade the bereaved parent from feeling bad about this experience: “At least it happened early!” or “At least you can try again!” Other kind, but deadly words include:

  • “Well, you know it wasn’t meant to be”
  • “It must have been defective, so this is better”
  • “Don’t worry, you’ll have another chance”

Helpful tip: If it wouldn’t be appropriate to say at a funeral, it’s not appropriate to say to someone who’s just lost a pregnancy. Would you ever walk up to someone who’d just lost their partner and say, “Well, there’s plenty of fish in the sea!”? Nope.

We wouldn’t think of saying, “This must not have been meant to be,” or “There’s someone else out there who’s perfect for you, you’ll see.” Saying these things to parents who’ve lost a pregnancy can be just as insulting and hurtful.

“It’s time to move on.” While this message isn’t always so explicit, newly bereaved parents often talk about other people’s apparent obliviousness to their pain, which brings us to the second thing I’ve learned …

I sometimes call the experience of losing a pregnancy “invisible grief.” There’s the loss of the anticipated child, who parents often feel quite connected to, even if only through the not-quite-pleasant evidence of its growth — more than one woman who lost her pregnancy during the first trimester has spoken of longing for morning sickness.

For first-time parents, there’s a feeling of connection to that identity — parent — for which there isn’t any visible evidence. There’s no more bump, no new baby to show. But the grief is there.

One mom spoke of the daily experience of waking up and having it hit her in the gut all over again, remembering that she wasn’t pregnant any more, that there wasn’t a baby in the next room.

Yet, there are few sanctioned ways to acknowledge this. There’s no bereavement leave. There’s quite often no funeral. One thing that many people have said helped them was our work to design a ritual of saying goodbye.

Ritual is something humans do all over the world. It helps us feel the completion of something, the transition to a new identity or phase. So, I will often invite clients to create a ritual that’ll be meaningful for them.

Sometimes, they’ve asked family and friends to gather. Other times, they’ve gone away and done something special. One couple went to a special place in the woods, where there was a stream. They fashioned a little boat and put in it letters to their baby, then watched as it went down the current and out of sight.

Our brains are amazing. They’re always learning, trying to figure out how to do things better. One downside of this is that, when something awful happens, our brains are convinced that we could’ve prevented it.

Bereaved parents can feel literally distraught trying to figure out what it was they could’ve done differently and letting their shame take over. Other times, it can turn into a blame game:

  • One person feels like pregnancy loss happens about a fourth of the time, so it’s not such a big deal, while their partner is devastated.
  • A bereaved mother is pragmatic — the child wouldn’t have survived. The father, on the other hand, feels guilt, sure that it’s his “bad genes” that made it happen.
  • An unmarried woman is deeply grieving the loss of this pregnancy and also facing the real possibility that she’ll never have the chance to conceive again. Her partner is relieved — he never wanted kids.
  • A woman’s angry because she warned her pregnant partner not to keep exercising so hard and, no matter what the doctors say, she’s sure that’s why the pregnancy ended.

Which leads to number four …

Both shame and blame drive people apart. Added to their pain of loss can be the pain of isolation or feelings of unworthiness. But, when couples can come together to stand up to shame and blame, they can end up closer.

Pain calls for tenderness. I have seen the pain of loss open up couples to new levels of compassion and tenderness with one another.

Grief takes time and, when there’s no road map, it can seem like it’s never going to end.

Because pregnancy loss isn’t talked about, people often feel like they’re off track, not moving forward as they “should be.”

Here are some things my clients have shared as helpful:

Plan for important dates: So many times, people I’ve worked with have gotten to a place where they’re doing well, then suddenly start feeling really, really awful — only to realize that they’d forgotten that it was the baby’s due date or a key anniversary.

Plan for these dates. They’re great for rituals. They also don’t have to be times to wallow. If you’re feeling great on the baby’s due date and have planned to take the day off, enjoy! You’ve earned it.

Set limits with people that meet your needs: Let that family member who asks “So, have you started trying?” or other intrusive questions know that you understand they mean well but it’s really intrusive. One mom told me she just started using the phrase “that’s private” on repeat.

If someone wants to get you out to cheer you up and you don’t want that, let them know. If it fits your relationship with them, you can let them know you appreciate their intention and what would work for you: “I really appreciate that you want me to feel better but I’m just sad now. I’d love to see you/go to the movie/have dinner, as long as you won’t mind if I’m sad.”

Pamper yourself: One friend of mine started using the phrase radical self-care and I think it perfectly fits what grieving parents need. This isn’t maintenance or special treat time. It’s nurture-wherever-you-can time.

Don’t worry if you need that manicure, or extra gym session, or ice-cream-cone-in-the-middle-of-the-day-for-no-particular-reason. If it brings a bit of enjoyment or comfort and isn’t dangerous, go for it.

Be kind to yourself and your partner: If you don’t have a partner, let your friends know that you need extra kindness.

Remind yourself that grief gets easier over time: You don’t have to let go of, or move on from, your child. You can find your own way to carry your connection with them, however brief, forward in your life.

That mom who talked about being hit in the gut each morning? I told her I was writing this piece and she said: “Tell them it gets easier. It’s always there, but it doesn’t hurt as much.”

Dove Pressnall is a single mom, psychotherapist, and nonprofit entrepreneur who lives near downtown Los Angeles. She has previously lived in Oregon, Montana, Texas, Oklahoma, Papua New Guinea, and Liberia, in that order. As a therapist, Dove loves helping people find ways to reduce the impact of problems on their day-to-day lives.