«Men and women process a miscarriage differently»

Mr Lettieri, what triggers a miscarriage in a partnership?

Depending on psychological stability and the current family situation, it can trigger anything from a mild shock to a serious crisis. There are various factors at play. For example, it is not the same whether a couple with two children experiences a miscarriage or whether a childless couple has to deal with a third miscarriage. It is also important to realise that feelings such as grief, despair, guilt and sometimes even fear and anger are completely normal and can last for weeks or months.

They say that mothers and fathers deal with miscarriage differently.

In practice, I actually experience a difference. The unborn child is naturally further away for the father. He has a more «distant» relationship, simply due to the fact that the child is growing inside the mother's body. To put it bluntly: when a couple loses an unborn child, the father is rarely already a «father».

The woman, on the other hand, is a mother from the very first moment. In addition to the grief that a mother experiences after a miscarriage, many women also often struggle with feelings of guilt and failure: «There's something wrong with me». Or: «Why isn't it working for me?». The father, on the other hand, is back in the «courant normal» of everyday life much more quickly and looks to the future.

Feelings such as sadness, despair, guilt, sometimes also fear and anger are completely normal.

This is not easy for a mother who has just lost her child ...

Yes, that is the case. Especially when it is the first child or the couple has been dealing with the desire to have children for a long time, this can lead to a great deal of stress. It is not uncommon for this emotional maelstrom to result in a depressive episode for the mother, which makes psychotherapeutic help necessary. The couple dynamic part of the crisis should not be underestimated either. In extreme cases, the couple can break up as a result of such a situation. If a crisis situation does not slowly begin to calm down after a few months, it therefore makes sense to seek help as a couple.

What advice would you give couples in such a situation?

If feelings such as anger, sadness or shame are present, they must not be trivialised or ignored. They need space and time and sometimes manifest themselves in phases. In addition, as mentioned above, men usually experience the loss in a more abstract way: they tend to perceive the condition of their wives as a problem rather than the loss of the child directly. They often have the attitude of not wanting to dwell on the problems for too long so as not to make them worse from their point of view. This is simply a male way of dealing with the issue and is basically perfectly fine.

But this attitude often leads to a conflict, ...

... because both expect that the other should deal with things the way they need to. «She» often finds him cold and distant in such a situation and feels left alone. «He», on the other hand, thinks that she exaggerates and only makes things worse with her «uncontrolled feelings».

How can couples get out of this emotional dilemma?

It is important that both learn to recognise what each needs for themselves in this situation and that they communicate this to their partner. In this way, each person first takes responsibility for themselves. The second step is to see what each can do for the other. For the man, this means being there in a way that is good for his partner. Even if he would approach the problem differently from his point of view. And for the woman: expressing what she needs in concrete terms, allowing his closeness and affection without expecting him to feel the same as her. What I like to tell men in my practice: The man doesn't have to work miracles, nor does he «have» to «do» anything big. It's often about simply being there, listening, being a counterpart. This is very healing for the woman, and ultimately for both of them.

A farewell ritual can help a couple to come to terms with the situation, you say.

Yes, «joint carrying», which includes a personal farewell ritual, helps couples to come to terms with the situation. In contrast to a stillbirth, which is legally defined from the 22nd week of pregnancy or from a foetal weight of 500 grams, there is no institutionalised funeral for a miscarriage. This means that there is no culturally anchored ritualisation process that embeds the farewell.

Do you have an example of a farewell ritual from your practice?

I had a couple in therapy where the woman lost the baby at an early stage. When she realised that something was wrong, she drove to the hospital alone and suddenly everything happened quickly. Meanwhile, the husband was at work and only heard the news in passing. His partner went through it alone. In the course of the therapy, which they had started for completely different reasons, it became clear that this experience had left much deeper wounds for them than it had initially appeared. As a result, the woman had distanced herself internally, which he couldn't understand. And neither could she. This only became clear through the therapy. As a couple, they decided to perform a ritual that included travelling to the hospital together, where he could «finally» hold her and she could cry. This helped them both to let go.

How much grieving is «healthy» for the soul?

Grief comes in phases, similar to ebb and flow, but in longer and uncontrollable waves. If the grieving process proceeds «normally», these waves should slowly become weaker over time and the intervals between them should become longer. I also think it's important that at some point, the focus of life should return to the living. Otherwise, diffuse feelings of guilt and anxiety could arise again among the living siblings. If everything goes well, the loss will be «psychologically integrated» over time. The loss suffered is not forgotten. But it fades into the background and becomes part of what you have gone through as a couple and family. Some parents also remember a certain date on which they do something together as a ritual every year.

It's often about simply being there, listening, being a counterpart.

How should parents deal with the issue of miscarriage when they already have children?

It is helpful to differentiate between what a child can understand and what they are able to feel. While the former depends very much on the developmental age, children sense what is going on around them from day one. For example, the child senses that mum is suddenly very sad, that dad is perhaps withdrawing or that there is sudden tension between the two of them. This is why a miscarriage in the family should not be a taboo subject for siblings. Otherwise the child is left with an emotional void that it cannot categorise. This often triggers unconscious fears or feelings of guilt. Mums and dads should therefore not «go easy» on their children, but share this emotional reality with them, if it is one of course. After all, if the parents are coping well emotionally with a miscarriage, in the sense that neither the mother nor the father suffers from it, it does not need to be discussed with the child.

What is the best way to tell children that their unborn sibling is no longer there? Many parents use images such as: The little brother or sister is now in heaven, an angel or a star child. What do you think about this?

Parents usually find the approach intuitively and do not overwhelm their children with medical explanations, but use simple, mostly symbolic images. It also depends on how a family deals with the topic of death in their culture and religious beliefs. It is important to convey the topic to the child in an age-appropriate and simple form. If the parents choose a farewell ritual, they can also involve the siblings with their ideas. For example, one child gave his cuddly toy to the «grave». This «carrying together» helps to let go and strengthens the emotional bonds within the family.

They also say that children usually have a more natural approach to death than adults.

That is indeed the case. They ask two or three questions about the death and can go back to playing the next moment, only to ask again two weeks later about the sibling «in heaven». There is another aspect that parents should not underestimate despite all the grief: Children are very orientated towards what they sense in their parents. This is because children's sense of security depends heavily on the state of their parents. If they see that mum and dad are «doing well» despite everything, then children also feel safe in such a situation.