Non-viable pregnancy and perinatal bereavement: recognising the loss

A pregnancy can end very early, sometimes even before those around the woman have been informed. Yet for the women and couples concerned, this loss can still involve very real grief. On World Pregnancy and Infant Loss Remembrance Day, Dr Giulia Garofalo, a gynaecologist in the Early Pregnancy Unit at Erasme Hospital (H.U.B), discusses the importance of recognising every individual experience, without ranking losses.

“It was very early.”

“You’re young; you can have another one.”

“You already have children.”

These phrases are sometimes spoken with the intention of providing reassurance. Yet, when addressed to a woman or couple who have just learned that the pregnancy is no longer developing, they can be difficult to hear.

Because behind a few weeks of pregnancy there may sometimes lie months, or even years, of plans for a family. A desire to become a parent, hopes and expectations, changes envisaged in everyday life, perhaps a name, discussions, and a place already imagined for the child. A pregnancy can therefore carry a project long before it becomes visible to others.

There is no stage at which a loss becomes “significant enough” 

At the Early Pregnancy Unit (EPU) at Erasme Hospital, teams of gynaecologists and midwives regularly meet women facing a pregnancy that is no longer developing during the first trimester. Over the course of these encounters, one observation becomes clear: there is no gestational age that, on its own, can determine the extent of the grief experienced. 

“ As doctors, we like data and reference points. But grief also involves a great deal of personal feeling,” explains Dr Garofalo. 

Some women may identify as having experienced pregnancy and infant loss from the first weeks of pregnancy. Others will not describe themselves in this way. Some will want to talk about it, while others will not. Within a couple, experiences may also differ. There is no single way to experience this loss, and what matters is being able to recognise everyone’s right to experience the event as they feel it.  

From a medical perspective, the term “pregnancy and infant loss” is also used to refer to grief related to the loss of a child around the time of birth. It does not always reflect the unique nature of very early losses. However, in the absence of a specific term that is widely used for these situations, it can help recognise an essential reality: the loss of a pregnancy can also be a grieving experience. 

When the pregnancy has not yet been announced 

Pregnancies that are no longer developing during the first trimester are often experienced very privately. Many women have not yet announced their pregnancy to those around them. This is their choice, but when the pregnancy ends, this privacy can make the grieving process particularly lonely. 

The woman may have to go to hospital several times, undergo treatment or a procedure, and change her work or family arrangements. She may have to explain an absence without wishing to reveal what she is going through. 

“ For some patients, there may be a form of double grief: the loss of the pregnancy, but also having to experience this loss in silence,” observes Dr Garofalo. 

This aspect is specific to very early pregnancies. Physically too, the first trimester is a period of many changes related to pregnancy. The pregnancy may therefore end while the woman is still fully experiencing the transformations taking place in her body. 

This is why the words used matter. The term “miscarriage”, which is widely used in medical language, can sometimes be experienced as unsettling by parents.

“ Some words can give the impression that what happened was ‘false’, when the pregnancy was very real,” stresses the gynaecologist. 

The aim is not to impose terminology on parents, but to remain attentive to how they themselves describe what they are experiencing, and to give them the opportunity to talk about it in their own words. 

An announcement that cannot be reduced to a consultation 

For doctors, a pregnancy that is no longer developing may be a common situation. For the patient, it is an especially unique experience, whether it is happening for the first time or not. The news therefore requires time: time to explain what is happening, present the different care options, answer questions, but also make room for emotions. 

This is one of the benefits of the Early Pregnancy Unit: providing a setting in which patients can receive dedicated care and take the time they need to understand the situation and ask their questions. 

In the emergency department, a pregnancy that is no longer developing may sometimes be diagnosed in the middle of the night, in an especially difficult context. At such times, simply being able to say: “You are not alone. You will be able to meet a midwife and a gynaecologist to take the time to talk about what has just happened” can already change the experience of receiving the news. This obviously does not erase the loss, but it means the person is not left alone with it. 

Providing support without minimising 

Supporting a woman or couple facing a pregnancy that is no longer developing does not mean finding the words that will make the pain disappear. It first means not assuming what this pregnancy represented for them. 

Saying “you can have another one” assumes that you know their future. Saying “you’re young” fails to take their history into account. And having one or more children already does not make the loss less significant.

Conversely, a few simple gestures can have a real impact: taking the time, listening, allowing silences, answering questions, acknowledging the loss, asking the parents which words they would like to use, and giving them room to express what they are feeling. 

“ The way we communicate is a genuine skill. Yet it is still insufficiently taught in medical training,” believes the gynaecologist. 

Care is also evolving: recommendations, protocols, treatments, ultrasound practices and more. This is why it is important for healthcare professionals to continue their training and to be able to rely on specialised teams whenever necessary. 

Making room for every experience 

There is no “correct” way to experience a pregnancy that is no longer developing. Some people will need to talk about it extensively. Others will wish to remain private. Some will identify with the term pregnancy and infant loss; others will not. Acknowledging a loss does not mean imposing a way of experiencing it. 

For the women and couples concerned, Dr Garofalo’s message is above all an invitation to allow themselves to put into words what happened, when they feel the need: “Alone, as a couple, with loved ones or in a support group,” stresses the gynaecologist. Although recognition of this grief is progressing, spaces specifically dedicated to talking about pregnancies that are no longer developing during the first trimester remain few and far between, or even non-existent. 

For healthcare professionals, the message is just as important: take the time, do not trivialise, choose your words carefully and recognise the uniqueness of each person’s story. 

Because a pregnancy can be short without the project it carried being so.