What No One Tells You About Pregnancy After Loss.

The Unique Challenges and Ways of Coping with Anxiety, Fear and Grief During Pregnancy After Miscarriage, Stillbirth, or Infant Loss

Aug 30, 2024

The Rollercoaster of Pregnancy After Loss (PAL)

Many times when you read about PAL (pregnancy after loss), the most common statement you come across is “emotional rollercoaster.” Some people dislike this term, as a rollercoaster is often associated with fun, and PAL is far from fun. Others find the term relatable—after all, not all rollercoasters are exciting; some are terrifying. You might feel scared, wanting to get off but unable to. There are moments of pause, a brief plateau, only to be followed by the next rise, which sends you plunging into another wave of overwhelming emotions. This is what being pregnant after loss feels like—one day, the utter fear and overwhelm weigh you down, and the next day, a glimmer of hope shines through, only for it to quickly shift again.

Why the Emotional Upheaval Happens

So why does this wild emotional upheaval happen in the first place? The short answer? Trauma. Losing a pregnancy and baby is traumatic—it shakes the very foundation of our world and beliefs, turning what once felt stable and predictable upside down. You change, and the way you see everything changes. This new pregnancy is not the same as the previous one. Your outlook is now tinted by the unique experiences of grief, guilt, sadness, and anxiety, mixed with hope and brief moments of excitement. It’s overwhelming, but you’re not going crazy. The waves and intensity of these emotions are a normal reaction to what you’ve been through, to your story. And importantly, you are not alone in this.

brown wooden framed gray wooden door saying the word "emotions"

Understanding the Unique Challenges of Pregnancy After Loss (PAL)

I've mentioned before that the reason why Pregnancy After Loss (PAL) feels so different from a pregnancy without a history of loss is because of the trauma associated with it. Let’s dive deeper into that.

A Shift in Beliefs and Expectations

When you enter a pregnancy after loss, you're stepping into it with a profoundly changed perspective—about yourself, others, and the world. Your reproductive story, as Jaffe1 describes it, has been rewritten by the pain of your past experiences. No longer do you hold the once-familiar belief: "We want a child, so we stop contraception, we keep trying, we get pregnant, I give birth, and we have a baby." For most, this sequence feels almost inevitable—something to be planned, as if it’s the most natural progression in the world.

But your reality shattered that illusion. The trauma of losing a baby is like an earthquake that rocks the very foundation of your belief system. Doors you never knew existed have now been forced open, and they can never be closed again. As you enter a subsequent pregnancy, you do so with a knowledge that others don’t possess. You know that the story doesn’t always have a happy ending. This awareness brings with it a deep sadness—a sense of being robbed of the joy, innocence, and blissful ignorance you once had. You can’t look at the future through rose-tinted glasses because you know the harsh realities and risks. You were the one in a million, part of a club you never wanted to join.

The Weight of Trauma in PAL

When you finally see those two lines on the pregnancy test again, instead of joy, you’re gripped by sheer terror and panic.

"What if it happens again?" you think.

And soon after, another thought creeps in:
"What will people think? Will they believe we’ve moved on? Will they assume we’ve forgotten the baby we lost?"

Guilt and anxiety swirl together, leaving you feeling trapped in an emotional storm.

With PAL, every "normal" pregnancy worry tends to spiral out of control. Symptoms, movements—things that might have once been minor concerns—now feel like life-or-death matters. You’ve already experienced the worst-case scenario, so it’s only natural that your mind goes there again. This detachment you may feel—an emotional cushioning that lasts for the entire pregnancy—is your mind’s way of trying to protect you from another heartache. (In case you’re unfamiliar with the term, emotional cushioning refers to the tendency to emotionally distance yourself from your pregnancy as a way to shield against potential loss. It’s a common response in PAL.)

You may find yourself taking multiple pregnancy tests, checking your pants and bed for blood, and avoiding telling anyone about the pregnancy until much later. You hold back from preparing for the baby because now you know that being pregnant doesn’t always mean bringing a baby home.

Dr Michelle Tolfrey

from the Publication

From The Other Chair

poignantly puts it in her POST about her own struggles with the emotional rollercoaster during her pregnancy following the loss of her daughter Orla:

Since the outset, the overriding theme of pregnancy after loss has been one of anxiety, which was there from the moment that I saw those lines appear on the test.
This anxiety has been persistent, and at times all encompassing. It is always there in the background, but will reach various peaks and be triggered by the most unexpected of things. Small events and decisions even then would send me into a tailspin, and my capacity for rational thought went out of the window.

The Anxiety of Antenatal Appointments

Another layer of trauma is tied to antenatal appointments and hospital visits. Every scan is a reminder of hearing the devastating words, "I’m sorry... there is no heartbeat." Just being in the hospital building can be triggering, making you almost expect something bad to happen. And to add to that pain, you often have to repeat your story to different professionals, each time reopening the wound.

The Isolation of PAL

What makes all of this even harder is that no one talks about it, deepening your sense of isolation. People around you may carry misconceptions about PAL: that a miscarriage is easier than a stillbirth, that having another baby will help you move on, that grief will stop once you’re pregnant again. These hurtful misconceptions are far from the truth, yet when reinforced, they can make you feel even more isolated, traumatised, and alone in your struggle.

a women with closed eyes and mouth covered with post-it note that does not allow her to speak up

Grieving and Celebrating Simultaneously

One of the most unique and challenging aspects of PAL is that while you are pregnant, you are still grieving the loss you’ve suffered. You pass milestones in your current pregnancy while simultaneously mourning the milestones that were—or were not—given to you with your previous baby. It’s hard to comprehend how you can celebrate life while grieving another loss. And that is the paradox of PAL: you can—and for your healing, you must—do both.

You need to make room for both the loss and the new life you carry. You are a mother to both your lost baby and the one you now carry, and there is space to honour and celebrate both.

Embracing All Emotions on Your PAL Journey

The truth is, no matter what you read or what others say, you will feel conflicting emotions. Your experiences touch the two most essential points of our existence—life and death. You will feel joy, hope, and excitement, but also overwhelming grief, loss, anger, and despair. To navigate this difficult journey and heal while carrying your baby, you must allow yourself to experience all these emotions fully. And I mean it—validate your feelings as you would validate those of a dear friend. Find space for them all.

Not long ago, I wrote about grounding yourself during emotional storms in a way that keeps you from losing yourself or drowning in the turbulent waters. You can read it HERE. Along with validation, it's crucial to speak to yourself kindly, acknowledging your hurt and pain, just as you would with a friend. You wouldn’t tell your friend to "get a grip" or "move on." You would listen, acknowledge, and say, "Of course you’re feeling this way."

But what else does a good friend do? They help you move forward—not move on, because we can’t move on from losing a baby. But we can move forward. We can take all these emotions and still make a conscious choice—a choice that requires effort and strength—to remind ourselves that we are allowed to feel hopeful and to celebrate this new pregnancy. Grounding yourself in moments of deep fear allows you to find the courage to celebrate and make room for small joys, whether those joys are related to the pregnancy or other aspects of life.

A Gentle Conclusion and Reflection

Navigating pregnancy after loss is a journey filled with complex emotions, where joy and grief coexist. It's okay to feel both, to allow space for the memory of your lost baby while also embracing the life growing inside you now. Remember, you don’t have to face this journey alone. There is strength in seeking support, in validating your emotions, and in moving forward—however slowly.

I know this has been a long read, and it’s a lot to take in. To make it easier to revisit these points, I’ll be breaking this content down into smaller, more digestible pieces in future posts. In the meantime, I’d love to hear from you.

What emotions have you found most challenging to navigate during your pregnancy after loss?
Have you found ways to honour both your lost baby and your current pregnancy?

I’d love to hear your thoughts in the comments below to understand more about your experiences.

a signature at the end of the post saying "warm wishes, Aleks"

Other recommended Substackers writing about reproductive trauma and baby loss:

For my paid subscribers, I’ve created an exclusive resource: Embracing Hope While Managing Anxiety: Your Daily Companion for Pregnancy After Loss.
This guide offers daily practices, reflections, and tools designed to help you find peace and hope amidst the challenges. Imagine moving through your pregnancy with more peace, confidence, and the reassurance that you have the support you need.
You can download the guide by clicling HERE.

Jaffe, J., & Diamond, M. O. (2011). The reproductive story. In J. Jaffe & M. O. Diamond, Reproductive trauma: Psychotherapy with infertility and pregnancy loss clients (pp. 9–29). American Psychological Association.