Motivation and emotion/Book/2025/Pregnancy loss and emotion

Pregnancy loss and emotion:
What are the emotional consequences of pregnancy loss for parents?

Overview

Figure 1: Couple Imagine this ... Tara is 28 years old, and she and her partner have been trying for a baby for a year and a half. Recently, Tara experienced a miscarriage at 11 weeks and 4 days. She feels lost and helpless, and struggles with thoughts that her body has let her down. Despite being reassured by medical professionals that her miscarriage was unavoidable caused by spontaneous pregnancy loss, Tara still carries around the guilt that she could have done more. She finds it hard to describe the grief of losing someone she never met, yet had already imagined a whole future with. Tara’s partner is also experiencing their own grief and guilt about the miscarriage. They want to be supportive but feel unsure how to comfort her, sometimes feeling paralysed in their emotions. They struggle to identify exactly what they’re feeling — there’s no single word for it — but they believe they should feel sad, even when the emotions don’t come in the way they expect. Tara and her partner have not yet told anyone about the miscarriage. Friends and family often ask about the baby, and each question quietly deepens their grief. For now, they hope to keep their loss private, allowing themselves some space before sharing their emotions with others, where they fear they might be met with pity rather than understanding.

Pregnancy loss is often described as an invisible grief; a loss that can be profoundly life-changing, yet one that many parents feel unable to openly share. While medical conversations often focus on physical recovery, the emotional consequences can be far more complex and enduring.

Around one in four pregnancies end in miscarriage, yet the emotional impact for parents is frequently minimised or overlooked (Brier, 2008). For many, the loss is not only of a pregnancy but also of future hopes, identities as parents, and expectations of family life. Despite its prevalence, stigma and silence often prevent parents from accessing the emotional support they need, leaving them vulnerable to grief, depression, anxiety, guilt, and trauma (Farren et al., 2016)

Focus questions What are the hormonal, emotional and psychological changes that occur during pregnancy and pregnancy loss? What is grief? What emotional theories are connected to pregnancy loss? What are the emotional consequences of pregnancy loss for parents?

What are the hormonal, emotional and psychological changes that occur during pregnancy and pregnancy loss?

Pregnancy and miscarriage involve profound hormonal, neural, emotional, and psychological changes that interact in complex ways. Understanding these mechanisms helps explain why parents experience intense emotions and why miscarriage can have lasting effects on mental health (Quenby et al., 2021; Field et al., 2010).

Understanding Pregnancy

Description

Pregnancy is when a person carries a developing baby inside their uterus. It starts when a sperm fertilizes an egg, creating a tiny embryo that attaches to the uterine lining. Pregnancy usually lasts about 37 - 42 weeks and is divided into three stages, called trimesters.

Figure 2. Showcasing pregnancy development inside the womb as the baby grows.

• First trimester (weeks 1–12): The embryo starts developing major organs, and the parent may experience symptoms like tiredness and nausea.
• Second trimester (weeks 13–26): The baby grows bigger, movements can often be felt, and some early symptoms may ease.
• Third trimester (weeks 27–40): The baby grows rapidly, and the parent’s body prepares for birth, which can cause discomfort.

Pregnancy involves a mix of physical, hormonal, and emotional changes to support the baby’s growth before it ends in either a live birth, miscarriage, induced abortion or a still birth.

Hormonal Changes

Hormonal Changes in the Body

During pregnancy, levels of estrogen and progesterone rise sharply. Estrogen promotes uterine and breast development, while progesterone maintains the uterine lining and prevents premature contractions¹(Mayo Clinic, 2022). Human chorionic gonadotropin (hCG)² signals early pregnancy, maintaining estrogen and progesterone production to support the developing embryo (Mayo Clinic, 2022). Relaxin loosens ligaments in preparation for birth, and oxytocin and prolactin prepare the body for lactation³ (Glynn & Sandman, 2014).

Hormonal Changes in the Brain

Circulating hormones cross the blood–brain barrier and influence neurotransmitter⁴ systems (Soares & Zitek, 2008). Estrogen modulates serotonin and dopamine, supporting mood regulation and cognitive function, while progesterone and its metaboli te allopregnanolone enhance GABAergic activity⁵, producing calming effects (Schiller et al., 2014). Oxytocin increases activity in the amygdala⁶ and prefrontal cortex,⁷ promoting bonding and social cognition (Rilling & Young, 2014). Cortisol gradually rises to support fetal development but can heighten stress reactivity when chronically elevated (Field et al., 2010).

Effects on the brain and body function

Hormonal changes prepare the body for birth and caregiving but can also contribute to mood variability, fatigue, and heightened emotional sensitivity. Neuroplastic changes occur in regions including the prefrontal cortex, amygdala, and hippocampus, enhancing vigilance and caregiving behaviours (Kim et al., 2010). Physically, the hormones regulate uterine growth, blood volume, and metabolism to support the fetus.

Emotional and psychological effects

Hormonal modulation helps explain common pregnancy emotions. Estrogen-mediated serotonergic activity can promote positive mood, while fluctuations may trigger anxiety or depressive symptoms. Progesterone withdrawal can increase irritability or restlessness. Oxytocin fosters attachment and empathy, facilitating social support and parental bonding. Cortisol influences stress responsiveness, linking physical changes to emotional experiences. Psychological adjustments include shifts in identity, anticipatory anxiety about parenthood, and preparation for caregiving (Glynn & Sandman, 2014; Field et al., 2010).

Understanding Miscarriage

Description

A Miscarriage is the loss of a pregnancy before the fetus can survive outside the uterus, usually before 24 weeks of gestation. It is sometimes also called a spontaneous abortion, though that term is more clinical.

Miscarriages are relatively common, especially in the first trimester, and can happen for a variety of reasons, such as:

• Chromosomal abnormalities in the fetus
• Hormonal imbalances in the parent
• Health conditions like diabetes or thyroid problems
• Infections or certain medications
• Lifestyle factors, though these are less commonly the main cause

Symptoms of a miscarriage may include vaginal bleeding, cramping, abdominal pain, and the passing of tissue. Some miscarriages happen very early and may be mistaken for a heavy period.

Hormonal Changes

Hormonal changes in the body

Miscarriage leads to rapid declines in estrogen and progesterone, disrupting uterine maintenance and causing fatigue, cramping, and other physiological symptoms (Quenby et al., 2021). Oxytocin levels may also drop, particularly if contractions are medically induced. Cortisol⁸ surges as part of the stress response, further affecting the body (Farren et al., 2016).

Hormonal changes in the brain

The sudden hormonal withdrawal disrupts serotonin, dopamine, and GABA signaling, contributing to low mood, anxiety, and sleep disturbance (Schiller et al., 2014). Reduced oxytocin signaling may impair emotional bonding, increasing distress (Rilling & Young, 2014). Elevated cortisol can heighten anxiety and stress reactivity through the HPA axis⁹ (Field et al., 2010). Dopaminergic reward pathways may be affected, leading to anhedonia¹⁰ and reduced pleasure, particularly in parents who had high anticipatory attachment to the pregnancy (Glynn & Sandman, 2014)Template:Not in References.

Effects on brain and body function

Hormonal disruption impacts cognitive processing, attention, and memory, while HPA-axis activation amplifies physiological stress responses. Physical symptoms of miscarriage, such as bleeding and uterine contractions, are compounded by emotional and neural effects (Quenby et al., 2021).

Emotional and psychological effects

The neuroendocrine changes explain much of the emotional experience following miscarriage. Sudden progesterone and estrogen withdrawal can provoke grief, guilt, sadness, and anxiety. Reduced oxytocin contributes to feelings of isolation or difficulty bonding with partners. Increased cortisol and disrupted dopamine pathways may lead to heightened stress, sleep disturbance, and anhedonia. Psychologically, miscarriage can impact identity, future parenting confidence, and increase risk for depression, anxiety, and PTSD (Farren et al., 2016; Quenby et al., 2021).

Key comparison

Hormone	Pregnancy: Effect on Body	Pregnancy: Effect on Brain & Emotion	Miscarriage: Effect on Body	Miscarriage: Effect on Brain & Emotion
Estrogen	Uterine and breast development	Supports serotonin & dopamine → mood regulation	Rapid drop → uterine shedding	Disrupts mood, may trigger sadness/anxiety
Progesterone	Maintains uterine lining, prevents premature contractions	Enhances GABAergic activity → calm, reduces anxiety	Rapid drop → uterine instability	Disrupts GABA → irritability, anxiety
hCG	Maintains estrogen/progesterone	Supports early pregnancy signals	Falls after pregnancy loss	Contributes to hormonal imbalance
Oxytocin	Prepares for bonding & lactation	Increases amygdala & prefrontal cortex activity → empathy, social cognition	Drops after loss	Reduced bonding, feelings of isolation
Cortisol	Gradual rise supports fetus	Modulates stress response	Surges during miscarriage	Heightened stress, anxiety
Dopamine	Reward pathways support anticipatory bonding	Enhances pleasure, motivation	Withdrawal or dysregulation	Anhedonia, reduced pleasure

Quiz

1

Question 1 |type="()"

	Estrogen
	Progesterone
	Cortisol
	Dopamine

2

Question 2 |type="()"

	Amygdala
	Hypothalamus
	Prefrontal cortex
	Hippocampus

What is grief?

Description

Grief is the emotional response to loss, especially the loss of someone or something important, like the death of a loved one, the end of a relationship, or even a major life change. It’s a natural process that can involve a range of emotions—sadness, anger, guilt, confusion, relief, or even numbness.

Grief isn’t just emotional; it can also affect thoughts, behaviors, and the body, leading to difficulty concentrating, changes in sleep or appetite, and physical symptoms like fatigue or tension.

People experience grief differently. Some may go through it in stages (commonly described as denial, anger, bargaining, depression, and acceptance), but there’s no “right” way or timeline for grieving.

Essentially, grief is the mind and body’s way of processing and adjusting to a significant loss.

Miscarriage often produces a unique type of grief, as parents mourn the loss of both the baby and the imagined future tied to that child (Côté-Arsenault & Dombeck, 2001). This makes pregnancy loss distinctive because it combines bereavement with disrupted identity, hopes, and social roles.

Kübler-Ross model

The most well-known framework for grief is the five stages of grief proposed by Kübler-Ross (1969): denial, anger, bargaining, depression, and acceptance. While widely recognised, research suggests these stages are not always experienced linearly, nor do all individuals pass through each one (Maciejewski et al., 2007). For miscarriage, some parents may experience prolonged guilt or self-blame that does not map neatly onto these stages.

Denial

A protective response where the individual struggles to accept the reality of the loss, often feeling numb or in disbelief. For miscarriage, parents may initially find it difficult to believe the pregnancy has ended

Anger

Intense frustration or resentment, which may be directed at oneself, a partner, medical professionals, or even fate. Parents may feel anger that their body “failed” or that others cannot understand their pain.

Bargaining

Figure 3. The 5 stages of grief.

Attempts to make sense of the loss by imagining “what if” scenarios or negotiating with a higher power. This can involve guilt, such as wishing they had done something differently to prevent the miscarriage.

Depression

Deep sadness, hopelessness, and withdrawal as the permanence of the loss sets in. Parents may feel overwhelmed by grief, emptiness, or lack of motivation.

Acceptance

Gradual recognition of the reality of the loss and a process of adjusting to life without what was lost. Acceptance does not mean forgetting the baby, but finding ways to move forward while carrying the memory.

Dual process model

The Dual Process Model¹¹ explains grief as an oscillation between confronting the loss (loss-oriented coping) and adjusting to life changes (restoration-oriented coping) (Stroebe & Schut, 1999). This may apply strongly to miscarriage, as parents often move between grieving their baby and dealing with practical challenges such as medical recovery, workplace responsibilities, and future fertility planning.

Continuing bonds perspective

The Continuing Bonds¹² perspective suggests that many bereaved individuals maintain a psychological connection with the deceased, which may be expressed in naming the baby, keeping ultrasound photos, or commemorating anniversaries (Klass, Silverman, & Nickman, 1996).

Meaning reconstruction

Another influential theory is Meaning Reconstruction¹³, which highlights the importance of making sense of the loss and integrating it into one’s identity (Neimeyer, 2001). For parents experiencing pregnancy loss, this might involve redefining what parenthood means or re-evaluating future life goals.

The partners grief

Partners often experience grief that differs from the birthing parent, yet their loss is sometimes overlooked or invalidated. This is sometimes referred to as disenfranchised grief,¹⁴ because society often focuses more on the physical and emotional recovery of the mother, leaving partners without recognition or support (Doka, 1989). Partners may suppress their emotions to remain “strong” for their significant other, yet this can increase feelings of isolation. Additionally, hormonal and psychological changes that occur in non-birthing partners during pregnancy—such as elevated prolactin and reduced testosterone to promote bonding—can abruptly shift after miscarriage, influencing mood and emotional regulation (Gettler et al., 2011). The combination of personal grief and the pressure to provide support can strain relationships, as both individuals struggle with different grief trajectories{{f}.

Did you know? A baby’s heart starts beating very early: Research suggests that the heart begins beating around 16 days after conception—even before many people know they are pregnant! (University of Oxford, 2016) Grief can literally hurt: Intense grief activates the same brain regions as physical pain, which is why emotional loss can feel like a heavy ache in the chest (Kross et al., 2011). Why it matters: These facts highlight how pregnancy and pregnancy loss are not only deeply emotional experiences but also involve real physiological changes—from the earliest stages of fetal development to the body’s response to grief. Understanding the physical and emotional dimensions can help parents and supporters appreciate the full impact of loss.

Emotion-Specific Theories and Pregnancy Loss

Understanding the emotional consequences of pregnancy loss can be enriched by considering psychological theories of emotion. Two particularly relevant frameworks are Lazarus’s Cognitive Appraisal Theory and affect regulation models, which help explain why grief, guilt, anxiety, and other emotions arise and how they are managed.

Lazarus’s Cognitive Appraisal Theory

Lazarus (1991) proposed that emotions arise from individuals’ appraisals of events relative to their personal goals, values, and well-being. In the context of pregnancy loss, parents may evaluate the miscarriage as a threat to their identity as parents, a violation of expectations, or a loss of anticipated life plans. This primary appraisal—judging the event as harmful or threatening—triggers emotional responses such as sadness, anger, or anxiety. Secondary appraisal involves evaluating coping resources: parents who perceive limited social support or personal coping ability may experience more intense negative emotions (Lazarus, 1991). For example, Tara’s feelings of guilt and helplessness can be understood as a product of appraising the miscarriage as both a personal failure and a threat to her envisioned future as a mother, coupled with limited perceived coping resources.

Affect Regulation Models

Affect regulation models emphasize the strategies individuals use to manage or modulate emotional responses, including both adaptive and maladaptive approaches (Gross, 2015). Following pregnancy loss, parents engage in affect regulation to cope with overwhelming grief and stress. Adaptive strategies, such as seeking social support, journaling, or maintaining rituals to honor the lost pregnancy, can help process emotions constructively. Maladaptive strategies, such as emotional suppression or avoidance, may reduce immediate distress but can prolong grief, increase anxiety, or impair relational support (Gross & Thompson, 2007). Partners, in particular, may suppress their emotions to remain supportive, reflecting a form of affect regulation that can inadvertently intensify their own disenfranchised grief.

Integration with Pregnancy Loss Research

Applying these emotion-specific theories to miscarriage highlights the dynamic interaction between biological, cognitive, and social factors. Hormonal shifts (e.g., drops in estrogen and progesterone, altered oxytocin signaling) influence emotional reactivity and affect regulation, while cognitive appraisals determine whether the loss is experienced primarily as threatening, unfair, or meaningful. This theoretical lens helps explain the wide variability in parents’ emotional responses, the oscillation between grief and daily functioning described in the Dual Process Model, and the challenges of coping with a socially invisible loss.

Emotion	Typical Cognitive Appraisal (Lazarus, 1991)	Example from Pregnancy Loss	Affect Regulation Strategies (Gross, 2015)
Sadness / Grief	Event perceived as irreversible loss; threat to parental identity or future plans	Feeling empty after miscarriage; mourning the imagined future with the baby	Adaptive: Sharing feelings with partner or friends, journaling, memorial rituals Maladaptive: Suppressing emotions, avoiding reminders
Guilt / Self-Blame	Perceiving personal responsibility or failure for the loss	Believing “I could have done more” despite medical reassurances	Adaptive: Cognitive reappraisal to recognize uncontrollable factors, discussing feelings with supportive others Maladaptive: Rumination, internalizing blame
Anxiety / Worry	Anticipating future threats to fertility or health	Fear of complications in next pregnancy	Adaptive: Seeking information, medical consultation, planning next steps Maladaptive: Catastrophizing, avoidance, hypervigilance
Anger / Frustration	Perceiving unfairness or violation of expectations	Feeling anger at the body, fate, or medical circumstances	Adaptive: Expressing feelings in safe contexts, advocacy for better support Maladaptive: Suppressing anger, interpersonal conflict
Isolation / Emotional Numbing	Perceiving lack of social support or understanding	Feeling alone in grief; partner’s grief feels invisible	Adaptive: Reaching out for social or professional support, engaging in joint rituals Maladaptive: Emotional withdrawal, over-suppression, avoiding social contact

What are the emotional consequences of pregnancy loss for parents

Intense grief and sadness

Following pregnancy loss, parents commonly report intense sadness, emptiness, and a sense of loss that is sometimes described as “ambiguous” because it relates to a life that was imagined rather than lived (Brier, 2008). Emotional responses can be amplified by the hormonal shifts that occur during miscarriage, including abrupt drops in estrogen and progesterone, which are associated with mood dysregulation, irritability, and vulnerability to depressive symptoms (Quenby et al., 2021; Schiller et al., 2014). Cortisol surges during miscarriage may also exacerbate anxiety and stress reactivity, further intensifying feelings of despair (Farren et al., 2016).

Anxiety, guilt, and self-blame

Parents may experience heightened anxiety about future pregnancies, fertility, and their perceived responsibility for the miscarriage. Guilt and self-blame are common, even when medical professionals affirm that miscarriage was unavoidable. These emotional reactions are supported by neurobiological changes: reductions in oxytocin may impair social bonding and feelings of connection, while dopaminergic withdrawal can contribute to anhedonia and diminished pleasure in daily activities (Glynn & Sandman, 2014).

Trauma and posttraumatic stress

For some parents, miscarriage can produce trauma-like responses, including intrusive thoughts, hypervigilance, and avoidance behaviours. The activation of the hypothalamic-pituitary-adrenal (HPA) axis in response to loss can trigger heightened stress responses and interfere with emotional regulation (Field et al., 2010). Parents who experience miscarriage in a medicalised or sudden context may be more vulnerable to these symptoms.

Partner-specific grief

Partners often experience grief differently, reflecting both personal loss and the need to support the birthing parent. This is sometimes classified as disenfranchised grief, as social recognition and support may be limited. Hormonal shifts in non-birthing partners, such as elevated prolactin and decreased testosterone during pregnancy, can abruptly change after loss, affecting mood and emotional resilience (Gettler et al., 2011). Partners may suppress emotions to remain supportive, increasing feelings of isolation and complicating the couple’s shared adjustment.

Relationship and social consequences

Pregnancy loss can strain relationships, particularly if partners grieve in different ways or at different paces. Misalignment of grief responses may lead to misunderstanding, conflict, or emotional withdrawal. Social stigma and the invisible nature of pregnancy loss may further inhibit parents from seeking support, compounding feelings of isolation and distress (Côté-Arsenault & Dombeck, 2001; Brier, 2008).

Emotion comparison

Emotional Consequence	Birthing Parent	Non-Birthing Parent / Partner	Notes / Mechanisms
Grief and sadness	Intense grief, emptiness, loss of anticipated future	Grief may be less recognised; feelings of helplessness	Linked to hormonal withdrawal (estrogen, progesterone) and disrupted attachment pathways
Anxiety	Concern about fertility, future pregnancies, health	Worry about supporting partner; anticipatory anxiety	Cortisol surges and HPA-axis activation increase stress reactivity
Guilt / self-blame	Feeling body “failed,” questioning own actions	Feeling unable to comfort or “protect” partner	Dopamine dysregulation can contribute to anhedonia and rumination
Anger / frustration	Directed at self, medical professionals, or fate	May feel anger at situation or perceived lack of control	Emotion regulation may be challenged by oxytocin withdrawal
Trauma / intrusive thoughts	Medicalised or sudden miscarriage may trigger PTSD-like symptoms	May experience secondary trauma witnessing partner’s distress	HPA-axis activation and stress hormones influence neural circuits for threat detection
Relationship strain	Misalignment of grieving pace or expression	Pressure to support partner while grieving	Disenfranchised grief and social stigma can amplify isolation
Emotional numbing / anhedonia	Reduced pleasure in usual activities	May suppress emotions to remain strong	Dopamine pathway dysregulation and stress hormones

Conclusion

The emotional consequences of pregnancy loss are wide-ranging and deeply personal, often reaching far beyond the physical experience itself. For many parents, the grief is complex and ambiguous, tied not only to the loss of a baby but also to the imagined future, anticipated identity as a parent, and social roles that were expected to unfold. Hormonal and neurobiological changes following miscarriage, such as abrupt declines in estrogen and progesterone or dysregulation of dopamine and oxytocin, intensify sadness, guilt, and anxiety, creating vulnerability to depression and trauma-related symptoms.

While the birthing parent’s experience is often foregrounded, partners also endure profound but frequently unacknowledged grief. This disenfranchised grief can leave them feeling invisible and unsupported, particularly when societal narratives minimise or overlook their emotional needs. Differences in how partners grieve can place additional strain on relationships, compounding the sense of isolation for both.

Ultimately, pregnancy loss is not only a private sorrow but also a relational and social challenge. Recognising the emotional consequences for both parents, and validating the legitimacy of their grief, is essential in reducing stigma, fostering connection, and supporting long-term wellbeing. Without this recognition, parents risk carrying their loss in silence, further intensifying the invisible weight of their grief.

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External links

Blomberg, C. (2019, October). Silently suffering after pregnancy loss [Video]. TEDxSiouxFallsWomen. YouTube. https://www.youtube.com/watch?v=l22udhFhsOE

Hanasono, L. (2018, June). The M-word: Shattering the silence on miscarriage [Video]. TEDxBowlingGreen. TED Conferences. https://www.ted.com/talks/lisa_hanasono_the_m_word_shattering_the_silence_on_miscarriage

Pregnancy Help Australia. (n.d.). Centres directory. https://pregnancyhelpaustralia.org.au/centres

Red Nose. (n.d.). Grief and loss support. https://rednose.org.au/support/grief-and-loss-support}}

See also

• Pregnancy loss and emotion (Book chapter, 2024)