Incomplete Pregnancies Deserve Aftercare, Too

Whether they've experienced a miscarriage or undergone elective termination, everyone should have access to a better post-pregnancy recovery.

Having A Kid In America

There's no denying it: raising a child in the United States is challenging. There is no federally mandated paid parental leave policy, a worrying lack of affordable child care, and an infinitesimal regard for parents' physical and mental health once they leave the hospital, all of which contribute to the country's high maternal mortality rate, which ranks among the highest of any industrialized nation. Even yet, for many women, the pregnancy experience continues after delivery. Given the state of the system at the moment, it is clear that postpartum care for women who have had an abortion is a crucial but frequently neglected part of their emotional and physical recovery.

Incomplete Pregnancy

Incomplete pregnancy includes miscarriage and abortion. The American College of Obstetricians and Gynecologists (ACOG) estimates that 26% of pregnancies result in miscarriage. That figure doesn't include abortions, which The Guttmacher Institute counted at 930,160 in 2020. Over two million women yearly suffer incomplete pregnancies, many of whom are left with no information on how to care for their bodies or mental health.

"The dialogue surrounding women's and birthing people's health still has so much lacking," says Sunita Osborn, PsyD, MA. "In some ways, it seems like we're still tied to this concept where there are some aspects of the [pregnancy] journey we're allowed to speak about, and others portions are forbidden, stigmatized, and not to be addressed."

Thankfully, businesses are starting to cater to non-baby pregnancies. Advocates for all phases of pregnancy (including post-miscarriage or abortion) and aftercare kits for incomplete pregnancies are growing.

The postpartum period, which lasts six to eight weeks (though no nationally required parental leave legislation), is seldom discussed. Even if you don't give birth, early pregnancy may cause physical and physiological changes.

Physical aftercare depends on your pregnancy stage. According to Jasmine Pedroso, MD MPH FACOG, OB/GYN, hormonal and physiological changes, including nausea, fluid retention, dysgeusia, and breast tenderness, might last longer the farther along you are.

"Hormone alterations last six weeks to a year following a full-term pregnancy. These alterations last two to four weeks after a miscarriage or termination." In this case, Dr. Pedroso notes side effects might include irregular bleeding, cramps, and mood changes, which usually recover between two to four weeks.

Unfinished pregnancies can affect mental health. Osborn: "An incomplete pregnancy may cause melancholy, worry, wrath, sorrow, relief, and perplexity. It may all happen in one day and cycle." She says that miscarriage might affect a person's identity "Do I lose my womanhood if I can't have a healthy pregnancy? It may reveal parts of oneself you didn't know existed until they were broken and challenged."

The Rise Of Incomplete Pregnancy Kits

A new product category addresses the physical and psychological repercussions of incomplete pregnancy. Brands Frida and Bodily provide miscarriage and termination kits. "After experiencing two unexpected pregnancy losses myself, we felt it was important to address this isolating and physically challenging time in a woman's life with the same thoughtfulness and sensitivity as we do for [people] who leave a hospital with a baby, especially given how similar some of the needs are," says Frida CEO Chelsea Hirschhorn, who founded the brand in 2014.

"An overnight menstruation pad sometimes doesn't cut it when it comes to ensuring a peaceful recovery after pregnancy," she says. These issues inspired her Frida Recovery Kit for Incomplete Pregnancies ($34.99). It contains four sets of disposable underwear, six ultra-absorbent maxi pads, and an upside-down peri bottle for showering and toileting.

Bodily's core package contains memory bracelets, a turmeric mix, a pregnancy loss support book with "resources... on how to manage and talk about your loss with words of encouragement," and Dr. Osborn's The Miscarriage Map: What To Expect When You're No Longer Expecting ($90). Based on your trimester, the company suggests adding mesh underwear ($14 for 5), maxi pads ($7.50 for 14), and breast pads ($24 for 4, $36 for 6).

Post-incomplete pregnancy sufferers may need emotional or mental health care to compensate. Hirschhorn promised to strengthen the patchwork home physical therapy plan using Frida's items. The recovery package promises to assist women through all stages of healing, regardless of how their pregnancy ended.

A package like this may assist with at-home aftercare, but you should still see your OB/GYN to ensure you're recovering well and physically well. "Those packages are thoughtful and sensitive extra tools for women during a very difficult time," says Santa Monica-based board-certified OB/GYN Lisa Masterson, MD. "They shouldn't replace a women's doctor's care. We must anticipate women's physical and mental requirements during and after [miscarriage or abortion] and their specific demands. Some have strong assistance, while others need referrals."

How Full-Spectrum Doulas Can Help

Losing a pregnancy or choosing to terminate is very difficult, so having a caregiver who understands these incomplete pregnancies may be helpful.

"I always tell my [miscarriage] clients that they're not just mourning the loss of something that was eight weeks in your experience; you're mourning the loss of a system that you've carried with you for years, decades, even if you didn't necessarily [realize it]," Dr. Osborn says, referring to the story of parenthood we learn as children. "Early miscarriage may be quite unsettling." She adds that even voluntary abortions change people's perceptions about themselves, the world, their family, and their identity. A professional caregiver can at least make sure you're informed before, during, and after.

Full-spectrum doulas may help. Birth doulas provide educational, emotional, and practical assistance to clients undergoing many life transitions, including abortions. "There's a lot of heated sentiments surrounding it given the link of our society to abortion," says Vicki Bloom, a full-spectrum doula who works with abortion clients in-person and over the phone before, during, and after their experience. "We must meet that individual where they are and provide emotional and bodily comfort."

Bloom believes a full-spectrum doula may assist a patient awake throughout an elective termination with a medical professional using breathing methods to ease discomfort or distract them. Pregnant women who have home abortions may call a hotline for help from a certified caregiver.

Bloom has also counseled miscarriers. "They may be having a sudden miscarriage at home and want assistance," she explains. "The doula may have to adjust if a birth client loses the pregnancy. Finally, some in-clinic abortion clients have medical issues after an incomplete miscarriage. Any doula working in that setting will witness a case like this." Bloom notes that most full-spectrum doulas operate as volunteers or on a pay-what-you-can basis due to the nature of the profession.

Bloom also prioritizes aftercare for her clients, as not everyone has a supportive network. "When I'm working with the medication abortion hotline, I may offer, "Can someone in your life bring you an ice cream sundae?" The individual might think, "Oh yes, my sister would be okay with me asking that." Helping people find what works may be powerful."

Dismantling The Culture Of Shame

The doctors believe that miscarriage and abortion conversations are becoming less taboo now that healthy, joyful newborns are getting more attention. Still, having these talks or taking time off to recuperate might be difficult.

"When we don't have other individuals saying yeah, this happened to me too, then I'm not going to feel like I can truly share this, which is incredibly dangerous," says Dr. Osborn. "Shame may grow from unpleasant ideas. I love that more individuals are sharing their loss stories."

The Family and Medical Leave Act (FMLA) allows eligible workers to take up to 12 weeks of "unpaid leave to care for their own serious health conditions, among other purposes," without risking their jobs. Some miscarriages are considered "serious health problems" under the FMLA. Still, individuals who lose a pregnancy beyond 20 weeks or choose to terminate are not protected. Additionally, the embarrassment underlying incomplete pregnancy sometimes leads people to disregard these measures and continue working.

InHerSight, a data analytics organization investigating women in the workplace, discovered that 23% of 1362 individuals knew about this protection, their employer advised 3% that they may take time off, and 91% took no time off after a miscarriage. Only 3% required more than three weeks off work to recuperate.

"I underwent two D&C operations that needed a day off work and extra follow-up visits," adds Dr. Osborn. "Even with little medical intervention, you may need to see a doctor to monitor the pregnancy loss. Using sick time or PTO for these might add to your loss."

She says that although pregnancy loss may be devastating, taking time for yourself empowers you to choose what feels best and most therapeutic each day. For some, it means attending a team meeting because being among colleagues rejuvenates them; for others, it means taking a few days off work to watch TV or take a hot bath.

"If we require assistance, care, and time to heal, we may think something is wrong with ourselves. Thus, if you sense guilt, unpleasant and common following pregnancy loss, consider where it comes from and what help you want for your loved ones."

With aftercare resources growing and the culture of shame surrounding incomplete pregnancy fading (thanks in large part to people sharing their own stories of loss), these experiences that were once so stigmatized are now a recognized chapter in the journey of pregnancy—the ones that don't always end with a baby.