The “Fourth Trimester” Of Miscarriage That Nobody Ever Talks About

Why it's past time to support grieving parents in their physical and emotional health.

woman in hospital bed Travelerpix / Shutterstock

Please undress from the waist down, place your clothes and dignity on that chair, and lie on the exam table with your feet in the stirrups. We’ve kept them ice-cold for you.

I wasn’t getting my hopes up because of my first grossly abbreviated pregnancy — a few days of spotting followed by a gush of blood the morning of the first prenatal appointment was a clear sign it wasn’t good news. 

Even before the doctor asked me not to include my husband by video chat, I knew. There was no heartbeat.


A static image. Silence. A hushed apology.

Don’t get me wrong, it rocked me.

My body, with the gut-wrenching cramps. My mental health, already off-kilter from the move, job loss, pandemic. My marriage, asking for support and attention from someone who wanted us to maintain our independence.

But somehow, I found my way back.

This time, a flutter of activity! A blinking cursor of electric current beat rapidly, making my own heart race. Tiny legs danced in my uterus and I wanted to, too, right there on the table. It was the most beautiful thing I had ever seen.

RELATED: Losing My Baby Actually Improved My Marriage


The doctor said because I had gotten to this point — farther along than before because I wasn’t planning it and didn’t realize — the likelihood of any issues was small.

When I left the appointment, the staff was all smiles, congratulatory. They gave me their own little version of What to Expect When You’re Expecting with info about what to (and what not to) eat, a summary of the growth of the baby by trimester, and testing I needed or could opt-in to.

One week later, I floated to my next appointment in a flowy maxi dress that accentuated my non-existent bump, feeling pregnant. Like a real mom. Glowing.

The tech squirted the cold blue goo on my still-flat belly and began to press the wand into my lower abdomen.


I’d had enough experience on her side of the table to know immediately.

“There’s no heartbeat.”

I said it first before she had a chance to react or acknowledge, as she still searched aimlessly for what we both knew she wouldn’t find. Where I had just seen a grainy black-and-white flutter there was now stillness.

The blood drained from my body and I lay there frozen, unable to render emotion.

RELATED: The Grief Of Miscarriage While Your Friend Has A Baby

Finally, I glanced at my phone, where my husband stared at me through FaceTime, confused. He stood outside the clinic (thanks, Covid), but his voice sounded a million miles away. I ended the call and got shuttled into another room to talk to the doctor.


“You can wait it out at home, take some medicine to help you pass the fetus, or get a D&C, a surgical procedure to remove it.”

My brain was swimming with thoughts but somehow simultaneously completely blank.

On the car ride over, we had been planning a Mother’s Day announcement to my family and friends (with little crochet hockey skate booties to honor my husband’s Canadian roots). I now had to focus on making treatment decisions and planning how to separate from my olive-sized offspring.

I dreaded sharing this news again. I was caught in a place where I knew I wanted, craved support but I wasn’t sure I was going to get what I needed.


The responses ranged from unhelpful to downright toxic. (There were the blessed few who held space and provided comfort and withheld commentary, for which I’ll always be thankful).

Congratulations! At least you know you can get pregnant!

Maybe you should have stopped drinking sooner.

Have you been exercising too much?

It’s good that you weren’t that far along yet.

My friend had a miscarriage, but now she has three beautiful kids.

I was hoping you were going to tell me I would be a grandma.

When are you going to try again?

It was a painful thing to carry death inside of me.

And even more painful to feel so alone with it. For a few days, I was at the crossroads of mortality. One soul here, one soul gone.


After my surgery, I was in my most vulnerable state. Anesthesia will do that to you. The tears and drool streaked my face, and I guess that’s what it would have been like if I had a real baby, too.

When you’re sitting in a half-open hospital gown with an IV stuck in your arm, thick ugly gripper socks, and smudged glasses, you can ask for human kindness and emotional support without a side of pity. When the nurse came to see if I needed anything, I asked him to hold my hand.

Is everything ok? Are you cold?

No. I’m sad.

It was one of the most tender moments of my entire experience.

My husband dutifully took care of me for a few days after my D&C, warming up my stuffed owl heat pack and ordering my favorite takeout. I went from maternal to childlike in one fell swoop.


But once I was able to get back to my “normal” (what is normal now, anyway?) routine, it was as if the tragedy I’d just endured was over, forgotten.

When I came back three days later for my follow-up appointment, the mood was cold, clinical.

Your bleeding has improved (check). Your pain is under control (check).

Your heart and soul are shattered into a million pieces and you’re about to fall into a deep sense of loss and grief and you’re completely on your own with it (check check check).

Oh, and you can start trying again after one cycle.

The staff was silent this time. No smiles. No helpful handbook of what the hell I was supposed to do now.


The $2000 bill came in the mail later.

RELATED: This Is How Long Women Should Wait To Get Pregnant Again After A Miscarriage, According To Experts

They call the three months after you deliver your baby “the fourth trimester,” of pregnancy because there’s so much growth and adjustment and recovery that happens with both mother and infant. It’s an incredibly delicate and fragile time. In many cultures, there are important rituals around care and connection.

These support rituals simply do not exist when there’s no baby.

If I had brought a baby home, there would be fanfare. Gifts and calls and visits. There would be new mom advice, however unsolicited, about the best bottles or playmat or sleeping method.


There was no “it takes a village” now. Only the overwhelming, solitary grief of losing someone I’d never met.

You hear about pregnancy hormones that make you crave ice cream or feel extra sappy or horny, but nowhere in the pamphlets or on the internet or even in medical school had I heard about what happened when those hormones abruptly spiral before they’ve completed their intended task.

I wasn’t warned about the raging cramps and incessant bleeding. I had no idea to expect the baseball-sized bald spot that turned up a few months later.

I was the only person who named my deeply emotional experience as postpartum depression. Who else was even looking for or paying attention to these risks, providing ANY information to me? Giving a heads up recovery could take months.


Why isn’t there a goddamn booklet about what to expect after your baby dies inside of you and you have to get it scraped out?

I found a miscarriage coach online, but even she was posting photos of her “rainbow babies” (the children she had after her losses) and I just wanted to scream.

You got your happily ever after and you get to talk about the low points because you made it to the other side! But, here I am just stuck with nothing.

Seeing pregnant women, hands resting gently, blissfully, protectively on ballooning bellies still makes me nauseated.


I would love to see the “pro-lifers” stepping in for miscarried fetuses and grieving moms with the same zeal that they scream about “murdered” babies and Godless women.

I get it now, why people have funerals to say goodbye even when there is no body in the casket. Rituals mean something.

I didn’t have ashes to scatter or a tombstone to put in the ground. But it was in nature that I felt most connected to the lives I carried in me.

I asked my husband to take a bereavement day off from work so we could go to the water and think about our baby.

Bereavement day? That’s for when a family member dies.

Well, what the hell do you think happened here???


I’ve never met Poppy or Olive, nicknamed after their sizes from the pregnancy app. I can’t share memories of their smiles, their first teeth, their first steps.

But without these, it’s harder to bring others into my grief. To understand my misery. Yet, I need company.

There is as much value in community and togetherness around mourning loss as there is around celebrating new life.

The loss of a dream. The loss of hope, of what could have been. Even the loss of my hair.

I understand how perhaps someone’s mind could go directly to thoughts of the next one, another chance, a real baby.

I’m just not there yet. I’m still thinking about them.


We need to acknowledge the Fourth Trimester of Miscarriage.

To recognize the deep physical and emotional traumas of pregnancy loss. To support mothers at every stage of their pregnancy, including their untimely endings. To educate them about what is normal, and how to heal. To give them time to heal. To let them know they are not alone. To celebrate the brief lives of the people we never got to meet.

Let’s do better for miscarrying parents.

Dr. Sonia Ashok is a physician-turned-leadership coach and women's health advocate. You can learn more about her work on Connective Coalition and read more stories on Medium.