Recurrent miscarriage: when hope becomes dangerous

“This time I didn’t buy anything. I didn’t even keep the test. I threw it in the bin the moment I saw the two lines.”

She says it calmly, almost practically, the way someone might describe tidying the kitchen. But there is a whole history in that sentence. With the first pregnancy, the test was kept in a drawer, photographed and sent to her sister. With the second, it was kept, but nobody saw it. With the third, it went in the bin. Each loss took something away — not only a pregnancy, but also the right to be glad about one.

I wrote about pregnancy loss as a grief that those around you often fail to see in Pregnancy loss: the grief others don’t acknowledge. Here I want to stay with what happens when the loss happens again. When a loss is no longer a misfortune that “can happen to anyone” but becomes a pattern. And when hope, which used to be a source of strength, begins to feel like something dangerous.

The medical questions — why this is happening, which tests make sense and what the results mean — belong with your gynaecologist or with a clinic that specialises in infertility and recurrent pregnancy loss. I am writing about what remains once the clinic door has closed behind you.

When it happens not once, but again

Miscarriage is common. People hear this after their very first loss, often as comfort: “It happens to lots of women.” Recurrent miscarriage, though, is rarer, and for that very reason lonely in a different way. A review in The Lancet (Quenby et al., 2021), which brought together data from several countries, estimates that around 1.9% of women have had two miscarriages and around 0.7% have had three or more. These are small percentages — and anyone who falls within them knows it. The comfort that “it happens to everyone” no longer holds.

Professional guidelines differ on whether recurrent loss begins after two losses or only after three. The European Society of Human Reproduction and Embryology (ESHRE) counts two in its guideline. For the people living through it, that threshold matters less than a feeling almost all of them recognise: that after the second loss something shifted from “bad luck” to “something is wrong”. And that the next pregnancy, if it comes, is something different from the first.

Research on women with recurrent pregnancy loss finds markedly more depressive symptoms and emotional stress than among women without this experience (Kolte et al., 2015). Research on couples shows that the burden does not stop with the woman — it reaches her partner and the relationship between them too (Serrano and Lima, 2006). None of this is surprising. What is surprising is how little room it gets in the conversations a couple otherwise has in clinics.

Why hope starts to hurt

In a first pregnancy, hope is natural. You don’t think about it; it is simply there. You start imagining when the birthday will be, what the name will be, where the cot will stand. After a loss, that hope collapses — and because it was so large, the emptiness it leaves is large too.

After a second or third loss, something often happens that seems illogical at first glance: you begin to fear hope. Not because you no longer want a child. Quite the opposite — because you want one so much that you cannot bear the thought of climbing so high and falling so far again. Hope becomes something you cannot afford. As if being careful with hope were the only way to protect yourself.

This protection works in the short term. If you don’t let yourself be glad, the loss may not hit you so hard — or so you think. But the experience of women who describe it is different: the loss hurts just as much, there are simply fewer weeks before it in which things could have been good. Hope cannot be switched off entirely. You can only push it beneath the surface, where it keeps working, just without your permission.

The psychologist Pauline Boss used the term ambiguous loss for losses that have no clear ending or shape. Recurrent miscarriage has much of this in it: you are losing someone others never met, and at the same time losing a picture of the future that you have not stopped wanting. The grief cannot come to a close, because the same story could happen again.

Searching for a cause, and results that say little

After recurrent losses, people usually begin with tests. That makes sense and it matters, and what is right for the two of you is something to discuss with your gynaecologist. But there is something people are rarely prepared for: in a large share of couples — according to the European guideline, around half or more — no clear cause is found.

For some, this is a relief, because it means no problem was discovered. For many, though, it is the hardest possible result. If a cause were found, you could name it, be angry at it and perhaps do something about it. “Unexplained” leaves a space that the mind fills on its own. And a mind that has lived through several losses often fills it with guilt.

Before an appointment, it helps to write down the questions you genuinely want answered — including those that seem silly or too emotional. Not because the doctor has to answer all of them, but because thoughts tend to scatter in a consulting room. One of the questions can be what support you can get during a next pregnancy, if you decide on one. The European guideline, too, stresses that couples with recurrent loss need supportive care, not only tests.

Guilt, and a body you no longer trust

“What did I do wrong?” Almost every woman who has lost a pregnancy asks herself this. After several losses, though, it often turns into something more stubborn: “Something is wrong with me.” The body that was meant to be a home for a child becomes something you don’t trust. Some women describe feeling betrayed by their own body. Others say they have started to feel angry with it.

Guilt plays a particular role in loss. It gives a sense of control. If it is my fault — because I lifted a heavy bag, because I was stressed, because I drank coffee — then next time I could do things differently. The thought is painful, but it contains a hope that the thought “I couldn’t have prevented this” does not. I wrote more about this mechanism in Guilt after a loss: “I could have done more”, and the concept is also explained in the knowledge base under guilt.

With recurrent loss, guilt is often accompanied by shame. Shame that you can’t manage something that others seem to manage “all by itself”. Shame in front of your partner, because you think you have taken something from him that he could have had with someone else. Shame in front of your mother-in-law, your colleagues, the friends who no longer ask. Shame is an emotion that hides, so it often goes unspoken even in the closest relationships.

Two partners, two rhythms

Recurrent loss does not happen only to the woman. It happens to the couple. But not in the same way. She experiences the loss in her body — with bleeding, pain, a procedure, hormones that take weeks to settle. Her partner is beside her and often feels he has to be strong, has to “hold it together”. So his grief tends to retreat into the background, sometimes even from himself.

This creates a rift that is particularly dangerous with recurrent loss: one wants to talk, the other would rather forget and move on. One would try again straight away, the other needs a pause. Neither is wrong. But if you don’t talk about it, each of you starts interpreting the other’s behaviour in your own way.

(composite, not a real person)
“You just carried on. You went to work the next day as if nothing had happened.”
“Because I didn’t know what else to do. If I’d stayed at home, I’d have just sat there watching you hurt and not been able to help.”
“I thought it hadn’t touched you.”
“It did. I just didn’t think I had the right to feel bad when you were the one who went through it.”

In relational family therapy, in which I am training, we see a moment like this as very valuable. Not because it takes the pain away, but because it reveals that both of them were grieving, each in their own language. I wrote more about how differently partners grieve, and why that is not a sign that they love each other less, in Grieving as a couple: why you grieve differently and how it need not break you.

A world that doesn’t count

With the first loss, people may know. With the second, the circle is smaller. With the third, often nobody knows except those closest — because the couple didn’t dare announce a pregnancy that might end again. The result is that most of these losses remain invisible. Grief that nobody sees is hard to live through, because it has no place where it can be shown. The wider picture is covered in The grief nobody acknowledges: miscarriage, divorce, losing a job.

Even when people do know, they often don’t know what to say. The sentences that wound most after recurrent loss are exactly the ones meant as encouragement: “It’ll definitely work next time.” “At least you know you can get pregnant.” “Just relax.” The first promises something nobody can promise. The second denies that the loss is a loss. The third hints that it is all her fault. If you are wondering how to be with someone going through this, What to say to someone grieving, and what not to may help.

Some couples therefore create their own private way of remembering. A name, a date, a small object, a plant in the garden. There are no rules for how to do it, and no obligation to. But with losses that nobody else records, it can be a relief if at least the two of you do.

What helps when hope becomes dangerous

I don’t want to offer simple recipes. With recurrent loss there is no sentence or technique that takes the fear away. But a few things often make the way a little easier.

Hope and fear can exist at the same time. You don’t have to choose between being glad and preparing for the worst. You can tell yourself: “Today I am pregnant. Today this is true. I don’t know what tomorrow will bring.” That is not naivety. It is an accurate description of what you know.

Your body will probably be on alert. After several losses, it is almost to be expected that your body will sound the alarm at every cramp, every change, every trip to the toilet. We call this hypervigilance — an excessive watchfulness for signs of danger. It is not a sign that you are “losing it”. It is the learned response of a body that has already been through loss.

You don’t have to be kind to yourself on command. With recurrent loss, the advice to “be gentle with yourself” can sound like one more task you’ll fail at. Self-compassion is not a feeling you are supposed to have, but a way of answering yourself when guilt appears. It can start very small.

Talking about the next step is not a betrayal of the loss. Couples often feel guilty for already thinking about trying again while they are still grieving. Both can happen at once. What matters is that the decision is not an escape from sadness and that you make it together.

Exercise: two questions for two people

This exercise is meant for a couple, but you can do it on your own too. It takes about half an hour. Choose a quiet evening, without phones.

1. Each of you writes down what you missed most during the last loss. Not the child in general, but something concrete: “for someone to tell me it was a child”, “to be able to talk to someone”, “to be able to stay home for at least one day”.
2. Each of you writes down what you fear most about a next pregnancy, if one comes. Don’t explain; just write.
3. Read to each other what you have written. First one, then the other. The one listening doesn’t respond, reassure or correct. Just listens.
4. Each of you names one thing that surprised you in what the other wrote. This is often the key part of the exercise — discovering that the other felt something you didn’t know about.
5. Agree on one small step. For example, how you will tell each other when fear appears. Or which of the people closest to you will know about a next pregnancy. Make the step concrete and doable.

If the exercise leads to an argument, or to more pain than you expected, that is not a failure. It often means there is more unspoken between you than you can work through alone — and that a third person might be welcome.

What belongs with the doctor and what belongs in therapy

People often ask me whether therapy is meant to help the next pregnancy succeed. It isn’t. Psychotherapy does not treat the causes of loss and does not replace medical care. But it can help you carry what medicine cannot.

In therapy, the aim is not to stop being afraid. The aim is for fear not to be the only one making decisions. For you to be able to grieve each loss in its own right, rather than all of them at once. And for your relationship to remain a place where you can talk, not a place where you avoid each other.

In relational family therapy we also look at what a couple brings with them from the families they come from. How was grief handled in your family? Was crying allowed, or did everyone carry on as if nothing had happened? Were there pregnancy losses for your mother or grandmother too, which nobody ever talked about? Questions like these are not meant to find someone to blame. They often reveal why it is so hard for someone to show sadness — or why they can’t bear it when the other shows it.

Where this doesn’t fully apply

I want to be precise here, because recurrent losses are very different experiences.

Not everyone experiences a loss as the loss of a child. Some people experience the loss of an early pregnancy mainly as a medical event or a disappointment, not as a death. That is no less valid a response. Nobody has to grieve in the way I describe here if that is not what they feel.

Not all distress is grief. If thoughts of not wanting to live appear, if you have not been able to sleep for weeks, if you can no longer get out of bed or manage everyday things, that is a reason to contact your GP or a psychiatrist as soon as possible. If thoughts of death are strong, call the crisis line Klic v duševni stiski on 01 520 99 00 in Slovenia (every day from 7 pm to 7 am) or the Samaritans helpline Zaupni telefon Samarijan on 116 123 in Slovenia (24 hours a day), and in an emergency 112.

Therapy is not the answer to everything. Sometimes a couple doesn’t need a therapist, but someone who listens to them at the clinic, a good friend, or simply time. Sometimes the most helpful thing is to meet others who have been through something similar. And sometimes practical help matters more than anything: someone who cooks, takes sick leave, clears away the baby things still sitting in the wardrobe.

The next pregnancy doesn’t have to be the goal. For some couples the path continues after several losses; for others it stops. Both can be considered decisions. Deciding not to try again is not a defeat.

When you decide on a new pregnancy

If you decide to try again, it helps to know that the fear will not disappear with a new positive test. It often grows stronger at exactly that point. Many couples describe how the particular weeks when a previous loss happened turned into milestones that had to be “survived”. I describe in more detail how to live with this in Pregnancy after loss: the fear that lasts until birth.

Here I will mention just one thing: fear is not a prediction. The fact that you are afraid doesn’t mean it will happen again. And the fact that you dare to hope doesn’t mean you are tempting fate. Hope is not what caused the loss. Nor is fear what will protect you from it.

What to remember

• Recurrent miscarriage is rarer than a single loss, so it is often lonelier — the comfort that “it happens to everyone” no longer holds.
• After several losses, hope can start to feel dangerous; this caution is an understandable protection, but it doesn’t make the loss less painful.
• In a large share of couples no cause is found; “unexplained” is often filled by guilt, which is not proof of fault.
• Partners grieve differently; that is not a sign that one of them doesn’t care.
• Medical questions belong with the gynaecologist, while therapy can help you carry grief, fear and your relationship — the two complement each other.