Skip to main content
Get Matched with a Provider
podcasts

Healing and Hope: Navigating Pregnancy After Loss – Podcast

By Jason Clayden on January 29, 2025

Dr. Kristen MacGregor joins us to discuss navigating pregnancy after a miscarriage or loss. Dr. MacGregor, a clinical health psychologist specializing in women’s health, explores the significant anxiety that often accompanies subsequent pregnancies after a loss, the importance of integrating behavioral health into medical care, and strategies to help women enjoy their pregnancies despite their fears. 

We cover the role of loved ones and clinicians in providing support, emphasizing the importance of compassion and understanding. 

Learn more about Women’s Mental Health

Nicholette Leanza:

Welcome to Convos from the Couch by LifeStance Health, where leading mental health professionals help guide you on your journey to a healthier, more fulfilling life.

Nicholette Leanza:

Hello, everyone, and welcome to Convos from the Couch. I’m Nicholette Leanza, and on today’s episode, I’ll be talking with Dr. Kristen MacGregor, and we’ll be talking about how to navigate pregnancy after a miscarriage or loss. So great to have you back on, Kristen.

Dr. Kristen MacGregor:

Thanks for having me, Nicholette. It’s been a while.

Nicholette Leanza:

Yes. So tell us a little bit about yourself since it’s been a little while, and what led you to a specialty in women’s health?

Dr. Kristen MacGregor:

Yeah, absolutely. So I am a clinical health psychologist by training, and basically what that means is I help people navigate health problems that also have a mental health overlay. Think about lots of different kinds of problems fall into that category, but women’s health is one of the clinical specialties that I found myself in love with over the course of my training. So I’ve been with LifeStance for three years, but prior to that, I was at UMass Medical Center in Worcester, Massachusetts, where I was the integrated behavioral health psychologist in an OB-GYN clinic. I was primarily surveying women going through fertility treatment, but also met with women across the spectrum of women’s mental health and women’s health conditions, and so this topic came up quite frequently in that clinic where I wouldn’t often see women right after they had experienced a pregnancy loss. I would often see them when they were pregnant again following that loss, which I found to be really interesting and very similar experiences, and yeah, that’s what led us to this topic today.

Nicholette Leanza:

And you mentioned integrated health. Can you tell us just a little bit about what that is for those [inaudible 00:01:59] familiar with that term?

Dr. Kristen MacGregor:

Yeah, absolutely. So it basically means putting behavioral health into a medical clinic, whether it’s primary care or medical specialty. We know that… There’s still a stigma, unfortunately, around mental health, and so by putting behavioral health where people naturally go to seek out their medical care, it reduces that stigma and normalizes behavioral health as just part of the normal provision of healthcare, which is so important in a women’s health setting. There’s so much emotion that’s tied to women’s health conditions across their reproductive lifespan, and it was such a wonderful opportunity to be able to work closely with these OB-GYN physicians and collaborate with them, and also just send the message to women coming to get their medical care that your emotional health is just as important as your physical health.

Nicholette Leanza:

Definitely. Thank you.

Dr. Kristen MacGregor:

Yeah, that’s a good question.

Nicholette Leanza:

Yeah. No, I wanted to make sure people understood what it was. So what can someone expect after getting pregnant after a loss?

Dr. Kristen MacGregor:

Yeah, it’s really interesting, that, and makes a lot of sense. A miscarriage can be devastating, and it doesn’t really matter if you have a pregnancy loss at seven weeks or if you have it at 20 weeks. The experience is often very similar, that it’s grief and often silent grief, especially if you have an early loss in the first trimester. Oftentimes, you haven’t told people that you’re pregnant and you’re suffering both physically and emotionally. It can be very painful to experience a pregnancy loss and the procedures that you go through after that. It can be very physically and emotionally painful and so often suffering in silence. If you have a second trimester loss, of course, it’s a different type of experience because people often know, but I think there’s some expected grief. There’s an expected grief process that you experience that grief, and then at some point, you’re over it, you move on and then elect to, which is problematic in and of itself, and then elect to become pregnant again.

And so I think the part of it’s really misunderstood and that I just noticed in seeing women after woman that had experienced this is this significant anxiety that comes along with being pregnant. Because often, women think that… I think that we all know that miscarriages are relatively common, but I don’t think that we think that they’re going to happen to us necessarily, and then when they do, I think that there’s just so much anxiety and panic that it’s going to happen again. And so that’s often what brought people into care, was that they were having this debilitating anxiety that was interfering their functioning, with the intrusive thoughts that something was going to happen, that just terror every time they went to the bathroom that they were going to be bleeding and these types of things, and so people were seeking help to just navigate these anxious feelings.

Nicholette Leanza:

So what are some things they can do to help enjoy the pregnancy?

Dr. Kristen MacGregor:

Yeah. So that’s the other part too, is that with anxiety often comes avoidance. We know that it’s not a healthy strategy but it’s a common one, that when you feel scared about something or feel worried about something, you often try to avoid thinking about it or try to avoid doing things that will make you think about it. And so in this case, what I also noticed was that women were closing themselves off. “I’m not going to let myself be excited. I’m going to wait a long time before I tell my loved ones.” Often, if their loss was at 15 weeks, let’s say, that leading up to that same week when they lost the pregnancy, you see that anxiety, just, “I’ll feel better once I pass that.”

Nicholette Leanza:

That point. Yeah.

Dr. Kristen MacGregor:

Exactly. And spoiler earlier, they don’t. I think you get past that 15 weeks, and it’s, “I just need to now make it to my 20 week ultrasound, and then I’ll feel better. Or I just need to wait until I get to that week where my pregnancy is viable and then I’ll feel better.” And so lo and behold, all of a sudden, you’re 30 weeks into your pregnancy and you’ve missed it. You’ve spent all of this time worrying about that the other shoe’s going to drop, and look back, and I’ve certainly seen this too where people regret not enjoying it up until that part. And even with telling people, like, “Oh, we’re pregnant, but we had a loss and so we’re a little bit nervous, or we’re not whatever. We’re not planning a baby shower. I’m not buying things yet. I’m not going to plan for the nursery yet.” And then again, you get to the end and you’ve missed the whole thing.

So I think I did a lot of talking about that with women that were in this experience, and I think it’s easier to logically understand that and think about how, yeah, that makes a lot of conceptual sense. I don’t want to regret getting to the end, but how do I do that? And I think people are more or less receptive to some of these strategies. Mindfulness strategies can be super helpful. Noticing those thoughts that you’re having, that this isn’t going to work out or I’m not going to be able to… This is never going to happen for me, and having some acceptance and some self-compassion around those thoughts and trying to move on I think there’s a lot of evidence for, and this one was a little bit harder for some people, but this notion of fake it till you make it.

Why don’t you behave like this is going to work out, because what’s the risk? I think often, the answer to that question is, “Oh, I’ll be that much more devastated if I…” But will you? I think you’re going to be devastated either way, and so why not experience this joy while you can for as long as you can? And again, in practice, this is much more challenging than just talking about it like we are now, but I think setting some goals around those strategies, doing some behavioral experiments to say, what would happen if you just looked at some cribs online and picked one you might like, or those types of things. And then really, of course, thinking about what feels reasonable for folks too and feels realistic within their own personal values and goals and stuff like that. But I really do think having that understanding of, I don’t want to get to the end and feel like I didn’t experience this often just once or twice in a lifetime experience that people get to have.

Nicholette Leanza:

Right. So how can loved ones provide support during this vulnerable time?

Dr. Kristen MacGregor:

Yeah, that’s a good question, and I think just having that understanding around a miscarriage isn’t just something that a lot of people can just get over or move on from, and starting any sentence with at least, I would not recommend. At least you were able to get pregnant. At least you didn’t get too far along in your pregnancy before you lost the baby. At least… Never start a sentence with at least. It’s not helpful. And things like, “Oh, I understand how that would be challenging. What can I do to be helpful?” And also meeting people where they are. If they don’t feel ready to plan a baby shower, don’t force that on them. Help understand where they’re at. What’s the barrier? What’s getting in the way? Those types of things. Never say, “You haven’t moved on from that yet?” No, thank you.

Nicholette Leanza:

Right.

Dr. Kristen MacGregor:

And I’m not just making this up. These are real things that I’ve heard from people’s loved ones that they’ve said, like, “No, don’t say that.” And I think just in general, we just never know what people’s individual experience is like, and so try not to make those assumptions around that.

But I think on the flip side, you can help model joy for people, which is another strategy that I’ve encouraged women that I’ve worked with to do. You tell people and they get so excited. It’s okay to get excited along with them, and so spouses and other loved ones can demonstrate that, yes, this is a wonderful time. This is such an exciting time. And yes, you can be anxious, but you can also be happy at the same time. Those two things can exist at the same time.

Nicholette Leanza:

Gosh. So how can clinicians be helpful during this time?

Dr. Kristen MacGregor:

Yeah. I think similarly, some of those unhelpful statements I think can come out of anybody’s mouth, like a physician, even a therapist sometimes. I would hope that we are a little bit more delicate as a group of people in our language that we use, but even as a therapist, making sure that we’re understanding this. It’s a really unique experience. This doesn’t come up in a lot of other sort of grief experiences. You lose a loved one, you’ve had an amount of time with them on the planet. You have happy memories of them already. This kind of grief is grieving what could have been, and so I think having some compassion around that and some understanding around that, and knowing that and supporting, again, where people are while also modeling that, yes, you can worry, but also, this is a happy time, so it’s okay to feel happy at the same time.

Nicholette Leanza:

Right. I think it’s also important to educate clients, knowing that getting over the miscarriage isn’t just something just like that. I think really letting them know, especially if they’re hearing from loved ones, “Okay, you’re still… Why are you still worrying about this? Or why are you still grieving this?” To meet the client where they’re at and to let them know that this isn’t often something that’s just that easy to get over, but like you mentioned before, being able to feel two things at once. It’s okay to still be grieving, but yet at the same time, still finding joy in the pregnancy again. Great words of wisdom there for sure. Now, how can clinicians and doctors work together regarding this issue?

Dr. Kristen MacGregor:

Yeah, it was such an awesome opportunity to be able to be embedded in this office, because I did have rapport with those clinicians to say, “Yeah, she’s still struggling with this, and yes, she’s anxious,” and give my OB-GYN colleagues some advice around how to talk about some of these things and what to say and not say, because I had heard from their patients that I’m now taking care of, some of the things that were unhelpful. So I think that’s definitely a place. There’s just so much opportunity when we work together and when we’re in the same physical space. I know that’s not the reality for everybody. I wish that it was, but I know that it’s not.

But even still, I think we as a behavioral health field don’t do a great job communicating with other specialties, and I do think it’s an opportunity, with the patient’s permission, to reach out to the OB-GYN who might be taking care of them in pregnancy, just to say, “Hey, I’m seeing your patient. Reach out if you have any concerns. She’s definitely anxious but we’re working on it.” There’s a lot of benefit to doing that, for you as the clinician, for the OB-GYN to know that their patient’s getting taken care of, and then for the patient too, the woman who’s experiencing that, that everybody’s on the same page and then are maybe more mindful about what they say to her in her visits when she is super scared and sending you portal messages every single day about not feeling enough kicks in the second trimester, which is always a stressful time.

Nicholette Leanza:

Definitely. Any other takeaways you’d like to share?

Dr. Kristen MacGregor:

Yeah. I think we summed up a lot of the issues nicely, but I do think just the bottom line is that we never know what someone’s emotional experience is going to be, and I think pregnancy is such a time where people have such strong opinions about what people do, what people should do. Do we find out the gender? How we feed the baby, how we give birth, and all of those things. And I think just in general, even though people love to share their opinions, maybe be sensitive before you say something about how you think something should be done, because you just never know what that person’s experience has been leading up to now.

Nicholette Leanza:

Some great words of advice right there. Sometimes, maybe just don’t share the opinion too. [inaudible 00:14:30].

Dr. Kristen MacGregor:

I agree with that.

Nicholette Leanza:

So thank you, Kristen. Thank you for sharing this conversation with me on this very sensitive topic, so I appreciate everything you shared and helping our listeners navigate this vulnerable time.

Dr. Kristen MacGregor:

Yeah, absolutely. Oh, I guess one more thing.

Nicholette Leanza:

Yeah.

Dr. Kristen MacGregor:

So for any women who find themselves in this situation where they’re struggling, come and see us.

Nicholette Leanza:

Oh, of course.

Dr. Kristen MacGregor:

This is a great time, right? It’s a totally appropriate time to get some additional support from somebody who can help you navigate.

Nicholette Leanza:

Yes, definitely. Thank you, Kristen.

Dr. Kristen MacGregor:

Yeah, thank you.

Nicholette Leanza:

I’d also like to thank the team behind the podcast, Jason Clayden and Juliana Whidden, with a thank you to Jason who edits our episodes. Thank you for listening to Convos from the Couch. Take care, everyone.