Endometriosis: Symptoms, Impact, and How to Cope

Painful and/or heavy periods, pain during or after sex, chronic pelvic pain in your lower tummy or back, or pain when urinating during your period? If you’ve experienced some of these symptoms, you might have endometriosis.

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What Is Endometriosis?

Endometriosis is a condition where the tissue that lines the inside of the womb (uterus), called the endometrium, grows in other parts of the body, typically within the pelvis.

In a normal cycle, the uterine lining thickens in preparation for pregnancy and sheds during menstruation if pregnancy does not occur. With endometriosis, similar tissue outside the womb responds to the same hormonal signals, building up and breaking down each month, but the blood has no way to leave the body.

Over time, this internal bleeding can cause:

• Cysts in the ovaries

• Lesions or nodules on pelvic organs (uterus, ovaries, fallopian tubes, bladder, intestines)

• Adhesions that cause organs to stick together

Endometriosis affects an estimated 20–30% of women in their reproductive years (from puberty to menopause). While the exact cause remains unknown and there is currently no cure, effective treatments exist to manage symptoms and improve quality of life.

The Hidden Struggle of Endometriosis

Despite its prevalence, awareness of endometriosis is low, even among healthcare professionals. Many women face delayed diagnoses or misdiagnoses with some women waiting years for answers.

The pain and fatigue can disrupt daily life, lower productivity, and lead to withdrawal from social activities. This often creates feelings of isolation when loved ones don’t understand the condition. Nearly half of those affected also report depression and anxiety.

For some, endometriosis also impacts fertility, adding grief to an already challenging experience.

How to Cope with Endometriosis

Living with a chronic condition like endometriosis isn’t easy, but there are strategies to help manage both the physical and emotional toll.

1. Practice Radical Acceptance

Start by acknowledging your feelings, anger, sadness, anxiety, or frustration, without judgment. Notice the thoughts running through your mind and whether they are supportive or self-critical.

Radical acceptance means facing reality as it is, without getting stuck in “Why me?” or “What did I do wrong?” Accepting doesn’t mean approval or giving up. It simply frees up energy for what matters most to you.

2. Challenge Unhelpful Thoughts

A medical diagnosis can trigger negative thinking patterns such as:

• Catastrophising: “I’ll never live a normal life.”

• All-or-nothing thinking: “I’m useless because of this condition.”

• Self-blame: “This is my fault.”
  

To challenge these, ask:

• What’s the evidence for and against this thought?

• What’s the worst and best case scenario?

• What advice would I give a friend in this situation?

3. Ask for Support

Endometriosis is real, and asking for help doesn’t make you a burden. It can feel difficult, but you can ease this by preparing what you want to say. For example:

• “Could you accompany me to my medical appointment?”

• “If you see me curled up on the couch, could you make me a hot drink?”

Educate your loved ones about your condition and express gratitude when they help. A simple “Thank you” goes a long way.

Supporting Someone with Endometriosis

If your loved one has endometriosis, here are two key ways to help:

1. Offer Emotional Support

• Show compassion and flexibility. Plans may change if pain flares up.

• Avoid minimising their pain with phrases like, “It’s just cramps” or “Others have it worse.”

• Validate their feelings: “It makes sense you’re frustrated. I’d feel the same.”

Rather than rushing to solve the problem, listen and acknowledge their experience.

2. Provide Practical Help

• Learn about the condition so you can better understand what they’re going through.

• Offer specific help: grocery shopping, meal prep, or accompanying them to appointments.

• Take care of yourself, too. Supporting someone with a chronic condition can be emotionally draining.

Final Thoughts

Endometriosis is more than a “painful period.” It’s a chronic, life-impacting condition that requires compassion, from both ourselves and others. With awareness, support, and the right coping strategies, it’s possible to live meaningfully despite the challenges.

Fertility Stress in Men: Causes, Impact, and How to Cope

Fertility Stress in Men: Breaking the Stigma and Finding Support

Many men who face fertility challenges remain silent. Not because they’re unaffected, but because they’ve been told, directly or indirectly, that their emotions don’t matter. That they shouldn’t talk about it. That masculinity means strength, and strength means never struggling.

But the truth is this: struggling to conceive can affect men deeply.

It can challenge your sense of self, your confidence, and your relationship. It can bring shame, frustration, and a grief that’s hard to name.

Why Men Often Grieve in Private   

In many cultures, men are raised to fix problems, not talk about them. Fertility difficulties, then, feel like something unfixable. Something that makes you feel helpless. That helplessness often gets internalised as failure or weakness.

You might find yourself thinking:

Ψ “I’m not enough.”
Ψ “I should be stronger than this.”
Ψ “Why can’t I just cope and move on?”

These thoughts are common. But they’re not fair or realistic.

How Fertility Stress Affects Men

Stress related to fertility doesn’t just live in your head. It can affect your body, mood, sex drive, and energy. Research shows that chronic stress may interfere with testosterone levels, sperm quality, and libido, creating a cycle of anxiety and shame.

Fertility-related stress can also:

Ψ Cause irritability, withdrawal, or emotional numbness
Ψ Trigger sleep difficulties and reduced motivation
Ψ Lead to tension in relationships, especially when both partners are grieving differently

This kind of distress is real. And can be managed.

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Managing Fertility Stress: What Helps  

1. Name what you’re feeling

Suppressing emotions may seem like the strong thing to do, but it often makes stress louder. Instead, try giving your experience a name: grief, anger, shame, frustration.

You don’t need to say it all perfectly. Try starting with:

Ψ “I didn’t think this would hit me so hard.”
Ψ “I feel useless, and I don’t know what to do with that.”

Naming an emotion is the first step in loosening its grip.

2. Talk to your partner: More than just the plan, but also the pain

Men often go into “solution mode” during fertility struggles. But emotional connection matters more than quick fixes.

You might say:

Ψ “I don’t know how to fix this, but I want us to get through it together.”
Ψ “I feel like I’m supposed to be the strong one, but I’m struggling too. Let’s try and figure this out together.”

These conversations can feel vulnerable. But they build closeness, not weakness. Your partner might even appreciate the fact that you don’t seem as “okay” as you appear, as that could validate their own struggles.

3. Challenge Old Beliefs

Thoughts like “If I were man enough, this wouldn’t happen” or “Needing help makes me weak” are echoes of old messages, not truths.

Try cognitive reframing to challenge them:

Ψ “Struggling makes me human, not less of a man.”
Ψ “Getting support is taking responsibility for my wellbeing.”

4. Redefine strength

True strength isn’t silence. It’s about your resilience, honesty, and connection. Fertility challenges don’t define your worth, and speaking up doesn’t make you weak.

Ask yourself:

Ψ What kind of man do I want to be in this season
Ψ What kind of compassion or support would I hope to receive from others?
Ψ How can I show up for myself with that same compassion?

You’re Not Alone

Fertility stress can shake your confidence in ways you didn’t expect. It’s not a measure of masculinity but a sign of how deeply you care about your future and your family.

You don’t have to carry this weight alone. If fertility stress is affecting your mental health or relationships, reaching out for professional support can make a difference.

Pregnancy Hormones and Link with Mental Health

Pregnancy is a transformative experience filled with joy and exhilaration. However, it can be physically and emotionally taxing on the mother’s body. During pregnancy, hormonal fluctuations occur and can manifest positively or negatively on a mother’s mental health. These hormonal changes may lead to or exacerbate mental health conditions and can occur before, during or after the pregnancy. Understanding these hormonal changes is crucial to understanding their impact on a mother’s mental health. 

Pregnancy Hormones  

Drastic hormonal changes can have a toll on the mother’s emotional well-being. This includes changes in hormones such as progesterone, estrogen and oxytocin. 

1. Progesterone  

Progesterone is thought to help in regulating our mood and anxiety. During pregnancy, progesterone levels progressively rise but decreases sharply after delivery. This sudden decline results in a drop in mood, increasing the risk of postpartum depression. 

2. Estrogen  

Like progesterone, estrogen levels increase steadily and then sharply decline after birth. It affects body functions including brain function and works together with serotonin to impact an individual’s mood. Its sudden decline could also increase the risk of postpartum depression. 

3. Oxytocin  

However, not all hormonal changes have negative impacts. Oxytocin, also known as the “love hormone” increases in its production during pregnancy. This promotes stress and anxiety relief.  

The intensity of hormonal changes varies by individuals. Factors such as a history of mental health issues, lack of social support, trauma and biological predispositions can increase the risks of experiencing poor mental health during pregnancy.  

 Effects of hormonal changes during pregnancy are more common than you think, with up to 40% of mothers in Singapore reporting feelings anxiety or depression. Therefore, it is important to be aware of the signs and symptoms of these maternal mental health conditions to tackle the symptoms before they escalate. 

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Symptoms of Declining Mental Health 

Maternal mental health refers to the social, emotional and mental well-being of a mother during pregnancy or postpartum. These hormonal changes, if left untreated, can result in maternal mental health disorders such as perinatal anxiety, perinatal depression, post-traumatic stress disorder or bipolar affective disorder. Therefore, it is crucial to understand some of the symptoms and warning signs of pregnancy related mental health disorders.

Symptoms of perinatal anxiety and depression include:  

• General or persistent worrying  

• Feelings of irritability, frustration, or restlessness 

• Changes in appetite  

• Difficulty sleeping, waking early in the morning, or oversleeping 

• Withdrawing from friends or family  

• Diminished interest or enjoyment in activities  

• Feelings of worthlessness, guilt or helplessness 

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Building Mental Resilience During Pregnancy 

Apart from understanding how hormonal changes in pregnancy can affect our mental health, there are also active steps we can take to build our mental resilience. Mental wellness strategies include: 

• Engaging in regular exercise  

Moving your body promotes the release of endorphins also known as “happy” hormones that naturally boost your mood and relieve feelings of stress.  

• Maintain a support network  

Surrounding yourself with people you love and trust, such as your partner, family, friends or pregnancy support groups can provide emotional comfort and practical help. You do not have to struggle alone. 

• Get into a routine  

When your mind feels out of control, maintaining a sense of structure in your life can be reassuring. Setting regular sleep, meal and relaxation times can create a sense of control and reduce feelings of anxiety in your life. 

• Eat a balanced diet 

Did you know that what you eat can also affect your mood? Ensuring you consume a well-balanced diet rich in all the essential vitamins and nutrients is crucial in promoting healthy brain function and mood regulation. 

• Practice mindfulness and relaxation techniques 

Engaging in mindfulness and relaxation techniques (e.g. 4-7-8 breathing) can help manage anxiety and promote feelings of calm, even in moments of stress.  

However, if emotional distress during pregnancy affects daily functioning or persists for an extended period, it is crucial to seek guidance from a mental health professional.  

Hormonal changes play a significant role in shaping a mother’s mental health and the overall pregnancy experience. Thus, understanding the connection between hormones and mental health is essential for fostering self-awareness and reducing stigma. By engaging in self-care strategies and seeking professional care when required, you are equipped to thrive in your pregnancy journey. 

The Hidden Stress of Trying to Conceive: Navigating Fertility Stress

1 in 6 couples in Singapore face difficulties in conceiving naturally. Struggling with fertility stress can cause us to experience feelings of depression and low self-esteem, highlighting the profound impact this stress can have on our mental health. The adverse effects of fertility stress are far-reaching, impacting our mental health as well as putting strains on relationships with our partner, family and friends.  

So what can we do to help with fertility stress?

Understanding Fertility Stress

Struggling to conceive is a deeply personal and emotional journey, and it is completely natural to feel stressed. Pressures of a ticking biological clock and societal expectations may leave you feeling a sense of loss, anxiety and hopelessness.

Stress is our body’s normal response to threatening or overwhelming situations and can result in both physical and mental responses. While we cannot completely get rid of stress, we can first gain a better understanding of it, which will help us learn to better manage it.

When we are stressed, our body releases hormones such as cortisol that can result in an imbalance of key reproductive hormones - estrogen and progesterone. This affects our ovulation and menstrual cycle, which could make it harder to conceive. High stress levels could also result in irregular menstrual cycles, making conception planning unpredictable. In extreme cases, stress can cause anovulation, where our ovaries are unable to release mature eggs.

So stress and fertility difficulties can result in a vicious cycle.

Struggles with fertility may result in distressing emotions like anxiety, frustration and sadness. This emotional toll in turn exacerbates stress levels which causes further disruptions in your body's physiological balance, making fertility challenges even harder to navigate.  

For compelteness, other factors, like ovulation disorders, damaged fallopian tubes, or health conditions like endometriosis can also play a role. 

Managing Your Fertility Stress with Psychological Strategies

Here are strategies we can adopt to regain a sense of control over our bodies. Let’s look at some of them: 

1. Create (Small) Moments of Predictability

Try building in blocks of time where you have “fertility-free” times where you don’t track, research or talk about it. Set aside daily time blocks, morning or evening, for "fertility-free" periods. During these times, avoid tracking symptoms, researching, or discussing fertility. Creating mental space away from the topic can support emotional well-being.

2. Challenge Unfair Self-Criticism

A harsh, often irrational, inner critic tends to rear its ugly head when we think trying to conceive is something that we have control over, or responsibility for (fact: we don’t have control over our genetic or biological makeup). When the self-criticism gets too much, reflect on these critical thoughts and consider:

Ψ Would I say this such unkind words to a friend in my position?
Ψ Is this thought helpful or just punishing?
Ψ What would it mean to be “good enough” right now, instead of perfect?

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3. Relaxation Techniques  

Relaxation techniques such as progressive muscle relaxation and mindful breathing can help ease stress.

When we are stressed, our muscles naturally tense up, causing pain and discomfort. This in turn signals to our bodies that it is stressed and worsens the cycle of stress. In progressive muscle relaxation, you intentionally tense a group of muscles as you inhale, then release the tension as you exhale. You can repeat this process for different muscle groups to promote relaxation in your body. 

Breathing techniques such as 4-7-8 breathing can also help with feelings of anxiety. Here are the steps:

Firstly, ensure you are sitting or lying down comfortably. Next, breathe in through your nose for 4 counts, hold for 7 counts, then exhale through your mouth for 8 counts. These relaxation exercises help reassure your body that it is safe, allowing you to feel calmer.

4. Building (and Relying!) on your Support Systems  

You are not alone. Share about your difficult feelings with your partner or loved ones - fertility stress is not just a women’s issue; men can go through it too. Facing fertility stress together can make a big difference. Communicating how we feel can have a cathartic effect and prevents feelings of isolation.

You may also find comfort in joining fertility support groups like Fertility Support SG where you can connect with others who understand what you are going through and can offer encouragement during this journey. 

5. Final Thoughts on managing fertility stress

Fertility stress can make everything harder.

The fertility process is not just a medical journey - it’s an emotional one, a relational one, and a deeply human one. You don’t have to go through it holding your breath. You can grieve, rage, rest, fall and get up when you’re ready, with supportive people by your side.

And if despite everything, you feel yourself struggling with, consider working with a psychologist to support you to:

Ψ Untangle complicated emotions like guilt, shame or resentment
Ψ Navigate conversations with your partner, family, or doctors
Ψ Reconnect with parts of your life that feel sidelined by fertility stress

Women’s Emotional Concerns

This is an overgeneralisation to say the least. How emotional “should” we really be?  

In the 19th century, doctors removed uteruses to treat “hysteria”, a so-called “female-problem.” But, surprise! Here in the 21st century, we have found out that men are just as emotional as women: in fact, men and women experience similar emotional fluctuations.  

Society tends to be more accepting of women expressing emotions compared to men. As a result of these gender norms, women may have more opportunities to develop emotional awareness through lived experiences.  

With multiple roles and identities in our daily lives, women are often weighed against the expectations of culture and society. As a result, we experience a whole range of emotions, which sometimes become too much to manage. When we feel like we’re losing control, we may start to experience emotional distress.  

What emotional challenges are commonly experienced by women?  

Ψ Biological 

There are many biological reasons we feel heightened emotions. Most of them relate to hormonal changes that occur in different stages of our lives. Since puberty, we experience the menstrual cycle. It prepares our bodies for pregnancy, and eventually ends with menopause. 

The key “female hormones”, oestrogen and progesterone, ebb and flow according to these processes. Associated with other hormones like cortisol and adrenaline (the stress hormones), they cause us to feel changes in energy and mood. 

In addition to mood changes, we often endure pain and discomfort from these biological processes. Balancing these with our roles and responsibilities can make coping challenging. 

Ψ Psychosocial 

You are a woman: a daughter, a mother, a wife, an employee, a caregiver...  

Women often find ourselves juggling multiple roles.  

Juggling these roles can become a major source of stress for women, since it involves managing relationships. How do we meet both society’s expectations and our own for every role we play?  

How we cope with these challenges depend on our personality traits and experiences, which influences our emotional responses. When we struggle to cope, we could experience burnout or overwhelm. This puts us at an increased risk of mental health conditions depression and anxiety. 

Here are some examples of psychosocial stressors women face: 

• Reproductive and sexual health 

• Work-life balance 

• Gender discrimination 

• Body image and self-esteem issues 

• Relationship issues (parenting, partners and family dynamics) 

• Mental health conditions 

Coping with women’s emotional concerns 

There are many ways we can explore our emotions and the concerns that come along with them. Consider giving some of these strategies a try! 

• Build self-esteem through Positive Self-Talk 

• Try Stress Management Strategies 

• Practice self-care through Mindfulness  

Feeling lost? Let us assure you: you’re not alone. The empathy we women can provide each other with can create a safe and supportive community for us to lean on. By showing our compassion and harnessing our unique strengths, we can navigate challenging emotional concerns. 

For specialised help, contact our experienced Women’s Health Psychologists. We are ready to support you through the exciting journey of womanhood.  

Fertility, IVF, and Egg Freezing

The clock ticks 

We’ve graduated from school at last! With energy abundant, we hit the ground running. We’re eager and zealous to take on the world, to explore its beauty, to pursue our hobbies, and to carve a name for ourselves in our careers! The world is truly our oyster! 

Yet, in a seemingly cruel twist of fate, this moment is also the most conducive period to conceive a child as our fertility is at its peak. If we choose to sprint ahead with other pursuits, time waits for no man and marches on mercilessly. For most of us, fertility begins to decline at approximately 32 years of age. This means that the chances of pregnancy get lower as we age. Additionally, there is also a higher risk of complications when getting pregnant later in life, which poses health risks to our child and ourselves.  

As time ticks on, the pressure to decide between motherhood and our other pursuits rises steadily. We are bombarded with unending questions of when we plan to have kids, “friendly” reminders of our age, and have to contend with our own desires to make sure that our kids will be born healthy. Over time, it can be very stressful and distressing.  

Assistance 

Thankfully, there are a few methods available to us if we wish to have both pursuits and motherhood!  

The first would be IVF (in vitro fertilisation). IVF can help boost fertility and chance of pregnancy, and this is done by fertilising our eggs with our partner’s sperm in a laboratory and then replacing the eggs back into our wombs.  

The other option would be EEF (elective egg freezing).  EEF can help preserve fertility by freezing and storing our younger and healthier eggs.  

With these two methods, we have the options to preserve or boost our fertility so that we can enjoy other pursuits in our youths! 

 How do I decide? 

1. Radical acceptance 

   It’s stressful to face our biological clocks. It’s frustrating to be bombarded with questions. It might feel unfair that we need to pause our other pursuits for motherhood. We hear you. These are all natural and very valid feelings to have. But holding on to such feelings can quickly tire us out, and we could already use more sleep as is!  

   Instead, let’s try to make the conscious effort to acknowledge our emotions and the reality of the situation. Acceptance would not lessen our stress or frustration, but it could afford us the energy to move forward, to make and stick with our decisions. 

2. Challenging thoughts 

   Societal and cultural expectations can be harsh, and we may worry about how our decisions may be perceived: 

   • “Am I selfish for pursuing my career/hobby?” 

   • “Will others think less of me if I use these technologies?” 

   • “Am I a terrible mother?” 

   These unhelpful thoughts hurt us and may not actually be true. So, what can we do about them? Well, we can try to recognise these thoughts when they do happen and challenge them by asking ourselves the following questions: 

   • What would we say to a friend who is going through the same situation? 

   • Is there evidence that supports these thoughts? 

   • What about evidence that contradicts these thoughts? 

3. Seek support 

Our loved ones and friends know us well and this could be a great opportunity to check in with them. Let’s try to share about our worries, receive their support, and to hear their opinions and thoughts on the matter.  

We could also consider booking an appointment with a health professional to find out more about fertility, the available options, and any possible side effects. That way, we empower ourselves to make a more informed decision in the future. 

Our body 

It’s not easy being a woman, so let’s be kind to ourselves. Let’s remember that it’s our body and our choice as to whether we wish to have children earlier, later, or not at all.   

Perinatal Obsessive-Compulsive Disorder (OCD)

What if I harm my baby?

What is Perinatal Obsessive-Compulsive Disorder (OCD)?

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterised by obsessive thoughts, and behavioural compulsions.

Ψ Obsessions are intrusive, unwanted and persistent thoughts and mental images.

Ψ Compulsions are repetitive acts, including avoidant behaviours, that aim to reduce the distress associated with the obsessive thoughts. They could look like cleaning rituals, repeated checks, counting, saying a particular word or phrase, or avoiding certain places or activities.

Perinatal OCD occurs during pregnancy or a year after childbirth. It could be another manifestation of existing OCD or a sudden onset of a new condition.

Find out more about Obsessive-compulsive disorder

Symptoms of the condition often centre around the baby. They are associated with fears that the baby would be harmed, such as through contamination, inappropriate handling, etc. While individuals with perinatal OCD probably recognise that their obsessive thoughts and compulsive behaviours are irrational, they feel consumed by those thoughts and unable to break free from the rituals.

Often Undetected and Unspoken

Having a baby is stressful and overwhelming. As parents, it’s normal to feel anxious about caring for a young child, and worried that they will harm the child. This anxiety, at manageable level, could actually be helpful in ensuring that you avoid potential risks to your pregnancy and child. 

While many parents have that fear, people who suffer from perinatal OCD give undue importance to those thoughts, and believe that they are capable of causing harm.

These parents may be reluctant to disclose their anxious thoughts for fear that they may be regarded as the potentially dangerous and harmful parent.

Parents may also not be aware of the condition or recognise it as an illness. They may see themselves as an unreliable and unfit parent, or attribute their fears as “going crazy”. 

Failure to detect and address perinatal OCD can result in persistence of the distressing thoughts, and affect the relationship the parent has with the child and their family members. New fathers and mothers (or even those without children) with perinatal OCD may struggle to enjoy moments and bond with the child.

Depending on the severity of your condition, it can also impact your confidence in caregiving and overall quality of life as you spend the day worrying about your child being harmed.

How can I Cope with Perinatal OCD?

Ψ Learn more about OCD

Find out more about the condition. Understand that it is not your fault, and that you are not going mad.

It is often comforting to find an explanation for what you are going through. With better understanding of the condition, you could also make sense of the consuming thoughts and compulsions that you have.

Ψ Learn about your symptoms

Everyone’s triggers and symptoms would look different. It is always a good idea to note how your symptoms present and when they present. This give yourself and ideally your therapist a clearer idea of your presenting difficulties and how to manage them.

Ψ Talk to someone

Reach out to a loved one and share with them what you are going through. It can be relieving just to tell someone your feelings. It could be helpful to first write down your thoughts and feelings before you bring this up with someone.

It can be also reassuring to hear that similar anxious and distressing thoughts are experienced by other people too. Connect with support groups online or in your local community (e.g, OCDNetwork) to receive the emotional support much required in this journey.

Ψ Get practical support

Your anxiety may make you unavailable to care for your child for the time being. Reach out to your family and friends to help with the caregiving tasks.

Let them know how they can help (e.g., could you help to change the baby’s nappy)

Ψ Seek professional help

OCD can be managed with psychological therapy, and sometimes with the additional help of medication. Typically, Exposure and Response Prevention Therapy (ERP) and Acceptance and Commitment Therapy (ACT) are used to help individuals with OCD. They involve exposure to anxiety-provoking situations and accepting the intrusive thoughts while engaging in value-aligned behaviours respectively.

Your therapist will work with you to develop a management plan that best supports you. Things would get better, however overwhelming they seem now.

Supporting a Loved One Who is Struggling with Perinatal OCD

Many individuals who experience perinatal OCD worry that they get ostracized when others find out. Do not criticise their compulsions. Assure them that you are there to support them if they ever need it. 

Learn about the condition. With greater understanding of the condition, it may be easier for you to see why your loved one is acting the way they do. You would also realise that providing assurance (e.g., “I’ve sterilized the milk bottle”, “the baby is still breathing”) might not be the best form of support for them – counterintuitively it may sound. Instead consider staying by their side as they experience the discomfort rather than reinforce their rituals.

If you are concerned that you or someone you know is struggling with perinatal OCD, seek professional help. Feel free to reach out to us for support with coping with OCD.

Losing a Baby to Miscarriage or Stillbirth

Both miscarriage and stillbirth refer to the loss of a baby during pregnancy. Whereas miscarriage occurs before 20-24 weeks of gestation, stillbirth is when a baby is born dead after 20-24 weeks of pregnancy.  

Statistics in Singapore

In Singapore, about 20% of pregnancies end up in a miscarriage while stillbirth happens in 0.5%-1% of pregnancies. In most cases, the cause cannot be established. Some known causes include infection, umbilical cord accidents, and placental complications.

A word from our clinical psychologist:

Perinatal loss is a term broadly used to describe losses before, during and after pregnancy. There are different types of losses during pregnancy, including miscarriage, stillbirth, ectopic pregnancies and medical termination for various reasons. No matter when or how the pregnancy loss happened, losing a baby has been described by some of the clients I have worked with, to be the worst kind of pain. Their loss experience defied their assumptions and expectations of a "normal" course of pregnancy through the trimesters until the smooth delivery of their healthy baby, just like everyone else! A "typical" path towards parenthood, towards forming a family (with children) is all that they had hoped for. Given this, a range of emotions - anger, sadness, grief, shock, guilt amongst others may result, as a part of the grieving parents' mourning process. 

For there is so much to mourn - the loss of their "healthy" baby, the loss of sense of "normalcy" in their lives, the loss of that anticipated future with baby as a part of the new family, and the loss of the new identity, hopes, dreams as soon-to-be parents. Instead of celebration of their baby's arrival, some grieving parents may find themselves confronted with the starkest reminder of their loss, in the form of a symbolic farewell ritual, or funeral ceremony and burial event for their baby. For some families who choose these practices, they shared that it can be very helpful for their grieving process and closure. But, there is no one way to grieve, so honour your own needs, beliefs, emotional and physical capacity to decide what is best for your unique situation. 

What can complicate perinatal grief is also in part due to the "invisible" nature of pregnancy loss, especially in the early stages. This can make it very hard to talk about it with others and for loved ones to fully acknowledge the deep, emotional and psychological impact of such losses. Hence, it is necessary to remind all that perinatal losses are as worthy of care and compassion as other types of relationship losses. This is because attachment relationship bonds has already formed between conceiving parents and baby, as soon as they learn about being pregnant. 

Given the tough, unbearable pain of perinatal losses, much compassion is needed all around. Grieving mothers/fathers need to learn to be more self-compassionate and manage their own harsh self-talk, especially those about failure and being unworthy as parents. Given that the nature of perinatal losses are often unexpected, resulting in a big sense of loss of control, it can be beneficial to find little ways of taking charge, for instance, of daily routines, or setting of boundaries about what you are comfortable discussing. This can assist with restoring some sense of normalcy and control as you navigate grief. 

A journey shrouded by shame and silence

Given that pregnancy losses are common, some women may feel that they do not deserve to grieve. On the other hand, despite the substantial occurrence rate, resources to support these women are scarce.

There has also been stigma and blame attached to pregnancy loss, where mothers are implied to have failed to take good care of their babies. Even well-intentioned advice could come across as insensitive and dismissive. This unspoken roller-coaster journey can feel unforeseeably lonely and difficult. 

An unimaginable pain

The loss of a child, no matter how brief they have been in your life, is profound. It goes against the natural order of life and no parent can ever be prepared for it. The loss of a child is also the loss of an imagined future with them – the hopes and dreams that cannot be fulfilled.

With the devastation, there may also be guilt that you could have been more attentive to your diet and body, and anger that it had to happen to you. Mothers may also feel alone thinking that their partner does not understand their pain since their partners are not the one who carried the child.

How can I cope with a miscarriage or stillbirth?

Everyone grieves differently – in different ways and on different timelines.

Here are some ways we hope can help with your grief.

Ψ Make room for your feelings

Allow yourself to feel all that you feel – guilt, anger, confusion, panic. Observe where you are feeling these emotions in your body – aches in the stomach, tightness in chest? Let yourself be where you are at the moment. There is no prescribed timeline which states the stage of grief you should be at at any point of time.

Ψ Be compassionate to yourself

Understand that it is not your fault nor a personal failure.

As mentioned earlier, there is no timeline for grief; you will move along with your grief rather than moving on from it. Do not expect yourself to forget. Instead, expect yourself to feel triggered on the anniversaries or when you see other families with children. When that happens, allow yourself to take short breaks to grieve – it can be in a toilet cubicle or in a corner of a park. This place should be somewhere you feel safe and comfortable to express your emotions. 

Ψ Pay attention to unhelpful thoughts

Certain narratives may start playing in your head: “My life is worth nothing if I do not have children”, “I am not complete without children”, “It is all my fault”, “I’m a useless mother”. When played enough times in your mind, these thoughts may seem convincing. But they are not true.  

You could challenge these thoughts by asking these questions.

• What's the evidence for and against these thoughts?

• What would I tell a loved one who is going through the same situation? 
  
  

Ψ Grieve with your partner

An event like the loss of a child could bring a couple closer to each other or lead them to drift apart.

You and your partner may respond to the death of the baby differently – one may turn to crying, one may turn to work to avoid thinking about the pain. Some couples may not want to burden their partner with their anguish so they choose to keep their feelings to themselves. When you are unsure of how your partner feels about the loss, there is a chance that you feel that they are less affected by the loss. And this, will lead to emotional distance and tension in the relationship. 

Recognise that this is uncharted territory for both of you. Seek your partner to grieve as a team. Communicate with each other your sorrow, and try to understand how both of you will grieve in different ways, but together. 

Ψ Consider a grief ritual

For some, a grief ritual gives some form of closure to the episode. The symbolic ritual could be in the form of a scrapbook, memory box, journal entry or even a remembrance trip. 

Ψ Look after yourself

The miscarriage or stillbirth takes a toll on your physical body. The grief and emotional pain may take hold of your life, leaving you with no mental capacity to plan for your day. A routine may be helpful to ensure that your physical well-being is taken care of. You need your sleep, food and physical activity.

Ψ Seek support

Reach out to your family and friends. Be with your loved ones even if you do not feel like talking about the loss; their company in itself may be comforting.

To ease your return to work, we encourage you to speak with your bosses to let them know how you want your return to be managed (e.g., shorter hours, work-from-home arrangement, inform your colleagues to not broach the topic).

The pain of grief could be overwhelming. But you are never alone. Consider seeking professional psychological help in the forms of support group and therapy. Some support groups include:

• Child Bereavement Support (Singapore)

• Angel Hearts

• Miscarriage, Stillbirth, & Child Loss Support Group

• Pregnancy and Infant Loss Support Group Singapore

• Pregnancy After Loss Support (PALS)

How family members can support their loved ones

This key idea should underlie all of your efforts to support them: Acknowledge and validate their pain.

Understand that the loss hurts them deeply, and it will take time for the pain to feel more bearable. Some may feel comforted by phrases like “I’m so sorry it happened”, “I cannot imagine your pain but I’m here for you”.

The aim is never to cheer them up – you would be disappointed if you want to do that because you cannot take their pain away; rather, it is to join them in their pain as they struggle with their intense and painful emotions.

On anniversaries or in situations where the parents may be reminded of their loss, you could check in on them gently by asking how they are feeling or if they want to spend time together.

If you notice that their grief has affecting their daily life for a concerning amount of time, let them know why you are concerned (i.e. what did you notice and explain why it is concerning), and encourage them to ask for professional help. You could also go the extra mile and accompany them to visit a psychologist.