Errors in Clinical Treatment Surrounding Perinatal Grief

An Article Review

Markin, R. D. (2016). What clinicians miss about miscarriages: Clinical errors in the treatment of early term perinatal loss. Psychotherapy, 53(3), 347-353.

Find the original article here.

Spontaneous miscarriage is defined as the loss of a pregnancy before the 20th week of gestation and is the most frequent type of perinatal loss, occurring in approximately 10-25% of all pregnancies (American College of Obstetricians and Gynecologists, 2015) and frequently leads to symptoms of depression, anxiety, and traumatic grief reactions (Blackmore et al., 2011; Lee et al., 1996).

This article discussed clinical errors in the treatment of perinatal grief due to miscarriage(s), including: (a) minimizing or avoiding painful affects related to the miscarriage, (b) assuming grief is resolved upon a subsequent healthy pregnancy, and (c) failing to work through early unresolved losses that are reawakened by the loss of the pregnancy.

The author argued that these unintentional errors, typically committed by significant others in the patient’s life, are similarly made by well-intentioned clinicians due to a lack of knowledge about the psychological impact of miscarriage and, moreover, an unconscious avoidance of such a common yet distressing loss.

Background information relevant to each clinical error was briefly reviewed, followed by recommendations for a better approach to the situation and verbatim clinical exchanges. The author suggests that, in general, a better approach to treatment is based on the assumptions that: (a) miscarriage is often a traumatic loss in a woman’s life, and (b) the traumatic affect associated with the event should be approached, rather than avoided, within a safe affect regulating relationship with the therapist.

Cite This Article

Markin, R. D. (2017, March). Errors in clinical treatment surrounding perinatal grief [Web article] [Review of the article What clinicians miss about miscarriages: Clinical errors in the treatment of early term perinatal loss, by R. D. Markin]. Retrieved from


American College of Obstetricians & Gynecologists. (2015, August). Early Pregnancy Loss: Frequently Asked Questions. Retrieved from

Blackmore, E. R., Côté-Arsenault, D., Tang, W., Glover, V., Evans, J., Golding, J., & O’Connor, T. G. (2011). Previous prenatal loss as a predictor of perinatal depression and anxiety. The British Journal of Psychiatry198(5), 373-378.

Lee, C., Slade, P., & Lygo, V. (1996). The influence of psychological debriefing on emotional adaptation in women following early miscarriage: a preliminary study. British Journal of Medical Psychology69(1), 47-58.


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