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Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them.


Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them.


Through a collaborative approach, harm reduction works within the realities of our world and addresses those truths, rather than deny them.

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Specialty Topics

It’s Time for a Proactive Approach to Infertility and Women’s Mental Health

Recommendations and resources for mental health and medical providers to support women's mental health during infertility and miscarriage

It’s Time for a Proactive Approach to Infertility and Women’s Mental Health
Sarah Jameson, LCSW


min read


table of contents

Trauma, grief, and loss are my specialties as a therapist but I wasn’t prepared to experience infertility. 

Starting the infertility journey is lonely. It’s painful, emotionally and physically. I didn’t know where to find support or if anyone understood what I was going through. I remember sitting alone in doctors’ offices and emergency rooms, lost in the worst of my own thoughts, with no information or support—even when I was going through miscarriage.

What I realized was that unless you really search for it, there isn’t a lot of information and support out there. It was only deeper into my infertility journey, after my third loss, that I found strength, hope, courage—and eventually, healing—through the help of my own therapist and support groups where I could connect with other amazing women.

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Infertility is more prevalent than people realize. In the United States, 1 in 5 married women looking to have their first child are unable to get pregnant after trying for a year. One in 4 from that group has “difficulty getting pregnant or carrying a pregnancy to term.” 

I vowed for this to be my advocacy when I was fully healed. I don’t want anybody to feel alone as I did. I’m sharing lessons from my own experiences and from working with others so therapists and other medical providers can better support people dealing with infertility and other parts of pregnancy.

Integrate support at every step

Doctors and nurses provide information on how to get pregnant, how to care for the baby—but nobody walked me through grief and loss until after the death of my sweet twin boys. I had a wonderful chaplain at my hospital who came into my room, cried with me, and pointed me to a support group. Not everyone gets even that. 

So many people continue to feel alone after their first or second loss. There’s no reason finding support is such a struggle. 

We need to shift from a reactive culture to a proactive one. Mental health care should be integrated into every part of someone’s journey to have children. 

Give resources from the beginning

One way to start integrating support is by providing mental health resources right away, either when someone becomes pregnant or decides to try to conceive. Use a “prevention” approach so all women know the resources they need, no matter what journey they’re on, living children or no living children. 

Nothing truly prepares you for the pain and trauma of infertility. However, people can prepare by building coping skills and mental resilience if it happens to them. 

A proactive culture looks like making information available in doctor’s offices. Stock pamphlets with statistics and information about loss. Doctors and nurses can have articles and books that they recommend or give patients. 

Loss can hit so hard you don’t have the energy to search for help. Clinics can provide patients lists of therapists who specialize in grief and loss, so they have support ready when people need it most. 

The time I needed the most help was when I was alone with my thoughts in the middle of the night. Having a book to pick up and read helped me feel less alone. Having a support group on Facebook of other mothers that knew what I was going through helped the most.  

Continue mental health care after birth

After birth, babies become the sole focus when it comes to care. Mothers get one final check up—a physical check-up—and then we’re left on our own. 

Don’t get me wrong: I was thrilled to have my rainbow baby! Thrilled and unprepared for the postpartum anxiety that followed. I worried that she could die any second. Even mothers who didn’t experience traumatic pregnancies or birthing feel anxiety, depression, and sometimes anger. I dealt with fear and dread every single check-up during my pregnancy with my rainbow baby. After she was born, I dreaded every day that she would die in her sleep or from illness. I befriended the nurses, who did their best to comfort me, but they weren’t equipped to help with my emotional pain. 

Again, having a support group of women who knew what I was going through helped immensely. The catch was that I had to find them myself. 

Pregnancies—whether healthy, difficult, traumatic, easy, or anything else—change us, physically and emotionally. Our hormones can be all over the place but even beyond that, it’s a long process. Yet only babies get follow-up care and checkups. Parents, birthing or not, go forgotten. (Support for new parents who didn’t give birth is important, too, but could be its own blog.) 

An estimated 1 in 5 people who give birth experience postpartum anxiety. Most new parents experience some symptoms of depression after giving birth, called the “baby blues.” Longer and more serious, postpartum depression affects 1 in 7 women. 

For many women, postpartum depression could be the first time they’ve experienced depression, or any other mental health condition. They don’t have the tools to identify what they’re feeling nor the support to name it, much less put it into perspective. 

We should follow up with new parents, let them know they aren’t in this alone. There are resources and people who can and want to help during this time. 

Recommendations for health professionals

When I started my infertility journey, I had a therapist I really liked but she knew nothing about what I was going through. I didn’t expect this to be among her specialties but it helped me realize the value of therapists being educated about this topic. We need to have some knowledge about how to help people going through infertility and where to point them to. 

How can therapists help clients? 

Prepare for medical appointments

When it comes to medical appointments and journeys, we can walk clients through encounters with people who don’t know what they’re going through. We should prepare them for facing ignorance from the people who should have answers. 

Let clients practice what will happen and what to say during appointments so they feel some control over the situation. 

Rehearse everyday questions and reactions

“How many children do you have?” 

It’s the dreaded question. 

Practice answering it with your clients. I would try answering this question in different ways with different types of people: good friends, acquaintances, and strangers. 

It was trial-and-error to find what I was comfortable saying. Sometimes I felt comfortable answering, “One,” sometimes “one living child.” Other times I felt I needed to say, “One living child, and 2 in heaven.” (I admit that I still feel conflicted leaving out a baby I lost in an early miscarriage. For most people, it’s too complicated for a passing exchange.) 

Another one to practice responding to is, “You’re pregnant! You must be so excited!” 

Yes but also way more terrified to lose this baby because my body doesn’t do pregnancy well. Dealing with my emotions when these questions arise is important so I can feel confident in my response. Each of these reactions in the past had been a trauma trigger. 

Therapy provides a safe space where people can find responses that work for them. 

Talk through triggers

Many of us already have practice doing this for clients with other issues. As we know, media like television shows can be triggers. “This is Us” aired around the time I had my daughter. I couldn’t watch pregnancies on TV for the longest time, especially ones where they lose a child. 

It’s still hard but it’s become easier over time as I did my own exposure therapy to tolerate things that were painful to remember. 

There’s also guilt to navigate when other people’s joy becomes a trigger. How do you deal with friends who are pregnant or become pregnant easily while you struggle with it? Invitations to birthday parties become a source of dread. 

As a therapist, I knew I couldn’t give into my fear. I knew I had to give myself grace, to be gentle with myself. My professional experience meant I knew my limits and could feel okay skipping some events as well as pushing myself if I knew something was good for me.

Our clients don’t always have that kind of knowledge, so it’s up to us to help them recognize those feelings and practice self-compassion. 

Advice for medical professionals 

Doctors and nurses must be educated on how to deal with grief and loss with empathy. Pregnant women often go to the ER with the worry of miscarrying yet receive no support. When I was giving birth to my daughter—now 6 years old—the resident ER doctor coldly told me that I should prepare for a miscarriage. 

He didn’t know my history of loss and infertility. Besides the fact that he should have reviewed his patient’s medical history, medical staff in general should be trained on how to deliver news with empathy. Balance what patients should prepare for rather than guessing and jumping to worst case scenarios. 

That includes comforting patients through the anxiety of waiting for news. I’ve endured long, excruciating waits while stonewalled by nursing technicians looking for a heartbeat. We had to wait for a doctor to finally arrive and read out the results. During these times, we should strive to have doctors on call if they think a miscarriage might be the case. 

Patients can feel if something is wrong. Don’t draw out their wait to receive news about their own bodies and families. Providing people with timely information about what is happening is the empathetic and ethical action. 

Resources to start

I continue to share my own journey with infertility and miscarriage. It’s helped many of my friends open up about past losses they never felt they could talk about and helped people support loved ones through losing a baby, instead of saying the “wrong thing.”

Like many aspects of women’s health, infertility and pregnancy often go undiscussed. Hope is great but we can’t let the fear of loss silence us. In my opinion, not talking about the possibility of loss during pregnancy is mentally unethical. 

Creating a more informed and open culture about women’s health helps everyone support each other better. 

Here are some resources that I use and recommend: 


Facebook support groups


About the author
Sarah Jameson, LCSW

Sarah Jameson, LCSW is a therapist at UpLift. She specializes in treating trauma, especially combat and sexual trauma, and has experience working with families. She earned her Master's in Social Work from Virginia Commonwealth University.

Edited by

Eliana Reyes

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