The Miscarriage Dialogues: Dr. Alice Domar on Stress, Stigma & Supporting Ourselves Through Loss

The psychologist, author and Harvard Medical School professor opens up about the emotional toll of miscarriage, the myth of stress-induced loss and how we can better support those grieving.

There are clinicians who study grief—and then there are clinicians who change the way the world understands it.

Dr. Alice Domar has done exactly that.

A trailblazer in the field of mind-body medicine and a longtime advocate for women’s mental health, Dr. Domar was one of the first researchers to explore the connection between stress and infertility. Her groundbreaking work has helped transform how we talk about reproductive health, grief and the silent toll of trying to conceive.

But what makes her work especially powerful is how deeply personal it is. Inspired by her own mother’s struggles with infertility—a story marked by stigma, secrecy and the absence of support—Dr. Domar has spent her entire career making sure others feel less alone.

Today, she serves as a health psychologist at Inception Fertility, a part-time associate professor at Harvard Medical School and an internationally recognized speaker and author. But at the heart of it all is a profound commitment to helping people heal—not just physically, but emotionally and psychologically, too.

In this installment of The Miscarriage Dialogues, we’re honored to share our conversation with Dr. Domar. From the outdated scripts women are still handed after pregnancy loss to the quiet grief of secondary infertility, she brings empathy, clarity and decades of wisdom to the table. She names what so many of us have felt but haven’t had the words for—and offers a more compassionate way forward.

Whether you’re navigating your own experience of loss, supporting someone who is or simply trying to understand this terrain more deeply, Dr. Domar’s insights offer comfort, validation and a path forward.

She reminds us that miscarriage is not a personal failure. That grief isn’t linear or predictable. And that the most powerful thing we can do—for ourselves and for each other—is to speak the truth out loud.

This is a conversation about real loss, real healing and the radical permission to feel it all. We hope you find comfort and knowledge in this episode of Miscarriage Dialogues.

You were one of the first researchers to explore the connection between stress and infertility. What initially drew you to this work, and how has your understanding evolved over time?

I was drawn to this work because of my parents’ experience with infertility. They went through both primary and secondary infertility to have my sister and me at a time when the topic was rarely discussed—even between couples. My mother often talked to us about how isolating and painful it was—not just the medical process, but the silence surrounding it. Her openness stayed with me and shaped my awareness from a young age.

Listening to her describe her experiences—including the emotional toll, the stigma and the use of anti-anxiety medications to actually conceive my sister—I developed a strong belief that stress and infertility were deeply connected. I wanted to understand that connection more fully—and even more than that, I wanted to be the first to study it.

How did your academic and professional journey shape your focus on the mind-body connection in reproductive health?

During my Ph.D. and postdoctoral work, I chose to focus on the psychological aspects of fertility within the field of OB/GYN. My entire career has been centered around the question: does stress impact fertility, and can relieving stress improve pregnancy rates? Over the years, my research has shown that infertility causes stress—and there’s growing evidence that stress may also contribute to infertility. It’s a classic chicken-and-egg scenario, but one I’ve dedicated my life to exploring.

You’ve spoken about the staggering prevalence of miscarriage. Despite how common it is, so many women feel isolated and ashamed. Why do you think that disconnect still exists—and how can we begin to change the conversation?

I am horrified—and frankly exhausted—by the fact that even today, women are still told not to share news of a pregnancy until after the first trimester—just in case they miscarry. The implication is that miscarriage is something to be ashamed of. It’s not. In most cases, a miscarriage is due to a genetic or physical issue with the fetus. It has nothing to do with the woman, her behavior or her thoughts. Miscarriage is a medical condition—physiological, not psychological.

When we keep pregnancy loss a secret, it reinforces stigma and isolation. But when women speak openly, they’re often met with support—and they help others feel less alone. That’s why it’s so important to normalize these conversations.

Have you seen any cultural shifts in how we talk about miscarriage in recent years—and what role does public storytelling play in that?

Thankfully, things are starting to change. Public figures like Meghan Markle and Chrissy Teigen have shared their experiences, and that visibility matters. The more we talk about miscarriage, the more we empower others to share their stories and seek support.

I always encourage my patients to think carefully about when and whom they want to tell—but to know that if they do experience a loss, they are far from alone. In fact, it’s likely that many people in their lives have been through a pregnancy loss and just never felt able to talk about it—until someone else did first.

In your work with patients, what emotional patterns or responses do you see most often following a miscarriage? Are there common misconceptions about how we “should” grieve?

There’s no one “right” way to grieve a miscarriage. Every loss is different, and each person’s experience is shaped by their circumstances—whether it was their first pregnancy or their fifth, whether they conceived naturally or through years of infertility treatment.

Many women feel isolated, overwhelmed or ashamed after a miscarriage, often blaming themselves for something that’s almost always due to genetic or physiological causes. Common emotional responses include withdrawal from others, loss of interest in daily activities, difficulty functioning and pain when seeing other pregnant women—especially those with similar due dates.

One major misconception is that early losses shouldn’t be grieved, or that people should simply be grateful they were able to get pregnant. But a miscarriage isn’t just the loss of a pregnancy—it’s the loss of a future. That grief deserves space, no matter when the loss occurred.

I often encourage patients to find personal ways to honor their loss: planting something, writing a letter to the baby they imagined or wearing jewelry with that fetus’ anticipated birthstone. These gestures can be deeply healing.

Read: 5 Ways to Honor a Miscarriage

Sadly, many people also hear dismissive or hurtful comments like “it wasn’t meant to be” or “you can always try again.” But the truth is, the emotional impact of miscarriage is real and long-lasting. Studies show that even years later—and even after having a healthy child—many women still think about the loss almost every day.

We need to make more space for honest, compassionate conversations about pregnancy loss—and remind people that they are not alone.

You’ve explored the impact of infertility and loss on couples. What advice would you offer to partners who are grieving differently—or struggling to support each other?

In my experience, no two partners grieve in exactly the same way or on the same timeline. For the person who was pregnant, the loss is typically physical, painful and immediate—cramping, bleeding, medical procedures. It’s visceral and concrete. For their partner, especially if they weren’t present at ultrasounds or involved in the daily experience of pregnancy, the loss can feel much more abstract.

One day they’re told their partner is pregnant, and the next, they’re told they’re not. There may be no visible signs to the partner that anything has changed, making it harder to emotionally connect to the loss.

This difference often causes frustration. I've worked with many women who feel hurt or unsupported because their partner doesn’t seem as upset. But I always remind my patients: you're grieving the way you need to grieve, and your partner is grieving the way they need to grieve. Don't expect them to express their emotions the same way you do.

Instead of waiting for your partner to grieve the way you think they should, tell them what you need. Do you need a hug? A walk? Some quiet time or a shared ritual? Be specific. Don’t expect them to read your mind, especially while they're processing in their own way.

Often, the non-pregnant partner focuses on supporting their partner in the moment and may not start grieving themselves until later. That delay is normal—and it doesn’t mean they don’t care.

For couples struggling to connect, I often recommend a simple exercise called paired listening. Each person gets five minutes to speak uninterrupted while the other listens. Then they switch. It helps create space for both partners to feel heard, even if they're at different emotional points.

If things feel especially strained or stuck, there’s no shame in seeking couples counseling. Sometimes having a neutral space to talk through the pain can make all the difference.

Many of our readers are navigating secondary infertility, and it’s something that often gets dismissed or minimized. Can you speak to the emotional toll it takes and why those experiences are just as valid?

Secondary infertility is actually more common than primary infertility—so if you're going through it, you're far from alone. But despite how common it is, the emotional experience is often misunderstood or dismissed, both by others and even by those going through it.

One of the biggest challenges is that many people assume that if you got pregnant once—especially if it happened easily—it will happen just as easily again. So when it doesn’t, it comes as a shock. And for those who needed fertility treatment the first time around, the idea of starting that process over again can feel overwhelming and exhausting.

Women facing primary infertility can sometimes choose to avoid baby showers, pregnant friends or kid-focused environments. But if you’re raising a child while struggling to conceive again, those reminders are unavoidable—you’re surrounded by children and often in constant contact with parents who may be expanding their own families.

Another common emotional stressor is the pressure—internal and external—to have children close in age. There's a widespread belief, rooted in outdated evolutionary patterns, that two years apart is the “ideal.” But when secondary infertility disrupts that timeline, it can create anxiety, guilt, or grief over imagined family plans slipping away.

In reality, research doesn’t necessarily support the idea that closely spaced siblings are best, and in many cases, more space between children can actually be beneficial. But that doesn't lessen the pain for someone who feels like they’re falling behind their vision for their family.

Secondary infertility is every bit as emotionally complex and deserving of compassion and support as primary infertility. It’s not about “already having one.” It’s about the grief of unfulfilled hopes, shifting family dynamics, and the invisible emotional labor of carrying those feelings while caring for another child. It’s not about how many children you have, it’s about how many children you want to have.

What are some of the most meaningful ways friends or family can show up for someone who’s experienced pregnancy loss? And on the flip side—what should people not say or do, even if well-intentioned?

The most meaningful thing you can do for someone grieving a pregnancy loss is to simply show up—and listen. Don’t ask them what they need—they likely don’t know. In the midst of grief, it’s hard to make decisions or ask for help. Instead, offer something concrete: “I’d love to bring you dinner Tuesday night,” or “Can I take you out for a walk or coffee this weekend?” Giving choices shows you care without putting the burden of decision-making on someone in crisis.

Small, thoughtful actions go a long way. Drop off a meal, walk their dog, entertain their child, do a load of laundry, or just sit with them so they’re not alone. Grief is isolating, and knowing someone is physically and emotionally present can be incredibly comforting.

When it comes to what not to say—choose your words carefully. Even well-meaning comments like, “At least you know you can get pregnant,” or “It was early—it just wasn’t meant to be,” can feel dismissive. Instead, say, “I’m so sorry. I’m here for you.” Be a safe space, not a problem-solver.

If you’ve experienced a loss yourself, it can help to gently share that—so long as it’s with the intention of making them feel less alone, not to compare experiences. Every loss is different, and what helped you may not help them.

There’s often a deep fear around trying again after a loss. How do you counsel patients who are caught between hope and anxiety when it comes to future pregnancies?

First and foremost: having one—or even several—miscarriages doesn’t mean you won’t go on to have a healthy pregnancy. In fact, even after multiple losses, the odds are still in your favor.

One of the most important things I emphasize to patients is that the loss was not their fault. This is a conversation I have every single day. It wasn’t the glass of wine you had before you knew you were pregnant, or the argument with your partner, or the bump in the road you hit while driving. It wasn’t your obnoxious mother in law, , the workout, or the ambivalence you felt about being pregnant. Thoughts and emotions don’t cause miscarriage. It’s almost always physiological.

There are some known risk factors—such as age, heavy alcohol or caffeine use, obesity, poor nutrition or substances like THC or CBD—but outside of those, there’s little a woman does or doesn’t do that causes a loss.

I remind patients that when you’re pregnant, the fetus is often the most protected part of your body. And when fear creeps in—because of course it does—it’s about learning to hold space for both hope and anxiety. Both are valid. And both can coexist.

You’ve written about the intersection between infertility and postpartum mental health. Can you share why women who’ve gone through loss or fertility struggles may be more vulnerable to PPD or anxiety—and what support systems can help?

Infertility often involves years of trying and emotional investment, leading women to believe that having a baby will be a perfect, joyful experience. When the reality of postpartum hits—sleepless nights, crying babies, and physical recovery—it can be overwhelming and trigger postpartum depression (PPD) or anxiety. The shame that follows, thinking they “should” feel happy, can deepen these feelings.

Women who’ve experienced a loss carry anxiety throughout their pregnancies, which often doesn’t subside until they hold their baby. And anyone with a history of depression—whether from infertility or previous losses—is at higher risk for PPD.

If you feel persistently down, anxious or overwhelmed after delivery, talk to your OB or midwife. If you ever have thoughts of harming yourself or your baby, seek emergency help immediately. While “baby blues” are common, PPD affects 10-20% of new moms, and it’s not just hormonal—sleep deprivation and lack of support contribute significantly.

My advice? Accept help when it’s offered, whether it’s meals or childcare. And explore online resources like MamaLift, a newly FDA-approved tool that may help prevent PPD. Every bit of support matters.

Your work blends mind/body medicine with clinical psychology. What simple tools or practices would you recommend to someone going through grief who feels emotionally overwhelmed or disconnected from their body?

First, it’s important to seek support from mental health professionals who specialize in reproductive medicine. Ask your OB or midwife for recommendations or visit ASRM.org to find members of the Mental Health Professional Group, qualified professionals by state. We’re trained to recognize the nuances of grief, from baby blues to postpartum depression and psychosis, and offer tailored support to help you feel better.

Postpartum issues, especially the impact of sleep deprivation, can feel overwhelming, especially in the first few weeks. Most people hit their lowest point around six weeks, but things often improve around 12 weeks. Recovery is different for everyone—some may have easy babies and strong family support, while others may face more challenges. If you’re struggling, don’t hesitate to ask for help, especially if you’ve had a tough delivery or C-section. Help can come in the form of physical assistance, like someone holding the baby or taking care of household tasks or emotional support from friends or family.

Many hospitals, OBs and nurse midwives offer new mom support groups, which can provide comfort, reassurance, and a sense of community. These groups can be a lifeline, as they help you feel less isolated and remind you that what you’re going through is normal. If you don’t have access to a local group, check online communities, like Facebook, where you may find people who understand what you’re going through.

What gives you hope in this work? Are there conversations happening now that feel different—or more promising—than they did a decade ago?

Absolutely. When high-profile women like Chrissy Teigen and Meghan Markle speak openly about the emotional devastation of pregnancy loss, it gives everyday women permission to grieve openly too. If Chrissy Teigen says she was in mourning for six months, or Meghan Markle calls it the hardest thing she’s ever experienced, that helps someone think, Okay, maybe how I’m feeling is normal. Maybe it’s okay that I’m still struggling.

A generation ago, women didn’t talk about pregnancy loss at all. There was so much silence, shame and isolation. But the truth is, no one is ever alone in this. There’s nothing someone has gone through that someone else hasn’t experienced too. Just talking to someone who’s been there can be incredibly healing.

I think it’s amazing that these conversations are happening more. It’s the same with infertility—that level of openness simply didn’t exist 20 years ago.

Lastly, what’s one thing you wish every woman who’s experienced miscarriage knew or heard?

First and foremost: This is not your fault. Nothing you did—or didn’t do—caused this. And when you’re ready to try again, know that the odds are still in your favor to have a healthy baby.

That said, if it’s been a few weeks and you’re still not functioning—if you can’t get out of bed, can’t shower, can’t return to work, or care for your other children—it’s time to talk to someone. Feeling awful for a week or two is normal. But if the grief is stopping you from functioning, please reach out to your OB or midwife. You don’t have to suffer in silence.

And if you’ve had two or more losses, don’t try again without a full evaluation. You should see a reproductive endocrinologist who can run specialized tests on both partners. Sometimes, no cause is found—but when there is something identifiable, like a genetic issue, a uterine abnormality, or a bleeding disorder, it can often be addressed before trying again.

Whatever you're feeling is valid, and there are people who want to help and support you until you do have that baby in your arms.

These conversations matter, and so does your voice.

If you have a story to share, an idea to pitch or just want to reach out, we’d love to hear from you. Email us at jenn@milaandjomedia.com or send us a DM at @miscarriagemovement.

Talking about miscarriage shouldn’t feel like a secret. Let’s keep pushing for change—together.