Termination for Medical Reasons

Reviewed by Dr. Sanam Shamtobi, PhD, PMH-C

Key Takeaways

• TFMR (termination for medical reasons) is the ending of a wanted pregnancy after a severe fetal diagnosis — and the grief that follows is real, complicated, and often invisible

• Many people who go through TFMR describe feeling completely alone — the loss is misunderstood by family, minimized by society, and rarely talked about openly

• This grief can include shock, profound sadness, guilt, relief, anger, and love — sometimes all at once

• Therapy specifically for TFMR grief can help you process what happened, navigate the complicated emotions, and find a way to carry this loss forward

• You made a decision from a place of love. That matters.

You got a diagnosis that no one prepares you for. You were given devastating news, an impossible timeline, and a choice you never wanted to make.

And then, on the other side of it, you were expected to just... keep going.

Maybe people didn't know what to say. Maybe some of them said the wrong thing. Maybe you find yourself unable to explain what happened — or unsure whether you're even allowed to call this grief.

You are. This is grief. And it's some of the most complicated grief there is.

What Is TFMR?

TFMR stands for termination for medical reasons. It describes the decision to end a pregnancy — often a deeply wanted one — after receiving a diagnosis of a serious fetal condition, chromosomal anomaly, or life-limiting illness.

This might have happened after an anatomy scan at 18–20 weeks. After an amniocentesis result. After a NIPT screen that sent you down a road you never expected.

Every TFMR story is different. Some involve diagnoses that are incompatible with life. Some involve conditions where the outcome was uncertain. Some involve a mother's own health being at risk.

What they all have in common: you didn't choose this situation. You chose the most loving response you could imagine to an unimaginable one.

Why This Grief Is So Hard

TFMR is sometimes called the grief no one talks about.

Most people around you may not know what happened. You might have told them you had a miscarriage because it felt simpler, or because you couldn't face the questions. Or maybe you did tell people and found that the reactions were confusing, awkward, or even hurtful.

Some of what makes TFMR grief especially complicated:

The pregnancy was wanted. This wasn't a crisis pregnancy. You may have been excited, named the baby, told people, set up the nursery. That wanted-ness doesn't disappear with the diagnosis — it becomes part of the grief.

You made an active decision. Even when you know you made the right choice, many people experience guilt, second-guessing, and the weight of having been the one to decide. That weight is real — and it can sit differently than a loss where the decision was taken out of your hands.

Society doesn't have a script for it. There are no bereavement cards for this. Most people don't know what to say. Some say something that implies you shouldn't be grieving, or should move on faster. The absence of ritual and acknowledgment makes the loss lonelier.

Relief and grief can coexist. Some people feel relief alongside the sadness — relief that their baby won't suffer, relief that they made a decision aligned with their values — and then feel guilty for feeling relieved. These feelings aren't contradictory. They're both true at once.

What TFMR Grief Can Look Like

There's no right way to grieve this. But many people describe:

• Profound sadness and waves of grief that feel like they come out of nowhere

• Isolation — the sense that no one in your life really gets what you're carrying

• Guilt or second-guessing, even when you know intellectually that you made the right choice

• Anger — at the situation, at the diagnosis, at people who say the wrong thing

• Physical grief — difficulty sleeping, eating, concentrating

• Anxiety in subsequent pregnancies, if you try again

• Avoidance of babies, pregnant friends, or situations that remind you of what was lost

• Difficulty feeling connected to your existing children

• A fracture in your relationship — not everyone processes grief at the same pace or in the same way

Some people also experience symptoms of PTSD following TFMR — intrusive memories, hypervigilance, emotional numbing. If this sounds familiar, birth trauma therapy may also be relevant for you.

How Therapy Can Help

Therapy for TFMR grief isn't about helping you "get over it." It's about having a space where you don't have to protect anyone else from what you're feeling.

At The Mother Hood, we understand the specific complexity of TFMR. We won't ask you to justify your decision. We won't imply a timeline for your grief. We won't conflate this with other types of pregnancy loss — it shares some qualities, and it is also its own thing.

In therapy, you might:

• Finally say out loud what happened — sometimes for the first time with someone who isn't in your personal life

• Process the decision itself — not to relitigate it, but to integrate it and reduce the grip of guilt

• Name the baby and grieve them as a real person — because they were

• Work through the grief at your own pace — without anyone else's timeline imposed on you

• Prepare for a subsequent pregnancy — which often brings a complicated mix of hope, fear, and grief

We use evidence-based approaches including EMDR for trauma symptoms, grief-focused therapy, and somatic (body-based) work. Dr. Sanam Shamtobi and our therapists have specific experience supporting pregnancy loss and perinatal grief.

Individual therapy gives you a private space to do this work at whatever pace feels right. If you also want community, you may find our group therapy helpful — being with other people who understand, without having to explain.

You Deserve Support

This was a pregnancy loss. Your baby was real. Your grief is real.

You made a decision from love — love for your child, love for your family, love for the life you knew you could actually give. That doesn't make it painless. It just makes it complicated in the specific way that love makes things complicated.

If you're ready to talk to someone who understands — someone who won't ask you to justify or minimize or rush — we're here.

Reach out to start therapy at our Brentwood office or via telehealth anywhere in California.

You can also read about our broader support for pregnancy loss and miscarriage grief.

Frequently Asked Questions

Is it normal to grieve deeply after a TFMR, even though we made the decision ourselves?

Yes. Making an informed, loving decision to end a pregnancy doesn't make the grief any less real. You lost a baby you wanted. The fact that you made an impossible choice out of love for that baby doesn't protect you from mourning them. TFMR grief is pregnancy loss grief — complicated by the weight of having had to decide.

Why do I feel so alone after my TFMR — like I can't talk to anyone?

TFMR is one of the most isolating losses because it's still stigmatized and widely misunderstood. Many parents can't share what happened without risking judgment, which means the support networks that show up after other losses often don't. Therapy gives you a space where you don't have to edit yourself or protect others from the reality of what you went through.

How is TFMR grief different from other pregnancy loss?

All pregnancy loss involves grief, but TFMR carries specific layers: grieving the diagnosis, the decision itself, the future you'd imagined, and often a child who was wanted and named. There can also be moral distress — questioning the decision even when you know it was right. A therapist who understands TFMR specifically can hold all of that with you.

What kind of therapy helps after TFMR?

We draw on grief therapy, trauma-informed approaches, and EMDR when the experience had traumatic elements — which it often does. We also create space to talk about the child you lost as a person, which many parents desperately need and rarely get. You don't have to minimize what happened to receive support here.

Is TFMR the same as a miscarriage?

No — though both involve pregnancy loss and carry real grief. A miscarriage happens without a decision being made; TFMR involves an active choice in response to a diagnosis. The grief can look similar in some ways and very different in others. Therapy that's specifically informed by TFMR is more useful than general pregnancy loss support for many people.

Will my therapist judge me for the decision I made?

No. At The Mother Hood, we approach TFMR with the belief that you made the most loving decision you were capable of making in an impossible situation. Our role isn't to evaluate your choice — it's to support you through the grief that followed it.

How long does TFMR grief last?

There's no set timeline. Some people begin to feel more integrated within months; for others, grief resurfaces at anniversaries, during subsequent pregnancies, or at unexpected moments years later. Therapy isn't about reaching a point where you no longer feel anything — it's about being able to carry the loss without it taking over your life.

What if I tried to get pregnant again and it didn't work?

Some people go through TFMR and then face secondary infertility or further losses. This can compound the grief significantly. Our fertility and IVF support page covers some of what comes up in this territory — you're welcome to reach out and talk through what you're experiencing.

Do you offer telehealth?

Yes. We offer therapy throughout California via telehealth, and in-person sessions at our Brentwood office (12011 San Vicente Blvd, Suite 402, Los Angeles).

For a comprehensive overview of maternal mental health support in Los Angeles, visit our maternal mental health Los Angeles page.

The American College of Obstetricians and Gynecologists acknowledges that termination for medical reasons carries a grief that deserves the same compassionate support as any other pregnancy loss.

Medical Disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. If you are experiencing a mental health emergency, please call 988 (Suicide & Crisis Lifeline), text HOME to 741741 (Crisis Text Line), or contact the Postpartum Support International Helpline at 1-800-944-4773. Always consult with a qualified healthcare provider about your specific situation.