Edinburgh Scale After Pregnancy Loss: Why It Should Change

When I was 6 weeks pregnant, my husband, Ben, and I found ourselves in the harsh glow of our obstetrician’s office, anxiously awaiting the chance to get a glimpse of our little one on the ultrasound screen for the first time. She was barely the size of a lentil, but within that lentil was endless possibility — and also the potential for heartbreak.

Four months earlier, I had walked into a routine obstetrician appointment and been told that our nearly 18-week-old fetus had no heartbeat. One moment she was with us, the next she was gone, her life extinguished so quietly that I hadn’t even noticed it slipping away. The doctor called it a “missed miscarriage.” I wondered who missed it? Was I supposed to notice something was wrong, and if I had, what was I supposed to do about it? Could someone have saved her? Was that someone me?

Now I was back in my OB’s office with a new baby inside me, and while the fluorescent lights hummed overhead, the receptionist slid a clipboard of paperwork across the counter in my direction. Among the forms was the Edinburgh Postnatal Depression Scale (EPDS) — a short list of 10 assertions meant to measure the state of my mental health.

I’ve been able to laugh and see the funny side of things. Yes, most of the time.

I’ve looked forward with enjoyment to things. Yes, most of the time.

I checked the boxes quickly, almost mechanically, until I reached one that stopped me in my tracks: I have been anxious or worried for no good reason.

I stared at the line, pen hovering in my hand, unable to choose an answer. Was my anxiety “for no good reason?” Did the researchers who created these forms think my worry was irrational? What’s a good reason to worry, what isn’t, and more importantly, who decides that?

I’d spent the last four months torn between rationality and emotion. The rational side told me I wasn’t to blame for my loss — that nothing I had done or failed to do had caused my daughter’s fleeting life to end. But logic has little power over grief. Deep inside, in the tender, exhausted, hormonal, and desperate corners of myself, I still believed it was somehow my fault and, at the very least, I should have known something was wrong and done everything I could to save her. I was haunted by the relentless refrain of “Who’s to say it won’t happen again?”

Now I was pregnant with another little girl, and every step I took, every bite of food, every restless night felt like it carried the weight of life or death for this second chance we’d been given. As I sat in my OB’s waiting room with the Edinburgh Postnatal Depression Scale before me, I wondered: were my worries “for no good reason”?

A minute later, the sound of my name pulled me out of my daze. The nurse stood at the doorway, hand outstretched for my paperwork, and I followed her to a cold vinyl chair. All I wanted was to see our baby on the ultrasound screen and make sure she was still there. “You forgot to answer one of these questions,” the nurse said as she turned to me.

“I didn’t forget,” I said. “I just didn’t have an answer.” I paused, letting the silence fall around us. “Yes, I’m anxious, sometimes debilitatingly so. But no, it’s not for ‘no good reason.’”

Her eyes scanned my obstetric history on the monitor, and I saw the realization settle in. She looked at me with a startled recognition and nodded.

“You’re right,” she said softly. “It’s a poorly worded question.”

At that moment, her words felt both like validation and an indictment — confirmation that the lingering fear and panic inside me was real, but also a reminder of how easily grief and anxiety can slip through the cracks of these checkboxes that are designed to measure them.

I soon learned why. The Edinburgh Postnatal Depression Scale was developed in 1987 to identify postnatal depression, and only later was it used to detect anxiety disorders through three “subscale” questions, one of which was the question that stopped me in my tracks.

I’m still not sure whether the Edinburgh Scale was given to me that day because I had recently experienced a pregnancy loss, or if it was given to me simply because I was a newly pregnant patient coming in for my first OB check. Either way, what struck me most was that, up until then, there had been no systematic effort to check on my state of mind in the wake of such a devastating loss. Between that heartwrenching day when we lost our first daughter and this new appointment where we were meant to be meeting our second, I had multiple touchpoints with the hospital system, yet never once was my grief measured in any meaningful way: scientific, psychological, or otherwise.

Had anyone asked how I was doing? Yes, of course. But those questions were fleeting, tossed into the space between lab results and next steps. And in those rushed exchanges, what else could I say but the easy answers, “Fine, I’m getting by,” words that required nothing of them, words that easily allowed the moments to keep moving along. Doctors nodded, shared their heartfelt condolences, and then the conversation quickly shifted. The rawness of my loss slipped quietly back into the shadows while we focused on the future and getting my body ready for another try.

If I had stopped any of the doctors and nurses on my care team and asked whether I had reason to be anxious, they likely would have answered with a resounding yes. But then again, I knew how fortunate I was. I was being seen by the top fertility specialists and obstetricians in my area. I had the support of my husband, who was experiencing this grief alongside me, along with our amazing family and great friends who stood close as we navigated our way through it.

There are other tools designed for women like me who experience pregnancy loss, the Perinatal Bereavement Grief Scale, for instance — yet it remains unclear how often they’re actually used. A 2023 study found that only one-third of U.S. hospitals mandated dedicated staff time for perinatal bereavement care, making it hard to imagine that specialized scales like this are widely implemented. If postpartum mental health care is already drastically uneven — defined by gaps in who gets screened, who gets treated, and how — then it’s no surprise that those gaps widen when loss enters the picture.

In reality, most hospitals and clinics likely lean on the Edinburgh Scale, if they use anything at all, because it checks all the boxes with a single screen. But as we know and can blatantly see, its questions are not specifically designed to assess the unique anxiety that comes after a loss.

Looking back, I can’t help but think how much of a difference a single phrase might make to a woman who is still trying to assess her own state of mind. “For no good reason” may add self-doubt to an already fragile spirit. “For no good reason” may make a woman question herself more than she already is. “For no good reason” implies that there are “good” and “bad” reasons to be anxious. What are the good reasons? And the bad? And shouldn’t it be up to the patient to decide?

For women like me, there’s always a clear reason why we’re feeling anxious. Perhaps it would be a small start, but even changing the language could make space for women whose grief deserves to be seen and acknowledged. Changing the language would help us start trusting ourselves again. However we may be feeling, there’s a reason for it, and what we need is to be heard.

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