TFMR (Termination for medical reasons)

If you've found your way here, something brought you.

Maybe a scan room that changed everything. Maybe weeks of waiting for results that you already half-knew. Maybe a decision you had days, hours, or just minutes, to make. Maybe a procedure you have not been able to fully describe to anyone. Maybe a body that still remembers a pregnancy your arms cannot hold. Maybe a loss from years ago that you carry quietly, because so few people understand.

Whatever brought you here, your baby was wanted, your decision was made with love, and your grief is real. You are not alone.

What is TFMR?

Termination for medical reasons (TFMR) is the ending of a wanted pregnancy following a serious diagnosis[2]. This is not the same as an elective abortion, and it is not how most parents would ever describe it. TFMR parents have, almost without exception, been planning, hoping for, and loving the baby they had to say goodbye to.

TFMR can follow a diagnosis of:

Diagnoses can be made at the 12-week scan, the 20-week scan, or later. Some are confirmed only after invasive testing, such as CVS or amniocentesis. The decision to TFMR is never simple and never one parents wanted to be making.

The UK legal context, briefly

In England, Scotland and Wales, TFMR is provided under the Abortion Act 1967, most commonly under "Ground E", where there is substantial risk that the child would suffer from such physical or mental abnormalities as to be seriously handicapped. There is no time limit for TFMR under Ground E. Northern Ireland law was reformed in 2019 and now permits TFMR under broadly similar circumstances.

The legal framing of TFMR sits within abortion law, but the lived experience is one of pregnancy and baby loss. UK charities, NHS bereavement services, and the Baby Loss Certificate scheme all recognise this.

How common is TFMR?

At least 5,000 pregnancies a year end in TFMR in the UK[3], roughly twice the number of pregnancies that end in stillbirth. Despite this, TFMR remains one of the most invisible forms of baby loss because of the silence and stigma around it.

In a recent UK survey of more than 1,300 TFMR parents, around 87% reported feelings of guilt and 80% reported feelings of isolation[2]. Around 72% felt their experience was not the same as other types of baby loss, and many described not feeling at home in general baby loss support spaces. This is part of why dedicated TFMR support is important and needed.

The weight of the decision

The TFMR decision is one of the most agonising a parent can face. There is no time to prepare, no playbook, often no obvious "right" answer. Parents describe:

• Trying to absorb a diagnosis they may never have heard of before.
• Weighing what continuing the pregnancy would mean for the baby, in terms of suffering, prognosis and quality of life, and what it would mean for the woman, the partnership, and other children.
• Reading every piece of information they can find while feeling unable to make sense of any of it.
• Feeling that there are no good options, only different versions of grief.
• Wishing the decision was being made for them, and at the same time fiercely protective of being the one who decides.

Whatever you decided, you made the decision out of love. Counselling, including before and during the decision, is offered through fetal medicine units and through ARC. It can be valuable both to help you reach a decision and to support you afterwards.

What TFMR can involve

The procedure depends on gestation, on the diagnosis, and on local provision. In general terms:

You have the right to be cared for by people who treat your baby and your loss with the dignity they deserve. If care has fallen short of this, your hospital's PALS service, ARC, and Sands can all help you raise it.

The physical and hormonal aftermath

TFMR is a significant physical event as well as an emotional one. After any TFMR:

• Bleeding and cramping can last days to weeks.
• Lactation can begin from around 14 to 16 weeks of pregnancy onwards, and is often deeply distressing. A midwife or GP can advise on managing this, including with medication if you wish.
• Hormones drop sharply, similar to what happens after a birth. The hormonal aftermath can bring mood instability, anxiety, sleep disturbance, hot flushes, night sweats and brain fog in the days and weeks following.
• Periods usually return within four to eight weeks of an earlier TFMR; later TFMRs may take longer.
• Pregnancy hormone (hCG) takes days to weeks to reduce, so pregnancy tests can remain positive for a time afterwards.

This hormonal experience matters. It is not "just" the grief. Both the grief and the hormonal impact are real, they are happening at the same time, and both deserve recognition.

The grief

Grief after TFMR is profound and layered. Almost everyone who has experienced it describes some version of:

• Love and grief, completely intertwined.
• Guilt, even when you know TFMR was the right choice.
• Anger at the diagnosis, at the world, at having to make this decision at all.
• Isolation, because so few people know, and so few of those who know really understand.
• Fear of being judged by family, by friends, by faith communities, by anti-choice rhetoric, by themselves.
• Identity questions around motherhood, parenthood, womanhood, and the future.
• A particular kind of disenfranchised grief, in a culture that doesn't quite know what to do with this loss.
• Waves of fresh grief that return around anniversaries, due dates, milestones, and other people's pregnancies.

These reactions are appropriate to the loss of a baby you wanted, the trauma you may have experienced, and a decision you never expected to have to make.

Mental health risks worth knowing

The mental health impact of TFMR is significant. Research consistently shows that around half of women develop post-traumatic stress symptoms in the months after TFMR, and around a quarter experience clinically significant depression at four months[4]. Rates are particularly raised in those with a previous psychiatric history, a history of trauma, or limited social support.

These symptoms often soften with time, but can return around anniversaries, such as the date of diagnosis, the date of TFMR, or the expected due date, and during subsequent pregnancies. None of this is a failure. It is a reasonable response to one of the most difficult experiences a parent can go through.

Partners and family

Partners of TFMR parents are often overlooked and yet are grieving deeply too. They may carry:

• Their own grief for the baby and for the future.
• Trauma from being present at scans, conversations and the procedure.
• A sense of needing to "hold it together" for their partner, while having no space for their own feelings.
• Guilt about not being the one who carried the pregnancy.
• Difficulty knowing whether and how to talk about it.

Partner grief deserves space and support in its own right. ARC and Petals both offer specific support for partners. Couples often grieve at different rates and in different ways. This is normal, but it can be painful, and couples counselling with someone familiar with baby loss can help.

Other children in the family may also need space to ask questions and to grieve, in ways appropriate to their age. Compassionate, clear, age-appropriate language is generally better than metaphor or silence.

Anniversaries, subsequent pregnancies, and "after"

There is no fixed timeline for TFMR grief. It often softens, but does not disappear on a schedule. Triggers can include:

• The date of the diagnosis.
• The date of the TFMR.
• The original due date.
• The age your baby would have been.
• Other people's pregnancies, scans, and births, particularly at the gestation you were at.
• Subsequent pregnancies, which are often intensely anxious, especially around scans and at the gestation of the TFMR.
• Perimenopause, when the question of fertility shifts into a different phase.

If you are pregnant again after TFMR, please ask for additional support early. UK fetal medicine units, bereavement midwives and specialist counselling services can all help carry this. Tommy's, ARC and Petals all support pregnancy after loss.

The Baby Loss Certificate

Since February 2024, parents in England can apply for a free Baby Loss Certificate to recognise a pregnancy loss before 24 weeks, and the scheme explicitly includes TFMR. Since October 2024 the scheme has been open to losses at any time in the past, not only recent ones. Each certificate recognises an individual baby, and both parents can be named. Applications are made through the GOV.UK website.

Losses from 24 weeks onwards are registered separately through the stillbirth process and receive an official stillbirth certificate. A baby born with any sign of life is registered with both a birth and a death certificate.

What helps

There is no "getting over" TFMR. There is finding ways to live with it. The things that tend to help, in different combinations for different parents:

When to ask for help

You don't need to wait, and you don't need to be in crisis. Reasons to reach out include:

• Grief, intrusive thoughts, flashbacks or numbness affecting daily life.
• Difficulty sleeping, persistent low mood, or panic.
• Anxiety about subsequent pregnancy.
• Relationship strain that you can't navigate together.
• Triggers, including anniversaries, scans, and others' pregnancies, that feel overwhelming.
• Carrying TFMR alone, with no one in your life who knows.
• Wanting to talk to someone who is not going to flinch or judge.

Trusted UK resources

Frequently asked questions

Is TFMR the same as an abortion?

Legally, in the UK, TFMR is provided under the Abortion Act 1967. In every other sense, emotionally, relationally, and in lived experience, TFMR is not what most parents would describe as an abortion. It is the loss of a wanted baby following a serious diagnosis. UK charities and NHS bereavement services treat TFMR as a form of baby loss, and the Baby Loss Certificate scheme explicitly includes it.

Did I make the right decision?

There was no decision that was free of grief. Whatever you chose, you chose it because you loved your baby. Many parents find it helps over time to acknowledge that they made the best decision they could with the information they had, at a moment they didn't choose. A counsellor familiar with TFMR can help you sit with the question if it returns.

How long will the grief last?

There is no timeline. Grief often softens over months and years, but does not disappear on a schedule, and waves of fresh grief can return around anniversaries, due dates, milestones, and during subsequent pregnancies. None of this means you are stuck or doing it wrong. It means your baby mattered.

Should I tell people?

There is no right answer. Some women find it deeply healing to be open about TFMR. Others share only with a few trusted people, or stay quiet for years. Both are valid. You do not owe anyone an explanation, and you are also allowed to tell your story when and to whom it feels safe.

Can I have another pregnancy after TFMR?

Most TFMR parents who want to go on to have another pregnancy do so. Depending on the diagnosis, you may be offered genetic counselling and additional monitoring or testing in subsequent pregnancies. Pregnancy after TFMR is often intensely anxious. Early specialist support, ARC and Tommy's all help.

Is it worth having therapy?

For most people, yes. TFMR-specific counselling, through ARC, Petals or specialist therapists, supports the particular grief, trauma, and decision-related weight of TFMR. Going gently towards support is not a sign of weakness. It is a recognition of how heavy this is.

Take what's useful. Leave what isn't. Go gently with yourself. You wanted this baby, you grieved deeply, and you are not alone.