• • •
A few days after my miscarriage, that familiar face of hers crinkled in shock on my laptop screen as I spewed the horror of that fateful day: October 11, 2012. Valerie was there; to hold my story, the utter disbelief, that pulverized heart of mine, my unyielding astonishment, grief’s hangover. She was there through it all, a witness to the multifarious layers: the anger outbursts, the moments I clung to denial, and was there when I flirted with hope in fits and starts. She was there just as she had always been.
My seemingly disturbing, far-flung feelings (which I soon learned are the norm) were met with understanding, and it was here I could roll around in the grief, roar about resentments, shriek in horror of the events I’d navigated. Here I had permission to get messy in the heinous struggle I so badly wished wasn’t mine.
Over the course of our sessions, Valerie and I explored what it was like to live in a worn-down body and a fractured psyche after enduring this specific kind of trauma. Although she opts not to speak in clinical language or diagnostic terminology with her patients—and therefore, I wasn’t formally diagnosed with post-traumatic stress disorder—together, we began to see how this trauma changed various aspects of my life. The symptoms of my trauma accompanied me through my days (and nights) for too long to remember. This is, of course, not unique to my experience—research has found that approximately four in ten women experience symptoms of PTSD after miscarriage.3 And several of PTSD’s hallmark signs—intrusive memories, irritability, emotional detachment, severe anxiety, to name a few—became the territory I now navigated. But memorizing statistics and perusing scientific studies to better treat my patients turned out to be far different than coming face-to-face with an awareness of the precariousness of mortality firsthand. The me that existed before my loss could compartmentalize the science from the personal and separate lived experiences from the hard data in order to provide those in need with perspective and guidance. But the me that existed after could not. Now, I was a statistic. Now, I was stuck replaying the visuals and the physical feelings associated with death occurring in my body.
Valerie was there when I realized that I had thought I was okay, but I wasn’t. And because of the hour we spent together each week, I eventually puttered out and ultimately stopped moving. Through the consistency of her emotional presence and our extensive conversations, at long last, I allowed myself to stand still and fall apart.
• • •
On the other six days of the week—the days I didn’t speak with Valerie—putting pen to paper and leaking the trauma onto the page was a godsend. Typing away on my keyboard became synonymous with a semblance of salvation. It was there, on those pages—the published ones, the eventual Instagram captions, even the ones hidden away in a Microsoft Word file that never saw the light of day—that I connected with myself profoundly, in a sort of meditation on pain. Writing had been something I loved, always—be it journaling, working on papers during both of my master’s degree programs, undertaking my award-winning dissertation, or crafting published pieces—but during this time, writing became a true conduit for survival. The empty pages don’t judge; in fact, they are begging for emotions to be unleashed upon them. Blank pages were there to receive my stories, and by telling and retelling over and over again—whether the words were hesitant or free-flowing, whether they were simplistic or robust—I created pathways to lean toward my rawest self, no matter how distressing and befuddling the feelings I found there were. But soon my need to create in the name of self-preservation morphed into something new, something capable of encompassing far more than my traumatic loss. As I continued to write, I started to hope that my words would do for others what they were able to do for me: dig trenches and form pathways through loss, grief, trauma, and mourning, so that those who felt their own variation of the same trauma I had been enduring could also find a way to stop running from the person that miscarriage, pregnancy, and infant loss had made them to be. I started to envision a scenario in which the pages honoring my own loss would assist someone in finding a unique and personal way to honor their own.
By writing my way into the depths of my heartache and engaging in conversations with Valerie that acted as a life preserver, pulling me back to the surface, I was able to inch closer to a calling I had not yet yielded: a call to action that would unveil the crushing pain I was consciously and unconsciously attempting to ward off, and, in doing so, give silent permission for others to unabashedly do the same.
*Names and details of patients, community members, and friends have been altered to protect confidentiality and maintain anonymity.
3
“The strident trifecta: silence, stigma, and shame.”
Pregnancy and infant loss have been a constant since the dawn of time. And not just for humans. It’s been discovered that humans and nonhumans alike experience grief after the loss of a pregnancy or infant. One animal study found that chimpanzee mothers whose infants died carried around the mummified remains of their babies for up to two months.4 Similar behavior has been observed in elephants, giraffes, and marine mammals.5 In addition to observing marked behavioral changes in animal life upon losing offspring—such as listlessness, standing vigil, the refusal of food and companionship—researchers have pinpointed animal grief through hormonal changes in females who have lost a baby, namely an increase in stress hormones called glucocorticoids.6 Suffice it to say, this kind of primal reaction to sudden death is not a human construct. We do not have a monopoly on grief. It is the cultural associations and reactions around it that we are responsible for, and those have changed significantly over time.
As far back as ancient legends, the theme of losing a pregnancy or infant as a consequence for bad behavior, perceived failure, or generational transgressions is fairly prevalent. In many cultures, miscarriage and stillbirth are conceptualized, even now, as direct punishment for wrongdoing; affiliation with sorcery, supernatural elements, or evil spirits; or the breach of a taboo by the pregnant woman. I have extensively researched other cultures’ perceptions of miscarriage, wanting to explore those beyond my own as a Jewish American woman to get a sense of global patterns (or lack thereof). For example, the conceptualization of pregnancy and infant loss as being a direct consequence of negative actions has been seen in Malawi, among the Maasai community, and in western Kenya, where it is believed that a woman’s wrongdoing might result in pregnancy loss.7
Certain countries have a unique perspective on pregnancy and infant loss due to the prevalence of their infant survival rates. Faced with the high probability of losing their babies, these women fortify their emotions until they know the baby will last. In Nigeria, for example, where infant and child mortality rates are high, mourning is not a practice incorporated into culture. In fact, given the rates of loss, newborns aren’t recognized as true members of society until they’ve surpassed infancy. And in Brazil, where infant survival rates are low, researchers have observed that maternal attachment and bonding are a far more gradual process than the one we observe in the United States. In Bijnor District, located in northern India, pregnancy itself is considered a “matter of shame,” and is therefore not widely discussed or celebrated. Being proud of pregnancy is frowned upon. The loss of a pregnancy is rendered a nonevent, with no rituals or communal support to accompany it.8
• • •
For as long as I’ve been researching, thinking, and writing about miscarriage, I’ve been aware of a strident trifecta that accompanies the topic: silence, stigma, and shame. These three concepts are responsible for so many of the challenges we face when it comes to pregnancy and infant loss. They work in concert at nearly all times, obstructing conversations and connection around this all-too-common topic, and isolating those who experience it. While they’re inextricably linked, they are part of a vicious cycle that actually has a starting point. And culturally speaking, a relatively easy one to trace.
In the Western world, there have been periods where we actually weren’t nearly as hes
itant to talk about the experience as we are today. For one thing, at a time when methods of birth control were virtually nonexistent, and abortion was illegal and therefore dangerous, some women welcomed miscarriage as a relief—financially, physically—from carrying and caring for more children.9 There was no reason not to put voice to that feeling. It was described in articles in the 1800s as a blessing, nature doing its job. But miscarriage and pregnancy loss could also be very dangerous for women; infection and even death were possible outcomes. It was imperative to not stay completely silent, lest you jeopardize your own life.10
There have been glimpses of this more vocal approach in recent decades, like in the 1970s, when the modern wellness trend was really born, and miscarriage became a public health issue. Women began demanding answers when they noticed pregnancy losses corresponding with safety issues like pesticide use and hazardous living conditions. We were shouting, begging to be noticed and taken seriously.11 But by and large, silence has been the norm. Especially as the twentieth century drew to a close, and access to safe, legal abortion care became constitutional law due to the passage of Roe v. Wade and birth control became more attainable than it had ever been before, things started changing. The prevailing narrative, especially among white, middle- and upper-class women, became that, essentially, all “kept” pregnancies are wanted pregnancies.
Advances in modern medicine have also been both a help and a hindrance. We can now know we are pregnant sooner than ever: tests can catch a pregnancy days before a missed period, and at just six weeks, before women may even know they’re pregnant, fetal heart tones—more commonly known as the “heartbeat”—can be detected. Advances in sonography and the introduction of 3-D ultrasounds magnify fetuses so they appear as large, and as fully formed, as infants. And so, the gestational lengths of our pregnancies rarely dictate our emotional response to them—for so many of us, they seem real the moment they begin and the connection only strengthens from there. And while the medical gains of these scientific feats cannot be understated, they have both expanded and complicated our collective reaction to pregnancy loss. Instead of being a blessing or a medical necessity, a public-health concern or a consequence of a past misdeed, miscarriage is now often associated with just one word: “grief.” And for the generations that came before us, grief was often considered a private emotion. Our mothers and grandmothers didn’t grow up in a culture where openness and dialogue about pregnancy and infant loss was encouraged, and they did not have the language to pass along to us. We have been kept underground.12
Silence has even become encoded in medical recommendations. It’s common practice in the medical community to suggest women wait to share their pregnancy news until they are “out of the woods.” In obstetric terms, that generally means waiting until after the first trimester, or around twelve weeks, when the likelihood of miscarriage is statistically lower and screenings that help determine the chance of a fetal abnormality have been conducted. Once the first trimester passes, the conventional wisdom goes, you’ve reached an ostensible safe zone—a time to celebrate and let your baby bump show. When you begin to unpack the messaging of “wait until the second trimester,” the logic goes something like this: “Don’t share your good news until you are in the clear. This way, if your good news becomes bad news, then you won’t have to share your bad news.”
Stop and think about this—really think. By suggesting that women stay mum during these preliminary weeks and in the event of an early miscarriage, we essentially remove from the conversation—and in so doing, stigmatize—any woman who doesn’t experience multiple trimesters of pregnancy. It implies that you probably won’t want to or shouldn’t share news of a miscarriage, so you shouldn’t say anything until the risk of that happening is lower.
To be clear, it’s completely understandable if you’d like to keep news of your pregnancy to yourself for however long, and for whatever reason. Miscarriages are undoubtedly hard and, for some women, they can be difficult to discuss. But it’s worth reflecting on whether you’re consciously choosing not to share the details of your personal medical history or reflexively avoiding these conversations because it’s so ingrained in us not to talk about loss. Not to talk about grief. Or worse, if you are going underground with your feelings based on self-blame or guilt.
The reality is, a miscarriage at any stage might require support, and when we encourage women to be hush-hush in the early weeks of pregnancy, we’re potentially robbing them of that support should they need it. Opening up about loss and expressing grief (candidly and unabashedly—or any reaction, for that matter) can create a sense of community and connectedness during an otherwise isolating time. It also might inspire others to do the same. Grief, like all emotions, affects everyone differently, and sometimes we don’t have a clue what we need in the throes of our despair until we are forced to survive it. We cannot assume the stage of gestation will automatically determine the potential impact of a pregnancy loss—it does not. The pain of sharing or not sharing a loss that evokes feelings of grief, mourning, longing, or self-hate, whether it happens at five weeks or forty, is poignant and individual.
I was raised as a culturally Jewish woman and taught to believe that life begins at birth—that birth is the moment when a fetus is deemed a person. Because of that teaching, I found some comfort in the idea that I didn’t lose a life, but the promise of one. And as such, I didn’t initially relate to women who, for example, upon seeing a positive pregnancy test, immediately felt spiritually connected to the idea of who this future baby might be. Over time and after exposure to various perspectives and women’s stories, I’ve come to appreciate the myriad ways people feel about pregnancy and their connection to it. No matter how we interpret what is growing in our bodies, pregnancy, and/or its personhood, we have the right to grieve upon losing it and the boundless possibilities of a future that did not come to fruition. We also have the right to feel relieved, or even indifferent, about a loss without feeling judged. We have the right to mourn the milestones reached only in the most hopeful recesses of our minds—the first steps that were never walked, the first words that were never spoken. And we deserve to do so without assigning blame to ourselves or downplaying our emotional reactions, whatever they may be, as the result of society’s inability to sit uncomfortably in grief, or any other response to miscarriage discussed in hushed, whispered tones. We need to remind one another of this very fact—the fact that there is no one at fault here, and no one is defined by the ways in which they navigate the aftermath—by refusing to sit in silence.
Because regardless of what we feel as individual women, the end result of encouraging silence on a societal level is stigma and, quite possibly, shame. We gravitate away from what we do not understand; we cannot understand what we don’t discuss. And it takes an incredible amount of courage to break away from an accepted norm, making dialogues all the rarer. Because of our culture of secrecy, many of us believe that miscarriage is uncommon; one survey found more than half of respondents believed that fewer than 5 percent of pregnancies end in miscarriage.13 And that survey shows just how widespread other related misinformation is: most respondents believed women could cause miscarriages by their actions, including experiencing stress or lifting something heavy, and nearly a quarter of respondents thought that the use of contraception, alcohol, or tobacco could result in miscarriage.14 These answers are so, so far from the truth, which is that most miscarriages are the result of chromosomal abnormalities.15 And this is where we’re starting from—a place of cultural misunderstanding amplified and perpetuated by solitude and shame. This is what we have to work with: a culture that thinks miscarriage is our fault. How can we fix it unless we talk about it?
Combine silence and stigma and you’ll inevitably reach the most personalized and arguably the most complicated spoke in the trifecta: shame. It’s a natural endpoint, the unfair result of having to internalize our thoughts when we can’t put a voice to them, and the fear that even if we did speak them, w
e’d be judged. Judged for doing something “wrong.” Or maybe we believe we did do something wrong. One of the reasons the grief from miscarriage is so complex is that our own bodies, which we believe we can control in so many aspects, are the very site of the loss. It is all happening within us, both literally and figuratively. This can make it understandably hard to translate the pain in a way others can understand. But that truth also increases the likelihood that we hold ourselves responsible. And shame is an incredibly difficult feeling to sit with. It devours from within, feeding on the guilt and self-blame it fosters in a never-ending cycle. It festers and overtakes our sense of self. Shame is perhaps best known for its propensity to spiral. I hear these thoughts all the time, both in the confines of my practice and in conversation with other women: “How could I let this happen?” “My body failed. It doesn’t work. I’m broken.” “If only I had/hadn’t exercised.” “I’m defective.” “I’m scared to tell anyone I was ambivalent about motherhood—they’ll think that’s why I lost the pregnancy.”
• • •
Celeste’s gaze was averted as she lay on my couch ascribing blame to herself for her recent loss. “I am bad. This happened to me because of me. Something is deeply wrong with me. Everyone but me can get pregnant and stay pregnant,” she said as she stared at the ceiling, cheeks hot pink, blushing with strong feelings.
Celeste’s early life may have set the stage for this way of thinking. Her mother, she recalled, had been depressed and overwhelmed ever since Celeste could remember. When Celeste was in utero, her mother—pregnant with twins—was put on bed rest in the middle of her second trimester. During labor, one of the babies died. Celeste was born healthy and thriving, but her would-be sibling did not make it. Mourning through the transition to motherhood, her mother found it tough to fully engage, to be fully present with her living child, which presumably affected the basic mirroring babies require. Bonding and attachment were compromised. Without these elemental building blocks, the development of self-esteem can be stymied. If not remedied, lack of maternal attunement can show itself as a shaky self-concept later in life, paving the way for habitual self-blame. For Celeste, this meant rampant shame burrowing its way into what she perceived to be personal failures. So, when she learned she’d had an ectopic pregnancy, she assumed it was her fault.
I Had a Miscarriage Page 5