She berated herself aloud, wondering if she’d made the “wrong decision,” if this somehow made her a “bad person,” and if by making this “choice” she’d be “punished” and unable to get pregnant once again. She worried that people’s judgment and lack of empathy were, in fact, justified. This worry of hers turned swiftly into rage, resentment, and harsh self-blame.
I’ve seen this time and again: disappointment from the outside internalized. I’ve watched as shame, stigma, and judgment whittle away at the resolve of those already in mourning, eventually overwhelming and manipulating the truth: That this is not their fault. That they did nothing wrong. Oftentimes, it is society at large’s ignorance, indifference, or prosecutorial criticisms that lead us to believe our losses are our fault. A punishment we somehow deserved. Pain was accumulating. It was palpable. “Your grief is yours,” I’d repeat. “You did absolutely nothing wrong. If this was a decision, you made a loving one. You deserve as much support as anybody else. You are entitled to your grief. It is yours.”
Sometimes my words seem immediately absorbed, and I can watch via body language the relief envelop my patients. Other times, this mantra, as it were, is skimmed over or worse, outright rejected. And in those moments, I witness them clinging onto self-hating beliefs and gutting guilt, their bodies rigid with blame. I stay the course and meet them where they are, time and again, as they process what they’ve experienced and people’s reactions to it. This is what support looks like. This is what we all deserve: to be buoyed no matter where we are.
To be heard. To be validated. To be nurtured. To be safe. To be steady.
These are the ways of support. You are entitled to your feelings. They are yours, and yours alone.
• • •
I think we are somehow conditioned to believe that grief is an evaluable property. That if we stack it up against others’ experiences (or our own), we can determine how long and how strongly we—or they—ought to be grieving. Like there is some invisible point system, tallying what we are allowed to feel, how long we are allowed to mourn, whether we have met the minimum tragedy threshold to be allowed to ask for help. With pregnancy loss, especially an early one, you might find, for example, that people think it is not deserving of the same type of compassion we offer those who have lost a relative, or a friend. “Aren’t you over it by now?” or “at least it happened early in the pregnancy. You’ll move forward quickly” are two salient and all-too commonly spoken examples I hear about in my office from patients and in online conversations. Bombarded by crushing disappointment and disillusioned despair, women express how dumbfounded they are—having thought their loved ones were more capable of nuanced empathy than they showed themselves to be. It’s as if the perceived severity of a loss situation somehow determines a grief time frame and its course, one that is delineated by others—others often being people who are not in the throes of it themselves.
But grief needn’t be monitored or surveilled. Though one woman’s loss might seemingly be “easier” or “harder” than somebody else’s, we can’t really know what her emotional experiences leading up to this point have been. One woman’s six-week loss might be felt as a normative, expectable, and unemotional event, while another woman’s six-week loss might yield complex ongoing grief. We can’t know unless we inquire. We all bring our individual histories of loss, community, and support to current losses.
Next time you hear about a loss, try to remember that one person’s interpretation might be altogether different than the person’s standing beside them. One woman might get pregnant “easily,” another through IVF; another has suffered multiple losses, another already has many children but wants more, and another thought she never wanted to be a mother—the list goes on. No matter the specific details of what any one person is going through, we all benefit from loving support and the suspension of judgment.
• • •
Still, it is not easy to know what to say, a fact I understand. Scrambling to show compassion or to avoid putting our feet in our mouths can surely prove onerous. The following bit of guidance on what to say—and what not to say—after a loved one experiences pregnancy loss can hopefully change all of that.
Don’t say: I haven’t reached out because you seem fine. I thought it was better not to bring it up.
Do say: You can turn to me—to vent, weep, reflect. I’m here to listen.
Some people prefer privacy, others long for support, or a little bit of both. Find out what she wants. Do not disappear. Challenge yourself to show up even if it makes you uncomfortable.
Don’t say: At least you know you can get pregnant. Things will be different next time.
Do say: I’m sorry for your loss.
Resist predicting the health of future pregnancies. Attempting to foresee like this minimizes what just happened, how she’s feeling in this moment, and assumes she will try again.
Don’t say: My miscarriage wasn’t as difficult as yours, mine happened early, in the first trimester.
Do say: This is a significant loss.
People start picturing their future families at different stages. Resist comparing trauma. Swapping stories might provide support—but it could just as likely create anxiety, envy, or resentment.
Don’t say: At least you have a healthy child. You were ambivalent about having another baby anyway.
Do say: …
Say nothing about her future babies or current children. Now is not the time. Shame, guilt, and self-blame are common among women who miscarry. Bringing up her ambivalence could compound confusion.
Don’t say: The baby wasn’t healthy. Aren’t you relieved things ended early? It wasn’t really even a baby yet.
Do say: How have you been feeling since receiving the test results—since learning the baby wasn’t healthy?
Millions of pregnant women miscarry every year. Despite the fact that miscarriage is common, many women who miscarry feel alone. Often, they’re scared of what this loss might mean about their reproductive futures. This is not the time to debate what constitutes an embryo, a fetus, or a baby. Loss is real, no matter the time frame.
Don’t say: You can always adopt.
Do say: I will not focus on “fixing” your future. I can be present with you in your pain.
Unless asked, do not give advice on family-building options. Let her lead the discussion about how she envisions her reproductive future.
Don’t say: It wasn’t meant to be. Everything happens for a reason.
Do say: Some people try to pinpoint a reason why their miscarriage occurred. You did nothing wrong. This is not your fault.
Support her in shying away from searching for things she might believe she’s done to deserve or create this loss. A majority of miscarriages are a result of genetic issues.
Don’t say: You look great! You don’t even look like you were pregnant.
Do say: It’s wonderful to see you. How are you feeling?
Commenting on her body, even if you are delivering what you think is a compliment, erases her recent pregnancy. This comment could also incite anger or disappointment that she’s no longer pregnant.
Don’t say: As soon as you get pregnant again, your grief will wane.
Do say: Time eventually eases sadness.
Some women grieve, others don’t. We shouldn’t assume miscarriage affects people in the same way or for the same amount of time. There is no benefit to rushing heartache.
I implore each of us to speak up—to talk about the very things that make us uncomfortable. To examine our fears, our superstitions, and our premonitions, if only as a way to understand what it feels like to engage rather than shut down when we find ourselves reckoning with an untimely death. Be present in no uncertain manner, and engage. If conversation about the vicissitudes of miscarriage became contagious, then the shame and isolation that often accompany this type of loss could, perhaps, be contained.
6
“I don’t know what I expected her to say, but it wasn�
��t that.”
I was born in the dry heat of August in New Mexico. My father was working on the Laguna-Acoma Reservation about fifty miles west of Albuquerque as a form of government service following his medical training. His days were full of caring for patients, and my mother spent most hours of the day looking after a toddler (my sister) and a newborn (me) on the reservation, about a mile down the road from the clinic on Route 66.
Life events and pursuits ultimately led to differing yearnings for my parents. I would not be surprised if the strain of these circumstances contributed to the end of their marriage. They met at a party a handful of years before my older sister was born in Jerusalem in 1965 and married two years later—just a few weeks before my dad started medical school—and I think it’s safe to say they grew apart as they each grew up. Our family moved to Los Angeles while my father undertook his residency at UCLA. By the time I was four years old my parents had split up, and my sister and I lived with our mother, seeing our father on weekends and Wednesdays. I have no concrete memory of my parents being married. I have no memory of their divorce.
My most vivid memories during my early childhood were the stretches of time between my father’s visits. I remember Carly Simon and James Taylor blaring on the turntable in the living room, their gorgeous, plaintive voices wafting across the house while I anxiously waited for my dad to come get me.
• • •
My father was the person I turned to when tweenhood commenced. When the time came, we discussed growing pains, breasts, pubic hair, menstruation, and fledgling boy crushes. I’m sure my girlhood ease in discussing such intimate things with my father was partly because he is a physician, but it was also because he took me seriously. He was matter-of-fact about the big questions of each successive milestone. He normalized these maturational seismic shifts just by being himself, and in doing so, validated my ability to be myself. His quick wit and deep, smiling eyes inspired certitude and steadiness, even while talking about ephemeral things like bras and girl gossip and tampons.
On the one-year anniversary of my miscarriage, my father’s was the voice I wanted to hear. I sobbed on the phone, replaying the details to him as my very pregnant belly jiggled with new life. He wept, too, as we reflected on my pain and he described what it was like to hear his “baby” go through this traumatic loss. He said he admired my courage to enter pregnancy again and provided me with a resting place to lay my grief.
Two months later, my father came straightaway to see me in the hospital after Noa was born on a drizzling night in mid-December. Watching him hold his brand-new granddaughter while he retold the story of my birth felt like something out of a movie. He recounted that long-ago night: how he and my mother had zoomed like the speed of light in their beige Volkswagen bus from the Laguna-Acoma Reservation to Presbyterian Hospital in Southeast Albuquerque. My dad likes to half-jokingly throw in that he thought he might have to deliver me in the back seat of the car because my mother’s contractions were quickening and the van simply couldn’t go any faster. He talked about my mom’s unmedicated birth with me, just moments after my unmedicated birth with my daughter, and marveled at the passage of time and the awe that hangs in the balance.
• • •
“Oh my goodness, you still look pregnant!” my mother said, scanning my body up and down. It was two days after my miscarriage. I don’t know what I expected her to say, but it wasn’t that. I instantly regretted letting her visit while the trauma was still fresh.
My mother’s comment landed with a dull thud. Her words felt like a critique, an admonishment. Why was she talking about my appearance?
The comment burrowed in me the same way my conversation with Sara did—this culturally mandated bad habit women have of reducing one another to our bodies’ shapes and sizes, then calculating our worth based on these measurements. It rarely, if ever, makes us feel good, so why do we do it? Why do we persist in commenting on women’s bodies—be they pregnant, unpregnant, post–pregnancy loss, or post–pregnancy with baby? Why do we cling to this cultural obsession with women’s bodies in times of duress, as if the size of our jeans can somehow mitigate the grief of a loss or smooth over the edges of trauma?
• • •
Was the obsession with my size my mother’s way of deflecting the reality of the situation? Was she trying to distance herself from the suffering that was radiating off me in waves? It all just felt so … inadequate. I was overcome by disappointment and surprise, feelings I experienced in a multitude of ways in the aftermath of my miscarriage. An unwillingness or inability to confront the pain of what had happened. I felt it from loved ones and even some colleagues. But from my mother? Mothers are people we hope—dare I say expect—will love us wholly, protect us, know how to comfort us, and rush toward their children in moments of crisis, not avert their eyes or talk about body shape. Not rely on harmful messaging as a way to, inadequately, see us through trauma.
I didn’t respond immediately, but the unintentional cruelty of my mother’s comment sat with me all day. Unable to set it aside, I called her that evening hours after she’d left my house.
“What you said today really hurt my feelings,” I blurted out when she answered. “Commenting on my body days after a miscarriage is completely inappropriate. I just lost a baby. At home, alone! I saw a dead baby! My dead baby.”
My rational self knew that my words would probably be met with an impenetrable wall of bricks. But I was not in a rational state.
She was on the defensive immediately. “Oh, you are so sensitive, Jessica! I just never know how to get things right with you.”
She hung up.
With the angry click of the phone, and the sound of nothing but a dull dial tone, my grief swelled. I burst into tears. This wasn’t the first time I had been besieged by one of my mother’s off-handed comments. This interaction, however, marked a turning point. For years, I made excuses for these kinds of exchanges. But this time, I expected—I needed—more. I couldn’t unknow the decades of mother-daughter disappointment, just like I couldn’t unknow the devastation of seeing my dead baby dangling from me.
I called back. She refused to speak to me. With my anxiety spiking, I persisted. I called again. Finally and reluctantly, she listened.
“Of course I still look pregnant, Mom! I wish I were still pregnant. How can you not see the cruelty in what you said?”
• • •
The truth about that conversation is that it revealed many things. It wasn’t just about my complicated relationship with my mother. It was a reflection of something more pervasive. In my many years of working with patients who had lost pregnancies, I understood on an intellectual level that our society wasn’t equipped to deal with this topic, even among mothers and their daughters. But it wasn’t until I was confronted with my own loss, and my own mother’s inability to find the right words, that I felt the sting of our cultural inadequacies.
Months later, my mother and I revisited what happened between us. What I came to learn was that my mother had not known anyone who had miscarried—or, put more accurately, because of the silence around miscarriage, she wasn’t aware that she knew anyone.
She hadn’t been confronted with having to find the “right” words until now. Though her comment was unfathomable, it opened my eyes to a larger cultural issue: our lack of conversation surrounding miscarriage, stillbirth, and infant loss.
I was left to wonder if my mother—and others who have floundered in the face of this kind of trauma—would know what to say if we refused the current state of silence. I am not minimizing my mother’s transgressions. Instead, I am calling for a cultural framework that aims to normalize, destigmatize, and provide tools for mothers and daughters (and others) to empathize more wholly.
I wish my mother had supported me differently after my miscarriage. My hope is that by attending to our cultural patterns of communication with regard to pregnancy loss, we will all have access to more loving, less fraught interchanges.
&n
bsp; 7
“The body and failure become conflated. It’s a complicated coupling.”
Our bodies prepare for parenthood during pregnancy. Milk ducts swell. Bellies expand. The uterus rises. Muscles stretch. If that pregnancy is then lost, the next course of action is decided by the body, and the body alone. Depending on where we were in pregnancy, our bodies might take some time to fully comprehend and adjust to the nature of the loss. Milk arrives for a baby that did not. Hormones plunge us into the depths of the postpartum experience without an infant to serve as a breath of fresh air.
In my case, I don’t know what I thought would come of my tender breasts, which had become swollen over the sixteen weeks of my pregnancy, but it shocked me to find them engorged with milk following my miscarriage. How is the body to know when “liquid gold” no longer has purpose—that it can’t one day sustain the little being that no longer inhabits the womb? Our bodies don’t know, until they know.
The unexpected sensation began as I was on a drive just two days after my miscarriage. I peeked under my shirt and into my bra as I felt my nipples abuzz. What is going on? I thought to myself. Why are my breasts hard as rocks? My breasts began to leak—milk streamed down my now-softening belly. There was no hungry newborn to receive it. No need for a pump to collect it. No point in lamenting its waste—who it was meant for was gone. Another unforeseeable layer of grief. Another reminder of what was and then what wasn’t.
Of course, no one else saw me in that moment alone in my car. What the world around me saw instead was another choice my body made of its own volition: to rapidly shrink back to its prepregnancy state. Other people saw a woman who was, as Sara had pointed out, back in her prepregnancy pants just a few days later. I’ll admit, I was genuinely troubled by how fast my prepartum body returned. It seemed not only odd but cruel—as if my body was trying to erase a pregnancy my mind hadn’t yet let go of, even after my body had.
I Had a Miscarriage Page 9