Known as the most common complication of childbirth, postpartum mood and anxiety disorders affect approximately 20 percent of women in the United States.22 Unlike the baby blues—seen in over 85 percent of new mothers, fading within two weeks’ time—postpartum mood and anxiety disorders do not go away on their own. In fact, left untreated, postpartum struggles can turn into intractable longer-term issues. Given Opal’s family history of depression, the twenty-four-week stillbirth, the grief surrounding not being able to safely get pregnant again, her conflicted feelings about IVF and embryos, and the fear that accompanied the surrogate’s pregnancy, it made sense that she was struggling. We discussed her feelings at length and monitored their course. We talked about her expressed fear of not being a “good” mother, and the nagging, persistent feelings of guilt and worthlessness. We talked about her desire to withdraw and the eerie feeling of numbness encapsulating her morning, noon, and night. She’d been emphatically opposed to considering medication when we originally discussed it, but as her symptoms persevered and her concern proliferated, she opted to revisit her next steps.
• • •
Sometimes, no matter how much we yearn for the role (or how ambivalent we are), the transition to motherhood is anything but linear. Particularly with a pregnancy loss (or several) under your belt, the imagined and hoped-for fluidity might not necessarily unfold in a straightforward way for loss moms. Be it anxiety or depression, or something more or less severe, mothering after loss can present unexpected twists and turns. And sometimes it doesn’t. Sometimes it’s smooth and ebullient. But either way, I think there is a need for pointed attention about maternal mental health when it comes to pregnancy after pregnancy loss and the potential emotional complexity that can arise in motherhood.
I think about the millions of people who have lost pregnancies and how they fare afterward. I think about the struggles that go unnoticed or unattended to. I think about how all-encompassing the role of motherhood can be. And I think about the vital importance of the mother’s well-being inside (and outside) of the dynamic with her baby. A mother’s emotional prosperity can help establish and ensure a fruitful attachment and a thriving relationship. Babies rely on parental attunement, mirroring, and consistency in care. This informs how they come to understand elemental things like love and trust. These building blocks pave the way for how they interact and interpret behavior in future relationships. And so, it is necessary to take your emotional temperature no matter how sure you are about motherhood. No matter how badly you wanted to become a parent. No matter how much you love your child. Because as humans, we are vulnerable. We are not impenetrable. We are affected by what came before. We are shaped by our experiences. And life has a way of throwing us off course sometimes—which can include pregnancy loss but also might show itself within the parenting landscape afterward. Whether you look in the mirror in those early days of motherhood and are all ear-to-ear grins or can barely even recognize yourself—barraged by disquieting, unexpected feelings—you are a mother. Don’t discount your feelings. Don’t minimize them. If you don’t feel you can do it for yourself, do it for them. Do it because you now have their eyes looking to you, and because what we model in the way we take care of ourselves (or don’t) matters.
• • •
Once my own anxiety softened—and then at long last, evaporated—I found myself back in a sturdy place from which to parent. Free from darting thoughts of worry, I embraced Noa’s place in our family and was all the more present in my interactions with Liev too. This took time. It took effort. It still does.
Even something so pure and simple as my daughter’s unconditional love was not immune to the far-reaching reins of my trauma. This is a situation many rainbow babies may not even know they’ve found themselves in—or that they’ve survived. But oh, how grateful I was to have transcended it. I often think about a phase she went through as a toddler—when she was firmly in a period of wanting to be glued to me, as if she wished we could literally merge. She wanted me by her side at all times. It was as if she remembered where she originated. This rainbow baby of mine truly makes me yearn for a pause button; a way to stop, or at the very least slow, the passage of time. Sometimes she stares at me with a knowing look, takes my face in her hands, and says, “Mommy, I grew in your body!” as if to express gratitude that everything went smoothly. As if she’s proud to have formed inside me. We made it. This girl, this love, this peace. We made it. And although life brings countless opportunities for distractions from emotional intimacy, I still want nothing more than to cozy up with this sweet one—to giggle, explore, gnaw on her edible feet, and live off of her soul-healing cuddles. I want to have forever with her, endless opportunities for us to learn together. She, no doubt, is a teacher. My teacher.
In anticipation of Noa’s first birthday, I wrote a mini ode to her. An illustration of what led to her and what has ensued since. I don’t know when, or if, I’ll ever show it to her. But I reread it often, reflecting on the rainbow that glowed over the hills of Hollywood as I labored, the one that held such significance, that yielded a sense of corporeal calm. I wrote of pushing her into the world, moaning with hope and fortitude. I transcribed the feeling of deep connection to her as I exhaled the fear that accompanied my pregnancy. I want her to know, in no uncertain terms, that I treasure the emotional roller coaster that led to her. I did not want it, but now that I have it I wouldn’t trade it away if I could.
I believe that, on some level, my darling girl somehow just knows. One morning she pranced out of her room, excitedly snuggled into bed with the rest of my brood, and said with unwavering pride, “I’m grateful for my family!” My son promptly kissed her all over and exclaimed that her feet smelled like cupcakes; my husband giggled and took her into his arms; I simultaneously welled up and grew a huge smile on my face. This is the unique place that rainbow babies occupy in families: in a way, they carry the complexity of grief we felt as well as the relief we might now feel. That is the bittersweet beauty of rainbows.
13
“Things. Things to have, and to hold, and to see, and to treasure.”
After the dreaded unmedicated D&C procedure was finally over, anchored to a reality I could barely comprehend by unruly smelling salts and salted crackers, I watched as my body slowly but surely stopped shaking. I’d lost a lot that day: a baby, a great deal of blood, an imagined future, not to mention any remaining shred of innocence I was privileged enough to still have had at forty years of age. My body reeled. My psyche too. I was taken from my doctor’s office and out of the building to our car in a wheelchair. Concerned about the possibility of me fainting from the significant blood loss, the doctors wanted to play it safe. And before I could fully embrace what had been taken from me, we were headed home—prescriptions in hand and a sip of juice to help stabilize me. Her remains stayed behind, to be sent off to the lab and analyzed. All we had were snapshots. Of her brief existence—of this liminal space we found ourselves in. Nothing more.
We took heart in knowing the fetal remains would be tested, to help determine why this unwonted experience happened at all. But that was all we thought to do. We didn’t think to ask about cremation, a ceremony, a memory box. Miscarriage doesn’t precipitate these conversations in the medical setting—about handprints, ashes, or funerals—whereas stillbirths often do. If I had experienced a stillbirth—the differentiation between these traumatic losses delineated by just four weeks, as the stillbirth term is applied to pregnancies at or past twenty weeks gestation—these options would have been presented to me. But due to what, at the time, felt like an arbitrary timeline, I was left without any tangible courses of action. No way to memorialize the life lost, save what occurred in my mind. My husband and I knew we’d be getting a call from my doctor in a couple of weeks, after she’d obtained the chromosomal testing results, but otherwise, I didn’t even consider thinking about anything I might get to have or hold. Something tactile. Something sacred. Something that signified that this experie
nce really happened. Honoring my loss or getting some semblance of closure around it was the furthest thing from my mind. I was still back in the bathroom, with the blood and the echoes of my primal scream and that godforsaken plastic bag. I was still just trying to survive.
Once my mind was able to focus on more than the sheer need to persevere, I contemplated things I’d heard and read about on the topic of honoring a loss. In my own Jewish culture, loss is seen as a normative, albeit challenging, outcome of pregnancy. For example, traditionally, many Jewish families don’t give gifts meant for unborn children (including abstaining from having baby showers) because these items could be a painful reminder if the pregnancy is lost. Despite customs that acknowledge the very prominent possibility of loss, Judaism’s position that life begins at birth leaves grieving families without standardized rites and rituals to honor a pregnancy loss. As I ruminated on my own culture’s traditions, I thought back to patients like Opal, whose faith was a consistent, guiding presence in her life, even when her belief in God resulted in feelings of inadequacy and guilt. I felt, in a strange way, almost envious that the role faith played in Opal’s life gave her, at the very least, a framework for processing her feelings; her questions about motherhood and fertility were, ultimately, a part of her relationship with God. It seemed that she, and others of similar convictions, believed that if they continued to focus on that relationship, healing through and from grief would come as a reward. While I’m not expressly adherent to the religious tenets of Judaism, I do find value in the customs. Knowing then that culturally, Judaism had little to offer in terms of schema and guidance, added to my already-frequent feelings of isolation in the wake of my loss. I yearned for comfort—and wondered if faith could provide some, like it did for Opal—but when it became clear it could not, I looked further afield.
And so, as I began to search for ritual, I let this be a moment to meditate on the nature of theological perspectives and reflect on how other spiritual codes choose to interpret and memorialize loss. For some, like Opal, there is an idea that loss, like everything, is part of “God’s plan.” This sentiment and its theological underpinnings didn’t resonate with me—why make something so heartbreaking into an experience God would have a hand in? “Everything happens for a reason” is another phrase that gets repeated in some spiritual circles. To this statement, my retort is a diplomatic “does it?” It’s a natural question, of course—one I had myself and that I parsed through after I read Rabbi Harold Kushner’s seminal book When Bad Things Happen to Good People. When Kushner’s three-year-old was diagnosed with a degenerative disease, he was faced with one of life’s most difficult questions: “Why, God?” As a result, Rabbi Kushner penned an elegant contemplation of the doubts and fears that arise when tragedy strikes. This text is a profound offering for those examining these philosophical dilemmas.
I’ve witnessed the many ways in which this question—“Why, God?”—can both aid and impede a person’s healing process after a pregnancy loss. Opal, for example, felt like she was “playing God” by utilizing IVF, the underlying message being that this experience—pregnancy and whether it was successful, the number of children her family was destined to have, when she would become a mother—wasn’t hers to determine. A higher power (the Christian God, in her case) was in charge of these reproductive outcomes, so seeking these medical options felt like an act of defiance, a deviation from God’s plan.
In Judeo-Christian scripture, God rewards the unwavering faith of a follower by granting her the ability to have children despite her being barren. “And by faith even Sarah, who was past childbearing age, was enabled to bear children because she considered him faithful who had made the promise,” reads Hebrews 11:11. Such messages can evoke feelings of inadequacy in people who are unable to get and/or remain pregnant. If God grants conception to those who are faithful, what does that say about religious women who are infertile? Who experience pregnancy loss? Who give birth to a stillborn? Religion and religious teachings can perpetuate the idea of “worthiness”—of who is, in the eyes of God, deserving of parenthood.
These edicts can also lead to a rift in one’s relationship with religion. Instead of being a source of comfort, it becomes a source of uncertainty. If God “causes” miscarriages, or at the very least allows them to occur, is this otherwordly being worthy of devotion? If our chosen faith is unable to carry us through grief, should we continue to live a life in service of that religion?
Of course, religion can also be an important way to help make sense of things that don’t make sense. The promise of an eternal afterlife in which parents are reunited with those they miscarried or delivered without breath can act as a beacon for those adrift in a sea of mourning. They are fueled by the knowledge that they will be able to love on the babies they lost once again. And in cultures steeped in specific religious teachings, the relationship with death and how the dead are honored can also provide comfort and hope. One can look at Mexican culture, for example, as a way in which death is not considered final, but an inevitable transformation of sorts. Practices such as Día de Los Muertos—the Day of the Dead—encourage and honor the constant contact between the living and the deceased. There’s a palpable relationship with those that have passed, one that is cultivated with great intention and reverence. And within these practices exists a gratefulness to God for allowing those who have passed to continue existing in connectedness with those they have left behind.
Religion can also be an important source of guidance, since spiritual leaders may act as grief counselors, consoling loss parents via scripture and providing another layer of support, especially essential for those who may not be able to afford or have access to other mental health services. In a congregation, there often exists a deep sense of community, and in times of trauma that community can provide meals, perhaps even child care if necessary, or simply distraction and a chance at reprieve. Religion and spirituality can and do provide another avenue to assist us in becoming reunited with our former, pre-loss selves, and better acquainted with the people we’ve become in the wake of pregnancy and infant loss.
• • •
Outside religion, I continued my search for concrete ways to memorialize my loss, looking to individuals in my life, scouring social media, and listening intently to patients as they spoke of theirs. People seemed to honor their losses in such meaningful, sometimes elaborate ways. But I wondered, Am I allowed to do the same? I straddled the line between an early and late loss, so what should this mean about the way I ritualized this experience (or did not)? Is this something that suits me? Honors her, me, us? Jewishly, does this feel resonant? If so, how? If not, why? I was pummeled by the options and by my thoughts on the matter. I wasn’t yet sure.
I gave myself time to marinate. There was no need to rush. And since I got pregnant again so quickly, there wasn’t much space to dig into these ideas. My head was trying its best to wrap itself around this next pregnancy and the hope I could muster that it would, in fact, last.
I was inspired by things I’d read online—Instagram posts, essays—about practices like naming. I seemed to gravitate toward basic, gentle acknowledgments most of all. Giving a name to a lost baby as a way to legitimize the dream of them, the time spent with them in utero, and the burgeoning attachment to the idea of their very existence seemed compelling. This idea grew more and more appealing in time. It seemed like such a profound way to acknowledge in a small way something so major. Through this simple act, there is a powerful way in which we capture and concretize the fact that they were there, even if ever so briefly. This not only seemed beautiful; it felt necessary.
So, three and a half years after my loss, and another pregnancy later, I named my would-be daughter. Liev had voiced wanting a sister before I had even become pregnant at all, and proclaimed that her name should be Olive. As I turned this idea over in my mind, it eventually crystallized: his would-be sibling would, in fact, be named Olive. I loved that Liev came up with it. And it seemed a perfe
ct name for her, in its symbolism and its meaning. The olive branch is a symbol of peace. Of reconciliation. Olive trees thrive under duress, bear fruit for thousands of years, and as a result, have come to represent resilience.
All of this felt fitting, like another important step in my grieving and healing process. Such reparation I found in this eventual naming—in being able to actually call her something. In my writing about loss, I could now not only talk about my loss, but also refer to the being who spurred this fierce, nascent passion in me: to change the cultural conversation surrounding pregnancy loss.
This emblematic gesture became a profound acknowledgment of the family member who never made it (in body) to our family tree, but whose brief existence deftly required the best parts of me. My fortitude. My vulnerability. My idealism. My hardiness was tough to locate at times, but my ability to adapt was with me through it all. It is with me, still. She is with me, still. My Olive.
This was a concrete step in memorializing my miscarriage, though technically not the first. Every year, on the anniversary of my loss, I light a candle. I light a candle in memory of her—a meditation on the recognition of that life-changing event, and the woman I became as a result. With pointed attention, I think about that day and reflect on all that’s transpired since. I think about whether or not she felt anything when her heart stopped beating; when she fell from my body. Did she feel pain?
On October 15 of each year, in honor of Pregnancy and Infant Loss Awareness Day, I also light a candle. In communion with the countless women living in every corner of the world who have felt some variation of pregnancy and infant loss. I think of us all. It’s astounding to consider the millions of candles lit on that particular day, and for the same particular reason. It’s an opportunity to memorialize globally, in unity. We remember. A deep ache we all have in common.
I Had a Miscarriage Page 17