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 pregnant people 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 recent one at that.
In the Western world, until the twentieth century, we actually weren’t nearly as hesitant 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. 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 silent, lest you jeopardize your own life.
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. 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 lost the language to pass along to us.
We were sent underground.
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 does evoke 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. 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. These answers are so, so far from the truth (which is that most miscarriages are the result of chromosomal abnormalities). 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, we’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.”
Attributing a miscarriage—and any response to it—to a personal character flaw or individual choice, rather than the basic comingling of chromosomes during fertilization and the profoundly unique ways in which we emotionally digest the happenings of our bodies, keeps us suspended in the past. In the absence of forgiveness and grace, understanding and ownership, self-blame and self-hatred are left to fester, causing far too many of us to relive these experiences and our responses to them over and over again. What could I have done differently? How did I let this happen? What if I had done X instead of Y, Y instead of Z? Should I have felt this way instead? And unfortunately, positioning a pregnancy loss as a moral or personal failing is something I hear about all too often in the context of both my work and my online community. This sentiment is prevalent in research as well.
If we believe it is standard to get pregnant and stay pregnant, we are more apt to experience shame, as we believe our experience is somehow outside of the norm. If we believe there is one response to the loss of a pregnancy, and we do not embody that response, we are also more apt to experience shame, as we assume those we express our feelings to will judge us for not living up to society’s expectations. Shame isn’t just the logical conclusion, then, but actually serves to reignite silence and stigma. It encourages a sense that we, alone, are feeling this way. Why share it with others? Why reveal ourselves to be vulnerable in that way? And so, the cycle begins anew.
If shame is where the trifecta regenerates, it’s also the best entry point to begin to break the cycle apart. As Brené Brown aptly put it, the antidote to shame is empathy. Miscarriage means many things to many people; I wouldn’t posit that there is any one defining feeling of a pregnancy- loss experience. But the best way to make room for all those experiences, for all those individual stories, is by speaking them aloud. Free from the all-too-pervasive trifecta. We may, for example, witness a sea change if we rebel against the notion that we should keep pregnancies “secret” until the second trimester, when we are “out of the woods.” That way, we may begin to see loss as “normal” (or at least common), and in doing so, break down those commonly reported feelings of alienation and isolation. If we know we’re not alone, suddenly we’re not so stigmatized. If we know we’re not alone, we can begin to chip away at that shame, letting it wriggle out of the isolating confines of our psyches, eventually fizzling out entirely as it languishes without a host to prey on. And if we could manage to do that, to squash shame when it threatens to overtake us, we can aim to ensure that future generations of women and other pregnant people will be self-possessed when it comes to this topic. That they will know—and deeply believe—that their losses have absolutely nothing to do with something they did or didn’t do. They will not hate on themselves. Period. That’s the world I want to live in. That’s the world I’m humbly hoping to help create.
From I Had a Miscarriage: A Memoir, a Movement by Jessica Zucker. Used with the permission of the Feminist Press. Copyright © 2021 by Jessica Zucker.