The emotion and attention around the model and cookbook author Chrissy Teigen’s decision to discuss her miscarriage on social media a few weeks ago remind us that this is still a topic that is not easy for many people to talk about.
Stories of pregnancy loss, and the grief and complex emotions it leaves behind, bring up new issues of how public - or how private - people want to be, and also challenge the health care system to provide truly helpful responses and support.
Even the terminology is loaded; some object to the term “pregnancy loss” as suggesting that a woman misplaced her pregnancy, and “miscarriage” seems to convey a sense of blame, as if something went wrong in the “carrying,” whereas in fact, most of these pregnancies end because there is a problem with fetal development.
As many as 10 percent to 20 percent of known pregnancies do end this way, many in the first trimester - and modern technology allows many women to know about their pregnancies much earlier than in the past.
“Collectively, it’s important the grief is being more recognized - this is a real loss,” said Angela Hiefner, a marriage and family therapist who is an assistant professor in the department of family and community medicine at the University of Texas Southwestern Medical Center.
Because miscarriage is so common, Dr. Hiefner said, health care providers in obstetric settings and also in emergency rooms may become desensitized. They need training to respond sensitively at the time a miscarriage occurs, and also to help parents find the level of help they need, whether in friends and family, in support groups, including online and social media connections, or in psychotherapy, which can be individual or for a couple.
“Every couple going through this, every partner can grieve differently,” said Dr. Hiefner, but in her practice, she sees many couples struggling, asking, “I’m going through this thing, but I’m not going through it the same as other people. Why can I not seem to get over this?” or wondering, “Why is my partner not having as hard a time as I am?”
People often come to Dr. Hiefner saying they feel they have lost something they didn’t even have. We have rituals and traditions that help people through other occasions of grief, but “those traditions don’t really exist yet for pregnancy loss - a lot of what I do is encourage parents to look for rituals that acknowledge that not only a life was lost, but these parents lost a future they had planned.”
Elaine Nsoesie, an assistant professor of global health at Boston University School of Public Health, studies nontraditional sources of public health data, and has looked at the ways that women talk about miscarriage on Twitter, seeking community.
Because miscarriages have been kept private in the past, she said, many people don’t know how common they are and therefore often feel isolated, or as if they must have been individually at fault. “People sometimes internalize it as a personal failure, rather than something that happens biologically to them,” she said.
There is a tendency to pathologize this grief, Dr. Hiefner said; if a 5-year-old died, no one would think it was comforting to say, “Oh well, you can have more kids, you’re still young,” but such messages are often offered to people after miscarriage and stillbirth, and they may be criticized if their grief persists.
Dr. Nsoesie was the senior author on a 2019 study of discussions on Twitter of miscarriage and preterm births that traced women’s accounts of their experiences and their stories of grief, including their misgivings about insensitive treatment they felt they had received. “People would say, oh, you’re going to have another baby - clinicians, too,” she said.
Because couples who have experienced a miscarriage may be more susceptible to subsequent separation and divorce, Dr. Hiefner said, her research is now looking at what helps some stay together, “what helps them navigate it successfully as a couple.”
And that includes accepting that your partner’s grief may look very different from your own. In a study of couples published earlier this year, she wrote, “the emergent themes create a picture of resilience after loss in these couples, in which the shared nature of the loss was a crucial aspect of the experience.”
Miscarriages and even stillbirths were lost or hidden losses for most of human history, perhaps in part rendered invisible by the volume of grief and anxiety that surrounded the deaths of babies who had been born alive but did not survive to grow up.
Many died soon after birth, and many more in the first months of that dangerous first year of life; as recently as the early 20th century, more than 10 percent of the babies born in the United States didn’t make it to their first birthdays.
Babies’ deaths were so taken for granted in the 18th and 19th and even early 20th centuries that many biographies, especially of the fathers of those infants, pass them by in a paragraph, or even a footnote. And there was also the ever-looming specter of maternal death; many women’s obstetric histories, right up through the beginning of the 20th century, were fraught with loss and danger. Even today, maternal mortality in the United States remains up to three times higher for Black and Indigenous women than for white women.
Miscarriages do occasionally make it into biographies, but usually because they are medically dramatic and threaten the life of the mother. Mary Shelley lost a pregnancy in 1822, and her poet husband Percy Bysshe Shelley had to pack her in ice to keep her from bleeding to death.
But when it comes to her emotional health and her grief, her biographers have to deal with the ramifications of losing her baby Clara, who was born premature and died at the age of 8 days, her next daughter, also named Clara, who died as an infant, and then her son William, who died at the age of 3 and a half. Of her five pregnancies, only one child, Percy Florence, lived to grow up.
Infant mortality dropped across the first half of the 20th century in the United States, and became even lower in the decades after World War II, as the baby boom got underway. But miscarriage remained a topic that was not much discussed in public, and certainly, the emotional implications of losing — and mourning - a pregnancy were almost completely ignored not just in public discourse, but also by the medical profession.
The first article in the medical literature that took note of parental grief following stillbirth, or delivery room death, appeared in 1959, with the title, “The Management of Grief Situations in Obstetrics.” Two decades later, in the journal Archives of Disease in Childhood, Emanuel Lewis, a psychiatrist at Charing Cross Hospital in London, noted that parents, after a stillbirth, were often left alone in silence; he argued for helping them to spend time with the baby they had lost, for taking photographs and mourning and holding funerals.
The “routine” and “expected” infant deaths of earlier centuries are now thought of as tragic outcomes to be prevented, although this is not yet a victory that is equitably distributed across the world - or even across our own society.
But with this progress, we have become increasingly able to see and hear the grief left behind by pregnancies that do not end as parents had hoped, to understand the attachment that they feel and the complex emotions when things go wrong.
“The best thing we can do is be comfortable sitting with our family members, our friends, our co-workers, saying, ‘I am so sorry you have been through this,’” Dr. Hiefner said. Acknowledge the loss and the grief, and ask what support you can provide. “It’s OK to be sitting with uncomfortable emotions and asking - that person usually knows best.”
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