Up to 25% of Pregnant Women Will Experience This. So Why Aren’t We Talking About It?
Women rarely have a problem announcing that they're going to have a baby, and will even post the ups and downs of pregnancy (including morning sickness and feeling fat) on Facebook. But when it comes to posting anything about a miscarriage, the experience is nearly never shared publicly out of sheer shame.
As many as 25% of clinically recognized pregnancies will end in miscarriage, according to the American Pregnancy Association. A miscarriage is when a pregnancy ends on its own in the first 20 weeks following the first day of a woman's last period, one midwife explained to Talking Points Memo. Miscarriages are an "incredibly common" experience, which is why many women, "if they're pregnant enough times, are going to go through this," Los Angeles-based obstetrician and gynecologist Jessica Schneider told Mic.
Breaking the silence: Despite its relative prevalence, people just don't talk about having a miscarriage, which reinforces the idea that miscarrying is something to be ashamed of. There are some intrepid individuals, however, who are sharing their own stories to shift the idea that women's common embodied experiences shouldn't be stigmatized.
After Los Angeles-based psychologist Dr. Jessica Zucker's patients learn that the rate of miscarriage is higher than they thought, they frequently ask, "Why doesn't anyone talk about miscarriage if it's happening to so many women?"
The lack of conversation around miscarriages prompted Zucker, who specializes in women's reproductive and maternal mental health, to write about her own personal experience in a vivid 2014 New York Times article. "Women don't need to feel ashamed of these losses," Zucker told Mic about her decision to speak out. "No one did anything to deserve these losses and by sharing our feelings we loosen the stronghold of stigma."
Jennifer Chen, who also wrote about her miscarriage in a January BuzzFeed article titled "Why I Don't Want My Miscarriage To Stay Secret," similarly sought to ease the stigma surrounding miscarriage through her own experience. "I felt in the dark about what my body was doing, I had no idea what was going to happen," Chen told Mic. Chen said she always read posts from friends celebrating pregnancies and births on social media, but never noticed anyone discussing their miscarriage. While this may reflect how people generally share only positive news on social media, Chen observed, most people are largely exposed to "only the positive outcomes of pregnancy."
The culture of silence surrounding miscarriage may be related to the very basic instructions women are given about publicly announcing their pregnancies. Doctors have long advised patients not to reveal their pregnancies until after the first trimester, to avoid the possibility of also having to announce a miscarriage.
After writing about her experience, though, Chen realized, "so many women go through this and they're so ashamed, and they're scared and they're so alone ... and [feel] they shouldn't talk about it." This realization changed Chen, she told Mic, and she believes "this is actually a discussion we should be having in a larger sense, not just me."
Rejecting the blame and shame: This silence not only makes women feel isolated after miscarrying, but also leads them to destructively internalize the experience. Schneider and Zucker both told Mic that almost all of their patients blamed themselves for their miscarriages.
"Almost all [patients who have miscarried] try to find their fault" in the experience, Schneider told Mic. And yet, she added, miscarriages are "almost never" the result of a woman's own actions. Unless pregnant women do something, "very outside the box, like using illicit drugs or were in a major car accident," she told Mic, they are not to blame for miscarrying. Routine activities like exercising, climbing stairs or even having a glass of wine are not likely to cause a miscarriage, she noted.
"I was analyzing the things I did in that time period thinking maybe I had a drink that night or something," Chen recalled. "I think there's a lot of shame involved, thinking that it's your fault, you did something to cause it ... and that's not true," she continued. "I think afterwards, it really made me aware of a lot of women are suffering on their own and they don't need to be."
"Women go directly to self-blame as a result of our culture's focus on control," Zucker asserted, adding that blaming themselves allows women to "feel some semblance of control" over an otherwise uncontrollable, devastating experience. But this misplaced blame is not only inaccurate — it also unnecessarily makes an already challenging experience that much more painful.
The physical, psychological and financial reality: Although every woman's experience is different, depending on a variety of factors — including the stage of one's pregnancy and an individual's medical history — the general physical experience of miscarrying usually includes bleeding and cramping.
But this is hardly the end of the experience. There are a variety of decisions to be made and treatments to pursue post-miscarriage. Women can allow the pregnancy to pass naturally, take medication to aid this process or undergo a "D&C" (dilation and curettage), which Schneider said is a surgical procedure that dilates the cervix and uses suction to remove tissue in the uterine cavity. Although Schneider identified this procedure as one of the most common ways to treat miscarriage, it's one that many women are completely unaware exists until the time comes to undergo this procedure.
While education is key to reducing shame related to miscarriages, the financial realities of a miscarriage must also be addressed. As Jessica Grose revealed in a recent Slate article on the topic, D&C's are incredibly costly: Uninsured women may pay between $4,000 and $9,000 for the procedure and may still have to pay between $250 and $1,200 even when insured.
Chen affirmed this reality. Though she was in the hospital for less than 24 hours, the medical costs related to her miscarriage cost her insurance company $48,000, she told Mic. "Imagine if I didn't have health insurance and I got caught with that bill on top of feeling miserable about this whole thing, but having this financial debt," she mused.
Additionally, women are rarely prepared for the deep psychological effects miscarrying can have. "My miscarriage impacted my understanding of my vulnerability, my mortality," Zucker told Mic. "For a time I was ... deeply wounded by this reproductive catastrophe. This loss made an indelible impact on how I feel about my life more broadly." Losing a pregnancy in such a "violent and traumatic way" made her question whether or not she wanted to have another child at all.
Although she did eventually become pregnant again, Zucker also notes that she felt an "ongoing subtle, but very hearty, anxiety" in that pregnancy. Miscarrying "definitely shifted my lens and complicated my thoughts on pregnancy, parenting and life more generally," she told Mic. But, "writing about my experience eventually brought me peace of mind."
Chen also said she felt the lasting impact of the experience. "I thought that there would be a point where it would just be like, 'oh OK,' like a break up and I'd just get over it and I'm done thinking about this," she told Mic. "I didn't realize how much of an impact it has in a way that you can't get over."
While there are common threads among the experiences of those who have miscarried, one of the biggest misconceptions about it, Schneider said, is that the experience is universal. One's experience is shaped by whether or not women have had healthy pregnancies in the past and how far along in the pregnancy they were, as well as countless other factors, she told Mic.
So how can we contribute to change? In addition to writing about her experience, Zucker took to social media to broaden the dialogue through the hashtag #IHadAMiscarriage. Her goal was to "galvanize an international conversation about pregnancy loss," she told Mic, "by naming the experience, by owning it publicly [so] some of the layers of shame would get peeled back and people would better understand just how common miscarriage really is."
Ultimately, these women agree, the solution lies in recognizing that miscarriage is not a woman's fault nor should it be a point of shame, blame or stigma. It's crucial for women — and men as well — to be educated about this relatively common experience which, though certainly painful and difficult, is also a significant, impactful experience in the lives of many. By starting a dialogue, we can work together to create a social landscape in which such difficult experiences are made at least a little easier to endure.
As Zucker told Mic, "The sooner we support one another in feeling the grief rather than trying to fix it or stave it off, the sooner we will move through the pain and get more in touch with our ever-present vulnerability."