James' World 2

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Sixteen weeks into my second pregnancy, I had a miscarriage alone at home on an otherwise unremarkable autumn afternoon. I had officially entered the supposed “safe zone” of the second trimester, the point in pregnancy where risks of fetal complications and loss drop dramatically. By the time I saw bright red blood, I was certain I was “out of the woods.” I had finally begun to wrap my mind around the idea of having another child. My husband and I were excited to introduce a newborn into the confident rhythm we had established with our 3 1/2-year-old son. It was the beginning of one of the most devastating and profound experiences of my life. As a clinical psychologist who specializes in reproductive and maternal mental health, I was well aware that up to 1 in 4 pregnancies end in miscarriage. I knew the heart-wrenching reality of that experience as well as I could without having yet lived through it myself. Throughout my own pregnancy, I’d listened to heartbreaking stories of pregnancy loss, including chemical pregnancies, ectopic pregnancies, twin loss, infant loss, stillbirths, and terminations for medical reasons. I’d sat with countless women as they processed their grief, how their histories and experiences compounded those feelings, and how the unfortunate silence, stigma, and shame that so often follows pregnancy and infant loss heightened their pain. Now, however, my theoretical knowledge of the experience became corporeal.

Despite the fact that up to 25% of known pregnancies end in miscarriage (the actual number being likely much higher due to chemical pregnancies and underreporting), research shows that a majority of women feel a sense of shame, self-blame, and guilt in the aftermath of pregnancy loss. Cultural ideas about women’s bodies and patriarchal messages have wormed their way into women’s own perceptions of themselves, firmly planting the idea that if we haven’t “successfully” carried a healthy baby to term, our bodies must be somehow defective or inadequate, or we must have done something “wrong” to cause the loss. However, most miscarriages are the result of fetal chromosomal abnormalities, not the result of anything a woman did or didn’t do. Despite this, a national survey found that people believed miscarriage could be caused by going through a stressful event (76% of responders), lifting a heavy object (64%), previously having an intrauterine device (IUD) (28%), or taking birth control pills (22%). The misconceptions surrounding miscarriage get even wilder: The survey found 21% of people believed it could be caused by getting into an argument, 7% thought it could be caused by moderate exercise, and 4% thought it could be caused by having sex.

In my practice, I’ve found that the impulse to blame ourselves is often about perceptions of control. If I did something wrong and this is my fault, that means maybe I can do things differently the next time around and therefore change the outcome. There is shame in those thoughts, but perversely, there is also a sense of agency. That grasp for control is closely related to the cultural stigma attached to pregnancy loss that prevents women from talking about it openly and breeds isolation and misinformation. But when women know the facts about miscarriage and why it happens, they are less likely to blame themselves.

While I fully believe in the importance of talking about stigmatized issues like pregnancy loss, sexual trauma, anxiety and depression, and aging, I know from experience that doing so is hard.

 

We live in a culture that tells women that so many of the challenges they face are somehow our fault and that whatever we’re feeling about those challenges should be kept quiet. That cultural message often keeps us from talking about the most important and real experiences in our lives, overwhelmed by the fear that if we do speak our truths, we will be met with stunned stares or awkward lapses in conversations. But in the absence of real, nuanced, and sometimes messy conversations about the truth of our experiences, we feel ashamed and often end up turning our pain inward, convinced we should be able to swallow it and push through.

Even as someone who fully believes in the importance of talking about stigmatized issues like pregnancy loss, sexual trauma, anxiety and depression, and aging, I know from experience that doing so is hard. There’s no single source of the pressure to stay silent about these taboo subjects; it’s in the water, so to speak. Women go through so many potentially momentous transitions over the course of their lives, inhabiting many roles and navigating continually changing bodies while fielding messages from a culture hell-bent on telling them how to look, how to feel, how to act, how to be at every available opportunity. In so many moments in a woman’s life, there’s an insidious whisper: This is too messy. Don’t talk about it.

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