October is Pregnancy & Infant Loss Awareness Month and, as someone who had four pregnancy losses, I’ve been thinking about what this means. What do we want people to be aware of, exactly? Here are 10 things I would want others to know about pregnancy loss.
1. Pregnancy loss is common.
Until it happens to you, it’s easy to think of pregnancy loss as something rare, something that happens to “other people.” I certainly thought this way. It doesn’t help that many of us who go through losses may not feel comfortable talking openly about our experiences, which leads to less collective acknowledgment of these losses. With the “first-trimester rule,” many women don’t tell anyone that they’re pregnant until after 12 weeks, so if they lose the pregnancy in that first trimester (which is the most common time for loss), they often don’t share that either.
The truth is that one in four pregnancies end in loss, and about one in one hundred pregnancies end in stillbirth. One of my obstetricians told me he felt the rate was actually much higher: “Ask ten women if they’ve miscarried. Nine will say yes, and the tenth is lying.”
2. Despite how common it is, many of us feel very alone.
In their the New York Times Opinion piece, “ You Know Someone Who’s Had a Miscarriage,” Lauren Kelley and Alexandra March write, “Miscarriage might just be the loneliest experience that millions of women have faced.” Reflecting on her own miscarriage, Michelle Obama said, “I felt lost and alone, and I felt like I failed. Because I didn’t know how common miscarriages are. Because we don’t talk about it. We sit in our own pain, thinking that somehow we’re broken.”
Because there is not enough collective openness about pregnancy loss (though we have made strides forward as a society in recent years), many of us suffer in silence, feeling embarrassed or ashamed or guilty about our losses. The more we bring this issue into the light of day, the less alone people will feel.
3. Pregnancy losses are medical events.
Before my losses, I had assumed that miscarriages were like what you see in movies-a woman goes to the bathroom, there is a little bleeding, she is sad, and then it’s over. I was shocked to discover how unrealistic this was. My first ectopic pregnancy required emergency surgery to remove my fallopian tube (where the embryo had implanted) and, essentially, save my life. My second ectopic pregnancy required a methotrexate injection (medication usually used for cancer) to stop the embryo from growing, a process that took several weeks. My early miscarriage was a “missed miscarriage,” meaning there were no symptoms-I went to a scan and there was no heartbeat. The actual miscarrying took several weeks. With my second-trimester loss, I had a D&E (dilation and evacuation-another surgery requiring general anesthesia) to remove my son from my womb. The recovery from each of these losses was intense.
Hannah Crowder, a school teacher who had to go back to work right after her loss, told Good Morning America, “I don’t think people who haven’t experienced loss understand how invasive it really is.” US Congresswomen Tammy Duckworth and Ayanna Pressley have introduced the Support Through Loss Act to help ensure women (and their partners) get time off for physical and emotional recovery after a loss. This kind of legislation is a long time coming.
4. Pregnancy losses just happen.
According to a national survey, 76 percent of people believe pregnancy loss is caused by a stressful event, and 64 percent think that lifting a heavy object is to blame. If we think, as a society, that pregnancy losses are within our control (eg, we just need to minimize stress and not lift heavy objects), it’s no wonder so many of us feel such guilt in the wake of a loss. In the same survey, nearly half of people who’d had a miscarriage said they felt guilty.
In reality, pregnancy losses just happen, often due to chromosomal abnormalities that are completely out of anyone’s control. In a way, we prefer to think that losses are within our control, because coming to terms with randomness can be terrifying. In her essay “I Went Out Full,” Emily Bazelon writes, “Pregnancy comes with a list of dos and don’ts, and doctors and the women’s health movement like to emphasize the responsibility we have for our bodies. So, when you miscarry, it’s hard not to feel like you did something wrong.”
5. Women do not get the support they need from medical professionals.
Because pregnancy losses are common, doctors often underestimate the impact they have on patients. A friend of mine, Georgie, who had a stillborn daughter and two first-trimester miscarriages, told me, “Medical people are trained to think things through medically and often have the emotions of a ruler. They may offer words of condolence, but more often than not, they’re looking at you like a textbook, not an emotional being.” I found this to be true as well.
According to a paper, 90 percent of women desired specific follow-up care from their physician after a pregnancy loss, and only 30 percent of them received such attention. Often, healthcare providers agree there’s a gap: 74 percent of them believe routine psychological support should be provided following miscarriage, and only 11 percent feel that the level of care is adequate.
6. Pregnancy loss can lead to depression and anxiety.
It can be hard for others to understand how deeply painful this type of loss is. It’s not just about losing the baby, but about losing a dream. I had fantasized about what life would be like with each of the babies I carried. I had seen them in my mind, begun thinking of names. The profound sorrow I felt was in response to the loss of those fantasies. With each loss, I had to grieve a relationship that ended before it really began.
It’s estimated that up to 20 percent of women meet the criteria for depression after a miscarriage. Sometimes, depression can linger: Women may experience depressive symptoms up to nine months after a loss.
Anxiety is common too: In the largest study so far to assess the psychological impact of early-stage pregnancy loss, approximately one in four women suffered moderate to severe anxiety one month after a pregnancy loss. And, like depression, anxiety can linger: In that same study, one in six still suffered moderate to severe anxiety nine months after their loss.
7. Partners are affected, too.
Admittedly, I was going through so much physically and emotionally after each of my losses that I didn’t even consider my husband’s experience. But partners suffer too. They often feel helpless in the face of a problem they can’t fix. Many feel lonely, like they’ve lost their partner. Some feel the responsibility to “stay strong” for their partner even though they are really struggling too.
Dr. Shara Brofman, a licensed clinical psychologist, told the Washington Post, “A partner could exhibit a more anxious presentation, or it could be a more withdrawn presentation. It’s ‘I have to be strong for my partner. I shouldn’t show my feelings.’ All the while, internally, they’re really struggling and maybe not even recognizing it… There’s such a focus on mom and baby, but we’re trying to be more inclusive. Everyone who is taking care of someone needs to be taking care of themselves, too.”
8. Grieving is a process.
As Mira Ptacin writes in her memoir, ‘Poor Your Soul’, “They call it grief but it feels like insanity.” It certainly does. There are the five “stages,” but I quickly learned that “stages” is the wrong word. Grieving is a process, and not a linear one. I jumped around different “stages” on a regular (sometimes daily) basis. This is normal, I’ve learned. Meredith Resnick, a licensed clinical social worker, writes in ‘All the Love’, “You’ll circle around your loss until you reach a point where you notice that, instead of feeling spent and exhausted from all this processing, you begin to feel stronger and more whole. It will happen.
It’s common for those around us to want to rush us through grief. They say things like, “Everything happens for a reason” and “You’ll get pregnant again!” in attempts to cheer us up. I wish people would let us just…grieve. It has to happen, in its own way and on its own timeline. David Kessler, author and founder of Grief.com, said, “We are a grief-illiterate society. We are also a society that wants to ‘fix’ everything. When someone is grieving, they aren’t broken. They don’t need to be fixed. They need someone to sit with them in their pain and to witness their grief.”
9. Pregnancy after loss is incredibly difficult.
After a loss, many of us are told, “Don’t worry, there will be another one!” This is frustrating because 1) we don’t want “another one,” we want the baby we were carrying; and, 2) getting pregnant after a loss is often scary and does not erase the pain. As singer Domino Kirke said, “Pregnancy after loss is a whole other thing.”
Grief doesn’t magically just go away with a subsequent pregnancy. In some ways, it’s exacerbated, showing up as anxiety and depression. From the British Journal of Psychiatry: “Women with a history of prenatal loss are consistently reported to exhibit significantly elevated rates of anxiety and depressive symptoms during a subsequent pregnancy.” Even if a pregnancy is carried to term and results in a healthy baby, the grief of a previous loss (or losses) is still there. According to one study, symptoms of anxiety and depression can persist for up to three years following a miscarriage.
10. It’s possible to find meaning.
It took a long time for me to find meaning in my losses, but I did. It’s important to note that others couldn’t do this for me. Some tried, as part of their attempts to rush me past my grief and find silver linings. But meaning is a very personal thing and I had to find it in my own way.
As I wrote in ‘All the Love’: “I’ve gained so many things from my losses. I’m more confident in my own fortitude and resilience. I realize I can survive more than I ever thought I could. This has made me less fearful, bolder.
I have such a deep appreciation for life, every breath of it. I realize how fragile and fleeting it is, how it can be gone in a second. This scares me sometimes, but mostly it liberates me to just live as fully as I can. I’ve learned the beauty of surrender.
My perspective has changed, for the better. Grief and loss demand thinking about death. And thinking about death demands reassessing life-what matters, what should matter. I don’t fret about stupid things as much. I focus on my passions, my relationships. I try to live in the direction of nurturing those things.
I feel more connected to others, more compassionate. I have a new understanding of the suffering out there, much of it silent and private. I know so many people feel alone, and my heart hurts for that. My experiences have encouraged me to share my story, to reach out however I can to alleviate just a little of the collective loneliness.
All of these things, all of this meaning, does not make up for the heartache of my losses. I’m not glad I lost pregnancies. It was awful. But I figure the best way I can honor my lost babies is to show them how they changed me. They meant something. They had lasting impact. They mattered.”
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