Why 2020 Was a Breakthrough Year for Talking About Miscarriage
Thanks to a few brave women who shared their stories in public, miscarriage was in the public eye in 2020. Here's why it needs to stay there.
Sharing miscarriage publicly
Chrissy Teigen is a high-profile and active user of social media. So when she and her husband John Legend lost their third child to miscarriage in September, it’s not surprising that she shared the devastating news with her Instagram followers.
“We are shocked and in the kind of deep pain you only hear about, the kind of pain we’ve never felt before. We were never able to stop the bleeding and give our baby the fluids he needed, despite bags and bags of blood transfusions. It just wasn’t enough,” Teigen wrote of her loss at 20 weeks of pregnancy. “To our Jack—I’m so sorry that the first few moments of your life were met with so many complications, that we couldn’t give you the home you needed to survive. We will always love you.”
Striking a nerve
There was an outpouring of love and supportive messages from her followers and those who had gone through a similar experience. But there were also comments that were anything but supportive.
Some people questioned why she had to share such a private matter in a public way. Others said she should just be grateful for the two healthy children she and Legend have.
And still others wrote that the Instagram post was a way to get attention. Some even questioned whether Teigen was ever pregnant in the first place. (Here’s what not to say after someone has a miscarriage.)
No matter the nature of the comments, one thing was clear: Teigen’s post struck a nerve. She talked about miscarriage—a topic long relegated to hushed whispers in private—in the most public of forums. And the importance of her honesty, to future parents, expectant parents, and parents who have also lost children, cannot be understated.
The pain of miscarriage
“Miscarriage is a loss, but it’s a pain that’s often unacknowledged,” says Jamie Kreiter, a certified perinatal mental health clinician and founder of Nurture Therapy in Chicago. “Some people think of it as an ambiguous loss because the baby isn’t here yet. But for the parents, the loss is very real.”
In an essay on Medium, Teigen tried to convey why it was important to share the black-and-white hospital photos that documented the couple’s grief during this heartbreaking experience.
“I explained to a very hesitant John that I needed them, and that I did not want to have to ever ask. That he just had to do it. He hated it. I could tell. It didn’t make sense to him at the time,” she wrote. “But I knew I needed to know of this moment forever, the same way I needed to remember us kissing at the end of the aisle, the same way I needed to remember our tears of joy after Luna and Miles. And I absolutely knew I needed to share this story.”
The stigma surrounding miscarriage
“The silence around miscarriage creates a stigma,” says Kreiter. “It creates a sense of shame, a worry that the loss is a reflection of the individual. But a big part of this is that there are not the same traditions around pregnancy loss as around other deaths and losses, yet the grief is the same.”
When someone dies, we know what to do: Cultures have different ways of commemorating a life. There is an opportunity for public mourning and displays of grief and proper or accepted methods to express their support or condolences. We have a rule book. (Here’s what Day of the Dead can teach us about grieving.)
But when it comes to miscarriage, there is no rule book. “This is what prevents people from sharing publicly,” says Kreiter. “Not having the rituals adds to people’s fears and reluctance to share.”
Karl Tapales/Getty Images
Miscarriage as trauma
Nevertheless, the loss is harrowing for the parents. “The loss of an unborn baby or newborn is traumatic,” says Rayna Markin, PhD, a licensed psychologist and associate professor in counseling at Villanova University. It defies our basic sense of right and wrong and of the world as a basically safe and just place. One reaction to trauma is to deny or avoid it—to not want to talk about or acknowledge that these events occur and can occur to anyone.”
This innate response to trauma, coupled with the lack of rituals surrounding how to process a miscarriage, forces women and parents to deal with the experience silently without the support they may need or crave.
“We have these stories we tell ourselves about family planning and what it will look like for us,” says Kreiter. “Usually, something like ‘we prevent pregnancy until we’re ready because we’re going to get pregnant so easily.’
“But one in four women experience a miscarriage,” she adds. “We never think, ‘I could be that one person.’ So if it happens, it causes a sense of shame and failure and a distrust in our bodies. Then we suffer in silence, which prevents (us) from hearing about other’s experiences or reframing our own.” (Here’s how coronavirus impacted IVF and pregnancy.)
Breaking through the silence
How can we break through the silent stigma surround miscarriage?
In an op-ed published in November, in The New York Times, Meghan Markle revealed she had a miscarriage in July. (Markle also received messages of support and criticism for sharing her story, prompting Chrissy Teigen to speak out.)
“Sitting in a hospital bed, watching my husband’s heart break as he tried to hold the shattered pieces of mine, I realized that the only way to begin to heal is to first ask, “Are you OK?”” she wrote. (Here are other famous women who had miscarriages.)
“We don’t ask women—whether they are pregnant, postpartum, or suffering a loss—how they are doing,” says Kreiter. “It’s an unhealthy, harmful pattern that occurs throughout the whole pregnancy experience.
“Perhaps it’s that we don’t want to know the answer,” she adds. “Maybe we don’t ask because we don’t want to upset a family who is suffering or we don’t want to mention it because of the secrecy. But asking the question is so important.”
The reason: Allowing women and parents to speak about their experiences helps them feel less isolated, which can be incredibly healing. It also helps normalize what they’re going through, the same way that public figures like Teigen and Markle sharing their own experiences can.
“Losing a child means carrying an almost unbearable grief, experienced by many but talked about by few,” Markle wrote. “Some have bravely shared their stories; they have opened the door, knowing that when one person speaks truth, it gives license for all of us to do the same. We have learned that when people ask how any of us are doing, and when they really listen to the answer, with an open heart and mind, the load of grief often becomes lighter—for all of us. In being invited to share our pain, together, we take the first steps toward healing.”
The innocently unhelpful
The lack of rules for sharing news of a miscarriage also means there is a lack of rules for responding, so people feel safe responding in various ways. Unfortunately, some of these are cruel and insensitive. Others are innocent, yet unhelpful or even unknowingly hurtful.
“This is like a nurse saying, ‘You’re young, you’ll have another one,’ ” says Kreiter. “The grief and the pain they are experiencing is not about the future baby they will have. It’s about the one they lost. It’s that one they wanted. And they need to be allowed time to grieve.”
For example, the loss often occurs within the first trimester or first 12 weeks of pregnancy, as about 85 percent of miscarriages do. (When a pregnancy gets to 20 weeks, less than 0.5 percent result in fetal death.) That’s often before you’ve even had a chance to share the news of your pregnancy, Kreiter says.
So when people hear about your miscarriage, their first response is, “Oh, I didn’t even know you were pregnant,” which is neither supportive nor validating of your trauma and grief, she adds.
“Today, when you find out you’re pregnant so early and you want support, the traditions around waiting to share the news are no longer workable,” says Kreiter. She recommends telling people within your inner circle early on. “The people you would need if something terrible were to happen.” (Here’s how sewing helped this woman cope with the grief of losing her young son.)
The physician’s conundrum
Despite being in what seems like an ideal position to normalize miscarriage, doctors can find themselves stuck between a rock and a hard place.
“I don’t think patients are aware of how common miscarriage is and it would be helpful if they were,” says Annalise James Hussain, MD, an ob-gyn at the Chicago Women’s Health Group. “At the same time, I don’t always set up the patient’s expectations. I don’t include the possibility of miscarriage in my talk at a pre-conception consultation, for example.
“A lot of times I’m only meeting people for the first time when they’re coming in to confirm their pregnancy, so I don’t have the established relationship,” she adds. “I don’t want to take away their joy and excitement of seeing their baby on their first ultrasound.”
Why miscarriages happen
One thing physicians can do is help reframe how and why miscarriages occur. “When patients have a miscarriage, the vast majority of the time, they will ask if it’s something they did,” Dr. James Hussain says. “But far and away, the reasons have nothing to do with something you actively did. It’s in science and biology.”
A miscarriage doesn’t happen because a woman actively sabotaged the pregnancy in some way. In fact, it’s quite the opposite: The body recognizes that the pregnancy is not normal and will not progress properly, so for the health and safety of the mother and the baby, the body puts on the brakes.
“Half of miscarriages occur because of a chromosomal abnormality. When all the DNA was coming together, things didn’t split properly,” explains Dr. James Hussain. “The other half are things like the baby not growing in the uterus or something about the woman’s anatomy being abnormal. The body knows things aren’t right for supporting a pregnancy, so the pregnancy doesn’t progress.”
Still, Dr. James Hussain acknowledges that every parent is different in terms of how they want to deal with pregnancy loss. Some may take comfort in information like this, while others may not. (Here are the surprising facts about fertility Ob-Gyns wish you knew.)
Grieving and moving through miscarriage
One way Kreiter encourages clients to process pregnancy loss is by creating their own traditions or rituals around the loss and its anniversaries. “This helps them take back a little bit of control over the experience,” she explains. “There is also some freedom involved—they can do something the first year and then something different the next year.”
For Teigen, posting and sharing her experience served as something of a ritual. “I cannot express how little I care that you hate the photos. How little I care that it’s something you wouldn’t have done,” she wrote in the essay on Medium. “I lived it, I chose to do it, and more than anything, these photos aren’t for anyone but the people who have lived this or are curious enough to wonder what something like this is like. These photos are only for the people who need them.”
It is also important for couples to be open with how they want to grieve and process. “Women tend to want to be emotionally vulnerable and have their feelings heard and validated, whereas men tend to engage in more active coping strategies,” explains Markin. That means men may appear angry and women may appear depressed, while both are actually just grieving.
“Understanding and respecting one another’s different ways of grieving is important to bringing the couple closer together so that they can support one another through the grieving process,” Markin adds. (Here’s how to heal emotionally after a miscarriage.)
Therapy can also be incredibly helpful. “I do a lot of psychoeducation and conversations around what is grief and loss and the difference between, hope, hopelessness, and anxiety,” says Kreiter. “Miscarriage brings a sense of feeling out of control, which creates a lot of anxiety. So we talk about how people can take back control.”
These may include strategies for sharing the news and how to be clear about what you are looking for from family and friends. “And, of course,” adds Kreiter, “it’s a space for them to grieve in whatever way feels right for them. In this way, therapy can be very healing.”
- Jamie Kreiter, LCSW, PMH-C, licensed clinical therapist certified in perinatal mental health and founder of Nurture Therapy in Chicago
- Rayna Markin, PhD, licensed psychologist and associate professor in counseling at Villanova University
- Annalise James Hussain, MD, OB/GYN at the Chicago Women's Health Group
- The New York Times: "The Losses We Share"
- Medium: "Hi"
- UC Davis Health: Understanding Second Trimester Miscarriage