pregnancy loss

The History of Talking About Miscarriage

One morning last August, I was having a prenatal ultrasound, the second in the course of my twin pregnancy. I had arrived late to the appointment, rushing across town after walking my daughter to school, and was jittery with nervous excitement. But as my OB peered into the display, her silence was a dead giveaway. “I’m really sorry,” she said. “I don’t see any heartbeats.”

After a D and C to remove “the retained products of conception,” I rested at home, lurking on internet message boards. I was reading about the mourning rituals of miscarriage: remembrance ceremonies, religious rites, even baby namings. At a check-up two weeks later, a nurse practitioner suggested that I should speak to a grief counselor, like her other patients had.

The news that twins were gestating inside me had taken me weeks to absorb, and the sudden shift in my fate was disorienting. It did feel like a loss, but what exactly was I grieving?

Exact numbers are hard to parse, but miscarriage is common, occurring in at least one in five pregnancies, the odds rising with age. Chromosomal abnormalities that spell doom for a growing embryo are usually to blame. Once the body realizes the pregnancy won’t develop, nature takes over, rejecting it. Women have, of course, been miscarrying since the beginning of time; stories of miscarriage go back as far as the Hebrew Scriptures. But the ways we talk about miscarriage have changed, especially in recent decades. A woman’s response to losing a pregnancy, however emotional and personal, never takes place in a vacuum.

After losing her pregnancy at 16 weeks, Dr. Jessica Zucker launched the social-media campaign #ihadamiscarriage to confront the cultural silence around pregnancy loss by encouraging women to share their experiences online. Stories aligned with Dr. Zucker’s movement — and miscarriage more broadly — have cemented an idea in our minds: that women have forever suffered in silence. A Google search returns a slew of headlines: “Women Aren’t Meant to Talk about Miscarriage” (The Guardian); “5 Reasons We Need to Talk about Miscarriage Because a Culture of Silence Isn’t Good Enough” (Bustle); “Breaking the Silence on Miscarriages” (New Republic). When Mark Zuckerberg and Priscilla Chan announced in 2015 that they were expecting a baby girl after suffering three miscarriages, the internet exploded in praise for the couple’s revolutionary candor. The only problem with today’s narrative is that it’s not quite accurate — the cultural silence around miscarriage is relatively new.

Shannon Withycombe, a historian and the author of the forthcoming Lost: The Meanings of Miscarriage in 19th-Century America, spent years digging through archives, women’s personal writings, and doctors’ publications. “I found a huge range of responses and interpretations of miscarriage,” she told me. Women expressed “grief, frustration, resignation, relief, and joy. Miscarriage could lead to death and it could be a minor inconvenience.” By the late 19th century, explained Withycombe, as birth control and abortion were becoming illegal in America, there weren’t many ways to limit family size. Losing a pregnancy, in this context, could mean many different things for different women.

In 1928, Margaret Sanger, the crusader for birth control, published Motherhood in Bondage, a collection of heartrending letters she’d received over the years from women (and some men), all of them desperate to avoid pregnancy. Teeming with accounts of miscarriage, Sanger’s book shows that silence was hardly the cultural norm. “I get pregnant every two or three months and in a few weeks miscarry. I realize it is killing me,” wrote a mother of four. “Soon I’ll be gone and who will see to my little children?” Miscarriage was once synonymous with dangerous hemorrhages and infections, not to mention financially draining medical costs — no wonder women talked about this life-or-death matter. The birth-control movement fought to emancipate women, not just from unwanted pregnancies, but from the burdens of miscarriage.

That was nearly a century ago, but even as recently as the 1970s, miscarriage was seen as a public-health issue. Historian Leslie Reagan examined changing magazine coverage over the course of the 20th century, and found that the silence of the past is “overstated.” Reagan wanted to know: How and when did miscarriage become a private tragedy? Whereas stories that ran in women’s magazines once framed miscarriage as a medical matter, a blessing (nature doing its work), or a public-health issue, eventually, a different narrative emerged. Even the photos that accompanied these stories prove Reagan’s point: Articles about miscarriage once featured pictures of happy babies and healthy mothers, a promise for the future. Only recently did another image take over the genre: the empty crib, or the sad, isolated woman, sitting alone on her bed.

For many women in the 1970s, miscarriage represented the opposite of private tragedy. These women saw it as a call to public action and as such, took matters into their own hands. Lois Gibbs, a stay-at-home mom in Love Canal, New York, convinced her neighbors to help research the effects of living on a former chemical dump. With the help of a volunteer scientist, Gibbs and her community uncovered higher-than-average rates of miscarriage, stillbirth, and crib deaths. In another high-profile case (one of several that decade), Bonnie Hill, a mom and teacher in western Oregon who miscarried in 1975, led a study that suggested links between the spraying of an herbicide in the nearby national forest and rising rates of miscarriage. Spurred to investigate, the EPA eventually banned the Agent Orange–like chemical.

In February of this year, 31-year-old Sharanda Taylor caused a stir when she showed up at a Richmond, Virginia, City Council meeting carrying a plastic tub containing the embryo she had miscarried. Echoing an earlier generation of women for whom miscarriage was a private heartache and a public health problem, Taylor attributed her loss to unsanitary public-housing conditions, including vermin infestations, which had given her constant stress and anxiety, putting her at greater risk for miscarriage. In Flint, Michigan, where systemic racism has produced a dystopian water crisis, women, doctors, and researchers suspect there are links between a spate of miscarriages and the poisoned water, which has already been tied to dwindling fertility rates and a sharp increase in fetal deaths.

Today, these stories are unusual. Because by the end of the 20th century, Withycombe told me, something had shifted. “We arrived at silence because of the triumph of reproductive control and the medical triumph of prenatal care,” she said. “We ended up with this narrative that every pregnancy is intended and every pregnancy is successful.” Glimpsing an embryonic heartbeat at six-and-a-half weeks, or a positive pregnancy test just days after a missed period, means that a pregnancy becomes real earlier than ever. “We are so often told that medicine is so advanced, especially in prenatal care and reproductive medicine,” that miscarriage shouldn’t happen, said Withycombe. “Once you miscarry, especially if you haven’t heard the statistics about how common it actually is, it’s easy to think it’s your fault, or that you did something wrong. Which only encourages women to stay silent.”

There’s another layer to the recent silence: the anti-abortion movement. By entangling pregnancy loss with abortion, anti-abortion activists have seized on miscarriage as an opportunity to push the idea that life begins at conception, changing the stakes of the conversation. “Most feminists have maintained a studied silence on the topic,” wrote Linda Layne, an anthropologist of miscarriage who suffered seven losses of her own. In her work, she has called for a “new feminist discourse of pregnancy loss” to put an end to the silence, loneliness, and shame.

When I had what’s called a missed miscarriage during my twin pregnancy, my body didn’t get the message that my pregnancy wasn’t going to work out. I needed a D and C (dilatation and curettage), a type of abortion, to clear the retained pregnancy tissue. While being prepped for the procedure, already woozy from Ativan, I somehow got into a conversation with my doctor, an abortion specialist, about language. Why use the separate word “miscarriage,” instead of the medical term, “spontaneous abortion?” A British study says this separation is a recent phenomenon, and I wanted to know why. In Spanish, for example, one of my two mother tongues, it’s either an “abortion” or a “spontaneous abortion”; there’s no equivalent to “miscarriage.” My doctor said the question had come up before, but seemed hesitant to go further at that particular moment — most likely, she was too busy preparing for what was about to happen.

From a medical perspective, miscarriage and abortion are the same, even if the language we use and the emotions associated with the two experiences are not. One key difference: Talking about your miscarriage won’t get you death threats.

Though in the Age of Trump, a miscarriage will get you punitive policies. As governor of Indiana, Mike Pence signed a law requiring hospitals to bury or cremate every miscarriage, regardless of gestation stage. Last May, Florida governor Rick Scott signed the “Grieving Families Act,” making his state the first to offer death certificates to women whose pregnancies end after 9 weeks and before 20 weeks of gestation. Idaho’s “Unborn Infants Dignity Act,” introduced by Republican lawmakers, does the same. This February, an all-male group of Wyoming Republicans proposed, but ultimately failed to pass, a mandatory “certificate of non-viability.” Nebraska is now debating a “commemorative birth certificate” for any loss before 20 weeks, after which a miscarriage officially becomes a stillbirth. As historian Lara Freidenfelds wrote at the blog Nursing Clio, legislating death rituals is an affront to women. Why can’t women decide how to respond to their own experiences and needs? Equally terrible is that these laws impose emotional uniformity, a narrative of grief “to make a political point about abortion.”

Finding the language or the rituals to process the death of a not-yet-human isn’t easy, and narrative of grief can be helpful, when Mike Pence isn’t writing the script. While researching miscarriage, I spoke to several women to ask how they dealt with their losses. I heard stories about a ceremony in the park, gardens planted, online communities, and in-person support groups. One woman simply cocooned herself in bed for a week, blaming the flu. The overwhelming emotion was grief, but I also heard fear, confusion, and ambivalence — a response like my own. One woman whose pregnancy wasn’t intended expressed relief. Another, whose marriage unraveled shortly after, described her loss as a blessing.

When it comes to miscarriage, any remaining silence should be broken, no doubt, but with the understanding that there’s no one way to talk. History reminds us that a miscarriage can mean different things to different people. Some may see it as a relief or a blessing, right along any grief. Speaking openly about miscarriage means making room for everyone to talk about miscarriage, no matter what they say.

The History of Talking About Miscarriage