When I was writing my book about miscarriage, I talked to my friend’s mother about her pregnancies for the first time. She told me about the three miscarriages she had in between her two daughters. Each happened around the same early stage of pregnancy. Two of them hadn’t bothered her at all, but one had floored her. She had imagined another sister for her two daughters and had even given her a name. She can’t remember why this second loss caused so much grief, but she could still feel its trace, decades later. As we talked, I could feel it too.
This woman’s grief didn’t have a hope of attracting the support and compassion, that many women receive today. Nor was there any interest in understanding why her pregnancies had ended. Her miscarriages happened in the 1970s and 80s when stillborn babies were routinely taken away after birth, and women urged to ‘move on’ and not dwell on things that ‘just happen’. A woman’s lot. My own first miscarriage of twin girls in the 22nd week of pregnancy, in 2002, played out a softer iteration of this received narrative – some of the staff looking after me through my long labour conveyed compassion, as did a small minority of friends and family. But I mainly swam through an ocean of silence that left me agonised and spurred on to campaign, advocate, and ultimately write a book about it all.
Now we are in a better place than my friend’s mother and I were. Thanks to decades of campaign and advocacy work, there is a greater public recognition of, and support for, reproductive loss. This includes a recognition that a miscarriage can involve a profound and significant anguish, wrapping around the bereavement of a ‘baby’. The baby nestling in mind – as opposed to how developed in body it is – is at long last being valued and honoured.
But I want us to also think about the varied experiences of pregnancy losses that are not captured by this narrative, as I’m concerned that they may not get the thought they deserve. These are the ones that usher in feelings other than grief, or that may challenge grief, or that grieve something other than a ‘baby’. I also want us to think pregnancies that end through choice – these can be bereavements too.
I’m cheered to hear stories in my consulting room, and in support groups, that speak of a very different medical and cultural landscape to when I started working in this field over 20 years ago. I know there is much room for improvement in bereavement care and funding, and woeful lapses in both continue to risk real harm being created. I will continue to join others pressing for further change, but it’s fair to say that women and their partners are far more likely to be understood after pregnancy loss than ever before. They are also more likely to become a part of an established story: that they are mourning their ‘baby’ and are ‘brave’ for sharing their experience.
We have many official signifiers to support this idea: The National Bereavement Care Pathway now has the signature of every NHS Trust in England. Baby loss certificates are available from the Department of Health and Social Care for those applying after a pregnancy loss before 24 weeks. Increasing numbers of workplaces are committing to Pregnancy Loss Pledges or similar policies, and – arguably the most notable development has been the amendment to the Employment Leave Act which will entitle employees after miscarriage to ‘bereavement leave’. Northern Ireland has followed suit with paid leave after miscarriage, and Scotland’s ‘miscarriage patient charter’ builds on the work of the NBCP. But with these great steps, an idea is emerging that a bereavement follows miscarriage, and that the grief is for a baby.
This notion can also be seen in first-person accounts published in mainstream press and broadcast stories, in books (such as my own), and social media platforms. Public stories tend to amplify emotional legibility, which ambivalent or more complex responses to loss tend not to have. This reflects a wider cultural moment shaped by polarised viewpoints, in which shades of grey are increasingly displaced by black-and-white thinking. Our digital culture tends to favour more shareable ‘hero’ or ‘victim’ narratives above others too. However each and every relationship to a pregnancy can only be described in a nuanced way. It is infused with both the real and imagined, and both of these are often intricate and always idiosyncratic.
In the introduction of my book, I wanted to impress on readers my desire to respect and honour such subtlety, and I quote: “I know of women who experience the loss of established pregnancies with little heartache, or may find a miscarriage a relief — and who don’t use the word ‘baby’ to describe what they lost. And I know that feelings may change over time, too: a miscarriage can be a relief for a while, but mourned at a later date, just as the desired termination of an unwanted pregnancy can later become a devastating loss.”
In the many interviews and conversations I had with journalists after publication, this idea was never picked up. I was repeatedly steered away from exploring a more complete emotional lexicon that is appropriate for pregnancies that end for all reasons.
While stories that were once deemed unspeakable have now become speakable, I worry that they may have inadvertently narrowed the space available for others to be adequately considered. I have heard them in the confidential conversations I have in my consulting room, perhaps because they don’t fit so comfortably in online spaces shaped by algorithms, or in a support group framed for bereaved parents. I will share with you just 2 examples – please bear in mind that they are fictional composites of many women I have spoken with.
Annie’s 12-week scan went well, her midwife checks too, but at 18 weeks of her pregnancy, her membranes ruptured and she gave birth soon after on a labour ward…. When we met, eight months later, she commended the compassionate care taken by hospital staff, but she was still coming to terms with a lasting incongruence between her feelings and what was assumed of her at the time of her birth. ‘I was asked more than once if I wanted to spend time with my baby, and to think about next steps in terms of having a cremation or burial. But we hadn’t got that far with our pregnancy to think that way.’
The couple were referred to specialist counselling, Annie went on, ‘the counsellor was lovely but she kept referring to our ‘baby’ and me as a ‘mother’ and Jo as ‘father’. We did try to explain we felt differently to this, but she didn’t seem to get it. I think she thought we were in denial, or that we were too crazed by grief to accept this – other people assumed that too. I understand that others may well have felt differently to us. Our pregnancy meant something very special, and we will never forget it, but we weren’t parents yet.’
Bea came to me after an early miscarriage. She was wholly occupied looking after her one year old son who had been conceived after after many years of trying and three rounds of IVF. She was astounded to be pregnant again, but had no mental or physical reserves to go through with it. Her miscarriage was a relief, and also tinged with wonder that her body could conceive on its own. ‘I felt proud of my body again, almost powerful. I could get pregnant after all, like all those women I used to envy who would get pregnant when they didn’t even want to be.’
I could say more about other clients who also don’t fit the received bereavement narrative. Many suffering the hell of recurrent miscarriage tell me of a strange relief that veneers an eviscerating ongoing despair when their pregnancy ends, yet, again. Another miscarriage can bring certainty at a time of overwhelming, barely bearable precariousness. Our faith, spirituality, cultural beliefs and socio-economic contexts also have a bearing on whether we can always mourn a baby – many women I know don’t mourn, knowing it’s God’s will there baby joined Him.
And while the bereavement narrative can’t capture all losses due to miscarriage, it may also run the risk of relegating the emotional impact of abortion. Just as this narrative excludes those who feel “relief” after a spontaneous loss, it acts as a barrier to those who might feel deep “grief” after an abortion. But a pregnancy ending because of reason cannot be assumed to be immunised against bereavement for another future that was impossible to fulfil. Yet women I have talked to feel less able to mourn, or talk about their loss with the freedom that those after spontaneous losses are increasingly able to do.
The comedian Grace Campbell, wrote about this in the Guardian. ‘What that doctor might never know, but I hope he will now, was that showing me that blob on a screen would provide a photographic memory for a grief I didn’t know I could feel. A grief for something I never knew, but something I know I would have loved very much. And that every time that image would flash into my head for months to come, I’d burst into tears like a child who’d tripped and wanted their mum.’
Ultimately, my hope is not to diminish the huge gains made in terms of support and understanding, but to expand them and to not let some pregnancy losses be unrecognised.