Miscarriage affects almost 1 million women in the United States every year. It’s incredibly common, but we don’t talk about it. Instead, women tend to quietly blame themselves, says Dr. Kate White, associate professor of obstetrics and gynecology at the Boston University School of Medicine and the vice chair of academics at Boston Medical Center’s OB/GYN Department, who has suffered miscarriages herself.
“People who are pregnant think: ‘If I’m eating the right things, staying active, and getting prenatal care, everything should be totally fine.’ I’m not saying that optimism is a bad thing — but people are shattered when their actions don’t lead to the outcome that they wanted. Pregnancy is really out of our control, but because we think that people are sort of responsible for their own fate, a bit of stigma and blame happens when people have a pregnancy loss,” White says.
And, if we do choose to share our loss, there are those comments from well-meaning but clueless people, such as, “At least you know you can get pregnant!” Helpful.
“Let me say that no comforting words ever followed the words ‘at least,’” White says.
COVID has also complicated things (of course): It’s tougher to get in-person visits; partners are often kept out of appointments, meaning women hear bad news alone; and some women are reluctant to go to the doctor at all for fear of exposure, she says.
As we cope, White says families should reframe miscarriage as bad luck — something that can happen to anyone and often does. She wrote the new “Your Guide to Miscarriage and Pregnancy Loss: Hope and Healing When You’re No Longer Expecting” to stop the stigma and open up the conversation. I chatted with her about how to cope with miscarriage, especially during a kid-focused holiday season when you might just want to hide (or dodge tone-deaf inquiries from granny).
What was your impetus for writing this book? What isn’t talked about enough?
I wanted to pull together both the medical information that I think people don’t always get from their doctors — because sometimes they’re just in shock, and they can’t absorb the information — and also the emotional information about what the path is like. As a doctor, I know what patients go through medically. I don’t see what happens when they go home. It wasn’t until I had my own two losses that thought, ‘Oh, this is just the beginning of this journey.’
Why does miscarriage happen?
When I see people in my miscarriage clinic, this is exactly what I say: Most miscarriages in the first trimester of pregnancy happen because there’s a chromosomal or genetic problem with the pregnancy, which means that a healthy egg and a healthy sperm get together but there’s some kind of mistake in those first few days after fertilization. I compare it to baking versus cooking. With cooking, you can throw anything in an omelet or a casserole and be totally fine. But baking is precise, and if you don’t follow the recipe exactly, what turns out may not even be edible. The ‘recipe’ to make a human is very much like that. It doesn’t take much to have a little duplication of some information here, a little break and loss of a chromosome there. That can doom the whole pregnancy. This happens in the days after you get pregnant, before you even know you’re pregnant. That’s the biggest cause, which means I tell people: This is not related to what you eat, if you had a drink, if you had sex, if you were stressed, if you didn’t sleep enough, if you lifted your 4-year-old nephew.
If you’re thinking: ‘Oh, I didn’t take care of myself. I didn’t do the right things. I made that happen’ — No! Sometimes it’s harder to accept that we don’t have the control. But, in reality, it’s out of our hands.
Why might a miscarriage happen after the first trimester? I know we tend to think, ‘OK, I made it past the first trimester!’ You feel like you’re safe.
The majority of miscarriages are in the first trimester. In the second trimester, there are four categories, not to get all PowerPoint on you. The first is abnormalities in the baby. ... birth defects that don’t originate on the chromosome, but that just happened in development. That’s a big cause. The second thing is medical illness in the pregnant person, because there are medical illnesses that make the pregnant person so sick that it actually predisposes you to loss during the pregnancy, such as diabetes, high blood pressure, and autoimmune conditions like lupus. Or there are structural problems with your cervix or your uterus, where your cervix has weakness, or what’s called insufficiency, and it dilates too soon. Sometimes, if you have an unusually shaped uterine cavity, that can predispose you to a loss as well. And stillbirth is the loss of pregnancy in the last trimester, which is less common than the other two — but it’s still about one in 160 pregnancies, which is about 1 percent of all pregnancies in the US every year. There are risk factors for that, but sometimes it’s unexplained, which is horrible … when you don’t know why it happened.
Are more women miscarrying due to COVID?
Happily, COVID does not increase the risk of miscarriage, which is great, but we do know that people who are pregnant who get COVID are more likely to get incredibly sick. And then, if they get incredibly sick, the baby is at risk as well.
Could you talk about how miscarriage affects people of color?
Women of color are much more likely to have pregnancy loss or pregnancy complications, and the thinking is that it is due to the chronic stress on their bodies from living in a racist society. Racism has negative health outcomes. That’s real. . . . It affects their body on a deep level, which is very different than an ‘I’m so stressed out’ kind of feeling. It affects blood pressure and hormonal regulation.
For readers who are dealing with a miscarriage — plus holiday stress — any coping advice?
Let me start by saying that there is no right way to grieve during the holidays. Grief is real. And I want to validate that, no matter what your pregnancy loss was, no matter how long ago it was, if you are feeling grief, you need to give it space. For some people, compartmentalizing their grief is going to work. But you do need to let it out at some point. You can run, but you cannot hide; it will catch up with you, and often when you least expect it.
So, it’s OK to be very open about dealing with your loss. It does not mean that you are weak or that you are struggling. It just means that you’ve been through something really painful, which means that you can make a mention of it in your holiday card if you want. You can talk about it with your extended family without ruining the holiday. You should be able to be your real self with your family. And you could talk about it at work, to give folks context about why you may not be your usual self and not going to all the holiday gatherings at the office. Being open can be a way for some people to really acknowledge the fact that this grief is real.
That said, it’s also OK to only be open with your family. Think about a special ornament for your tree. My husband bought a tree topper, a star for our daughter. Every year at Christmas, when we put this star in the tree, we think about her. Angel decorations are very popular this time of year, and a lot of people associate angels with lost pregnancies. If you have other kids, your kiddos could make something with crafts to represent the baby in some way, helping to decorate the house.
Think about leaving a wreath somewhere meaningful, whether it’s a place that means something to you as a family, whether it’s something like a cemetery, memorial, a statue. Or you can make a donation as part of your year-end giving to an appropriate charity. You can consider donating baby items that you had collected, if they’re too hard to keep.
And there’s always things like writing a letter to the baby. I did that quite a lot after my loss. … I could sort of just download all of my feelings and get them out of my heart. And, especially if your loss is fresh, it is really OK to take extra special care of yourself, which means shortening how much time you spend at holiday celebrations or not going at all.
As a society: What could we do better?
So, the first thing is acknowledging that miscarriage is incredibly common. It happens to one in three to one and four pregnancies, which means that it’s always happened to someone you know. When something like this happens, it’s not, ‘Oh, my God, this is some crazy rare tragedy.’ It’s actually very common. So it shouldn’t be so shocking. And this is directed to people loving someone going through a loss: You can’t fix it. You want to fix it for them, but you can’t. All you can do is hold the space and to say, ‘I’m sorry. I am here for you. What can I do for you?’
If you’re coping with miscarriage and seeking support, White recommends the following resources: