Research suggests that 1 in 4 women will have a miscarriage in their lifetime. As Saraiya and her colleagues suggest, over 1 million women in America will experience the loss of an expected child this year. Statistically, this translates to over 2,700 American miscarriages just today. This statistic hardly seems like an issue that can be ignored. Yet, even though the experience of miscarriage is so common, many note that it is rarely discussed. When the grief and suffering of miscarriage are not acknowledged, grief becomes disenfranchised. The goal of this post is to introduce the topic of miscarriage as a trauma-related community issue. Second, we want to name and identify the experiences that are common in miscarriage in order to open and expand conversational space for disenfranchised grief. Last, out of the naming and identifying disenfranchised grief, we want to equip you with tools and insights to curate approaches to care.
What’s already going on…
Since the turn of the century, and the development of online communities, discussions of miscarriage have begun to happen within popular culture. Common blog topics include: what not to say to, what to say, what to do to offer support, and general resources available within their specific communities. This is an amazing start to changing our perspective and response to miscarriage, but now it is time to go a step further. We want to do more than give you a few talking points on the etiquette of responding to miscarriage. We want to discuss what our communities need to know about miscarriage. Our aim is to destigmatize miscarriage, frame it within our history and culture, and also give some perspective on how the landscape is changing. It is also important to discuss the deep grief that can be experienced after a miscarriage and the uncomfortable fact that this is a type of disenfranchised grief. Here are seven things you need to know about miscarriage:
- Though miscarriage is common, we live in a culture which is uncomfortable talking about it.
- Just because miscarriage is common does not mean that it is ordinary.
- Miscarriage can lead to grief, postpartum depression, and increased anxiety about future pregnancies.
- Miscarriage defers legacy.
- Miscarriage can lead to a fractured identity.
- Miscarriage is both birth and death in the same moment.
- Miscarriage is physically painful and women need time and space to recover.
Though miscarriage is common, we live in a culture which is uncomfortable talking about it
American culture does not have many spaces where discussing death is acceptable, and yet death is very common. Historically, occurrences of miscarriage were not tracked in American religious, medical, or governmental systems. Miscarried babies are not given birth or death certificates, nor do they appear on documents such as the US Census, our Family Bibles, or our genealogical trees. According to our religious, medical, and governmental systems, miscarried babies do not exist. Think of what this tells our bereft parents. Their child in the womb doesn't count, it isn’t a person, it doesn’t matter, nor will it be remembered. This is culturally and historically how disenfranchised grief begins.
Just because miscarriage is common, does not mean that it is ordinary
Miscarriage is unique because it is common and it can also be traumatic. Just because it is common, doesn't mean that miscarriage can’t be life altering and devastating. As such, miscarriage requires an uncommon approach to a common experience. We also need to acknowledge that miscarriage for some women may be perceived as a relief because not all women who become pregnant wanted to become pregnant at that time. This polarized response to miscarriage makes it quite extraordinary.
Miscarriage can lead to grief, postpartum depression, and increased anxiety about future pregnancies
Postpartum (or the fourth trimester) depression is often associated with the time spent with one’s new born baby, but it actually includes the time after miscarriage too. It is important for pastors, counselors, and the community to be aware that both partners can enter into seasons of postpartum depression after the loss of their pregnancy. Offering continued support to both partners is helpful as preventative-care for these disorders as well as their reintegration back into their communities. Studies have shown that when grief from miscarriages are not recognized within their communities, the family experiences disenfranchised grief. Disenfranchised grief is grief that is felt by the bereft, but not recognized by their community and/or culture.
Miscarriage defers legacy
A traumatic effect of miscarriage is that it thwarts, disrupts, and defers one’s legacy. When it comes to legacy, humans are hardwired, deep within our neurobiology, to want to leave a legacy. This drive has a biological component, as with offspring, but it also has a psychological component, as with a gift that is given to future generations. In fact, legacy is so important that it is a major area of study within psychology. Psychologically, having a legacy helps people to feel good about the life they have lived and the gifts they have given to future generations. Having a legacy produces positive health benefits like reduced anxiety and increased self-esteem. Ultimately, one desire for a legacy is to be remembered in the living memories of one’s children.
Miscarriage leads to a fractured identity
At the start of pregnancy, both partners enter a season of identity transformation. During pregnancy, they move from wife to mother, husband to father; but miscarriage derails identity transformation. Charles Horton Cooley, a sociologist, suggests in his theory of identity called, “the looking-glass self,” that others are a lens through which we see ourselves. Applied to miscarriage, one’s children become a part of one’s social identity. As social identity theory has shown, identity is a source of meaning, structure, self-esteem, self-efficacy, and one’s worldview. Miscarriage can fracture one’s identity, violating or desecrating one’s worldview, or sense of self. For example, expecting mothers and fathers may report excitement with the anticipation of parenthood and a new life, ultimately a new identity. When miscarriage happens, these hopes, expectations, and imagined roles are destroyed, fracturing their identity. The road to healing, then, is about reconstructing the fractured identity.
Miscarriage is both birth and death in the same moment
Miscarriage is birth, but the parent’s arms are left empty. There is no baby’s cry to soothe, no hungry tummy to feed, but the woman still gave birth to the baby she was hoping to bring home. Miscarriage is death, but there is no funeral, no memories of their childhood or adolescent years, but what remains are the lingering “what if” questions asked when a person dies too soon. “Who would their first best friend have been?” “Would they have preferred winter or summer sports?” “Which dinner table jokes would they have laughed most at?” Miscarriage is like double death: death of the fetus and death of the child who could have been. Recognizing this paradox is an important step in being able to meet the bereft in their grief. Journeying through both birth and death with the parents can take many shapes and will be unique to each family. As pastors, counselors, and community members, be present with these families. Offer an adjusted service, ceremony, or ritual which may speak to what the miscarriage means to that particular family.
Many families perform their own funeral services, while others may organize a birthday party. Custom liturgies geared toward their unique loss is what some families desire, while others prefer prayers from their community. Services, ceremonies, and rituals are customary for other life cycle rites, it is time these are offered for the parents of miscarriage as well.
Miscarriage is physically painful and women need time and space to recover
The science behind how a woman’s body transforms into a vessel which can grow and sustain new life is a tremendous physical process. Blood volume increases, major hormonal shifts occur, the formation of the placenta, the ligaments physically adjust as the baby grows, and the ongoing provision of nourishment to the developing baby. This is no easy task for a human body to achieve and is still considered a medical miracle.
When miscarriage occurs, the woman’s body must process another physical and hormonal shift back to its non-pregnant state. The additional blood volume is shed, hormones spike, the placenta detaches from the uterine wall, ligaments and joints begin to tighten again, and the baby is released along with the placenta, sac, and uterine wall. Some women describe what happens as a bad period and others say it was more painful than giving birth to a full term living baby. What has taken months to develop is shed in a matter of hours or days and this is, to say the least, very painful and can be a physically and emotionally traumatic process. For example, many times, medical intervention is required to assist the release. During miscarriage, similar to labor and delivery, the woman’s body is working very hard to process the release of the baby.
What can we do?
Regardless of whether you’re a seasoned minister, community leader, or CEO of a company, we have a few helpful suggestions to guide care responses with people who have had a miscarriage. First, we draw on pastoral theologian and spiritually-integrative therapist Duane Bidwell’s work in his book, Short-Term Spiritual Guidance. While the context of the book encompasses spiritual guidance, Dr. Bidwell offers valuable tools of learned ignorance and curiosity that can be helpful concepts to begin developing a posture of genuine response to the bereft.
First, learned ignorance is all about “emptying” what a person thinks they know about miscarriage. Everyone has very unique and particular experiences that may be similar and different from your experiences and what you may have heard about miscarriage. Therefore, it can be harmful, not helpful, to presume we know what a person is thinking, feeling, or needs. The thing is, we don’t know. Thus, it can be helpful to take a stance of unknowing with learned ignorance. If we presume to know then we may make a statement like, “Just keep trying; you’re young!,” “Your baby is in heaven now, be happy,” or “That’s God’s way of telling you something was wrong with it.”
Second, to avoid well-intentioned, but potentially harmful comments, one needs to be present. Being present is similar to learned ignorance, but here, it is important to focus on what the individual(s) or family may need and remember that it is not about you. Sometimes providing a meal is helpful and sometimes additional childcare is a relief. Other times, sitting in the room in silence while they cry is what they need. We, as ministers, community leaders, or business leaders are here to help and serve the bereft. We will not know what they will need until they give us a clue, a window, a suggestion...until then, just be present.
Third, we need to be aware of how suffering can produce vicarious suffering and impact who’s suffering we are trying to alleviate, ours or the other person’s. The term vicarious is an empathy term and refers to the degree or extent to which an observer will think and feel in similar ways to the person they are observing. Research suggests that empathy for pain is actually grounded in our own pain. When observing the pain of another, we perceive their pain through an activation of our own histories and experiences of pain. For example, in an animal sample, rats would stop and freeze when they saw another rat being shocked only if they had been previously shocked.
Thus, in caring situations, there may be two drives: the first is to provide care for the one who suffers and second, to provide care for our own suffering that has been vicariously activated. In this situation, the two drives can become conflated and we can symbolically care for our own pain by trying to alleviate or assuage the pain of the other. This may show up in the provision of pithy statements, and encouragement, that attempts to alleviate (our own) suffering. Stopping, thinking, reflecting and learned ignorance can open us to an awareness and understanding of what they are going through and give us space to separate their pain and our pain. More importantly, stopping, thinking, and reflecting places them at the center of the care situation, not our own thoughts or feelings.
The reality of 2,700 miscarriages a day is one that counselors, religious leaders, and community leaders need to be aware of and address. We have provided 7 insights on the experience of miscarriage and hope this will inform your approaches to care that address not only individual trauma but also collective trauma that is living and embedded in our communities. Look for our next blog post which will address the fact that miscarriage (and fertility) is not just a women’s issue, but is very relevant to men as well. The second post will focus on men and the traumatic effects of miscarriage. Last, we would like to hear your stories and open spaces for discussion. Leave a comment here with ICTG and visit us on twitter @ictgorg and @pnwmiscarriage.
Layne Linda, “A Women’s Health Model for Pregnancy Loss: A Call for a New Standard of Care,” Feminist Studies 32, no. 3 (2006): 573. Pamela Geller, et al., “Satisfaction with Pregnancy Loss Aftercare: Are Women Getting What They Want?” Archives of Women’s Mental Health 13. No.2 (April 2010): 111-124.
Mona Saraiya, Cynthia J. Berg, Holly Shuman, Clarice A. Green, and Hani K. Atrash, “Estimates of the Annual Number of Clinically Recognized Pregnancies in the United States, 1981-1991,” Journal of Epidemiology, no. 11 (June 1999): 1025-1029.
Daniel J. Sligte, Bernard A. Nijstad, and Carsten K. W. De Dreu. “Leaving a Legacy Neutralizes Negative Effects of Death Anxiety on Creativity.” Personality and Social Psychology Bulletin 39, no. 9 (September 2013): 1152–63. https://doi.org/10.1177/0146167213490804.
Duane R. Bidwell, Short-Term Spiritual Guidance, Creative Pastoral Care and Counseling Series (Minneapolis: Fortress Press, 2004).
Markus Rütgen et al., “Placebo Analgesia and Its Opioidergic Regulation Suggest That Empathy for Pain Is Grounded in Self Pain,” Proceedings of the National Academy of Sciences, (September 2015): 1-9, https://doi.org/10.1073/pnas.1511269112.
Piray Atsak, et al., “Experience Modulates Vicarious Freezing in Rats: A Model for Empathy,” PLoS ONE, no. 6 (July, 2011): 1-12, https://doi.org/10.1371/journal.pone.0021855.
A member of the Evangelical Lutheran Church of America, Joseph Kim Paxton is an ICTG Advisor while pursuing doctoral degrees in Practical Theology at the Claremont School of Theology and Clinical Psychology at Pepperdine University. His current research areas include clinical-community psychology, pastoral care, social scientific approaches to biblical interpretation, group processes, spiritual struggle, coping, and attitudes.
Read all of Joe's blogs here >
Carly Jane Lee holds an MA in theology from Fuller Theological Seminary and is a graduate student of Clinical Mental Health Counseling at Northwest University. She is directs and co-leads a miscarriage healing retreat for bereft women in Seattle, Washington. In addition, she is a community leader opening spaces for theological and psychological discussions around miscarriage.
Read all of Carly's blogs here >