As a close friend has suffered a particularly difficult miscarriage recently, I want to pause from the usual vocations of life to express solidarity to and love for the many women who have similarly suffered. We are fortunate now, I think, in ways we were not once fortunate, to have ways to communicate about “fetal loss,” “miscarriage,” “spontaneous abortion”—whatever it is that we are trying to describe when a woman’s pregnancy ends without live birth. I would at the beginning remember that there are women who are not profoundly affected by miscarriage. The response to miscarriage will depend heavily on culture and personal factors. A woman who does not mourn a miscarriage should not be forced to do so, just as a woman who needs, existentially, to mourn a lost pregnancy should not be discouraged from doing so. If I know anything, it is that life is complex and we are individuals. We should seek ways to match our rhetoric and our responses to the needs of those we care for and respect rather than our sense of how the world ought to operate.
I hope that allowing myself some license to write in this setting will not be seen as suggesting that a male voice should be privileged on this topic. Beyond experiences with my wife and conversations with affected friends, I have no direct authority to speak on this subject. I am writing because I love so many people who have suffered miscarriage, and I want to honor them, to “mourn with those that mourn” as Christ calls me to. I welcome and expect that female voices will join in the comments and will be more potent, authentic, and moving than my own.
This event carries so much more than just the personal grief of an aspiring mother that we should tread carefully in our discussions. Miscarriages and the infertility with which they are often associated have been used culturally to demean and control women and their experiences for millennia. Even the term itself, with only a gentle nudge into etymological misinterpretation, seems somehow to suggest that the womb-bearing woman has failed in her duties to carry a fertilized ovum through to live birth. The stunning and to many inspiring prophet Ann Hutchinson of Massachusetts Bay Colony is only the most memorable example of a time when miscarriage was used to silence a woman—Hutchinson’s stillbirth of a disfigured fetus was all the proof the authorities needed that God wished her voice stilled. Countless women through millennia have been blamed for their (or their partner’s) infertility, and we would do well not to ignore that history when we consider any specific experience with miscarriage. I also do not mean for a moment to disparage the grief of women who never participate, successfully or unsuccessfully, in the cycles of physical reproduction. Their grief can be as real and as brutally unrelenting as that associated with miscarriage. In this moment, though, I have in mind those whose pain derives from lost pregnancy.
An attempt to define terms
As a linguist in recovery I can’t help but peer into the etymology of these words to imagine to myself how other people might have understood them. Miscarry (and in its turn the Latin-derived word “abortion,” which was largely synonymous with miscarriage for centuries) appears to have born the sense we would associate now with a car accident. A sudden and horrible failure of natural events that leads to peril or loss. If the sources I consulted are correct, to miscarry meant to die or be lost for over a century before it came to mean the very specific instance in which pregnancy does not result in live birth. I think I understand this extension of the word from loss generally to the specific instance of a pregnancy that does not proceed to live birth. Motion is such an important part of our mortal experience. It is when a face moves or lips part for respiration that we know for sure, in the tortured logic of a worried parent, that a sleeping child is still alive. Our key experiences of the world—worship, recreation, sexual intimacy, work—all incorporate movement, dynamic contact, exertion. In many cultures a fetus is considered to be alive when it begins to move within the womb, at its “quickening.” But in movement we are also vulnerable. We crash cars, ski into trees, slip from ladders, and fall down the stairs. We are always moving, the world is always moving, history is always moving, and we pray that God is at least aware of this fact. Moments of miscarriage, the wreckage of our physicalness glaring at us in silent agony, are times that this aspiration seems most poorly informed. Where, we might ask with the dying Christ, has God gone at our moment of agonal stillness?
Physical Betrayal: Of Bodies and Afflicting Casualties
There can also be in miscarriage the realization of how fragile we are as humans, how temporarily we tread upon this earth. The hope for future generations so strong within a body that every facet of a woman’s life can be affected by it is one day just gone. The Psalmist famously asked God “what are humans, that you are mindful of them?” and there is nothing quite like miscarriage to focus the impact of that question. We are in some respects all like a fetus, a dimly recognizable conglomeration of physical matter yearning desperately to be something more. Miscarriage can be the fatal frustration of that aspiration.
It is not just that the body has betrayed us. All bodies will do that some day. Knees will give way to osteoarthritis, lungs will slowly deflate, hearts will gradually scar and deform. Though we do not generally welcome its obsolescence, our body can be expected to betray our hopes for persistent good health. In miscarriage the great sadness may derive at least in part from the sense that our body has betrayed another being, a being so defenseless that it cannot even acquire an identity without our treacherous body. A sacred and miraculous capacity to create another human being proves brutally unreliable.
There is also the pain. How a pebble-sized object as smoothly and anciently alien as a coelacanth can cause so much pain is a great mystery to me. But a pregnancy has occurred; it just did not end with a human child. The great transitions of pregnancy leave their mark on the body, with echoes on the mind. Emotions are frayed, cognition sometimes cloudy. The “products of conception,” a collection of fetus and its supporting anatomical structures, must pass, with contractions of the uterus that can be as miserable as successful labor in a full-term pregnancy. If these “products” do not pass, bleeding and infection can threaten the disappointed mother’s health and even life. A “D&C” (dilation and curettage), the procedure we associate with therapeutic abortion, may be necessary to save the life and protect the uterus. There is no epidural anesthetic, no solicitous anesthetist hovering beside you, no hope for an imminent meeting with a new child, just the miserable contortions of a uterus expelling a stilled fetus and its placenta. Surely these pains are a testament to the physical distress that became ours as we sacrificed primeval purity for the strenuous mortality that makes of us divine beings.
An Abortive Grief
The grief of miscarriage can be difficult to categorize for both those who experience it and those who observe it. As opposed to other forms of bereavement, there is no specific identity to which the bereavement is attached. There are no memories by which the visceral love for a child can be moored. In many cases there is only the misery of pregnancy-associated nausea and the pensive contemplation of what this particular combination of our genetic material with another’s might look like, might smell like after a soothing meal of milk or formula, who this potential child might be or have been. There is no name, no funeral, no listing in the records of either church or state, only the occasional notation in a mother’s medical record, “Sp[ontaneous]Ab[ortion].” Such utter obliteration of a life that felt so real in anticipation can be difficult to process, to digest.
Despite, or perhaps because of, the lack of a familiar child to whom the bereavement can be associated, much of this grief may be channeled into self-doubt. Miscarriage can seem to be a failing grade on a test of motherhood, an inability to care for one’s body sufficiently to protect a body within it. However irrational, this self-doubt and self-judgment can be inexorable.
I live daily with the fear that I have failed my children, that my inadequacies or poor decisions will forever wound these wonderful souls in my heart and home. In lost pregnancy these worries can be amplified many-fold. We are obsessed already with our bodies, with the proper care of them and their potential occupants. We are ready to conduct witch-hunts for women who smoke or drink, however little, during their pregnancy. In my experience women after miscarriage often torture themselves with doubts about their too-brief stewardship of a body. They shouldn’t have eaten fish, they didn’t eat enough omega-3 fatty acids, had too many French fries, exercised too little, exercised too much, didn’t sleep well, didn’t hydrate enough when the nausea got bad. That a woman’s choices generally have nothing to do with the miscarriage can be less than reassuring.
An Abortive Condolence
The death of a child is an event so horrible most of us fall speechless in its presence. There can be no doubt that it is real and powerful and soul-wrenching. Though we often retreat as onlookers from such an event, we understand and can respect its tragic majesty. But a miscarriage may be much harder to honor. It could certainly have been worse, the fetus was never a person per se (bracketing for a moment the rancorous debates about therapeutic abortion policies). Most late menstrual periods are miscarriages; 80% of conceptions do not result in birth. Some onlookers will be so embroiled in skirmishes in cultural wars that they cannot see beyond arguments about intentional miscarriage to the sometimes surprising depth of grief that a woman feels when a pregnancy ends without a child. That something could have been worse does not mean that it is itself good.
It is all well and good to suggest that the biological system that assures the integrity of the next generation can only work by the random pairing of parental gametes, that most conceptions do not result in birth. Such observations sometimes serve rhetorical ends in our cultural wars. But we ought not to forget that these kinds of statistical observations describe probabilities of particular types of experiences or encounters but they do not drive how we will respond to them as individuals. Life is lived in details by highly specific people.
Grief, which in many modern Western cultures including our own, can be profoundly isolating, is perhaps even more isolating when what is mourned is something, someone that could have been. Women may worry that they are perceived as self-indulgent, that they should get back about their lives rather than pause to mourn what could have been. I pray that I will always be prepared to mourn with those who mourn the capsizing of the vessel of parenthood. May God bless all whose lives have been touched or changed by such loss during pregnancy.