Pregnancy and infant loss: breaking the silence to better support

Lightning doesn’t strike twice. We’ve all heard the saying before, taken to mean an extreme event won’t occur a second time after it’s been endured once. 

But the saying is a myth. In some cases, lightning does strike twice. And again. The Empire State Building is actually struck about 25 times every year1

Until this month, I didn’t think twice about whether or not lightning struck twice. 

My family is in the process of moving from Cleveland to Tampa and my husband and I spent the last two months house hunting. Before we started our home search, in what was the surprise of our lives, we found out we were pregnant. We have a 5-year-old, a 3-year-old, and after over a year of trying for a third child, we lost a baby this past Christmas after an ultrasound had confirmed a strong heartbeat. 

With the knowledge we were now expecting for a fourth time, we cautiously navigated the home-finding process. Do we look for a home with space for our family to grow into? A room for a nursery? An area for a basinet in our future bedroom? We wanted to be hopeful and plan for the best, but were reluctant after enduring the loss of a baby just nine months earlier.

I also hesitated to share the news of our latest pregnancy. As the days and weeks passed, we grew more confident in the idea we would get to bring this baby home and I started to let a few in on the secret. They met our news with excitement and well-intentioned sentiments: 

This is a different pregnancy, a different baby, and it will have a different outcome.”

Many women have healthy and successful pregnancies after a loss.

Lightning doesn’t strike twice.

Except for us, lightning did strike twice. The first time it struck sudden and violent, the second time it struck slow and silent. The day finally arrived for my husband and I to go in for an ultrasound of our fourth baby. The baby looked perfect but did not have a heartbeat. 

We had another miscarriage. 

A Future Dashed

When you have a miscarriage, you don’t just lose a pregnancy, you lose a baby. You lose a future you expected and planned for. A framework you had built up—dates earmarked, plans made, a specific house bought.

When you are suddenly looking at a future with one less person, the scaffolding is dismantled. A room planned for a nursery will not hold a crib or changing table. Plans are cancelled. Dates loom on the calendar—once filled with anticipation and excitement are now filled with dread and heartbreak. 

Losing these babies has been unexpected and disorienting. Their losses have upset our sense of balance, knocked us off our feet, and changed the course of our future. Our hearts and home expanded in anticipation of their arrival and now hold voids in their absence. The losses of these babies have been lightning strikes to our lives.

The first time you lose a baby, you don’t know how you will get through the shock and pain. The second time you lose a baby, the shock and pain are the same. It’s still just as devastating. But you’ve lived through it once. You know your heart will keep beating even though your baby’s heart stopped. You know life will go on even though your baby’s life will not. 

I no longer carry these babies inside of me and I will not get to carry them in my arms. Instead, I carry the grief of a stolen present and future. And I am not the only one who carries this. Approximately 1 In 4 pregnancies end in miscarriage2. 1 in 100 women will experience repeated miscarriages3. 1 in 160 women will live through the tragedy of stillbirth4. Chances are, you know someone who has lost a baby or have lost one yourself. And I am so sorry for your loss. 

More Than a Medical Event

Despite pregnancy and infant loss affecting so many, it remains largely undiscussed. According to a poll of 6,000 women conducted by the miscarriage-research nonprofit, Tommy’s, two-thirds of women who have miscarried say the feel like they can’t even talk to their best friend about it5. Women and their partners feel like they have to endure the physical and emotional tolls of losing a baby in silence, further compounding the grief, emotional, and physical distress they are experiencing.  

Rayna Markin, Ph.D is a licensed psychologist and leading researcher on the psychological experience of pregnancy and perinatal loss who partially attributes the pressure to not talk about the loss of a baby to the modern world view of seeing a pregnancy loss as not a psychological, emotional, or mental process, but as a medical event. 

Losing a pregnancy—losing a baby—has profound and far-reaching impacts on parents6, which Dr. Markin summarizes in her introduction for a special section of the journal Psychotherapy (Psychotherapy, Vol. 54, No. 4, 2017)7.

“Numerous studies have documented the devastating effects of pregnancy loss on parents, particularly on the mother, including chronic and severe grief that may extend for years, beyond the birth of a healthy baby, and does not follow the typical linear decline found with other types of grief, as well as symptoms of depression, anxiety, and trauma,” writes Dr. Markin. “Furthermore, after a pregnancy loss, women tend to report feelings of guilt, self-blame, a yearning for the lost baby, low self-esteem, and an increase in suicidal thoughts and obsessive–compulsive symptoms. Women have lost faith in their bodies, in the world as a fair and predictable place, and in others as a source of support and comfort.”

When society views miscarriage strictly through the lens of a biological process, it dismisses a parent’s deep grief and denies support for the myriad of potential health implications associated with pregnancy loss. Classifying a miscarriage solely as a medical event fails to see the mother as someone whose life has been irrevocably changed, further stigmatizes pregnancy loss, and silences the grieving. In these oversights, we are failing to support bereaved parents. 

A Call for Support

October is Pregnancy and Infant Loss Awareness Month, initiated in 1988 to cast light on the women, their partners, and the families who have lost babies and shared futures. 

Despite Pregnancy and Infant Loss Awareness Month first being recognized more than 20 years ago, drastic discrepancies still exist between patient needs following a miscarriage and current clinical practices. Women are responsible for seeking medical attention and coordinating care after the loss of a pregnancy while handling fluctuating hormones, grief, trauma, and the feeling that they can’t talk about their loss. Systems need to be created so women do not have to shoulder this burden in its entirety. 

The timing of care following the loss of a pregnancy has been shown to influence the degree of adverse physical and emotional health effects women experience8. With the knowledge that miscarriage is a significant source of psychiatric morbidity, mental health screening should be standard following the loss of a pregnancy. 

Counseling programs after a pregnancy loss are shown to reduce depression, anxiety, and stress in women with recurrent miscarriage9. Following a miscarriage, patients should be provided with resources to connect with licensed professionals who can offer appropriate treatment. 

Employers should allot paid leave for women and their partners who are experiencing the loss of a baby, which often requires a trip to the hospital, general anesthesia, and surgery. 

Finally, society should not shy away from parents who are navigating pregnancy or infant loss. We need to learn to sit with the broken-hearted, even if its uncomfortable. 

To change current practices and create better systems of support—both medically and socially—we must continue to raise awareness. 

How do we raise awareness of pregnancy and infant loss? By talking about it. We cannot create networks of support in silence. We cannot create healing environments in isolation. Which is why I am sharing my story of repeated miscarriages.

While my losses have left me empty in more ways than one, they have also made me who I am today: more compassionate and discerning. I find myself looking around rooms and counting heads. I wonder which women and their partners have endured the same losses my husband and I have. I know if a couple misses a holiday dinner, they may be recovering from a miscarriage. I know if a woman sends an email saying she won’t be calling in to a meeting due to unexpected surgery, she may be preparing for a D&C. I know a man who suddenly cancels work travel may be taking his wife to the hospital for surgery and grieving the loss of a baby. 

As we pack the belongings of our home in Ohio, I wish some of our future neighbors in Florida may know that the family moving during a global pandemic, also just lost their second baby in less than one year. 

Sharing stories of pregnancy and infant loss can be difficult, but it is necessary if we want to shape a society that supports grieving parents. Lifting up the voices of parents who have endured pregnancy and infant loss during the month of October is one place to start. 

Pregnancy and Infant Loss Awareness Month is punctuated by Wave of Light, a global event where everyone is invited to light a candle on October 15 at 7 p.m. to acknowledge all the babies who are not carried in the arms, but in the hearts of their parents. Please join me in lighting a candle to recognize the babies we have lost and all the others who are loved and missed. 

Sources:

1. https://www.noaa.gov/stories/5-striking-facts-versus-myths-about-lightning-you-should-know

2. https://www.who.int/news-room/spotlight/why-we-need-to-talk-about-losing-a-baby/unacceptable-stigma-and-shame 

3. https://www.acog.org/womens-health/faqs/repeated-miscarriages

4. https://www.cdc.gov/ncbddd/stillbirth/facts.html

5. https://www.parents.com/pregnancy/complications/miscarriage/why-its-important-to-talk-about-miscarriage/

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468887/

7. https://psycnet.apa.org/fulltext/2017-55835-005.html

8https://pubmed.ncbi.nlm.nih.gov/32550017/

9. https://pubmed.ncbi.nlm.nih.gov/33688267/

Spring Snow

I listened to the coffee percolate as I looked out the window at the wet snow that hung heavy on branches of spring blooms. Nine days until May and we woke up to nearly half a foot of snow. I wondered if the rose bushes that had started to bud or the clematis vine that had turned green would survive this late blanket of winter. Snow a month into spring isn’t unusual in Ohio, but a deep snow is. Two weeks ago, I sunbathed on my back patio in my swimsuit. Today, the same chair I had sat in with a book was buried under fresh powder.

My kids were moments from waking and my husband already gone to work. I sipped my hot coffee and took in the blue hue that washes everything moments before dawn on a snowy morning. A quick check of text messages and Instagram stories and it was easy to most were lamenting this late snow. And yet, I couldn’t help but feel a sense of peace about it.

I lost my third baby on the first day of winter and although it’s officially been spring for a month, the snow this morning felt like a reminder that while life will keep moving forward, the life of that baby will not be forgotten.

Miscarriage is such a deep well. It’s not easy to see what it entails and you often don’t know unless you’re right in it.

I’ve started and stopped writing about miscarriage many times since mine. I think this start and stop is rooted in a feeling that I need to have a complete and polished thought on what happened. A desire to write from scars instead of wounds. I’m realizing that miscarriage isn’t the kind of thing that has a final thought. It can’t be bundled up and contained into a neat package. I now recognize that miscarriage may be the kind of thing that ripples through the rest of a mother’s life.

My kids ate their breakfasts and begged to play in the snow. As much as I did not want to go outside in freezing temperatures at the crack of dawn, I also knew it may be the last chance I’d have to play in the snow with my kids at these ages. The last time I’d get to pull boots and hats and mittens on my 3- and 5-year-old. See them catch flakes on their tongues and lay on their backs with arms and legs outstretched, making angels.  

I felt peace about this unseasonably late snow because it seemed like some kind of poetic reassurance that things were going to be alright, but also because it felt like a mirror to parenthood, and life. You can plan and anticipate and set expectations, but life throws curveballs. And then the only thing you can do is pull on your boots and hats and mittens and embrace it. Things may not go as you planned or anticipated or expected, but they can still be beautiful.

Build with care

I used my grandpa’s level for a recent home improvement project. It’s wooden, sanded smooth and stained a deep walnut brown. Or, maybe it’s worn smooth from use, from being pressed against walls and beams and the oils of my grandpa’s hands conditioning the wood, him wiping it clean before putting it away, I imagine always in the same spot. I never met my grandpa, so what I know of him is what I have heard from others. He went to the Colorado School of Mines, I think. He worked in the coal mines that hugged the Ohio-West Virginia border. He taught my father how to set and check trap lines. He took care of his tools. In my mind, my grandpa is a black-and-white photograph and made up of these details, statements rather than stories. 

Between my grandpa and me, my dad had the level. Shortly after Levi and I were married, my dad gave us a Craftsman bag filled with basic starter tools—extras he had that would come in handy while living in a first apartment. Everything was well cared for. My dad takes care of what’s his. It’s one of the things I admire most about him. Everything has a place, everything is cleaned, instruction manuals are catalogued. Were those values instilled in him by my grandpa? Or from my dad’s time in the Marine Corps? Or maybe, a bit of both?

I wonder what my grandpa would think about me using his level to build something. I was told he knew I was on the way. My mom was pregnant with me when he died. So, in a way, I feel like I would have been to him what he is to me: known, but not. I wonder if it would make him happy that I am using his tools to build a place where his great-grandchildren will hang their coats and school bags. 

I hope he would notice I am taking care to build something correctly. Measure twice and then twice again and then make the cut. I would guess he would probably think it is senseless that I plan to hang the level on one of the walls above this project. A reminder of the man I never knew, the one who came before my dad. More so, a reminder of some of the values and lessons my dad has taught me, that may have trickled down through generations: build with care. Take care of what is yours.

And that’s what this small home improvement project was really all about. Creating a place where my kids can stumble inside, weary from another day in the world, and shed their coats and bags. A first glimpse of home, a safe space where they can leave any expectations and undue weight at the door. I hope it smells like home when they walk in. Something baking in the oven. Scrubbed countertops. Clean laundry and cozy throws. Most of all, I hope when they step inside and walk through that back hall, they feel a home built with care, and know just how deeply they are cared for. 

To the present

The heartbreak over the impermanence of life only exists with the moments we don’t want to lose. The ones that make us want to press pause and linger in like a long, summer afternoon.  How is it that those moments seem so few and far between and the difficult and mundane can seem so common? Is it as simple as a perspective shift? An attitude adjustment? Why do we wish away Mondays and set our sights on the weekend? 

In some cases, it can be as simple as attitude adjustment. But, I think it is more apt that there is a lack of acceptance. It’d be nice to fill our days with things that don’t make us want to race toward the weekend, and sometimes we can make changes to work toward that. But, what happens when things fill our days that we did not plan on? 

When we’re dealt a hand we didn’t envision, it can be devastating. Instead of accepting the present and focusing on how we can make current circumstances work, we all-too-often dwell in the past. We get stuck in the scenarios we had imagined in our minds and then disappointed that reality does not match up.

The inspirational gurus preach that only you have the power to make changes in your life to be happy. But they don’t seem to step into the waters that are beyond our control—the circumstances we can’t change. No one envisions a future filled with diagnoses, corporate buy-outs, unexpected loss of loved ones, global pandemics—all the things we cannot change and do not have control over. 

The world is a chaotic place and people are unpredictable. 

But, from chaos comes beauty. Storms overturn and unveil hidden treasure. Adversity sharpens the stone. The everyday provides time for growth, space to learn grace. There are times when we can’t change the circumstances–whether it be another Monday during a global pandemic or an unexpected major life event. And those times are also opportunities where we can choose to be disappointed that things are not going as planned, or accept what they are and set our course once again. 

Here’s to the present and what may arise from it. Here’s to sitting in the mundane moments and recognizing the beauty within them too. Here’s to rolling with the punches of the unexpected and rising once again. Here’s to casting away expectations from past lives and embracing the life right in front of us. 

A call to the creatives

Constant Moyaux. View of Rome from the Artist’s Room at the Villa Medici, 1863. Watercolour on paper, 11⅝ x 9 in. Musée des Beaux-Arts, Valenciennes. Réunion des Musées Nationaux/Art Resource, NY.

Creativity begins from a place of need—a desire to communicate an idea. Whether the realization of that idea is shared with others is at the discretion of the creator. Maybe they create only for themselves or maybe they create with the intent to share. A painting, an essay, a project made, music played or plans built—they’re all iterations of a response to a pull to see a thought in a tactile presentation. Brush strokes layered, words arranged, thread needled and stitched, materials sawed and bound together. Creativity is important because it is often these makings that look at a norm in a different light. Turn an idea on its head. Challenge patterned acceptances. Take something ordinary and make something extraordinary from it. It is this magic equation of transforming a feeling or idea into a proposal, if not a reality. And two things are necessary for it happen: time and space. These two things are really hard to come by as a work-from-home parent of young kids during a pandemic. 

I used to slip out to a coffee shop a couple times a month and had the time and space to sip a cup of hot coffee and write what I wanted—uninterrupted. I could step out of my regular space—the house where I’m mom and the home office where I’m a freelance writer—and into another where I could write what was on my mind. 

This need for dedicated space is why artists have studios. Carpenters have shops. It’s why a lot of writers write best early in the morning or late at night—when the demands of the ordinary aren’t immediate.

I worry that the pandemic is muffling the creatives. People who do not have any space from their ordinaries also do not have any space to create. 

A lot of creatives also need a transition time—a window where they can shift from the ordinary and into the making. 2020 has made it difficult to shift from the ordinary. A global pandemic, a much-overdue racial reckoning, social unrest, an election year—there is so much in the world that needs our attention right now, I feel guilty putting any time I can carve out into creative pursuits. 

But, I also believe now is the time creative thinking could be the most important. Art, music, words and design–all can bring us together. They all can connect us at the most basic level: as humans.

Maybe it is the creatives who are going to take the norms and force people to see them in different lights. Turn ideas on their heads. Challenge patterned acceptances. Take the ordinary and make something extraordinary. 

A call to the creatives: do not stop. Find the time and space. Even when it feels hard–or impossible—or you feel guilty to be putting pen to paper, brush to canvas, fingers to keys, needle to thread, saw to wood. Explore the feelings, communicate the ideas, do whatever it is you do to create the magic that could connect us all once again.