Why miscarriages have been taboo, and why women blame themselves for the loss

Written by Amy Ta, produced by Rosalie Atkinson

Psychologist Jessica Zucker counsels people struggling with pregnancies, people who’ve lost children, and those overwhelmed with anxiety about the process. But when she miscarried at home by herself, she grappled with how to take the advice she gave her clients: Slow down, don’t blame yourself, and don’t compare.

But women don’t often talk about miscarriages, maybe because they feel ashamed or they feel the loss was their fault. 

Zucker shared her experience on social media using #ihadamiscarriage, and created an online community with mothers around the world who dealt with grief and shame surrounding the losses of their pregnancies.

Now she’s turned those stories, including her own, into a new book called “I Had a Miscarriage: A Memoir, A Movement.”

KCRW: You write that one out of every four pregnancies end in miscarriage. What are some of the main reasons women miscarry?

Jessica Zucker: “It's so true that most people think that miscarriage happens a lot less frequently than it does. And the research has found that a majority of miscarriages are due to chromosomal or genetic abnormalities. But people tend to blame themselves. So I think with the lack of information, unfortunately, women are often turning it on themselves. So they question, ‘Did I not drink enough water? Did I exercise too much? Should I not have had sex? Should I not have had that sip of wine?’ And so rather than … turning to the basic science around pregnancy and pregnancy loss, people are taking on the responsibility on themselves.” 

Where did these ideas come from? 

“I think it comes from the fact that girls and women are groomed, I think, from the get-go to blame themselves for a variety of things when it comes to our reproductive health and reproductive outcomes. And so in the absence of information, we can fill it in with projections or fears or anxiety. And so people make meaning out of things that don't necessarily add up.”

Let's talk about what happened to you. You were pregnant with your second child. You had a young son already. And you were just into your second trimester, about 16 weeks along, when you miscarried. What happened?

“So two days prior, I started spotting, and I went directly to my doctor's office and the heartbeat was perfect. The placenta looked great. And so she sent me on my way. We were curious, we had no idea what was going on. It was very unsettling. But I tried to sort of go about my life as if everything was moving in an okay direction. 

The following day, I went to work. But then that night on my drive home, I started experiencing what I now understand to be Braxton Hicks. … [They’re] early contractions, which one would not typically feel at 16 weeks along. So I knew that this was very problematic, and that this was probably not going to have a good outcome. 

And then the following morning, my husband took my son to preschool, and I decided I would stay home and relax. But the blood changed in intensity and hue. And I just knew that this pregnancy was bound to end. 

And a few hours later, I went to the bathroom. I was feeling pretty overwhelmed, which what I didn't realize at the time, and I do now, is I was actually in active labor. So the feeling of overwhelm was really because … my body was going to expel the baby. And I sat down to go to the bathroom, and the baby actually fell out. 

So I texted my doctor, and she called me immediately and walked me through what to do over the phone. So I had to cut the umbilical cord myself, and then I promptly began to hemorrhage. All the while my husband sped home, we took the baby in a bag to my doctor's office so that she could test the fetus. And then I had to undergo an unmedicated DNC [dilation and curettage]. 

So long story short, even though I'm a psychologist, I specialize in women's reproductive and maternal mental health and have done so for about 15 years at this point, I had never undergone something this traumatic. I had never experienced a miscarriage firsthand until I did.”

You were all alone? And as you say, that is common with women who miscarry. Do you remember how you were feeling in that moment? Was it a blur in your mind?

“It was kind of a simultaneous blur and a speeding up with time. … I was living in a documentary. And I had never really heard of something like this in all my years of sitting across from people telling me their loss experiences. You typically go to the doctor and find out there's no heartbeat. So giving birth basically alone in the context of my home was surreal beyond measure. And initially, I felt a physical feeling of relief actually, because I was in so much pain leading up to the birth. And then I quickly realized that unless I kept going, that unless I mustered the stamina, the energy to keep going, I could have bled out right there and then.”

After that experience, you were discharged from your doctor's office, you weren't even in the hospital. Did you get instructions on what you were supposed to do after that?

“In terms of a to-do list, there really wasn't one. And there really wasn't a conversation around how might things go for you from here, psychologically speaking, physically speaking. And even though I had sat across from patients for years and years, hearing about the feelings of isolation and alienation and grief, I just had never corporally experienced this myself. And so it sort of flung me into new territory, professionally and personally.”

You returned to work fairly quickly.

“I don't know what I was thinking. Yes, I did. It's not like it sounded appealing to lay in bed and think through all the gory details of what had happened. I was also already a mother. So I didn't want to model that for my child. I didn't want him to be worried about me. I also felt, because I am a psychologist, very loyal to my patients. And I did not want them to begin to worry about me”

Jessica Zucker’s book is about women who’ve experienced grief and shame surrounding the losses of their pregnancies. Photo courtesy of Penguin Random House. 

How did you talk about this with your patients? Therapists don't normally talk about their personal lives with their patients. But in your circumstance, you were living the experience that a lot of them feared the most.

“That's right. And I was forced to talk about it because my pregnancy was so obvious. Patients don't typically know anything about their therapist. A therapist could be struggling with depression, anxiety, an eating disorder, getting divorced even. And a patient wouldn't have any idea. 

But when the therapist is visibly pregnant, there is no way you can get around talking about the loss of it, if that's what happens. … Because I specialize in this, so many of my patients had been through this or feared this. And I didn't know, upon my return, how patients would react.

And some had very strong feelings about it. Some were incredibly worried about me. A couple of people decided that they would take time off from our sessions because it was too triggering. And others actually felt ... closer to me or sort of reassured … that their therapist was in fact human, and that now that I had been through it firsthand, I could actually understand them.”

Did you feel that way? 

“Well, I do now. I mean, my loss was in 2012. And I think that initially when I came back, it was hard to hold their stories, my story, their stories, my story. It was a lot. And I should mention, my doctor suggested that we wait three cycles if we wanted to conceive again. So on the fourth cycle, I got pregnant again. So these very same patients saw me through yet another pregnancy, which brought up a whole other slew of things for them.”

You got pregnant within a few months after you lost this baby. You must have been terrified it would happen all over again.

“Yeah, that's the perfect word for it. I was basically checking for blood every single time I went to the bathroom. I was convinced that this or something else would happen again. And it was hard because my OBGYN said … ‘After you do the chromosomal testing, you'll probably feel huge relief if everything's okay (and it was). And when you get to the 16 week mark and you pass it, you will probably experience even more relief.’ And I was hoping that she was right. 

But unfortunately for me, given my unique position of sitting with patients and hearing about stories like stillbirth and infant loss … and having to terminate for medical reasons after the 20 week mark, and so on, I was now rendered unable to be, I guess, in denial about the potential of becoming another statistic.”

You had a healthy baby girl in your second pregnancy. It's interesting that after she was born, you decided to memorialize the baby lost. Why did you decide that?

“Learning about the pregnancy loss community, mostly through social media and through sitting with my patients, and hearing ways that they had memorialized and ritualized their losses, I became intrigued. I think because my loss was not deemed a stillbirth, because stillbirth is 20 weeks and beyond. I wasn't offered things like a lock of hair, or footprints, or handprints, or a funeral, any of that. 

But after listening to so many other people have these various ways of ritualizing, I became intrigued and interested in doing the same. And I think I couldn't do it while I was pregnant with Noah, because I was too scared. And so yeah, I decided eventually to name that baby. And I started writing about this topic nonstop, and decided basically to dedicate part of my life to changing the cultural conversation surrounding pregnancy and infant loss.”

Why is it such a difficult conversation for us to have publicly still?

“As a society, we struggle talking about grief, period. But then you add to it the fact that this is what I call an out of order loss, right? This isn't a loss of a grandparent or something you might expect along the way. This is an idea. It's an imagined family member. And so we rely on platitudes. And most of the platitudes that get thrown around in the wake of pregnancy and infant loss are just horrifying, and really send women running for the hills, and feeling a sense of isolation and alienation when they need connection the most. 

So people rely on things like, ‘Well, it wasn't meant to be. God has a plan. Everything happens for a reason. At least you can get pregnant.’ Rather than simply leaning into the grief with the person that they love. Or asking the person, ‘How are you feeling? I'm here for you if you want to talk about your loss. I'm so sorry that this happened.’”