It’s Time To Talk About Miscarriage
Two recent miscarriage announcements that went viral, and new research, suggest that the popular wisdom about when to announce a pregnancy is hurting more than it's helping
Last week, the popular YouTube vlogging couple Sam and Nia went viral with a pregnancy announcement video. The clip stood out in its overcrowded milieu thanks to a gender-role reversal: Sam collected a sample of his wife’s urine from an unflushed toilet and surprised her with a positive pregnancy test. Then things took a further twist: On Saturday, days after the public announcement, the couple published a video in which they announced that Nia had miscarried. She estimated that she had been roughly six weeks pregnant.
The very public way in which the couple said they were pregnant and then that they were not anymore would seem to support the tradition of waiting to announce a pregnancy until after the first trimester, when the risk of miscarriage drops dramatically. Indeed, the video was met with a chorus of nasty criticism suggesting just that. A Gawker commenter wrote, “This video was ridiculous for precisely this reason: IT IS TOO EARLY to tell everyone about it.” Others were more openly hostile, like @geeoharee, who tweeted, “honestly if you tell people during the first trimester they should respond ‘congrats on your miscarriage’ #statistics.” (Some critics have also questioned the authenticity of the two announcements.)
honestly if you tell people during the first trimester they should respond 'congrats on your miscarriage' #statistics
— What duck? (@geeoharee) August 10, 2015
But these videos—coupled with the recent public announcement by Facebook founder Mark Zuckerberg and his wife Priscilla Chan that they had gone through three miscarriages—are evidence in favor of an overdue shift. It is time to dismantle the three-month rule. The guideline, which has become an aggressively policed social norm that people are often judged for violating, is ostensibly meant to protect women. It does the opposite. Not talking about pregnancies early ultimately means not talking about miscarriage, and research suggests that our collective silence on miscarriage increases stigma, perpetuates myths and leaves couples who experience it feeling completely alone.
Zev Williams, director of the Program for Early and Recurrent Pregnancy Loss at Albert Einstein College of Medicine, says the emphasis on first-trimester silence contributes to the stigma around miscarriage. “In medicine, we always tell people, ‘Don’t tell anyone early in a pregnancy,’ because the risk of a miscarriage is so high, but the subtext to that is that if you have a miscarriage, you should keep it secret,” he said. “I think that’s a big mistake. We don’t do that in any other field—if someone gets a cancer diagnosis or a diabetes diagnosis we don’t tell them to keep it secret.”
“If you share the information that you’re pregnant with people you love and people who love you, they can be there for you when you’re going through the hard times.” —Kristen Swanson, the dean of the College of Nursing at Seattle University
It’s a big mistake in part because this culture of silence creates the impression that miscarriage is a rarity. In June, Williams published a survey of more than 1,000 men and women which showed people massively underestimate the frequency of miscarriage. Fifty-five percent of participants believed that it impacted fewer than 6 percent of pregnancies. The reality is that it happens in an estimated 15 to 20 percent of pregnancies.
This disconnect is by design. We have built cultural norms around when to reveal a pregnancy just in order to avoid discussing those that fail. While this approach might spare the discomfort of revealing a miscarriage—and that discomfort is very real—it can also make the experience of miscarriage much lonelier. Williams’ survey found that 41 percent of respondents who had gone through a miscarriage, or whose partner had one, said they felt alone in the experience. The study discovered that there is a simple way to combat that, though.
“One of the things we found was that when public figures and friends and relatives disclosed they had a miscarriage, there was a big improvement of feelings mitigating the isolation that people felt,” Williams said. That’s why he points to Zuckerberg and Chan’s announcement as “a huge service” and “a brave thing.”
The secrecy also allows myths about the causes of miscarriage to flourish. Most first-trimester miscarriages are the result of chromosomal abnormalities, but Williams found that the majority of survey participants believed that miscarriage could be caused by stress or lifting heavy objects. Nearly a quarter attributed miscarriage to “lifestyle choices” like using drugs and alcohol. The upshot is that couples who experience a miscarriage often blame themselves and feel ashamed.
Breaking the seal of silence is about more than just correcting harmful myths about miscarriage, though. “If you do not tell anyone you are pregnant, when you miscarry you have nobody who’s available to support you in your grief,” said Kristen Swanson, the dean of the College of Nursing at Seattle University. “If you share the information that you’re pregnant with people you love and people who love you, they can be there for you when you’re going through the hard times.”
Swanson, who has published studies on the emotional impact of miscarriage, added, “You get to experience the joy of anticipating a pregnancy with those you love and you get to experience the sorrow of it.”
Of course, following the three-month protocol doesn’t preclude sharing news of an early miscarriage, but it can make it much more uncomfortable. That is a sentiment commonly expressed in online support groups for miscarriage. Consider this post on The Bump: “well we only found out we were pregnant the day after thanksgiving and we found out we were miscarrying yesterday. We did not tell our family but we are wondering if we should tell them we miscarried. … I just don’t know how to tell our parents that we were pregnant but were not anymore.”
“I think that’s a big mistake. We don’t do that in any other field—if someone gets a cancer diagnosis or a diabetes diagnosis we don’t tell them to keep it secret.” —Zev Williams, director of the Program for Early and Recurrent Pregnancy Loss at Albert Einstein College of Medicine
None of this means that first trimester pregnancies should be routinely announced on social media. There are great reasons to be circumspect about a new pregnancy—including everything from fears about job security to avoidance of gossip. Williams understands this. “It is a very private thing that a lot of people do not want to share and that’s understandable and reasonable.”
It’s also the case that, as Swanson notes, “sharing it loudly and casually” can lead to “very awkward” situations, to say the least. She gives the example of a woman she interviewed in her research whose husband brought in her work uniform to the dry cleaner and announced that next time he’d be coming back with a maternity uniform. “She miscarried and went to the dry cleaner’s herself later on and said, okay, how awkward is this, standing there telling the dry cleaner who I hardly know, ‘By the way, I miscarried.’”
What’s important, from the perspective of experts like Swanson, is that women are informed about the risks of miscarriage but are not discouraged from, or criticized for, revealing their early pregnancies—and that they understand the power of sharing the news of a miscarriage if it does happen.
“You stand the risk when you tell people that you’re pregnant that you’re going to have to tell them that you are no longer,” she said, “but in telling them that you are no longer, you do leave open the space for a conversation where one in five pregnancies end in miscarriage.”
That’s something I wish I had considered earlier this year when I found out I was pregnant. My husband and I decided to wait to tell most of our family and friends about the pregnancy until after the twelfth week. We had never done this pregnancy thing before, and we didn’t feel equipped to question the accepted wisdom about it.
Then, at the eighth week of pregnancy, we had the first ultrasound. And as my husband stroked my hair, the nurse told us in coldly clinical terms, “My best guess is this pregnancy is not viable.”
Suddenly, we were faced with a predicament that we hadn’t anticipated when subscribing to the rule of first-trimester silence: Of course we wanted to tell our closest family and friends what we were going through—but how do you inform someone of both a pregnancy and miscarriage in one breath? How do you protect the listener from the roller coaster of emotions that we, as a couple, had experienced alone? I settled on: “I was pregnant and now I’m not.” Or, when I chose to be both more dramatic and accurate, since mine was a missed miscarriage, in which the body doesn’t dispel the so-called “products of conception,” I would say in my best Wednesday Addams voice, “There’s a dead fetus inside of me.”
This kind of revelation is difficult enough that, until now, there were still very close family and friends whom we hadn’t found a way to tell—and I doubt that would be the case if we had flaunted the first-trimester rule. That’s not to say I wish we had made a couple viral videos, but I do think it would have been easier if I had told a wider circle about the pregnancy instead of spending weeks drinking ginger ale in cocktail glasses. From here on out, I’m following my own rule: As soon as you’re pregnant, tell the people in your life—especially the ones whose support you would want and need if you do miscarry. But, more importantly, I’m never again sparing an opportunity to say, “I had a miscarriage.” There are people who need to hear it.