The silent grief – on miscarriage, pregnancy and loss.

I am ashamed to admit that I wavered on whether or not to write about this subject, despite writing about so many other difficult and sometimes personal topics.

Miscarriage impacts about 1 in 4 pregnant women, and it has impacted me multiple times. It is a difficult subject for any person, particularly those who have experienced it. When I was writing The Fictional Woman I had thought about writing something of my miscarriage in 2009 and later changed my mind. It was too dark and unwelcome a memory, and now I had a little girl, had started my own family, and I was not keen to revisit that experience.

And then it happened again. I could not shy away from it. I could not ‘forget’.

For only two sweet days my family and I had been delighted by the news of a positive pregnancy test. I’d felt the changes in my body one night and I knew. I could feel in my body that something was different, just as I had with both of my previous pregnancies. And then there it was in the morning, that crucial second line on the store-bought pregnancy test. We were in Hawaii (above), with family gathered from three continents to holiday together and celebrate my fortieth birthday, and there was no way we could have hidden our joy. We celebrated over dinner with a round of cocktails (mine virgin) and I thought about what would need to happen in my life to accommodate this very welcome news. I’d have to sell my apartment as soon as possible, as our family income would be reduced by somewhat more than half. I’d have to push back the publication of this book, as it would come out when I was due to give birth.

We wanted a second child. It was really happening. We were excited.

Had I waited another two days to take a pregnancy test I might never have known with absolute certainty that I was pregnant. I may have strongly suspected it (I know my body well enough not to miss the signs) but I would not have known for sure. But at the airport, having said goodbye to my sister, my father and stepmum, my body told me that things were not right. I was bleeding and there was no escape. We were already in the gate lounge, among the rows of identical chairs, illuminated with artificial lights that reminded me, too much, of a hospital waiting room. There was no space. No place to cry. We had to catch a plane in an hour. It was time to go home, with one fewer than I’d thought we were becoming.

All I could do was buy sanitary napkins and try to come to terms with what was happening inside my body. I reminded myself of the good things in my life, counting them in my head one by one, like the knotted threads on a lifeline. Throughout this I had the significant comfort of my then two-and-a-half-year-old daughter running back and forth in front of me, giggling and shouting, undeterred by our early wake-up that morning. I thought of all the women who, like myself, had always wanted to have children, yet did not have the comfort of their own healthy child when they miscarried. I knew this from conversations with friends, but most of all I knew because the last time it happened to me, I did not have that comfort either. I had miscarried four years earlier, shortly before I got married. I was living with my husband-to-be, Berndt, in my flat in Sydney when two pink lines explained my slightly swollen belly and my late period. I’d taken tests in the previous weeks and they’d come up negative. But something seemed to be up and so there it was.

Two pink lines. I had never seen those lines before and let me tell you, if you are a woman who hopes to one day have a family, the first time you see them it is thrilling and frightening and wonderful.

My fiancé and I were intoxicated with joy at the news. Yes, it was before we’d planned to become pregnant and our wedding was only a couple of months away, but we were damned excited. I’d wear a muu-muu for a wedding dress if I had to. I didn’t care. The experience of being pregnant for the first time was remarkable, truly. We told our families, though swore them to secrecy. We were too thrilled to hold it in.

Hello, you 

Almost a person 

Swell of my belly 

My genderless, nameless hope 

Faced with that first, exhilarating news of pregnancy, I managed to forget that I’d only just recovered from a urinary tract infection (a common risk with pregnancy, I later discovered) and that before I’d known I was pregnant, while the tests still came up negative, I had taken medication for a fever. Aspirin. A lot of it. As I now know, it may be safe to take some paracetamol during pregnancy, but not necessarily aspirin. When the pregnancy test came up positive a week and a half later, all that was forgotten. I was too overjoyed to think about what I’d just been through. All I knew was that this was my first pregnancy and I was going to be a mother. But my doctor was uncertain. Thinking back, I remember the look in her eye, her quiet caution. She set up an ultrasound for the following week and when the day came, the day when we would see our pregnancy on the monitor, we walked to the clinic from my city apartment, marvelling at the little swell in my belly, holding hands, giddy.

What we found in my womb, instead of a growing child, was a sac without a heartbeat.

I saw it on the monitor for only a moment, before they removed the ultrasound wand and told us they were sorry. Berndt had been holding my hand, and I just remember saying, ‘That’s terrible news,’ and falling silent. There was something inside me that had never become someone. Something foreign, and yet inside me. It was horrible and I had not seen it coming at all. Pregnancy was supposed to be a joy. The ultrasound clinic gave me time to cry it out, and then the doctor booked me in to a hospital to have it removed, only a few days later. I wept when they put me under for the dilation and curettage, after several blood tests – performed at my insistence – showed the diagnosis to be absolutely true. The hCG hormones were falling. The pregnancy had not developed. There was no blood flow. A sac with no one in it.

For some reason, the worst part about the experience, the thing that sticks in my head, was that although everyone was very professional, before they put me under a young nurse asked me a list of questions. One of the questions she asked was, ‘Are you pregnant?’ There could hardly have been a crueller question. ‘Am I? Pregnant?’ I repeated incredulously, unable to find any other words. I guess they always ask this before giving a patient a general anaesthetic, but I was blindsided. I didn’t know what to say. Yes and no was the answer. If I took a pregnancy test that day it would come up positive, as some of the hCG hormones were still present. But the hormones were falling, because the pregnancy had failed to develop. That was precisely the thing, wasn’t it? Why else would I be booked in for a D&C other than to clean out my uterus so I wouldn’t get sepsis or suffer a long and drawn-out bloody miscarriage?

They say when you first miscarry you lose your innocence about pregnancy. It was that way for me. The roses and balloons and pink and blue Hallmark cards don’t really cover it. It’s also tears and blood and uncertainty. The cycles of reproduction are grand and yet common, extraordinary, heartbreaking and life-affirming. Pregnancy is life or death, and sometimes both. The brutality and beauty of the way we all come into the world – every last human being – is something truly fragile and beautiful. And mysterious. For all the science we throw at it, with all the control we like to believe we have over our lives, this is the one thing that can’t quite be nailed down. It’s a roll of the dice, every time, even for the healthiest and luckiest of us.

You never were, except to me. 

Four years later, at the small Hawaiian airport, waiting for a flight after a long and much-needed family holiday, I was faced with what appeared to be my second miscarriage. Not an invisible one like the first time, where naively I had not even imagined it would happen to me and it took an ultrasound monitor to make it clear, but something I could feel. Something I could see.

I’d only just said goodbye to my father, who was about to fly back to Canada. I had not seen him in over a year, and it would be a year before I saw him again. He’d been so happy when I told him I was pregnant that the tears were visible in his eyes. After such a joyous family holiday, and the wonderful news that a baby was coming, I was in the airport miscarrying as I waited for the plane. I could feel it drain out of me and the brutality cut me to the core.

Some life-changing things, because of their innate darkness and intimacy, and also because they are exclusive to the female experience, are rarely talked about publicly. Until relatively recently, it was taboo to show off a pregnant stomach or even to discuss the details of pregnancy and childbirth. My father had been banished to the waiting room for my sister’s birth, though only a few years later, they allowed him to attend mine. Even to this day, reproduction is misunderstood by many, reproductive rights remain a hot topic, and even sex education and contraception remain highly controversial in many places. Miscarriages are not discussed in public with any ease, or at all. Like so many of the experiences related to sex and reproduction, this common experience remains all but invisible. While on holiday in Hawaii, newly pregnant, I spotted a woman with a beautiful pregnant belly, wearing a bikini, and my stepmother explained that she’d worn a popular pleated style of dress in the early seventies that hid her stomach so well that even close family friends did not know she was pregnant until she was in the hospital after the birth. Pregnancy was simply not discussed and a swollen belly was something to be hidden. Often, pregnant women avoided being seen in public at all.

Things had changed a lot, she told me, and in many ways they have. In other ways, though, things haven’t changed nearly enough.

Interestingly, it took becoming a parent myself, and becoming a writer on issues of maternity, breastfeeding and child survival for UNICEF, before most of my friends’ experiences with miscarriage became known to me. One friend confided in me that she’d fallen pregnant to her boyfriend and miscarried on the way to my wedding – just a couple of months after I’d had that first miscarriage. Another friend had a surprise pregnancy with her boyfriend and gave birth to a healthy baby girl, but when she tried again, experienced six miscarriages in just one year. She kept a little rock on her mantelpiece to represent each one, needing some tangible way to acknowledge them. Another close friend became pregnant with a third child and when the doctor explained that the foetus was not healthy and would not survive in the womb, she ‘flipped out completely’, as she put it. She told me she’d never seen herself like that. Yet another friend was in her eighth month of pregnancy and laboured through a stillbirth. Of those friends, few of them had told anyone except their doctor and their partner at the time. For most of them, it took many months, even years, to be able to talk about it. Had they been in a car accident or fallen and broken so much as a thumb, they would have felt free to discuss what had happened as soon as it had occurred and would have been receiving commiserations as they healed. But many women tell no one at all about their pregnancy until they show in the second trimester, and may not even tell their husband or partner when they miscarry.

One friend expressed her disgust with the common saying ‘she lost the baby’, as if somehow the woman had misplaced her foetus in a moment of profound forgetfulness. Another explained how barbaric and impersonal the medical terms for miscarriage were. There is something called a ‘blighted ovum’, when the fertilised egg implants in the uterus but doesn’t develop. ‘Blighted’, of course, is also a term meaning spoiled or diseased, and is used to describe the condition of a rundown urban area. Blight is a plant disease. Then there is the spontaneous miscarriage, like I had in the airport, which doctors refer to as a ‘spontaneous abortion’, despite the association with medical terminations that are carried out for unwanted or unsafe pregnancies. There is also the kind of miscarriage, like my first one, called a ‘missed abortion’, when the pregnancy has naturally terminated before the twentieth week but the body has not expelled it. ‘Silent miscarriage’ is the preferred term, but many doctors still use the term ‘missed abortion’, and I saw it on my medical paperwork.

I remember how incensed I was by the testimony of US Republican politician Terry England, when he voted in favour of the so-called ‘fetal pain’ bill, House Bill 954, that would ban all abortions after twenty weeks, robbing women of reproductive choice even in cases where the baby was not expected to live, effectively forcing women to carry stillborn foetuses. In his testimony, he said, ‘I’ve had the experience of delivering calves, dead and alive – delivering pigs, dead and alive … It breaks our hearts to see those animals not make it.’21 I recall the doctor who performed the D&C to remove my first miscarriage, and how she gently explained the importance of making sure the body was not carrying dead tissue, because it could cause infection. And then there was this politician, comparing women to cows and pigs, and expressing his sympathies with farm animals as he tried to restrict, by law, with penalty of imprisonment, the possibility of doctors removing the dead foetuses from women’s bodies. Psychologically, not to mention medically, it was a barbaric sentence to try to place on any fellow human being*.

(* It may come as a surprise to some that in 2015 abortion is still listed in the NSW Crimes Act, something activists are hoping to reform. In NSW an abortion is only lawful if the woman’s doctor believes on reasonable grounds that it is necessary to avoid a serious danger to her life or her physical or mental health, taking into account economic and social factors as well as medical ones, and the risks of the abortion are not out of proportion to the danger to be averted (Skene, 2004). Despite decriminalisation in most other states, many Australian women and families are still not entitled to make these crucial and deeply personal reproductive health decisions for themselves.)

In 2009, when I’d called my family in Canada to tell them the sad news that I had miscarried, I remember my father telling me that no one in our family had miscarried before. He seemed really to believe this was true, as if he would somehow know the history of all of the pregnancies and miscarriages in his family tree. He genuinely wondered why it had happened to his daughter when we didn’t have a family history of miscarriage. I knew that he was thousands of miles away, across a crackling phone line, trying to deal with news that made him both sad and puzzled, but it stung. This is the deception that comes from the taboo around miscarriage, the deception that allows us to think that miscarriages only happen to other people. Because we do not talk about it, particularly with men, most people do not know how common it is. March of Dimes – a non-profit organisation concerned with the health of mothers and babies – estimates that half of pregnancies end in miscarriage, often before women even know they have missed their period. Once that first trimester is over, the risk drops significantly. (The majority of medical sources estimate that less than 5 per cent of pregnancies end in miscarriage after that first crucial trimester.)

According to most estimates, about one in four known pregnancies end in miscarriage. The real numbers are hard to calculate, of course, because many people don’t know they are pregnant before a miscarriage shows as a late, heavy period. And because, well, we don’t often talk about it. One reason we don’t talk about it is that miscarriage is personal and often intensely difficult news for someone who hopes to have a child. The other reason, I believe, is internalised shame. As with most subjects on which we remain silent, the silence connects with a feeling of inadequacy and personal grief. Many women experience a concern that others will see them as a failure or ‘damaged’ in some way if they reveal they have experienced a miscarriage.

Then there are inevitable questions of ‘What happened?’ (or What did you do wrong?) when there are often no answers, or the internalised question of ‘What’s wrong with me?’, one that can come up so often in life but is especially brutal in matters of reproduction, as if unless we are able to reproduce, we don’t quite fully exist ourselves. Sometimes there is a reason for the miscarriage that can be identified – a health condition or, in the case of my miscarriage in 2009, an infection and medication that interrupted the fragile early stages of development. But often there is no clear reason at all, and the body has simply decided it is not the right one, or the right time. The vast majority (an estimated two thirds) of early miscarriages occur because of chromosomal problems in early development. With pregnancy tests now being widely available and increasingly accurate, women can know they are pregnant long before they would have in the past. Increasingly, this knowledge will come very early. Some chemist packs, like the one I used, claim to be accurate six days before your missed period, little more than a week after conception. Because the confirmation comes so early, perhaps as much as half of the time it will end something like it did in that airport for me – with a woman knowing without a trace of doubt that she was pregnant and now she is miscarrying.

It is a common convention to announce a pregnancy only after the first trimester, though we don’t often mention why that is. We don’t talk about it. One friend of mine passed out at a lectern in front of a crowd of people early in her first pregnancy. Though some of the women in the audience might have guessed the reason, she felt she could not simply come out and explain why she had passed out. As a result of this taboo, these ongoing fictions about pregnancy, women around the world suffer dizziness, nausea, and even fainting spells in silence. Enough. Back at home after the Hawaiian trip I could finally do the crying I couldn’t do in the airport. After a week or so of feeling unusual fatigue and a touch of nausea (both common signs of pregnancy), my hormones were slowly levelling out, hour by hour. I had miscarried a very early pregnancy. With the news confirmed by my doctor, I was able to grieve and start to come to terms with it. And this time, because of my previous experience and what I’d learned from it, and because of the discussions I’d had with my father, and what he’d learned, I had a completely different experience when I told my family the news. This time we had the tools to understand what had happened and were able to deal with it and support one another, and it brought us together. I felt far better for talking it out with my loved ones, and I feel far better for writing about the experience here (as for many writers, the page has been a solace throughout my life).

A few days later, I was scheduled to appear at the Sydney Opera House to speak on a panel as part of the Festival of Dangerous Ideas. I had been looking forward to participating – particularly as I admired my co-panellists, Emily Maguire, Dan Savage and Christos Tsiolkas – though I’d had no idea I would be going through something like this. My family were a great support, and though I wasn’t quite through the physical experience of the miscarriage yet – I was still slightly nauseous and suffering from light cramps – I felt I could cope. As it happened, just before we went on stage one of my fellow panellists, Seattle sex columnist Dan Savage, explained to us that he had been up all night vomiting due to food poisoning. He hadn’t slept and warned us that he might need to leave part-way through the session to be ill. We all expressed our sympathy and understanding. It occurred to me that if we had a different relationship to the realities of miscarriage, it would be possible for me to explain that I was unwell because I had been miscarrying, and might need to excuse myself if overcome by nausea, dizziness or severe cramping. But of course I said nothing. It felt surreal to step onto the stage, but the session went off without a hitch, and both Dan and I made it through, the audience none the wiser.

Slowly, I was getting to the other side. And so was my husband, Berndt:

As an event, it’s important. There’s so much hope when you first find out about the pregnancy, and then so much sorrow with a miscarriage. But it’s given the status of a non-event: you don’t tell anyone your partner is pregnant, just in case it doesn’t work out, and then when this fear is realised, and you’re gutted by it, you can’t say anything. But talking it through with friends helped to make it real: something that happened, something sad, which I could then get past.

By keeping these discussions taboo, we rob people of the basic support and understanding necessary to deal with their loss. By keeping these discussions taboo, we force women and families to suffer in silence.

Since writing about this issue in The Fictional Woman I have sadly suffered further miscarriages. It has been a hard road and my heart still aches for it. I am grateful for the family I have, and for my good health. I will cherish both.

My thoughts go out to those of you who are going through this, particularly those suffering in silence.

I cannot be silent anymore.

– Tara Moss

This blog includes an updated excerpt from The Fictional Woman, HarperCollins 2014.

Miscarriage, stillbirth and newborn death support services:

– Pregnancy Loss Australia

– List of Australia wide services 

– SANDS

– Bears of Hope

– Fertile Minds 

This post was originally published on Tara’s blog, taramoss.com and was republished here with full permission.