"Wise and compassionate . . . a profound game-changer of a book." Caroline Leavitt, author of Pictures of You
Though approximately one in four pregnancies ends in miscarriage, it remains a rarely talked about, under-researched, and largely misunderstood area of women's health. This profoundly necessary bookthe first comprehensive portrait of the psychological, emotional, medical, and cultural aspects of miscarriageaims to help break that silence.
With candor, warmth, and empathy, psychotherapist Julia Bueno blends women's stories (including her own) with research and analysis, exploring the effect of pregnancy loss on women and highlighting the ways in which our society fails to effectively respond to it. The result is a galvanizing, urgent, and moving exploration of a too-often-hidden human experience, and a crucial resource for anyone struggling withor seeking to better understandmiscarriage.
|Publisher:||Penguin Publishing Group|
|Product dimensions:||5.09(w) x 7.70(h) x 0.58(d)|
About the Author
Julia Bueno is a psychotherapist who specializes in working with women who have experienced pregnancy loss or struggled to conceive. Her writing has been published in The Times (UK), Express, Therapy Today, and welldoing.org, among others. She lives in London with her husband and two sons.
Read an Excerpt
A Child in Mind
The Unconceived, Barely Conceived, Unusually Conceived
When you think you're pregnant, and you're not, what happens to the child that has already formed in your mind? You keep it filed in a drawer of your consciousness, like a short story that wouldn't work after the opening lines.
-Hilary Mantel, Giving Up the Ghost
Miscarriage often involves the loss of a unique relationship with a babya relationship that may have begun long before the baby was conceived, especially for those who have yearned for a baby for years and may have struggled to get pregnant. But the notion of a relationship existing with our unbornhowever developed in the womb he or she may betook a pitifully long while to grab the attention of medical and psychological research and can still be a fragile one for many. And if this bond isn't fully understood, the grief flowing from its dissipation when a pregnancy ends has little chance of a healthy expression.
From the beginnings of my desire to get pregnant, nearly a year before I conceived my twins, I played out a number of stories in my head that also stirred my heart. Sometimes my baby was a girl, sometimes it was a boy, sometimes it had grown into a child. I would drift into reveries of how I would guide a teenage son to be a feminist or encourage a daughter to embrace physical adventures in a way that I never had. It didn't stop there-I even imagined becoming a doting grandmother to my grown child's children.
In early 2002, I took my first pregnancy test. I had, at last, a reason to suspect that my dreams had come true as, tantalizingly, my bleeding had failed to arrive. I knew exactly how the test worked, but I still read and reread the instructions in the packet, worried that if I interpreted them wrongly, I would sabotage any chance of becoming a mother. I prayed to a God I no longer believed in for a second pink line to emerge in the teeny white plastic window of the wand. My fantasy baby, wedged tentatively but tenaciously in my mind for the many months I had been hoping and hoping, was about to become real-or not. And when the second line did appear, the bond with my baby in my mind instantly changed dimension.
These heartfelt imaginings I both enjoyed and worried about are often beyond our control. If our thoughts have an emotional charge-such as "I desperately want a baby" or "Maybe this month I'll be pregnant"-they can easily become tenacious. Trying to stop thinking about something that concerns-or threatens-us rarely works: the ruminative power of our mind is too forceful. I have yet to encounter anyone who wants to be pregnant and can successfully switch off their hopes, dreams, and fears about it, even if they try.
This mental labor in itself contributes to the sparks of a relationship with our unborn: the more we think, plan, daydream, or dream dream about our longed-for baby, the deeper the grooves in our mind become. In neuroscience, this concept has been summed up by the phrase "Neurons that fire together, wire together," coined by a Canadian behavioral psychologist, Donald Hebb, who proposed that the more we repeat a thought, feeling, or behavior, the stronger the neural connections in our brain become. And as these neural connections strengthen, the more we are prone to these thoughts, feelings, and behaviors.
Imagine learning that you have a very good chance of winning the lottery over the next few months. I challenge anyone not to think about-or find themselves thinking about-what they would do with their winnings. A real possibility, or probability, of something life changing can worm itself deep into our minds and hearts. And when a pregnancy is confirmed, this probability-and corollary relationship with an unborn-that had prevailed in mind then literally prevails in body, and in the world too.
Claire came to see me in the wake of her first miscarriage at nine weeks, and she left me in no doubt about the strength of her feelings for the baby she was still yearning for. Many other people she had turned to couldn't seem to understand that, for Claire, it didn't matter how tiny it was or that she was unable to describe what it looked like. Her connection to her baby had begun months before its conception, and she described her thirty-five days of being pregnant as the most meaningful days of her adult life. While she never used the word "love" to signal how she felt about her child-to-be, it seemed a fitting word to me.
Claire had been with her partner Will for five years before they decided to have a child. They had talked about their future family during these years, but it had remained happily abstract until they began to try to conceive. She had wanted to be a mother since her childhood, and had assumed this role would be hers ever since she cared for her "cuddlies" as a little girl and, later, when she changed her brother's diapers and soothed him when he cried.
At first the couple luxuriated in their plans for parenthood while also enjoying each other, their friends, their holidays, and their careers. Their future baby emerged from the edges of their minds and became a fleshed-out being who could be considered with confidence, ease, and increasing detail: names and parenting styles were discussed. But as the first year of trying to conceive rolled into the second, Claire became less convinced that a pregnancy was going to happen. She described how an increasing lack of confidence in becoming a mother seeped out into a general lack of confidence at work and even among her friends.
As her imagined baby crawled away from the easy reach she had assumed for it, Claire would think about it more and more, however hard she tried not to-the neurons were firing together and wiring together. She became increasingly consumed with a desire to get pregnant, and the couple turned to the seemingly endless advice about how to boost their fertility. They gave up alcohol and late nights, bought expensive vitamin supplements, and took up yoga to combat the stress of unfulfilled desires. Sex became less spontaneous and carefree, and more of a necessity around the time of Claire's ovulation, whether either of them was in the mood or not. Claire stayed home more, in part because she was feeling more withdrawn, but also to protect herself from witnessing other pregnancies.
Each time Claire's period arrived, it brought increasing sadness and disappointment, as well as an excruciating mix of hope for the next month and despair that the hope might be destroyed again. Writing about his and his wife's struggle to conceive their son many years ago, the journalist Jon Ronson described his wife's experience of her period's repeated arrival as that of an "empty coffin." Those moving words returned to me when I heard Claire talk about her own months of trying to conceive: for her too, each menstrual bleed hurt like a small death.
Just as the couple was about to make an appointment with their doctor to investigate their fertility health, Claire's period was unusually late for the first time. Being pregnant had become so desperately desired, yet so unreliable a notion to believe in, that Claire needed extra proof that the baby she had nurtured in her mind was now actually in her body. It seemed too good to be true. She took four pregnancy tests before believing it herself, and then sharing the news with Will. Each stick revealed the word "pregnant," and she held on to them, not knowing then that they would become the only physical links to her baby that she would be left with.
The months of heartache evaporated in the couple's all-consuming joy: Claire's long-cherished fantasy baby now really existed in terms that others could understand. While she assimilated her unprecedented news, her bond with her baby crystallized into one she could really take hold of, and she could now more confidently play out her maternal instincts through nurturing her own body with its new, precious cargo. She bought a pregnancy book, began to explore pregnancy websites, and signed up for email bulletins-she wanted to know everything that she could about her new state of being, and of the being she was inextricably bound up with too. However tiny and unformed as her baby was at this stage, this had no bearing on the strength of what she felt.
Claire could rely on a simple piece of technology to swiftly and unambiguously diagnose her pregnancy-although she was in such disbelief that her dreams had come true that she repeated the test. After detecting the presence of the hormone human chorionic gonadotropin (HCG) in her urine, released after an embryo implants to the wall of the womb about six days after fertilization, her pregnancy test literally told her-by displaying the word "pregnant"-that she was a mother-to-be.
Claire took for granted all that she knew about conception-the release of her egg each month and the related bodily symptoms this would bring. She knew that it would provide half of the genetic material for her baby and that its fertilization would lead to the development of a human baby-and, she happily assumed, a live birth. Up until relatively recently, though, educated and middle-class women like Claire would not have had definitive knowledge of any of this, or of their pregnancies, until many weeks after a hunch. And for centuries, women who miscarried may have been unsure as to whether they had lost a baby at all.
It may well be that our ancestors' relationships to a baby in mind were different from those of a modern woman. Although there are descriptions of pregnancy-and its losses-in historical medical works and other written records, we don't know very much about how women felt about these experiences-or how they related to their unborn. We have so few records of women's inner worlds at these vulnerable times. The historian Suzannah Lipscomb noted, "Most of the women who have ever lived left no trace of their existence on the record of history. In sixteenth-century Europe, it is likely that no more than 5 per cent of women-at most-were literate; ordinary women left no letters, diaries, or notebooks in which they expressed what they felt or thought. For us, their voices are silent."
It may be that there is far more material in historical archives than we yet know about, but so far, the event of miscarriage in the past is a largely unexplored one. With small patches of exception, it tends to be subsumed into historical, anthropological, or sociological studies about pregnancy and childbirth. Until we learn more about our foremothers' private experiences of their pregnancies and early endings, we have to make some educated guesses based on what we know that they could have known.
There are some fascinating ideas about conception and pregnancy in ancient Greek Hippocratic medical texts that were influential for centuries-at least until early modern times. Three particular works-On Generation, Nature of the Child, and Diseases of Women-tell us the most, including that a woman's body was deemed to be "wetter" and more "sponge-like" in texture than a man's "hard," "firm," and "more constant" one. This idea seems to have stuck around to this day.
Echoing the thinking of the Greek philosopher and scientist Aristotle, these writings stated that conception happened when a male seed imposed itself successfully into a shapeless mass of female blood. If a woman's blood did not overwhelm the seed of a man, and there was no fault with the male seed, then a human form could ultimately develop from this mass. Women were often blamed for conceptions going wrong, so it's interesting that a male seed could also be deemed to be at fault. Pregnancies were diagnosed at "quickening," when a woman felt fetal movements (probably around sixteen weeks), with a male fetus apparently moving before a female could.
Following this Hippocratic thinking, anything lost through the vagina before quickening was not only not a baby but also deemed not human. What women lost was often described as a "uterine mole" that related to reproduction, while the Greek physician Soranus in the second century AD had a different view in his manual for the Romans, Gynecology. He saw "moles" as nothing to do with reproduction at all, linking them to ulcers or inflammation of the womb.
We don't know how women in classical times experienced the loss of these ambiguous "moles." The received wisdom of the time told them they hadn't lost a baby who they may have harbored in their dreams. If women's mental worlds were the same then as they are now, it may be that some challenged the standard medical views, knowing their body and its rhythms better than anyone else. We don't know if they thought a lost "mole" was the early inklings of their human child, which they may well have gone on to mourn.
Centuries later, when print culture expanded in seventeenth-century Europe and midwifery texts began to circulate-such as Nicholas Culpeper's Directory for Midwives (1651) and Jane Sharp's The Midwives Book (1671)-the diagnosis of a pregnancy still remained bathed in ambiguity. Some vivid depictions of pregnancy and suspected pregnancy in early eighteenth-century German and French texts echo the classical view that a woman's unborn child came into existence once it became animated enough to be sensed. But even this wasn't a watertight determination, as these sensations could be confused with the movements of "moles," colic, or wind.
One academic has suggested that during these early modern times, "until the birth of a live infant, there was no certain way to determine whether what a woman harbored within her was a child or rather, as one often-reprinted volume put it, 'a foul mass of flesh that comes to no perfection.'" What the modern reader may now suspect were miscarriages were often described as "blood curds," "wrong growths," or even "fleshy morsels"-words that sound pejorative to contemporary ears but are sadly not so far away from phrases I've heard used in reference to a miscarriage in modern times.
We are unlikely to ever know if "fleshy morsels" might have been fondly dreamed-of babies to early modern women in the privacy of their own minds. Or whether such women followed other wisdom. But as pregnancy testing became more accurate-and more available-as the twentieth century progressed, they could become more confident about knowing about, and bonding with, their suspected child in mind.
Beginning in the late 1920s, laboratory tests were developed to detect a pregnancy: women's urine was injected into living animals (first mice and rabbits, then frogs and toads), whose resulting physiological changes from the HCG (or lack thereof) would indicate a pregnancy. But this cumbersome method wasn't available to all: doctors rejected "curiosity" cases of healthy married women, and testing became mainstream only when home pregnancy kits emerged on the market in the UK and US in the early 1970s. Although these now remarkably sensitive tests have largely removed any ambiguity around conception (false results do rarely occur), when it comes to a pregnancy then ending in miscarriage, ambiguity seems to linger around what the pregnancy created: we don't tend to know if a "baby" existed, as we don't tend to ask.
Table of Contents
1 A Child in Mind: The Unconceived, Barely Conceived, Unusually Conceived 1
2 Derailed: Early Miscarriage 39
3 A Conspicuous Absence: Late Miscarriage 79
4 Again and Again and Again: Recurrent Miscarriage 119
5 Ripples: Partners, Family Members, Others 163
6 Efforts to Remember, Pressure to Forget: Funerals, Memorials, Campaigns 205