The women who find themselves in Dr. Zev Williams’ office are typically struggling from recurrent miscarriages. Some of them have experienced more than 20 pregnancy losses. They’re grieving — and they’re also blaming themselves for doing something wrong to cause the loss of their unborn children.
“Invariably, when I speak with patients who had had a miscarriage, they’ll say, I knew I shouldn’t have done this or that,” Williams, who directs the Program for Early and Recurrent Pregnancy Loss (PEARL) at the Albert Einstein College of Medicine, recounted in an interview with ThinkProgress. PEARL specializes specifically in miscarriage research and treatment.
“Stress is the answer I hear most often from patients,” Williams said. “I think virtually every patient who has a miscarriage thinks about the week leading up it, and thinks about things she did that she’ll say was the cause of the miscarriage — she had to move something in the office, or she had a deadline she had to meet.”
In fact, the majority of miscarriages are entirely unavoidable. Although researchers can’t always pinpoint the exact cause of a miscarriage, they do know they’re not triggered by everyday emotions like stress. About 60 percent of early pregnancy losses are actually caused by chromosomal defects in the embryo that would have prevented the development of a viable pregnancy, no matter how the woman behaved. In that case, a miscarriage actually represents a woman’s body doing exactly what it’s supposed to do: Ending a doomed pregnancy early enough so that it doesn’t risk her health or compromise her future fertility.
“For the routine healthy woman, miscarriages aren’t being caused by anything she’s doing,” Williams said. “If stress or aggravation or lifting something heavy caused miscarriage, none of us would be here today.”
If stress or aggravation or lifting something heavy caused miscarriage, none of us would be here today.
Nonetheless, according to recent survey conducted by Williams and his colleagues, widespread misconceptions about miscarriage persist. When asked to indicate what can cause a pregnancy loss, 74 percent of survey respondents incorrectly cited a “stressful event” and 64 percent incorrectly cited “lifting heavy objects.” Twenty-one percent said that simply “getting into an argument” could lead a woman to miscarry. Respondents also incorrectly identified previously being diagnosed with an STD infection and previously using birth control as factors that can result in a future miscarriage.
The survey, which was published in the Obstetrics & Gynecology journal this month, also confirmed that many people mistakenly believe that miscarriages are rare, even though it’s a relatively common reproductive health experience. Medical professionals estimate that between 15 and 25 percent of pregnancies end in miscarriage.
Troublingly, these entrenched myths about miscarriage contribute to feelings of guilt and shame among people who have been personally affected by one. Nearly 50 percent of survey respondents who indicated that they had previously suffered a pregnancy loss reported they felt guilty about it. An equal share, 41 percent, reported feeling like they did something wrong and feeling like they were alone.
Previous research has confirmed that women often deal with negative emotions after a pregnancy ends, whether that occurs through the unwanted experience of miscarriage or through the intentional decision to have an abortion. Reproductive rights and justice advocates theorize that these responses are largely reinforced by a society that connects women’s worth to their ability and desire to be mothers. When pregnancies end for any reason, women may internalize the implicit message that they have failed to be the kind of woman they’re expected to be.
There is such a deep shame attached to not being able to carry a baby to term.
“I felt, and feel, literally broken, and betrayed by my body,” one woman who experienced a miscarriage wrote to NPR after the outlet solicited stories from people who have been through this experience. “It’s irrational, but there is such a deep shame attached to not being able to carry a baby to term.”
Thanks to these emotions among women who do not carry their pregnancies to term, it may be harder for them to speak up about their experiences with miscarriage and abortion. Researchers have found that women are more likely to keep those things a secret from other people who they suspect would respond in a judgmental way.
“Because of stigma, sharing a vulnerable experience can be difficult and intimidating,” Steph Herold, the managing director of Sea Change, an organization striving to change the culture around stigmatized reproductive experiences, told ThinkProgress via email. “People can be brave, but no one is brave all day every day, especially when the world (and the internet!) is as cruel as it is.”
Herold’s organization has so far mainly focused on challenging abortion stigma, but hopes to eventually expand its work to provide similar support for people who have experienced miscarriages. “We want people who’ve had miscarriages to feel heard, supported, trusted, and loved, and empowered to share their experiences if and when they want to,” she said.
Similar to the emerging evidence that women who disclose their abortions can help shift public opinion about preserving legal access to the procedure, helping women feel more comfortable speaking up about miscarriage has the potential to lead to real changes in science and medicine.
We want people who’ve had miscarriages to feel heard, supported, trusted, and loved.
Williams pointed out that doctors still don’t know enough about exactly what causes recurrent miscarriage, which could end up exacerbating patients’ feelings of guilt and shame. Without a clear medical answer for the parents who want to know exactly what went wrong, he says, it’s all too easy for them to fill in those knowledge gaps by blaming themselves. However, perhaps because miscarriage isn’t widely discussed, there aren’t currently enough resources dedicated to this area of research.
“You don’t see as many lobbying groups or as much patient advocacy. Relative to the amount of people who experience miscarriage, there’s a tiny amount of money that goes toward it,” Williams said. “But there does need to be more research in the area. I think knowledge is a great way to get rid of myths.”
Even before the medical field makes more advances toward pinpointing miscarriage causes, there are some other things that doctors could start doing to help facilitate a culture shift around pregnancy loss.
Conventional medical wisdom says that women shouldn’t disclose their pregnancy until they reach the second trimester, once they’re past the risk of having an early miscarriage — something that implicitly sends women the message that they don’t want anyone to know if they end up miscarrying. Doctors sometimes subtly reinforce this worldview by advising their patients to wait to spread the news.
Williams suggested that medical professionals could be more careful to avoid taking a firm stance on about when exactly women should start sharing the news of their pregnancy, and leave that decision up to each patient. Instead, they could simply be upfront about the reality of miscarriage with their patients. While that information may be hard for a pregnant woman to hear, it would at least reinforce the idea that she won’t be alone if she does end up mourning a pregnancy loss.
“Maybe we should be giving them the information and just saying — you’re pregnant, congratulations, but I just want you to know there’s a 25 percent chance of having a miscarriage,” he said. “We could give that education before a miscarriage happens.”