We Need to Talk about Miscarriage

I had a miscarriage in November. It was “early”, which meant it left me feeling completely devastated but also oddly undeserving of my own grief; I had barely been pregnant before it was all over, but we had already told our parents and siblings.

I’m not writing about this because I want attention or sympathy, although some might cite my chronic tendency to over-share, or my love of medical statistics (and they’d be right – pregnancy is fascinating, but reliable, non-anecdotal advice can be hard to find, so I’ve become obsessed with seeking out good sources of information). The reason I’m writing about it now is that the only thing that made me feel better afterwards was hearing other women’s stories of their own losses, or talking to people whose partners had had miscarriages, and being reassured that a loss is a loss, no matter how early. I want this account to exist so that others can read it and (I hope) feel a little bit better.

My first instinct was to mourn; my second instinct was to feel guilty about mourning, because other people had reached eight, nine, twelve weeks, eight months, even, and I had only reached five weeks. How could I be sad when I’d suffered so much less? I also wept with fury when I received, exactly a month after my own miscarriage, a pregnancy announcement from close friends. It wasn’t their fault; they had no idea. But I raged, and sobbed, and was a mess. B was disappointed with me: weren’t we their friends? Shouldn’t I be nicer? How could I react like that when I should be happy for them? I tried to explain that yes, I was happy for them, thrilled even – or at least I knew I would be, soon; just not at that particular moment.

It’s a tired trope of the time we live in, but it’s worth repeating: your feelings are real. They might be selfish, or inappropriate, but that doesn’t mean they don’t exist. Allow yourself to be sad if you need to be sad.

***

I knew I was pregnant long enough to construct a potential person in my head, a really clever, charming child with funny mannerisms who liked being taken to the Ashmolean Museum and then for cake in the cafe downstairs. Until November I had only been interested in girls’ names, but as soon as we found out, I felt like I was pregnant with a boy (although studies show that when women claim to “just know” the sex of their child, they’re right at about the same rate as chance: 50% of the time). We wandered around an exhibition of Venetian drawings and talked happily about the fact that there was just one name, that name, and it was perfect. It was so perfect that I couldn’t imagine it being a girl any more. My lack of symptoms worried me a little, though. It didn’t quite feel real.

I began bleeding a couple of days later, painlessly. It was the weekend, so I rang 111, which is the UK non-emergency number, and asked what I should do. They told me that painless light bleeding in early pregnancy was nothing to worry about, but that I should call again immediately if I experienced strong cramping, or began to lose large blood clots. They scheduled me in for a scan at a nearby hospital two days later. At about 3.30am on the morning I was due to go in, I woke up in a lot of pain, barely able to speak, and knew exactly what was happening. I followed the other, grimmer instructions they’d given me: save any tissue you lose, put it in a clean container, bring it in to your appointment for analysis. “We need to know if you have an infection,” they’d said. “Oh, I’ll be fine,” I’d responded cheerfully, trying to push my fright back down my throat.

I could barely look at it when it did come out. It was just a sort of dark red sac. At that stage the embryo inside was still effectively just a blastocyst, barely even an embryo, the size of a small red lentil. All I could do was say oh my god, oh my god, over and over. B put it in a tiny tupperware box, swaddled in the white tissue I’d caught it in, and put it in the fridge as we’d been instructed, which seemed so horribly sensible. The next morning I put it in my handbag, unable to decide whether or not to treat this thing as something, or just a medical object like a urine sample. I was alone; B was in rehearsals all day. I took a cab to the hospital, but there was a terrible traffic jam near the entrance and I had to walk what seemed like miles to get to the place where they’d scheduled my scan. My back ached.

When I got there, I walked through a large waiting room full of very pregnant women, looking tired but content, and eventually reached my destination: a smaller, silent waiting room. There were two couples sitting in it. The women were crying quietly; neither was visibly pregnant. The men sat holding their hands, or trying to get them to agree to coffee. I had a couple of bananas in my bag and offered them up; the women jumped at them. They’d been sitting there for some time, they said, and were starving, but their partners didn’t feel they could leave their wives to go and get food in case their wives were called in while they weren’t there. Sharing food is an extraordinary thing, even if it’s just bananas. Suddenly we were all friends, tenuously, in spite of the fact that we were all very close to tears. Everyone talked about their pregnancies, their bleeding, their hope that in fact it was probably ok, even though everyone knew it wasn’t. We expressed optimism for each other. I think we all meant it.

I was called in; they did a pregnancy test on the urine sample I’d been asked to bring in. It came back negative; my hCG (pregnancy hormone) levels were so low that my body didn’t even think I was pregnant any more, but I’d known this would happen; since the bleeding had started I’d been obsessively taking cheap pregnancy tests, and they had all been negative. The worst part was having to sign a”release of foetal tissue” form. I cried a lot. The nurse explained to be quietly that since the pregnancy test was negative, they wouldn’t be doing a scan; there was no point. I was definitively not pregnant any more.

The doctor I spoke to later that morning was compassionate but matter-of-fact: “I know it probably doesn’t help to tell you this, but miscarriage at this stage is extremely common,” she said. “Go home and eat some iron-rich foods: spinach and steak. And have some orange juice to help you absorb the iron. And try again as soon as you feel ready. I’d be delighted if you conceived in the next cycle.” She gave me a leaflet from the miscarriage association. I went off to teach someone conversational English, then had tea with a priest. I told them both, which was probably inappropriate. They both expressed horror at the fact that I was going on with my day as planned instead of being at home in bed. I went home, reading my leaflet on the bus. It was comforting at first, but when I got to the part about “commemorating your baby”, I started crying again. It was too much. I put the leaflet firmly away in a dark corner of my handbag and read political commentary with fierce concentration until I forgot what had happened.

That night B brought home the most expensive steak he could find, and a really nice bottle of red wine. He also brought a friend who was staying the night on her way home because of bad weather. She did some Reiki on me, which made me cry a lot more, and made up Bach flower remedies which I took on tour. I wasn’t sure if it had made a difference, but the utter compassion of her actions was overwhelming. I was getting tired of crying, though.

The next morning I had to go on tour. I cried for eight hours on a delayed train to Edinburgh, feeling like something had been stolen from me. I spent a lot of the next month crying.

***

The thing that is supposed to make you feel better is that, if something goes wrong at five or six weeks, that potential person you spent so much time imagining was never viable in the first place. A lot of people told me that this miscarriage was my body “getting ready for the real thing”, which helped, and then made me angry. Why shouldn’t it work the first time?

Early losses are categorised as such if they occur before twelve weeks, and most are due to chromosomal abnormalities, in which case there is absolutely nothing you can do to stop the body rejecting something that wouldn’t have survived anyway. Behaving moderately “badly”, i.e. behaving as if you weren’t pregnant before you knew you were, probably won’t have an impact, so feelings of guilt about an accidental glass of wine at four weeks can be assuaged. As Emily Oster points out in her excellent book “Expecting Better”, at that stage of development, if a cell is killed off because you drank three glasses of wine at a party, it will simply be replaced by another cell, with no damage to the blastocyst. If a much larger number of cells die, there is no pregnancy: it’s an all-or-nothing situation, but at that early stage you probably wouldn’t have known you were pregnant unless you were trying. To kill off enough cells to actually end a pregnancy at this very early stage, you would have to binge-drink, or use a lot of recreational drugs.

There are varying statistics on the likelihood of miscarriage at various points in pregnancy, but it is useful to know that while about 25-30% of pregnancies end in miscarriage, the vast majority of losses happen before twelve weeks; and of those, most happen at around the time mine did, at five to six weeks. A friend with a robust six-month-old baby told me she took great comfort in this website while she was pregnant, which gives the daily odds of miscarriage from three weeks and zero days onwards. Watching the numbers drop so steeply was reassuring, she said. At three weeks, the risk is 33%. Almost no one knows they’re pregnant at three weeks; that’s a whole week before a missed period. By five weeks, the risk has dropped to 17.3%, and by seven it’s a glorious 3.9%, and thereafter it drops rapidly to 2%, where it stays for the duration of the pregnancy.

***

Some things I wish I had been told before I started trying to get pregnant:

• Often, if you’ve been on the pill for a long time, your first pregnancy will end in an early miscarriage.
• The rate of miscarriage at five weeks is higher than you might think, somewhere between 17% and 30%.
• Having had one miscarriage, or even two, probably has no impact on your likelihood of having another one (although there is disagreement on this; some studies suggest having had one miscarriage actually decreases your chances of a second one, and some suggest the opposite).
• Twelve weeks is not a magical cut-off point; the likelihood of miscarriage drops rapidly, but in a smooth curve, up to the twelve-week mark. There is no perfect time to break the news of a pregnancy; there is no “safe zone”. Stillbirths (much later miscarriages) still happen, although they are rare.
• Some people have “missed miscarriages”, in which the foetus dies without the mother’s knowledge, often after an early scan at which things appear to be developing normally. Because this sort of miscarriage is not accompanied by dramatic bleeding, the mother may go several weeks until finding out.
• An anecdotal fact: almost everyone I talked to who had children had also had a miscarriage, sometimes with their first pregnancy, but often in between healthy pregnancies. Before twelve weeks, chromosomal abnormalities are the overwhelming cause of miscarriage, and there is nothing you can do about them.
• Molar pregnancies and ectopic pregnancies are rare, but scary. They can result in positive pregnancy tests. They never end well.
• Miscarriage will knock you out emotionally and physically in a way you’ve never experienced before. You might not be a very nice person for a while. You may just want to stay in bed for a week. You may become clinically depressed.
• Probably related: having a miscarriage raises the likelihood of divorce.

***

In a way, I was lucky: it was early. A friend recently miscarried at five and a half months, and when I found out, I couldn’t stop crying: for her, for her husband, for the idea they had built, for the utter cruelty of it. They were so far past the “danger zone”, the socially agreed-upon 12-week mark at which announcing a pregnancy is considered “safe”. She might have felt that baby kick. I have no idea what the circumstances were, but she would have had, in some sense, to give birth. What happened to me was at least quick: waking up in agony in the middle of the night, unable to speak except to wake my husband up and say “pain“, knowing exactly what was about to happen, running to the bathroom, and then losing something that was definitely something, but wasn’t in any way recognisable as a baby.

There’s another way in which we are overwhelmingly lucky. As I write this, I’m just over seven weeks pregnant. My life has become dominated by nausea, and I can’t seem to get anything done except write, and read, and pick half-heartedly at crackers and omelettes. I’ve become obsessed with sorbet ice lollies (mango flavoured ones are a winner). Even looking at my phone makes me feel sick, but that’s reassuring: only about 5% of women with nausea miscarry in the first trimester, compared to around 30% of women without nausea. The statistics are on our side this time. At seven weeks and one day, the likelihood of miscarriage has now dropped to about 3.5%. This is so close to the 2% risk at 12 weeks that I feel able to share the news openly. Also, I’m tired of feeling sick all the time and not being able to complain.

***

I conceived again just six weeks after I lost the first pregnancy. They told me this would be likely to happen; after a miscarriage, your body is in “fertility overdrive”, and conception is even more likely than it would be in normal circumstances, where even under ideal conditions the chances are about 32% the day before ovulation.

The traditional advice used to be to wait until six months after a miscarriage before trying to get pregnant again, but new evidence says the opposite: in fact, the likelihood of a second miscarriage actually rises after six months of waiting.

A week ago, looking for a pregnancy vitamin that isn’t the size of a horse pill (my gag reflex, already strong, has gone into overdrive), the man in the shop asked me if I was pregnant.

“Yes,” I said. “Six weeks.”

He looked at me sideways. “Hmm. Don’t people normally keep it quiet until three months?”

I took a breath. “Yes, but I had a miscarriage in November, so I’m telling people about this one. I want to enjoy it while it lasts. And I want to tell people so that if it happens again, I’ll have their support. But everyone’s different. Some people are happier not saying anything so they don’t have to give bad news after they’ve given good news. Anyway, the rate of miscarriage risk drops really dramatically between five and twelve weeks.” I swept my finger downwards in the air, drawing an invisible graph. “Currently I’m at about 7%.” I beamed at him.

“Right. So how many months would your baby have been now? You know, the first one.”

I froze, staring at the shelf of pregnancy vitamins. He had surely meant it as a harmless question, but to me this was a monstrous thing to ask, a reminder of something I’d very deliberately avoided thinking about now that I’d moved into my second pregnancy. I didn’t want to be one of those women who kept track in their heads of how old their baby would be, or dreaded the original due date, even though I knew some of that was inevitable. Couldn’t I be allowed to let go of the first pregnancy and just be happy in the current one? Had I brought this on myself by admitting to a previous miscarriage and opening up the topic? What gave him the right to poke at my grief just as it was starting to fade?

“I don’t know,” I said slowly. “I was due in July, last time. With this one I’m due in late September.” I paid for some ginger candy to quell the nausea, and left.

***

B can’t stop telling everyone he sees at work, especially his colleagues who have children. It feels real to him, too – my queasiness is affecting what we eat, my previous enthusiasm for complicated cooking reduced to a strange fervour for antacid tablets and leftover cold porridge, and a pathological fear of all cooking smells, particularly spices. And the people he tells have been so delighted and helpful that I think he wants to keep hearing their reassurance: That’s so brilliant! Congratulations! Don’t worry, people much poorer than you have managed to raise perfectly fine children. 

I can’t stop telling people either (and this post constitutes the Big Reveal, far ahead of socially acceptable schedule). It feels so sunny and exciting to be pregnant again. My due date is the 24th of September, the (Catholic) feast day of Our Lady of Walsingham. Sound.

***

For many people, miscarriage is an intensely private experience, but I found it isolating and disturbing to keep it secret, so I began telling people, one by one. First my family, then my friends. I wanted them to understand why I was so wretched, why I might not want to hear about pregnancy announcements or births for a month or two. The support that followed the revelation was overwhelming and immensely touching, and I’m glad I told people. Every time I told someone I felt I was healing a little bit; every expression of sympathy and concern was like a dab of ointment on a raging wound.

I want that network if it happens again, which is why we’re not keeping it a secret this time. But the main thing I’ve learned is how different it is for each person, just as every pregnancy is vastly different; grief affects people in different ways. And none of your feelings, if you have experienced a loss, are wrong or inappropriate: anger, jealousy, disbelief, sadness, exhaustion – these are all real, and allowed. Keep it secret if it hurts to talk about it. Share it if that’s what you want; there will be sympathy and support from kind people when you need it.

We shouldn’t treat miscarriage as though it is shameful or embarrassing. In any other situation, if someone is ill or bereaved, they let people know, and they allow people to help, or at least to understand why they’re not available any more, or why they’re not themselves. A miscarriage is essentially an illness and a bereavement wrapped up together, making it doubly hard to recover. And yet when I had my own miscarriage, I did feel somewhat ashamed of it, in spite of my strong beliefs about openness, that sharing information and demystifying these things makes our society more compassionate. The only thing that helped was to talk. It’s a painful subject, but if nobody talks about it, newly-pregnant women won’t be prepared when it happens to them – and it will. Let’s keep talking.