Pregnancy Loss Interview with Dr. Jessica Zucker
How can women get through a miscarriage and keep up hope of getting pregnant again?
Miscarriage is common. More common than we think. About 15-20% of known pregnancies result in loss. Approximately 80% of miscarriages are due to chromosomal issues and typically happen within the first trimester. Having a miscarriage is not necessarily indicative of a larger problem. So, for a majority of women, a miscarriage is not something that should steal hope from building a family moving forward.
Though miscarriage is common, many women report feeling isolated and alone in the aftermath. This is primarily due to the silence and consequent stigma that shrouds pregnancy loss in our society.
With regard to maintaining a sense of hopefulness, as we know, this can be quite complicated as it intermingles with grief. Grief can be very confusing and overwhelming. There can be countless feelings associated with loss and grief, depending on circumstances such as social support, family structure, and so forth. Like grief, it is so individual, how we continue on in our hope. Being kind to ourselves as we try to make our way through this challenging time is key. Hope might come and go, but being gentle to ourselves should remain a central goal.
It’s important that we try to be tender toward ourselves as we navigate grief and the potential of a subsequent pregnancy. Being hard on ourselves can be tempting, but ultimately doesn’t yield positive feelings/results. It only serves to create additional hardship and stress. Resist.
I suggest taking one moment at a time if/when your mind runs off into the future, predicting outcomes that can’t actually be predicted. We can easily get caught in our heads and swirl round and round in the “what ifs”. Try your best to refrain from this dizzying spiral. It hurts more than it helps. A miscarriage doesn’t mean you will not go on to have a family.
Feel comfortable speaking with your healthcare providers about any of your physical concerns so that you can receive tailored information that is specific to you and your partner.
It is vital to remember that you are not alone and that support is available after pregnancy and infant loss.
Can you tell us three things that helped you through your grieving process?
First and foremost, writing. Writing about the various ways loss impacted my life was quite cathartic. It allowed me to process my feelings while simultaneously connecting with a community who understood. In so doing, I felt connected to women worldwide who I could be candid with about the spectrum of emotions that followed my loss and continue still, even into parenting. Reading stories of other women’s experiences helped enormously as well. The vulnerability in their words were palpable. Our hearts, though broken, clearly cracked open a new way of seeing/being/living/loving. Writing was also powerful in helping me harness my subsequent anxiety, the sadness, the anger, the fear, all of the feelings that arose after my loss. It allowed me to honor the feelings without judgement and to explore the crevices of this difficult journey. For me, there is a refreshing freedom in writing that often yields unforeseen insights.
Secondly, psychotherapy. Being in therapy following my loss was quite centering and even, at times, transformative. It helped me make sense of what was stirred up after my loss. It provided me with a place to fully fall apart. Navigating my subsequent pregnancy while in therapy helped bring a sense of calm to the pregnancy landscape and wrangled hope when it felt difficult to grasp.
Thirdly, my community of loved ones. My friends and family were profoundly helpful in that many of them experienced pregnancy loss or had their own stories of challenges related to pregnancy that allowed me to feel less alone. They provided comfort and a sense of empathy when I was in pain and sought a shoulder to lean on.
Many of our users who have experienced a pregnancy loss report having anxiety, worry and stress that affects both their waking and sleeping life. In your experience, what can women do to overcome this challenge?
Anxiety can be unruly. I suggest reaching out for help if/when anxiety feels unmanageable. Therapy can be an ideal place to talk through ruminations or concerns that are affecting waking and sleeping life. It is a helpful place to get tools and also discuss the specific things that are contributing to anxiety. Oftentimes, anxiety dissipates upon sharing it. Feeling heard helps. Coming to a deeper place of understanding about its roots and function can ease the intensity of anxiety.
If sleep is challenging, I recommend coming up with self-talk/mantras to be used before bed or to get back to sleep, if you wake in the middle of the night. Gentle self-talk: reminders to yourself that are kind, validating, loving. Writing might be useful. Reading something that is calming could also help ease the constant stream of worry. Loving mantras that help ignite hope, feelings of safety, and an overall sense of peaceful could be a helpful and meaningful practice to engage in when anxiety is running rampant.
I also suggest disengaging from social media before bed or if you wake up in the night. This is a good way to avoid potential triggers that may stir additional anxiety.
During the day, I suggest focusing on something other than one’s own life. In other words, whether it’s work or engaging in a purposeful or meaningful endeavor or something else, these things can act as an emotional anchor and stave off anxiety. It could also be helpful to employ other distraction techniques, not as a way to numb feelings, but to simply take brief breaks from them.
It is incredibly important to allow time and space to think, feel, and connect with/about your loss. We don’t want to pretend like our losses didn’t happen — by numbing or minimizing our experiences. We don’t want to push feelings away or act like they don’t exist. Though grief is painful and pain isn’t something we necessarily want to feel, this is now a part of our lives, a part of our narrative. It doesn’t behoove us to ignore it. We can address our pain. We can survive this pain. We inevitably grow from this pain. So whether it’s connecting with a partner, friend, family member, and/or therapist – it’s key that we acknowledge our grief and remain connected through it–with ourselves and with others.
Pregnancy loss might affect relationships / marriage. What are some common themes you’ve heard in your work, among friends, or even experienced after you own loss?
For relationships with friends – I was surprised by some of the reactions of people in my life after my loss – both in positive and difficult ways. I wrote an essay about it for The Washington Post – I Had A Miscarriage: Talk To Me. It is about the idea that miscarriage is not contagious, and in talking about our broken places, we don’t infect other people with our traumas. Of course we all know this, but there is a way in which our culture is so afraid to talk about grief and loss, especially this type of loss, and sometimes it feels like you’re being temporarily quarantined. We need people during this time in our lives. We need to know that community remains available to us and that we can turn to loved ones to share our stories.
Grief can bring closeness as well. Personally, I felt profoundly supported by my father throughout my grieving process. He checked in consistently. He was able to hold my feelings without attempting to change them. He listened empathically. He understands that grief is anything but linear and honored my process. He didn’t try to focus on the “bright” side, find a silver lining, or instill false hope. On the first anniversary of my miscarriage, I wept on the phone with my dad, recalling all the details of that horribly day, as my belly shook with new life, pregnant again. I spoke with him about my anxiety in my pregnancy following my pregnancy loss and the newfound sense of vulnerability I felt. He didn’t try to “fix” or change; instead he supported me with love and attentiveness. I was and still am deeply appreciative of his presence in my grief. This made an indelible impact.
In my work, I hear a lot about relational disappointment. It can be very difficult for friends, family, colleagues, and partners to know what to do/say, especially because culture doesn’t help us understand how to navigate this particular type of loss/grief.
For romantic relationships, I wrote a piece for Refinery 29 called Marriage After Miscarriage, about how my marriage was impacted by my miscarriage. Yet another part of loss that is under-talked about in our society. The thing is, our partners can’t always understand exactly what we are going through when it comes to pregnancy loss. They might not be able to understand the complexity of hormones, the body changes, the body image issues, the feelings about sex after loss, the bleeding, the D & C, etc. They might not be able to grasp all of the physical or emotional things that only the pregnant person experiences, from a corporeal perspective.
However, the strain of loss can yield incredible connection as well. In other words, though this hardship is something that we wish didn’t happen, there is a way in which it can provide an opportunity for deepening the marriage/partnership. To carve out dedicated time each day to check in with one another, to communicate openly about grief and loss and fear and the unknown. To talk about shame, self-blame or guilt, if this arises. All of the feelings that are difficult may also become a birthplace of emotional intimacy.
The key is to try to remain connected throughout the grieving process so that both people feel understood, cared for, and acknowledged.
Communication is the cornerstone of relationships. If things have gone awry after loss, it might be an apt time to evaluate the dynamics and what may have been stirred up in the aftermath of pregnancy loss. If there are people who you feel more connected to, expressing gratitude for their empathy can go a long way. And in relationships that may feel tense or disappointing, you might want to try sensitively discussing this too. You’ll know when you’re ready to do so.
What can women who are pregnant after a miscarriage do to not let fear and anxiety control them?
This is a tough one since pregnancy is LONG. When you’ve experienced pregnancy loss, miscarriage, stillbirth, or infant loss, the subsequent pregnancy can be quite fraught. There’s no way around how long and arduous it can feel sometimes, for those who are worried each day. But there are tools we can rely on that can help us get through.
Anxiety can get the best of us sometimes! As I mentioned earlier, therapy can be a great antidote and a place that provides solace as well as tools to use when anxiety strikes. Self-talk can be incredibly useful as well as employing thought-stopping exercises. These can accompany you anywhere you go and therefore can be called upon at any time.
Additionally, disengaging from triggering experiences can be crucial, be it online content or other things that seem to pique anxiety. For example, say you got involved in a pregnancy loss community online after your loss and found it to be a great source of support and connection – but upon getting pregnant again, the group now feels triggering. It might be helpful to take a break from that community for a while. And that’s okay. Stepping away from things that scare us during this tender time is necessary. Be aware of what feels helpful and what doesn’t. What feels loving and what doesn’t. What provokes anxiety for you and what doesn’t. Taking care of yourself during this nascent time is of utmost importance.
Your line of pregnancy and infant loss cards help others say the things that women need to hear after experiencing a miscarriage. What are some things that women who have experienced a loss could say to friends and family about the support that they need? How could they start / lead that conversation?
I find this question fascinating, mainly because often times in my work I hear women saying they don’t feel as though they should have to be the one to tell others what they need. “I’m grieving and I don’t have the energy to tell you how to be helpful – just do something loving,” – a very understandable feeling. Grievers want to be acknowledged, cared for, tended to, and made to feel like what they want through matters.
Should the initiation of a meaningful conversation about support be on the griever? I don’t know, but I do think if the griever wants to start that conversation they could start off by saying “I’m hurting and I’d love to know that you are here for me” or “This is more painful than I ever would have thought” or whatever else they may be feeling. They can invite their loved ones into their struggle thereby helping them understand that they long for closeness during this difficult time.
It takes a lot of courage and an open and direct communicator to come out of the silence, shame or stigma that surrounds loss and say to a loved one who isn’t saying a lot – “ I really want you to be here for me.” This can be quite powerful and may yield incredible results.
And yet, this type of communication can be tricky at times. Some people might be hurt by feedback whereas others desire it. So, I think small ways of saying “I’d love to feel your love right now” or “I’d love to feel more connected” or “I would love to hear from you a bunch right now” can be a good place to start.
Furthermore, if someone wants to share even more openly, saying something like, “I have felt like you haven’t been there, did my loss somehow bring up feelings for you about something?” they could do that, too. A conversation like this could be complicated amongst peers, however, especially other women who are pregnant, because perhaps they could be scared to talk about loss while pregnant.
As you can see, communicating (about support) after loss or during pregnancy after loss can actually be quite complicated.
Some women on our platform who have had a miscarriage struggle with the simple question “how many kids do you have?” Say they have two children but have had two miscarriages and want to say “four children” but that leads into a long conversations about what happened to the other two. Have you ever felt this way or have you ever had clients speak about this?
I hear about this in my work a lot, especially from women who have had stillbirth experiences or lost infants. Like so many things, this is such a personal and individual decision as to whether or not people include their losses when sharing with others about the number of children they have. If it feels important to share, do. If people don’t want to explain the details or share them with strangers, than respecting one’s own privacy and sharing with people who understand instead makes sense. Whatever you feel most comfortable with at any given time should be honored.
I think it’s important to think about this question as a culture. If there were rites and rituals embedded in our society around pregnancy/infant loss, perhaps these types of questions wouldn’t be so difficult to navigate. For example, in other cultures, like Japan, they acknowledge loss publically. I went to Japan in the Spring in part to research the way they honor pregnancy and infant loss. They have Jizo statues that represent lost babies and these are displayed in public. This is such a profound and beautiful way to integrate loss into society so that it isn’t seen as something that we stuff away or become quiet about. That we face alone. Shame and silence exist a lot less in cultures that acknowledge these experiences and the subsequent grief as normative.
It would be amazing if somehow we had something in our culture that really honored the loss in a concrete way so that questions like this wouldn’t be so difficult to answer.
We sincerely hope that Dr. Zucker’s perspectives helped to bring more comfort into your life, and that our after loss meditations below will continue to support you throughout your process.