A Q+A with the author of 'I Had A Miscarriage: A Memoir, a Movement.'
[Editor's note: This article shares a woman's story of and information about miscarriage.]
Book synopsis: Sixteen weeks into her second pregnancy, psychologist Jessica Zucker miscarried at home, alone. Suddenly, her career, spent specializing in reproductive and maternal mental health, was rendered corporeal, no longer just theoretical. She now had a changed perspective on her life's work, her patients' pain, and the crucial need for a zeitgeist shift.
Navigating this nascent transition amid her own grief became a catalyst for Jessica to bring voice to this ubiquitous experience. She embarked on a mission to upend the strident trifecta of silence, shame and stigma that surrounds reproductive loss—and the result is her striking memoir meets manifesto.
Drawing from her psychological expertise and her work as the creator of the #IHadaMiscarriage campaign, I Had a Miscarriage is a heart-wrenching, thought-provoking and validating book about navigating these liminal spaces and the vitality of truth-telling—an urgent reminder of the power of speaking openly and unapologetically about the complexities of our lives.
We sat down with Dr. Zucker to ask her about her book, I Had a Miscarriage.
What inspired you to write this book?
Zucker: In all my years of doctoral training en route to becoming a psychologist, never once was a therapist's pregnancy discussed. How to address it. How to navigate it. How to acknowledge, frame and process it. This additional entity in the consultation room was virtually absent from the clinical and theoretical curriculum. What's more is that the therapist's loss of a pregnancy wasn't touched or considered. How an obvious baby bump showed itself in the therapy office and then at once was gone was not something I was educated about until it happened to me—until I had to brave this path firsthand.
I specialized in reproductive and maternal mental health from the get-go. For over a decade, I'd been sitting across from women and families struggling with fertility, pregnancy, miscarriage, stillbirth, infant loss, termination for medical reasons, perinatal and postpartum mood and anxiety disorders, and the complexity of grief. Before undertaking my Ph.D., I received a master's in public health and worked internationally with a focus on reproductive issues. So as I considered how best to marry my public health background with my clinical training, it was an obvious path forward: to work with people navigating the often fraught terrain of reproductive outcomes.
After enduring a 16-week miscarriage while home alone, my personal and professional life shifted both in subtle and demonstrative ways. Now, understanding my patients' experiences from the inside out, I came face to face with emotions I'd only heard about in the confines of my office.
I was inspired to write this book to address the myriad ways our lives are potentially affected by loss. I wanted to take on the various aspects of life after loss that are all too often left out of the conversation: How loss affects our friendships, family lives, parenting, partnerships, sex lives, work, body image, pregnancy after pregnancy loss and, of course, our mental health.
This book is a memoir meets manifesto, which means that I invite the reader into the intimate details of my life while also sharing stories of other people in the context of my work life as well as my @ihadamiscarriage Instagram community.
This book is meant to inspire people to compassionately question any lingering feelings of shame, self-blame or guilt they may have in the aftermath of loss. This book is an invitation to wonder together if we might, once and for all, work to bid farewell to the antiquated cultural silence that shrouds miscarriage by sharing our stories. Disbanding notions of body failure and disquieting shame, together we can rewrite the reproductive script. It's a revolutionary idea, perhaps, but I think it's possible. I think it's necessary.
You write about the silence, the shame and the stigma surrounding miscarriage. What do you see as the antidote to this?
Zucker: There is a strident trifecta swirling around the topic of miscarriage — made up of silence, stigma, and shame. As I discuss in-depth in my book, each aspect of this trifecta stokes the next. The cultural silence provokes the blanketed stigma. The stigma ignites the insidious and all too pervasive shame. It's a troubling cycle we find ourselves in as we navigate life after loss, as we are slapped by a society that shuts down when it comes to conversations around out-of-order loss.
In turn, grievers are often met with stilted, awkward platitudes, whispered saccharine-coated sentiments, or worse, complete and utter silence. The current zeitgeist, then, further proliferates the silence. As the silence permeates, the griever might begin to question themselves and the very thing that just left them shattered. Was this my fault? Am I not supposed to talk about this? Maybe I should be over it by now… Alienated and thrust to the outskirts of communities, grievers begin to embody and potentially even embrace the stigma. And this lays the groundwork for shame to fester.
The simplest way to achieve an antidote to this unhelpful cycle is to speak our truths. To persist in telling our stories. To gently and unequivocally resist self-blame—looking to the science and research about the actual reasons miscarriages occur, rather than creating elaborate stories in our minds that all too often center on somehow having had the control to bring about a different reproductive outcome. To remember that we are, in fact, not alone.
Approximately 1 in 4 pregnancies result in miscarriage, yet somehow we don't seem to know of anyone who has been through it until we speak about our own. By no longer being hush-hush about these profound experiences, we can change the cultural tide. We can live in a world that acknowledges miscarriage and the resulting emotions. We can cultivate a society that honors grief and hard conversations. We must work to do this for ourselves and for future generations, particularly because miscarriage is not going anywhere. There is no cure. This is a constant. It is therefore time that we collectively determine to normalize what is a normal outcome of pregnancy.
One of the missions of your book is to help women—and their families—understand that pregnancy loss isn't a fault of their own, but instead a common albeit difficult event. Why do people blame themselves for something over which they have no control?
Zucker: My sense is that people blame themselves because, with the lack of a cultural framework for speaking openly about and addressing pregnancy loss, they turn inward. They turn in on themselves. I think we can agree that women are groomed to blame themselves for too many things from the get-go, and miscarriage is a ripe opportunity to hurl harsh statements at oneself or to believe that somehow you could've done something differently that would have brought about a different result.
We struggle with miscarriage in part because all too often we are surrounded by images of glowing baby bumps that we imagine got there easily. We live in a society that relies on happy endings in order to get through. We were raised in a world that commends achievement, accolades and positivity. We were taught that if we try hard enough to achieve something, we can and we will. Pregnancy, and all that can happen within it, falls outside of this ubiquitous trope. We cannot control chromosomes, genetics or things unbeknownst to us that may be happening in our bodies that can take a pregnancy off course. We don't have all the control. But we turn to questions like: What if I exercised too much? Was it that sip of wine? Did this happen to me because I was ambivalent about becoming a mother? Or, alternatively, did this happen because I wanted it too much? The throughline being: I did something wrong. My thoughts and/or my actions were the cause. If only I had done something differently, I would have brought about a different result. When it comes to pregnancy and its loss, the onus does not exist on these types of actions or inactions. The research informs us that these things did not provoke the miscarriage. But, the mind fiddles. The mind yearns for understanding, meaning, and closure. The mind wants to believe: Now that I know what I did to create this loss, next time I will do something differently. It's magical thinking. It makes sense that we grasp onto this way of thinking amid grief, even if it is faulty and ultimately unproductive. My hope is that if the cultural conversation surrounding miscarriage became a mainstay—and it was integrated into society—the knee-jerk reaction to place blame on oneself might dissipate.
When you experienced your miscarriage, you felt that despite being a psychologist who works in the reproductive space, you were not "prepared" for the aftershocks. What do you wish you knew then that you know now?
Zucker: I wish I knew that pregnancy loss has the potential to rattle you to the core. I wish I knew that grief comes in waves, is unpredictable, has no definitive beginning, middle or end. I wish I knew that the wild ride of posttraumatic stress deserves and requires pointed attention. I wish I knew that navigating postpartum hormones with empty arms might catapult me into another galaxy. I wish I knew that pregnancy after pregnancy loss would be fraught from start to finish.
I came to learn that heartache and hope intermingle. I came to learn that leaning into grief might just be the very antidote to drowning in it. I came to learn that no amount of what-ifs steal the flagrant anxiety or begets a different outcome. In facing vulnerability straight on, I was met with a deepened relationship with myself and even a bit more surrender. I came to find connection and community in unlikely places—like corners of the internet and on social media. I found out firsthand that speaking our truths can be a potent salve.
But here's the thing: It's not like I was altogether unfamiliar with these notions from a theoretical perspective. Yet, after I was lambasted by the spectrum of emotions that can follow pregnancy loss, I learned in real time that no amount of knowledge or book reading can emotionally prepare you for lived experiences. I learned that grief is natural; it is normal, a birthright. I learned that no one is immune.
As you point out in your book, not all miscarriages are met with sorrow—some are a relief, and this can be for any number of reasons. Why is this response to a miscarriage especially taboo to talk about?
Zucker: In my clinical practice and in my online community, I have heard women reflect on being relieved in the aftermath of miscarriage. Relief seems to follow from a hunch or intuition that something wasn't going right in the pregnancy, ambivalence about having a child, a desire not to become a mother at all (or not to expand the family further), and/or rooted in a belief that miscarriage is, in a sense, nature taking its course. Free from self-blame, the miscarriage is seen for what it is in a majority of cases: a chromosomal issue. Some lose the pregnancy before even realizing they were pregnant at all. Not everyone gets attached to a pregnancy from the get-go, and not everyone begins to envision a baby upon seeing the two pink lines appear in the positive pregnancy test window.
Given the fact that women are traditionally expected to become mothers — or at the very least expected to want to be—those who feel a sense of relief after loss might tiptoe on eggshells as they try to share their candid feelings. "I'm okay, really. I'm not sad" might be met with quizzical expressions or haphazard attempts at reassuring the person that "time will help" or that "feeling the pain is normal." Encouraging them not to stave it off, but instead, requesting they be honest about their heartache.
But, for some, pregnancy loss is not mired in myriad emotions. For some, heartbreak is not the experience. Their loved ones might be surprised by this response. What's more is that the pregnancy loss community itself might not feel like a natural home for them either, as they don't hear their experiences echoed in the same way we hear about feelings like disappointment, sadness or devastation. As such, feelings of relief or ambivalence oftentimes go underground, rendering the discussion around them especially taboo.
You write in your book about various interactions with friends and family after your miscarriage that left you feeling more alone and confounded. Why do you think it's so hard for people to know what to say in the aftermath of pregnancy/infant loss? What are some helpful things to say/do?
Zucker: People typically don't know what to say or what to do based primarily on the fact that, as a culture, we fail to adequately talk about grief. We barely acknowledge it. Especially this particular type of loss. What I commonly refer to as an out-of-order loss. Loss of someone or something others couldn't see, touch, know. This kind of loss spurs grief many simply don't know how to approach—the loss of an imagined family member. An ephemeral dream of a future teeming with littles underfoot.
As a society, we tend to shy away from speaking frankly about uncomfortable topics, and pregnancy and infant loss surely fall under this umbrella. In the absence of knowing what to say or what not to say, people frequently rely on well-meaning, albeit unhelpful platitudes. Platitudes are likely to land with a dull thud, potentially stunning the griever into silence. Baffled and bewildered, the one who has just endured a loss is now further confounded by nonsensical statements. Phrases such as: "At least you know you can get pregnant," "It wasn't meant to be," "God has a plan" and "Everything happens for a reason" do not help. These words do not relay support. Instead, they shove grief into the outskirts while not so subtly reiterating the looming cultural trifecta of silence, stigma and shame.
The most profound thing we can do for our loved ones in their time of pain is to meet them where they are—resisting temptations to "fix," predict the future or make unsolicited suggestions.
Do say: "How are you?" Don't say: "It'll be different next time."
Do say: "If and/or when you'd like to talk about your experience, I'm here." Don't say: "Stay positive."
Do say: "I'm here to support you through whatever it is you are feeling." Don't say: "Maybe you should do IVF next time or adopt..."
It's simple: Say what you imagine you might want to hear if you were in her shoes. Do what you imagine you might find loving if you had just unexpectedly lost a pregnancy. And if it's tough to figure out what you think you might want to hear in the aftermath of a loss, stick with consistency, compassion and love.
What is one piece of insight/advice you would give readers of your book about navigating loss/grief?
Zucker: I suggest allowing yourself to feel whatever it is you are feeling because no one feeling lasts forever. If/when you flirt with thoughts like I am the only one, attempt to remember that there are millions among us who understand this ache too well.
Grief is circuitous. There is no discrete timeline. It's messy. And there are certainly no guidelines or roadmaps for navigating the grief that can accompany pregnancy and infant loss. So please, do your best to be gentle with yourself in its wake. Resist urges to sidestep grief, to swallow it, to put yourself in situations where you can't be fully acknowledged for what you've just undergone.
In my book, I reflect on how trauma and grief suspended me in mid-air—making it difficult for me to be fully present in my life but also making it difficult to allow myself to fully fall apart, too. There's no such thing as powering through grief or perfecting it, either. We put one foot in front of the other. Somedays, that's the best we can do. Other days, we have the energy for more.
If you get the sense that professional help might be necessary, get it. If you want to share your story, do it. If you find solace in theology, go to it. If you prefer privacy, respect that. If you yearn for connection, locate a support group or places online carved out for communing around these particular types of losses.
Lean on friends. Through it all, attempt to keep in mind that you did nothing to deserve this. Nothing. Your story matters.
Dr. Zucker's beautiful and important book I Had a Miscarriage: A Memoir, a Movement (Feminist Press + Penguin Random House Audio) is now available everywhere books are sold.
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