Breaking the silence around miscarriage: ‘I felt like a failure, like it was my fault’

On a hot August afternoon last summer, Susana Thakur, 38, and Amaya, 39, danced, drank and celebrated at a friend’s wedding. Neither of them knew it at the time, but they were both pregnant. A few months later, when their respective doctors told them that they had miscarried, they both looked back on that night and wondered if perhaps they had done something wrong: if they had had one drink too many, jumped too hard. Or perhaps it that ham canapé or the unpasteurized cheese. They knew it was a masochistic thing to do — to blame themselves — but they did not know how common a mindset it truly was.

According to a study by the American College of Obstetricians and Gynecologists, women who miscarry tend to blame themselves, which leaves them feeling isolated and alone. Having suffered a miscarriage, the chances of suffering from depression and anxiety are multiplied by two and the risk of suicide by four.

After searching for blame in the recent past, Amaya and Susana looked back even further. They questioned their entire lives and sank into depression. “I thought it was too late, that I shouldn’t have waited so long to get pregnant,” explained Amaya, who does not give her last name for fear that it will adversely affect her in her job search. “I felt like a failure, like it was my fault,” Susana added. These two ordinary middle-class women from Madrid have known each other for 15 years. They consider themselves friends. But they didn’t tell each other what they were going through. For months whenever they saw each other, they would ask “how are you?” and answer “fine, thanks. You?” They smiled and talked about trivial things while they were broken inside.

Every year, 23 million miscarriages occur worldwide, which is equivalent to 44 lost pregnancies every minute. It happens all the time. And yet it never appears to happen, it’s almost always buried in silence. Between 15% and 25% of clinically recognized pregnancies end in miscarriage. “When the doctor told me that, I was shocked,” Susana said. “I thought this was something that only happened in 0.5% [of all pregnancies]. And, to tell you the truth, I never thought it could happen to me,” she admitted.

Susana believed that a miscarriage was a tragic exception. When it happened to her, she began to understand the reality: it happens to one in four women who are pregnant. The same thing happened to Amaya. As they shared their experience, other similar stories surfaced around them, like mines in a calm sea. “It’s mind-boggling how many cases there are around you, how many people go through this and don’t talk about it,” Susana said.

Having a miscarriage gets you into a secret club that no one wants to belong to. And it is only when you become a member that you realize how many others there are. “There is a kind of social mandate that pressures you to keep silent about it,” explained Pilar Gómez-Ulla, a psychologist specializing in perinatal bereavement. “It is based on the idea that, if you lose it [the pregnancy], it is better not to have made a big show of it, better not to have said anything. But, in that case, it also means that you’re on your own,” she added.

The silence surrounding the first months of pregnancy has been codified in medical recommendations and popular wisdom. Every woman knows that she should not talk about her pregnancy openly until after the first 12 weeks. This has a clear benefit: Amaya explained that when she found out about her miscarriage, she had to retrace a difficult and painful path: “It’s very hard, calling the person you had given the good news to, and say that no, it’s bad. You feel like an asshole, and you know the other person is going to feel sorry for you, and you’re going to talk for half an hour about how hard it all is. That’s when you say ‘okay, I totally understand why people keep quiet about it.’”

But this is not the only reason behind the silence surrounding miscarriages. Talking about pregnancy loss is difficult. It’s tough. The bloody and untimely end of a pregnancy lies at the intersection of three uncomfortable themes: sex, death and menstruation. This discomfort prevents conversation and encourages isolation and stigmatization of the sufferer. It shrouds in mystery a subject about which very little is known.

Doctors usually explain, as they did with Amaya and Susana, that miscarriages just happen. During the first months of pregnancy, during chromosomal division and duplication, genetic errors can occur, which are sometimes incompatible with life and cause a miscarriage. Most of these errors are random and of unknown origin.

Seventy-one percent of women who miscarry are not given a reason, according to a 2019 survey by the U.K. charity, Tommy’s. Most of them leave the doctor’s office disoriented, without understanding what has happened or why it happened to them. Without answers, many end up drifting in a sea of recommendations from forums and pseudoscientific books promising formulas to improve egg quality, or going to private doctors, nutritionists and herbalists. There are thinkers such as Linda L. Layne, author of the essay Breaking the Silence: An Agenda for a Feminist Discourse on Pregnancy Loss (JSOTR), who advocate the need to start an honest, public discussion about pregnancy loss as a form of feminist empowerment.

But Gómez-Ulla believes that this idea should be qualified and that women should not always be forced to always share their pregnancies and losses: “The important thing is to foster a climate in which we can make these decisions more freely.” And this climate is being created little by little. In 2009, she herself suffered a miscarriage in the first trimester of pregnancy. Previously, she had suffered the deaths of two babies who were born prematurely. Since then, she admitted, the change has been enormous: “Enormous in terms of health care, enormous in terms of the visibility of the issue in the media and in movies, [TV] series, and books. There are lots of women sharing their experiences.” But there is still some way to go.

Talking about it in the public sphere is reflected in the private sphere. According to a Boston University School of Public Health study, Twitter conversations about miscarriage have increased in recent years. The study analyzed how women talk about miscarriage online, seeking community. And the investigators found that the revelations of celebrities like Michelle Obama, sharing her own personal story, encouraged others to do the same. The study highlighted the role of celebrities in this issue: “The disclosure of miscarriage experiences by celebrities led other women who had similar experiences to disclose them,” explained Kadija Ferryman, one of the authors of the study. “For example, the revelation of Michelle Obama’s miscarriage generated more than 3,000 tweets.”

The childbearing years coincide with the years when you are trying to grow like crazy, establish yourself at work, fight for job security, get access to housing, and so on.

Pilar Gómez-Ulla, psychologist

This helps to better manage grief, according to Gómez-Ulla. “This is a process you need to do through dialogue,” she explained. If there is no other person around to talk to, it is a mourning that is not finished. “And that other is, first of all, your partner, your closest friends, your co-workers. But it’s also the society you live in, the political system and the laws.”

One of the possible reasons why miscarriages are more talked about is that they simply occur more. The risk of miscarriage is 12% for women between 20 and 29 years of age and increases with age to almost 65% in women over 45 years of age. On average, motherhood in Spain — and in many other countries around the world — has been postponed. The average age for the first pregnancy is 31.5 years.

This causes many women to blame themselves when their pregnancy goes wrong, pointing to their age as a key factor. “This is an important issue,” the psychologist said. “Because I question whether this is an individual decision. It is a collective drift. There is a whole society that is configured in a way that has caused motherhood to be delayed. The childbearing years coincide with the years when you are trying to grow like crazy, to establish yourself in the workplace, to fight for job security, to get access to housing, and so on.”

A positive result in a pregnancy test does not necessarily mean you are going to have a baby.

Susana, who suffered a spontaneous miscarriage

This analysis fits with Susana’s situation, who only in her late thirties has found the financial and emotional stability to start a family. Amaya has neither one nor the other, but after 35, the biological clock works more like a countdown. It is only now that both have realized how complicated this process is. “A positive pregnancy test does not necessarily mean that you are going to have a baby,” explained Susana. “It’s not just the little picture on Instagram announcing you’re pregnant, it’s a long process that doesn’t always go well,” she added.

It is a difficult thing to go through, but it’s easier with company. After six months, Susana took the first step. She sent a WhatsApp audio to Amaya that led to a difficult but healing conversation. “I think sharing your experience helps, even if it’s traumatic and painful. It makes you realize that you are not alone,” explained Susana. “I ultimately decided to talk about it openly, even with people who at the time didn’t know about my pregnancy. Because I think my story can help other women if the same thing happens to them,” she said. And she added: “If we talk more openly about painful issues, if we tell each other, there will be much more support. It will become more normal.”

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