I’ve lost babies. Well, I didn’t necessarily lose them. They’re not lost, like keys or something. To dispense with the polite euphemisms, they died at twenty weeks.
I felt isolated, devastated and as if there was no vocabulary for what was happening – clinically, emotionally or legally.
When my writing partner and friend Colleen’s baby died around 24 weeks, she didn’t know what word to use for it. In the United States, any loss after twenty weeks is considered stillbirth. But she didn’t have to give birth; she underwent a procedure called “dilation and evacuation.” So was it a miscarriage? A stillbirth seemed extremely painful and her baby wasn’t yet full-term, so she felt she didn’t “deserve” to say that. She never really found an answer that put her at ease.
I always called my loss at 20 weeks a stillbirth. The ultrasound showed that he had died, that I was in labor and that I was in my second trimester when it happened. Giving birth, holding the baby and remembering did not seem to fit in with a miscarriage. But a year later I was pregnant again and my 23-week-old twins received a fatal diagnosis. I called my decision an “induction of terminally ill twins.” That was correct and did not invite comment or judgment, but there was something missing from that language. When I started researching pregnancy loss, I learned the phrase TFMR: termination for medical reasons. I never knew it had a name.
But while I was researching and writing about pregnancy loss, Roe was overturned. I started thinking more carefully about my “TFMR”. By medical definition it was an abortion. In common American language perhaps? Some in my family say, “I don’t consider what you had an abortion.” The distinction usually comes from understanding the reasoning: the twin was dying. But it could also be because I was married, already a mother, and my babies were so wanted. I didn’t fit the narrative often promoted by anti-abortion advocates. The stark black and white political arguments and language did not fit my personal medical reality – and the reality of many others like me.
Pregnancy loss has been a problem of understanding, a problem of mental health or emotional support for decades, leaving women like me feeling guilty, blamed and ashamed. Since Roe fell, my reporting shows that things are becoming increasingly dangerous. In the absence of federal protections against abortion, I have discovered through our research that there can be serious consequences for women who never intended to terminate a pregnancy.
Some are turned away from the emergency room or, when in medical distress, receive substandard care in states with strict abortion bans. Others risk persecution for miscarriage in states such as Oklahoma, Alabama and South Carolina. According to ProPublica Amber Thurman has passed away after her medical care in Georgia was delayed. She had traveled to North Carolina six weeks pregnant for a medication abortion to circumvent her home state’s ban, but was back in Georgia when she experienced complications. A preventable death with a regular D&C treatment – one I had in another state, at a different time, after experiencing the same complication following a miscarriage from the same drug Thurman had taken: misoprostol. One an early abortion, one an early miscarriage. Same treatments. Very different outcomes.
Many people still do not understand that the same procedures used for abortions are also used to treat pregnant women experiencing miscarriages, stillbirths or medical emergencies. Medical care is the same across the reproductive spectrum; there is no distinction in clinical experience, doctors have told me. A loss before 20 weeks is called ‘a spontaneous abortion’. A person who has recurrent miscarriages is known in the medical world as having a “habitual abortion.”
This language is failing people across the political spectrum. My interviews repeatedly revealed that some women who supported abortion rights felt limited by the terms of political debate, as if they could not mourn their miscarriages for fear it would fuel conservative arguments. And there were conservative women I interviewed who were shocked when doctors said an abortion would be the best course of action for their health after a devastating diagnosis. An abortion was something they never expected.
Ten to twenty percent of known pregnancies end in miscarriage annualwhich affects approximately 750,000 to 1 million women in the US each year. The number of stillbirths is smaller and happens about 21,000 times a year, according to the Centers for Disease Control and Prevention. But that’s still not as rare as people think. An oft-repeated pseudostatistic is that you are more likely to be struck by lightning than to have a stillbirth. But the chance of being struck by lightning is high less than one in a million in a given year. In one in 175 births, a baby is stillborn.
If it happens so often, why don’t we talk about it?
Historians told me that in earlier eras of American history, the opposite of pregnancy was miscarriage – voluntary or involuntary, spontaneous or induced. But thanks to a series of medical advances that led to easy, accessible contraception and the option of safe, legal abortion, women increasingly chose pregnancy. So if she chooses to, it should work just fine. And if not, then there is the American idea that hard work leads to success. Try it, try again. Over the past fifty years, the opposite of pregnancy has become abortion.
Everything that fell in between was banished from existence, partly because women were made to feel like failures for losing a pregnancy, and partly because miscarriage doesn’t fit neatly into either side of the growing political divide.
We can talk all day about the words and politics that influence the way we perceive pregnancy loss. But the person suffering is unlikely to care if he or she is grieving or increasingly concerned about whether he or she can receive routine, life-saving medical care. After fifty years of invisibility during pregnancy loss, the lack of language and divisive politics leave pregnant women even further adrift.
Rebecca Little co-authored ‘I’m Sorry for My Loss’, available now.