Pregnancy Loss
Miscarriage and Memory-Making: An Uneasy Relationship

Miscarriage and Memory-Making: An Uneasy Relationship

When the Guardian journalist Hadley Freeman wrote about her miscarriage in early 2017, many readers praised the fact that this common, yet woefully misunderstood experience had been so candidly aired. Miscarriages do not elicit the type of kindly curiosity that ‘successful’ reproductive experiences often do, such as the pregnancy revelation, the swelling bump, or the process of giving birth (as long as this is without trauma). We still have a long way to go before miscarriages are spoken about with ease or without euphemism.

Freeman’s moving account touched upon a particularly uncomfortable aspect of the broader miscarriage taboo. She writes of the hospital-arranged cremation of her miscarried baby, explaining, “People are horrified when I tell them this detail, and they are even more horrified when they hear that, three weeks later, I had to go to a crematorium to pick up the ashes of the baby that never was.”

Screenshot of the title for the Guardian article by Hadley Freeman. (© The Guardian)

Hadley’s narrative adds to the growing number of published pieces on the personal experiences of miscarriage, reflecting both the increased advocacy by women for their reproductive lives to be taken more seriously and editorial discretions that increasingly support this. Over the many years, I have been supporting women through their distress of pregnancy loss, I also note a welcome — albeit small — shift toward a more sympathetic response to miscarriage in both medical settings and our culture more generally.

More and more people are saying “I’m sorry” than they were five or ten years ago, and certainly more than they were before pregnancy loss campaigning work began to increase their impact in the early 1980s on both sides of the Atlantic. This is when charitable organizations such as SHARE in the USA and the Miscarriage Association and SANDS in the UK formed.

But yet, Hadley’s observation of others’ response to the “detail” about her baby’s cremation didn’t surprise me in the slightest. When it comes to the thinking about, and the performing of, any efforts to remember a “baby that never was” by means of a commemorative act, bespoke ritual, or established funeral rite — friends, acquaintances and even family members of the bereaved can be baffled, or at worst, as Freeman suggests, “horrified.” Such meaningful acts, more familiarly aligned with the death of a fully embodied human, seem to push a cultural acceptance of the grief of miscarriage just a little too far. In turn, even the bereaved themselves can lack confidence or feel an embarrassment at their desire to mark their loss with some significance.

It may be that when it comes to saying a formal goodbye to a loved one, we expect there to be a body to inter or cremate. But miscarriages may not always result in a “body” to dispose of at all, or perhaps one that is uncomfortable to envision in the mind’s eye. The vast majority happen before 12 weeks of pregnancy, and it is those that I am thinking about here. Miscarriages also do not discriminate when they happen: maybe as a mother-to-be sits on a train to work, watches a film in the cinema or — in my case, once — as I stepped into a very difficult work meeting. They often occur without any preparation and can cause acute pain and overwhelming panic, all of which understandably leaves a woman not knowing what to do with all that leaves her womb. Invariably ending up in a bathroom, she may retrieve the early inklings of her child-to-be, or leave it to travel away with flushed water, not knowing what else to do.

But just because there may be a lack of embodiment of a maybe much-wanted, and maybe much-loved, “baby” (as the bereaved seeking support nearly always describe their loss to me), this doesn’t necessarily correlate with the weight of grief that follows, nor the inevitable desire to mark the significance of what has been lost. Yet we have no culturally accepted practices for this. We have baby showers, baptisms, and naming ceremonies, but nothing for the ending of pregnancies that are yet to be established enough to be “meaningful” in the public consciousness. Major religious practices may not help here either. Strictly speaking, prayers are not usually offered to children under six years in Islam; the shiva mourning ritual is not practiced for a Jewish baby who has died before 30 days; and unbaptized babies have historically been deprived entry to heaven by the Catholic Church.

The bereaved, searching for ideas — or even permission — for how to mark their loss in the face of a cultural void may well seek solace online. Pregnancy loss charities, communities, and bloggers share suggestions and experiences that could be seen as efforts to establish “pregnancy loss rituals.” I am often moved by hearing or reading of these carefully curated meaningful moments: candles that are lit and left to burn out, poems or prose that are composed and performed, balloons that are inflated and then released, or items bought in anticipation for a baby buried somewhere special. But there’s a caution or insulation to these acts, as if they aren’t quite normal to the outside world and at worst, with a spoken fear that others may find them odd.

Online charities also curate “virtual cemeteries,” where “inscriptions” bear witness to love and a commitment to remember a would-be family member forever, such as the Miscarriage Association’s Stars of Remembrance webpage. But these are also marooned in cyberspace and shared largely amongst kindred spirits who may be strangers, rather than close friends. Unlike an email request to sponsor a friend to raise money for a pregnancy loss charity, an email link to a virtual headstone is less likely to reach your inbox. Efforts to remember a miscarriage tend to reside solely with the bereaved.

Freeman writes about her miscarriage in the hospital in England, where a relatively new culture of remembrance for miscarried babies is evolving. Recent policy guidance in the wake of much-publicized, and abhorrent, hospital practices around disposal of miscarried babies means that hospital protocols have changed significantly. We have, thankfully, moved far away from the paternalistic days when miscarried babies could be disposed of without the consent of the recently pregnant mother and her partner, probably to join other hospital waste.

These days, a female patient may well (indeed should) be encouraged to think about the option for a funeral rite — hard-won campaign work has helped to shift the institutional axis from forgetting to remembering. Depending upon the availability of hospital funds and staff training, this may mean a bereaved (woman or couple) can choose between a burial or a cremation for their miscarried baby (and this will also vary as to whether both or just one are offered, and whether they would be individual or shared with other babies). But yet, these medically-endorsed funeral rites lack parity with funerals for those who lived and breathed. While this new culture of remembrance rolls out in more and more hospital wards, the world beyond has a while to catch up, just as Freeman suggests.

An increased cultural ease with ceremonies to mark the loss of miscarriage — through familiar funeral rituals or bespoke ones — wholly rests upon an increased cultural understanding of the nature of the grief, and extent of loss that is grieved for, that women and their partners can experience. Miscarriage continues to hover in unspoken and precarious realms of “almosts”: between birth and death, life and not life, parenthood and not parenthood. We don’t know how to orient ourselves amongst this all.

But perhaps one way to find our bearings is by educating ourselves about these sequestered commemorative acts, or even participating in those that are chosen by the bereaved when it comes to marking their loss. These visible expressions of a silenced grief experience can teach us much about the meaning of the miscarriage mourned, and in turn ultimately help us to improve our care and support of those in grief.

Julia Bueno is a UKCP registered psychotherapist practicing in London, UK. She has a particular expertise and experience of working with clients who have experienced pregnancy loss, or struggle to conceive. Her book The Brink of Being -- which explores the varied experience of miscarriage -- will be published in 2019 by Virago Press/Penguin USA.