Making Room for Miscarriage

After I miscarried my first pregnancy, I quickly realized that I needed a historical perspective to make sense of this shockingly unexpected and distressing event. Before I got pregnant, I had no idea that around 20% of confirmed pregnancies miscarry, mostly in their early months, and that miscarriages are a normal part of childbearing for healthy women. Once I understood the statistics, I was appalled by how many pregnancy “experts,” from pregnancy manual authors to pregnancy website marketers to my midwife, had encouraged me to bond immediately with a pregnancy they knew might not last. How did such a misleading and damaging expectation of perfect pregnancies, in the face of statistical reality, come to be?

Cover art, The Myth of the Perfect Pregnancy. (©Oxford University Press)

In my new book The Myth of the Perfect Pregnancy: A History of Miscarriage in America, I set out to write the history of our modern culture of childbearing in the US, and how it has produced our expectation of perfect pregnancies. I explored everything from the history of birth control, to changing parenting ideals, to the rise of prenatal care, to increasingly savvy marketing, to the abortion debates. In each of these aspects of American culture, I saw a steady trajectory over more than two centuries. Much of the change was positive. Striving for control over conception has led to modern birth control and women’s right to make decisions about their bodies. Emphasizing loving attachment between parents and children has resulted in more fulfilling parenting. Modern prenatal care has meant healthier mothers and babies. Consumer culture has brought some nifty baby gear.

But I could see that each of these cultural trends, when pushed beyond what science, medicine, and human bodies could guarantee, has led to unrealistic expectations of perfection, and inevitable experiences of disappointment and failure. Grief over early pregnancy losses is the epitome of this distress.

At the time I miscarried, in 2003, American childbearing culture already seemed overwrought to me. Websites were beginning to send out e-newsletters, pushing women to learn about embryonic development on a weekly basis, timed to their personal due date. It seemed ridiculously fine-grained, even obsessive, compared with the monthly sketches in my paper pregnancy manual. In Berkeley, where I lived at the time, the trend was for women to preserve their pregnancy memories in the form of a decorated plaster cast of their pregnant bellies. In comparison, I only had a few photos of my mother pregnant, and only incidentally, in family photos with older children. I knew a few women who had received ultrasound scans at 8 weeks, much earlier than the usual 18 weeks, even though they had not had any complications, just because they had fancy obstetricians who served wealthy communities. “How much more extreme could it get?” I thought. Boy, was I naïve.

Over the years of research and writing, I had to continually update my discussion of the present and recent past. Home pregnancy tests went from being advertised as accurate on the day of the missed menstrual period, to being able to detect some pregnancies up to 6 days before the expected period. In 2003, a test cost around $10 at the drugstore. More recently, the tests have been sold in bulk online for 50 cents each, and women who are “trying to conceive” sometimes report taking tests daily from the moment they think they could possibly be pregnant. The “trying to conceive” label itself underwent a transformation: in the early 2000s, online infertility support groups discussed the travails of “TTC,” and members bolstered each other in longstanding struggles to have children. Today, discussions on pregnancy websites and apps are full of women who discuss “TTC” as something that is simply the next step after going off birth control, and most seem blithely unaware of the term’s origin in infertility support groups. In 2003, early ultrasounds were generally reserved for women with complicated reproductive histories. Today, 8-week ultrasounds are routine in many obstetric practices, and a YouTube search for “8-week ultrasound” results in an unending queue of uploaded early ultrasound exams, viewed millions upon millions of times. Early pregnancy is the focus of an ever-increasing degree of scrutiny and emotional investment, extending — perhaps even accelerating — the trajectory I documented for the previous centuries.

A particularly striking new phenomenon in this trajectory is pregnancy apps, which have sprouted rapidly over the last few years. Apps bundle and feed off the hype. They have it all: articles with pregnancy dos and don’ts, daily embryo portraits and descriptions, baby registries, parenting advice, lists of baby names, fun ideas for announcing your pregnancy. In one of the creepier manifestations of high-tech pregnancy enthusiasm, the Hello Belly app offers an augmented reality feature, so that the user can project a representation of her embryo onto her stomach.

In addition to morning sickness cures and cutesy nursery decorating ideas, pregnancy apps also increasingly offer consolation and advice to people who have miscarried. After a miscarriage, the user simply needs to edit her profile, and she can access advice on grieving, bereavement, trying again, and rainbow babies. These resources are, admittedly, an improvement over early versions of pregnancy apps and websites, which were caught flat-footed by the fact that their patrons would frequently miscarry, and often added insult to injury.

Expectant mothers getting instruction on infant care at the New York Nursery and Child’s Hospital, in 1910. ( New York-Presbyterian/Weill Cornell Medical Center, Samuel J. Wood Library | Wikimedia Commons)

The one thing a pregnancy app will never tell you, though, is the advice that would probably help the most: delete your pregnancy apps, don’t rush to take a pregnancy test, do what you can to not dwell on a potential pregnancy, and wait to see what happens. (Do take good care of your health, of course, and continue to follow your health practitioner’s advice about medications and substances to avoid during early pregnancy.) Pregnancy is big business these days, and as the gateway to even bigger business — products and services for children and families — it is the focus of a panoply of marketing efforts. Apps (and websites) are driven by usage, in the form of click-throughs. When the best advice is “stop clicking,” you won’t hear it from an app or website.

When I first started researching online pregnancy advice, I figured that pushback from women who had miscarried would have some moderating effect on the maternal-industrial complex of manufacturers, retailers, service providers, marketers, and platforms aimed at hyping pregnancy, parenting, and all the products and services would-be parents might buy. Surely there would be backlash from women like me, who felt they had been misled, I surmised. Given how things have developed, I am now not so sure.

Cover page of the 1871 The Woman’s Medical Companion, and Nursery-Adviser. (Archive.org)

It turns out that pregnancy distress is good for business too. Anything that draws views and clicks connects a user to a source, exposes her to its ads, and allows her data to be collected. Maybe a miscarriage will keep a woman from shopping for baby clothes quite so early next time, but a series of articles on grieving, trying again, and coping with the aftermath of miscarriage during a subsequent pregnancy will keep her connected until she is ready to buy. The app or website might even sell her some ovulation kits in the process. There is no free-market penalty for cashing in on people’s desire to plan and control their childbearing and to love and bond with their expected children, and so women are set up to suffer.

It doesn’t have to be this way. But it will take some self-awareness and some women’s health activism to change it because even a small course correction takes a real effort when the current course has 250 years’ worth of momentum. We can start by sharing our pregnancy and miscarriage stories, including with our students and younger peers so that they can take pregnancy’s imperfections for granted when they are considering that path for themselves. We can collaborate to create nonprofit pregnancy apps that offer support but do not demand any more attention than a user really needs to give them. We can rethink how we use our technologies such as pregnancy tests and ultrasounds, and how we do or don’t sentimentalize them. We can begin to inject a small and necessary dose of fatalism and acceptance into the noble efforts we have made to gain control of our bodies and our lives so that we do not let a desire for perfection become the enemy of the good.

Further Reading

Lara Freidenfelds, The Myth of the Perfect Pregnancy: A History of Miscarriage in America (Oxford University Press, 2020).

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One Comment

Deborah Lowe

Every pregnancy is different I myself have been pregnant 18 times, 9 living children 8 miscarriages and 1 still born. With the pregnancy’s I only experienced a little morning sickness with 2 of them

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