We still don’t have a clear and reliable road map for helping us navigate the unique pain and grief that comes with losing a wanted pregnancy. Certainly no one prepared me for the emotional aftermath of the three miscarriages I’ve had in my life. With or without notice, it can happen no matter where you are—in a bathroom, a car, a meeting. The bough breaks, the baby is lost, and there isn’t a damn thing to be done about it.

Initially, I was guided through what came next by perceived messages that I needed to “let go” as prerequisite for “moving on.” But I discovered the process was more nuanced and complicated than that. Ultimately, I had to learn a crucial lesson—how to embrace my lost children, rather than erase them.

Growing up, my daughter had an anthology of insults and frights that she often asked me to reprise. “Tell me the story of when you accidentally drove away and left me at Dunkin’ Donuts.” If I omitted a detail, she corrected it. Her selection from the “greatest hits of bad things that happen to kids” always seemed to address a current need for comfort or courage, rather than a walk down memory lane. So it is with the narrative of miscarriage.

An essentially invisible loss can have meaning in the details that establish it as being powerful and real. These stories form the foundation upon which the imagined child can be mourned. A miscarriage story has two parts: how a pregnancy evolved and ended unexpectedly, and how a unique attachment still lives on. The first is addressed far more frequently than the second.

My focus here concerns the loss of pregnancies that are wanted at the time of their loss and grieved as a result. Of course, for many women, the loss is a burden lifted and cause for relief—whether because of poor timing, financial or relationship concerns, genetic or health risks, legal or religious constraints—but that doesn’t always mean that the experience is devoid of meaning or depth.

My mother’s four miscarriages in the 1950s and ’60s amounted to Catholic birth control and spared her from raising a family of more than six children. She was somewhat puzzled by my grief at my own losses, compared to her relief at hers. And yet, even in that relief, in their first moments outside the womb, she mothered those lost children. Doubled over the sink, behind the locked door of the downstairs powder room, she baptized them so that their tiny souls would have unfettered access to heaven.

Stop Making Sense

The common occurrence and relative hiddenness of miscarriages often conspire to reduce them to an unfortunate obstetrical incident, a temporary setback, which will be ameliorated with the birth of a healthy baby. Yet stock medical responses don’t satisfy the usually unanswerable question that remains for many women: “Why? Why? Why?”

It’s far easier to say how a woman became pregnant than how she stop­ped. And yet, wrapped in our culture’s still dim understanding of the degree to which we exert control over our bodies, voices begin to fill in the blanks with a litany of well-intentioned if vacuous idiotic reassurances and sledgehammers of shame.

My client Eileen, a 29-year-old attorney, had worked with me on her paralysis about making a difficult career choice, trying to reconcile her feelings about a job she hated with the amount of time and energy she’d invested in it. At the news of her pregnancy, she and her delighted husband began constructing what they jokingly termed “The Attorney’s Guide to a Perfect Pregnancy.” No detail was too insignificant to be deliberated about and thought through. By the fifth week, they’d conducted numerous reviews that had led to firm choices of everything from strollers to pacifiers. She bore her considerable nausea and fatigue with good cheer. Then, at 12 weeks, the end of her first trimester, she miscarried. Two days later, she entered my office, looking like hell, and dispassionately recounted every detail.

When I asked how she was doing, she sat up straight and parroted the usual answers that attempt to make sense of it. “Maybe it was for the best.” “We can always try again.” “At least I know now that I can get pregnant.”

From there, the guilt came. “We should have gone with the other doctor.” “I never told you, but I smoked before I knew I was pregnant.” “I skipped a week of those vitamins because they made me throw up.” “I ran that half marathon.” “We had intense sex a couple of times when I started feeling better.” “They say you’re not supposed to tell people you’re pregnant till after the first trimester, and we blabbed it right away.” On and on.

After two weeks of hearing these rationalizations and recriminations, I stepped in. “Do me a favor,” I said. “Cross-examine each of the statements you make.” She never got past “It was for the best,” before she sagged in her chair and burst into deep sobs. We examined each platitude, each piece of blame, until she loosened the grip of guilt that was tormenting her. It was only then that she was free enough to mourn.

Deserving to Grieve

“Your absence is inconspicuous; nobody can tell what I lack,” wrote Sylvia Plath after a miscarriage. It’s the lament of a woman trying to reconcile the devastating loss of her pregnancy against a larger backdrop, in which the invisible and incomplete is devalued and not considered worthy of much distress. The problem is that well beyond the loss of a pregnancy is the loss of what would’ve been a baby.

For a lot of women who want the pregnancy, attachment begins far closer to conception than birth. It’s fostered by the burgeoning double-edged sword of technology. We can pinpoint ovulation and the ideal conditions for a uterine lining. As the technology advances, we’ll soon be able to confirm our pregnancies before we even get our clothes back on. Very early on, the pregnancy takes form with still pictures that turn the inside out, the images of limbs that bend and move, the humanity of a heartbeat. The future floats safely within a woman long before it’s evident to the outside world.

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Whether it’s articulated in word or thought, the connection begins with “You are my baby, and I am your mother.” Many women engage with their tiny charges, in words, in songs, in caressed bellies, in dreams, in imagination. The depth of the connection is often dismissed as ephemeral. Why is there so much grief for something that came and went in 20 weeks or less? Twenty weeks is five months. Most of us have fallen madly in love in far less time. And whether or not the result was anything long term, these loves occupy our memories, and often our emotions, over decades. They’re more than static events. For some of us, they continue to live on within us, however much our outer life circumstances change over time.

How many women hear themselves grieve out loud and shut down for fear of being sappy, silly, or weak? When they resist the urge to mourn what’s not only gone, but was never even complete, it’s our task to help free them from the arbitrary boundaries that dictate how or what we grieve. We can start by helping them identify the range of feelings they may be struggling with—the powerlessness, the anger, the distrust of the future, wrenching sorrow, and isolation. To counter an indifferent world that puts little value on their loss and pain, it’s so important that we communicate our conviction that mourning is not excessive or self-indulgent. It’s not only absolutely appropriate: it’s necessary.

Creative Memory

Some once-pregnant women might experience a pervasive sense of emptiness that’s often expressed in words like barren and hollow. They can feel like walking graveyards, and the creative force that fuels a wanted early pregnancy can seem like a permanent casualty of miscarriage. That energy needs to be rediscovered and refocused for a woman to acknowledge her loss and give it creative expression, meaning, and memorialization.

In some sense, working with a woman grieving a miscarriage can be more difficult than working with a client who’s lost any other loved one. Ordinary memory lives on in sight and sound, touch and smell; you can relive the myriad interactions shared with that person. After a lost pregnancy, the cues to hang onto are fewer and more ambiguous.

But the process of mourning is also the process of regeneration, as the therapist encourages clients to mine their imaginations and dreams, to invite creative representations using whatever form attracts them. Some women plant. Others collect. One client honored her Jewish heritage by plucking small stones from special places she traveled and placing them in a jar continually rearranged so it was never empty and never full. There are now even pieces of jewelry to represent miscarriage, with the option of making the loss clear, or keeping it “close to the skin” and private.

I backed into the idea of a baby box years ago, after my first miscarriage, as I swept my bedroom of all the “baby things” I couldn’t bear to look at. I couldn’t throw them away, so I threw them into a New Balance shoebox. The plastic test stick that had announced my pregnancy, a sonogram picture, an appointment card for my doctor, a sticky note with my favorite baby names, the horoscope for my due date, depressing song lyrics from after the miscarriage, and the flakes of a single rosebud from a bouquet my husband had given me at the time—they all landed in the box that I stashed in my closet.

Months later, it literally fell on my head while I was reaching for an old sweater. As I sat with the box in my lap, I realized I wanted it covered in something prettier than a shoe-company logo, so I bought paper I loved and wrapped the outside carefully. I still add to its contents every now and then. Over time, it’s become less of an artifact and more of a dynamic collection that expresses my unique journey with my unborn child over the decades. Every year on that child’s due date, I pull it down and sit with it in much the same way I linger over my daughter’s baby album.

It’s my experience as this almost-mother, and as a therapist, that sometimes you have to look back until you can see forward. Several years ago, I discovered an undated “letter to my lost child” scribbled on a scrap of paper in the baby box. In every word I found the essence of mourning my pregnancy: the pain of separation, the wistful acceptance of the loss, and, above all, the need to breathe life into the bond I felt with the imagined child. I felt moved to rewrite my letter to honor what had changed with the passage of time:

Now to free you from that place in me where you are frozen in time, broken and lost. We were not meant to live together in the light, but come to me in darkness. Visit me in dreams, sweet child, where you are never hurting or hungry, and I am never sad. Play on, forever safe in my imagination, where you will always be my dream child. My perfect possibility.


PHOTO © iStock/arkstart

Martha Manning

Martha Manning, PhD, is a writer and clinical psychologist who has written five books, including Undercurrent: A Life Beneath the Surface. She has published frequently in the Networker as well as other magazines.