THE WASHINGTON POST – In the decade and a half that I spent researching my book The Myth of the Perfect Pregnancy: A History of Miscarriage in America, I discussed pregnancy and miscarriage with hundreds of fellow parents at the playground, and with fellow historians at professional conferences. The same common, incorrect assumptions came up again and again. Many were assumptions I had shared before I started my research, and before I experienced a miscarriage.
Miscarriage is hard to talk about. It’s sad and it’s personal, but it’s not uncommon or unnatural. Scientific and historical myths make miscarriage harder to understand and harder to discuss. By unravelling those long-standing misconceptions about pregnancy and miscarriage, though, we can finally start an open conversation that will normalise the experience, lift the painful burden of stigma and secrecy, and give us common ground to build better ways to think about pregnancy and cope with miscarriage. Here, I examine eight of those myths in the hopes of promoting better understanding.
MYTH: Miscarriage is a rare complication of pregnancy.
FACT: Approximately 20 per cent of confirmed pregnancies miscarry, mostly in the early months. About a third of women who have had two children have also had a miscarriage. This estimate of the rate of miscarriage has gone up in the past decade, not because miscarriages have become more common, but because we are diagnosing pregnancies closer to conception. A pregnancy diagnosed at the earliest possible moment with a home pregnancy test or a blood test, about five days before the first missed menstrual period (nine days after conception), actually has a 30 per cent chance of miscarrying. And many more fertilized eggs never implant in the first place. Statistically, a fertilised egg is significantly more likely to perish than to develop into a full-term baby.
MYTH: Having one miscarriage means a woman is likely to have more miscarriages.
FACT: While this is not true – a woman who has had up to three early pregnancy losses still has no greater chance of miscarrying her next pregnancy than one who hasn’t miscarried previously – the notion has a long history. Before the 20th Century, it was considered crucial for bodies to have regular “habits,” such as regular menstrual periods, regular defecation, and regular times for eating and sleeping. When it came to pregnancy, doctors and patients alike feared that an early miscarriage would initiate a habit of miscarriage. Today we know that only about one per cent of women suffer from recurrent miscarriage, and of those, about three-quarters go on to have full-term babies.
MYTH: If women follow medical advice, they can prevent most miscarriages.
FACT: Most miscarriages are not preventable. Since the early 20th Century, scientists have known that the majority of miscarriages are caused by chromosomal anomalies that render an embryo incompatible with life. Before the 19th Century, medical writers thought miscarriages stemmed from the pregnant woman’s body, habits or environment, but they did not generally translate this into blaming women. This changed in the mid-19th Century, as abortion rates rose rapidly. Medical writers increasingly suspected women of sabotaging their pregnancies and blamed them for miscarriages. In the early 20th Century, in their zeal to improve pregnancy outcomes, prenatal care advocates urged pregnant women to adopt a host of new (and medically unsubstantiated) responsibilities, such as an anti-constipation diet and regular bathing to rid the body of toxins believed to cause preeclampsia. They also advised pregnant women to avoid foot-pedalled sewing machines, heavy lifting and sexual intercourse to prevent miscarriage. However, barring some future large-scale embrace of as-yet-unrealised reproductive technology that would allow doctors to create embryos in the lab and test them for genetic soundness before implanting them into a woman’s uterus, we are unlikely to be able to prevent the naturally high rate of early pregnancy loss.
MYTH: In the past, women were ignorant about their bodies, so in early pregnancy, they didn’t realise they were pregnant, and when they had an early loss, they didn’t realise that, either.
FACT: Actually, before the 20th Century, women had a lot more personal experience with pregnancy than women do today, so at least in their later pregnancies, they had a more nuanced and subtle understanding of their personal pregnancy symptoms. Because they did not have a test that purported to give them definitive confirmation of pregnancy, however, they second-guessed themselves when they miscarried, interpreting the bleeding either as the return of a late menstrual period or as the raw materials of a pregnancy that failed to come together to produce a baby.
MYTH: Women always wished they could control the number of children they had, but until modern birth control, they simply were not able to.
FACT: In colonial America, most women welcomed large families as a source of financial support and community admiration. Around the time of the American Revolution, women and their husbands began to envision smaller families, and took action. Using traditional methods of birth control – abstinence, withdrawal, douching and abortion – they cut their childbearing in half. Beginning in 1957, the birth control pill offered more precise control. Along with other modern methods, the pill has allowed Americans to more fully control reproduction, but the cultural movement had begun two centuries earlier.
MYTH: Technologies such as ultrasound inevitably lead us to bond with our babies during early pregnancy.
FACT: Since the 1970s Americans have developed the ultrasound exam into an elaborate cultural ritual of “meeting the baby.” The sonographer’s words, and the expectations women and their partners bring to the exam, allow us to “see the baby” even in a hazy black-and-white image at eight weeks’ gestation. In some places, such as Greece and Israel, physicians do not encourage this expectation of “bonding” during early exams because they regard it as a strictly medical exam to search for problems with the pregnancy.
MYTH: The anti-abortion movement is the primary driver behind the cultural shift in the past few decades toward mourning very early pregnancy losses.
FACT: Anti-abortion rhetoric and images have promoted the idea that pregnancy entails a fully formed baby from conception. But non-political drivers, such as the 20th-Century rise of a massive marketing machine targeting parents as consumers, are just as important in the shift. In recent decades, marketers have figured out how to reach women early in pregnancy by using data women share with websites and apps. As companies compete to gain pregnant women’s brand loyalty, they encourage women to become emotionally invested in their pregnancies, and to start purchasing for the baby. They send baby name lists alongside coupons for strollers and diapers, even at a stage when a pregnancy is still quite likely to miscarry.
MYTH: All women grieve their miscarriages, especially when the pregnancy was wanted.
FACT: Until the 20th Century, most families lost at least one child to early death, and in comparison with today, miscarriage was simply not seen as the same kind of loss. As recently as the mid-20th Century, it was considered unusual or unseemly for a woman to mourn a loss even quite late in pregnancy. These days, though, women may feel stigmatised if they do not mourn a loss, no matter how early in the pregnancy.
Responses to early pregnancy losses are individual and varied. Some women grieve a miscarriage as the death of a child; others regard it as the loss of potential or opportunity. Some women may need to take time to process their feelings before trying again, while others feel best served by getting pregnant again as soon as possible. Pregnancy loss is an emotionally complex phenomenon profoundly shaped by social and historical context. Women may also interpret their losses differently at different times in their lives and reproductive trajectories.