As Americans, we don’t talk nearly enough about many of the things that actually matter in pregnancy. The topic that takes the top spot? Miscarriage and pregnancy loss. Having spent over a decade as a medical professional working in women’s health and birth, I’ve been witness to the heart-wrenching story on repeat: I have a couple scheduled for a follow-up, and I walk into the clinic room to find a family shattered by the news of loss—grieving alone.

During this process, emotions of confusion, guilt, and fear are commonplace. As the world moves on around them, there is often little comfort or support offered from friends or family. Because few—if anyone—in their close community even knew they were pregnant. “It was still so early.”

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Data shows that 10 to 20% of pregnancies end in miscarriage (the loss of a pregnancy), with 80% of these losses occurring in the first trimester. In the United States, that translates to roughly one million losses per year. Contrast that number with the fact that, culturally and societally, it’s common to hide a pregnancy until at least 12 weeks gestation, if not 20.

But if nobody knows you’re pregnant and an unfortunate loss does occur, where do you turn for support and comfort? No one would expect a family to weather a funeral alone, but for some reason, we expect women and couples to experience the loss of a child in silence. This can lead to people feeling isolated in their grieving, and eventually trickles down to the communal loss of solace in a shared experience.

It should also be noted that early pregnancy loss is no less painful than a later loss but is often mistaken to be “less of a big deal,” furthering the pain and grief when some do choose to share.

Unhelpful and painful comments from well-meaning friends and family or even the avoidance of the subject altogether show how little we as a society understand about how to talk about miscarriage and navigate this painful subject.

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This is such a deeply personal experience, but I hope this article can inspire a shared sense of empathy. As you read, I encourage you to consider why expecting parents may choose not to share their pregnancy news and what purpose that may or may not serve them.

It’s time for the communal experience of loss to be given back to families, to be discussed among one another more openly. It’s in that experience that we may be surprised to find the space to be held and supported in our grief.

Perhaps simply acknowledging the idea that we don’t talk about loss will spark a much-need conversation about why we should and how to talk about miscarriage. Below are some considerations to take into account as one begins to navigate pregnancy, the idea of pregnancy, or grief in the time of loss. They’re considerations that may help you feel a little less alone during the unthinkable while creating more space for others who have experienced loss themselves.

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How to Talk About Miscarriage In a Loving, Gentle Way

Gather your village: the first trimester is hard

The first trimester is often so much harder than expected. Romanticized images of women, glowing and smiling, holding their beautiful bellies are what we all envision as an early pregnancy ensues. However, the reality oftentimes looks more like a tired and grumpy woman, slightly bloated with her belly nuzzled in sweatpants. She probably has just enough energy to move from the bed to the couch while potentially getting into a hormonally-motivated fight with her partner. You get the point: it’s rough!

You might be surprised by how held you feel by letting a small number of your besties, family members, and perhaps the right boss or a few coworkers know you’re pregnant. Creating your own village of supporters to check on you and be gentle with you may lighten the emotional and physical burden of it all. In the event of a miscarriage or loss, you won’t be as isolated or alone with no one to talk to about what has happened and how to begin to move forward. You may find that the power of presence, a listening ear, or the story of someone who had a similar experience can be wonderfully supportive.

As you begin to navigate trying for a baby or early pregnancy, carefully consider who you want to invite into your village. And don’t feel guilty if it’s not your family. Remember: this time is about finding what will be supportive for you. I recommend choosing those you know will offer calm, supportive, non-judgmental love and show up when you need them. Finding the balance between guarding your energy and heart and reaching out for support when you need it is the goal.

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Shed the shame & stigma: miscarriages are never someones “fault”

One of the most common and heartbreaking questions I hear from patients after a miscarriage is this: what did I do wrong? In reality, there is likely nothing anyone could have ever done to prevent miscarriage. A surprising 50% of first trimester losses occur due to chromosomal abnormalities. In other words, it’s a fact of life that not every single egg ovulated is genetically normal. As painful as it is, fortunately our bodies won’t continue a pregnancy that isn’t healthy.

Outside of the parts we can’t control, women should also know that not being “perfect” while trying for a baby also has little to do with miscarriage. A few drinks before the stick turns pink, not sleeping enough, experiencing big stressors, having sex, exercising, or eating certain foods all have nothing to do with whether or not a pregnancy “sticks.” Unfortunately though, this information and reassurance aren’t readily accessible or easy to find, and you’re lucky if your doctor offers you a follow-up appointment after a miscarriage to explain what happened.

We are failing women as much medically, as we are societally when it comes to loss and how to talk about miscarriage.

As women begin to face the world during and after a loss, they may find it challenging to find an individual experienced and willing to listen and validate their loss and the very normal emotions that come with it. Societally, miscarriage seems to be one of the last taboos. It’s often undiscussed or avoided altogether. This hush-hush attitude compounds women’s experiences of shame and guilt by 1) not having a full understanding of how common loss is and 2) by experiencing their emotions as something to feel shameful or embarrassed of.

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If you’re struggling with a loss, advocating for yourself in a few different ways may help ease the pain:

1. Reach out to your women’s health provider and ask to schedule a miscarriage/loss follow-up appointment. In this space, you can ask any of the burning questions you may have about the experience and put your mind at ease about what’s happening in your body, when you can try again, or get on birth control. It’s also a good idea to get lab work done after a miscarriage to be sure there are no pregnancy hormones remaining in your body and your uterus can begin to reset.
2. Choose a few friends or family members to talk to about your experience with. Give yourself the time and space to process the loss you experienced. Know that grief is common in these moments. Processing your emotions and the reality of what has happened often makes it easier to move forward and carry less anxiety in future pregnancies.
3. Don’t be afraid to reach out to a therapist for support. This can be deeply healing. Couples therapy and support may be helpful as well if you’re having a hard time verbalizing to your partner or getting on the same page about what you’re feeling. There are many therapists who specialize in perinatal loss and women’s health issues. Find someone who will validate what you’re going through. Psychology Today is a great resource if you’re looking to connect with a therapist.

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