Is taboo the right word any more?

What we don't talk about when we talk about miscarriage

Photo by Paul Rysz on Unsplash

Something I was told when training to be a journalist was that the really big stories find people even if they’re not reading or watching the news.

In October 2020, almost a year to the day after I discovered I was pregnant for the fifth time, news broke that the model, author, and TV personality Chrissy Teigen had miscarried her baby boy Jack, halfway through the pregnancy.

I was hiding out at my mum’s house at the time, exhausted, over-whelmed – feeling a bit sorry for myself – and spending a week unplugged from my laptop and social media accounts, without my usual newspaper subscriptions and radio alarm tuned to the Today programme.

The news found me anyway. An editor friend texted me to ask if I’d write about it for her.

‘We are shocked and in the kind of deep pain you only hear about, the kind of pain we’ve never felt before,’ Teigen had written, alongside a series of black and white photographs taken at the hospital. The pictures are devastatingly intimate.

In one, an epidural is about to be administered into Teigen’s back. In another, she leans forward on the trolley-bed, hands clasped as if in prayer, eyes down. In every pained line and shadow of her face, you can read an internal ticker tape that will be familiar to anyone who has had a pregnancy end too soon: Please let them live. Please.

In several other, later images, Teigen and her husband cradle their baby boy, his face obscured inside a standard-issue hospital blanket. Their expressions could be those of any other new parents, that complicated mixture of primal love, intense pride, and plain old exhaustion. Only the bundle in their arms tells the whole story: too small, too soon.

The close-quarters emotion of these pictures proved too much for some. Opinions simmered, both below the line and from media commentators, debating whether there was something wrong about sharing this moment. Criticism ranged from mild concern over a grieving couple’s state of mind, and a feeling that some things are best kept private, to culture-war cruelty, such as the US congressional candidate who declared in a tweet (since deleted) that he hoped Teigen – who is vocally pro-choice – would ‘reevaluate [her] thoughts on abortion after their heartbreaking experience. It’s not a clump of cells. It’s either a baby or it’s not.’ (In fact, Teigen would later go on to say that she eventually came to understand what happened as a termination rather than a miscarriage, as labour had been induced to save her life, even though her son would not survive.)

Yet, for many, many others, Teigen’s post acted as a relief valve, allowing their own stories of miscarriage to pour out. At the time of writing, her Instagram post has been ‘liked’ 11.4 million times. There are more than half a million comments underneath it, many from women sharing the details and memories of their own lost pregnancies. In the ensuing media coverage, the same word came up again and again: ‘taboo’. ‘Could Chrissy Teigen’s courage break the baby loss taboo?’ ‘Miscarriage used to be a taboo, until Chrissy Teigen broke the silence.’

Miscarriage is almost always framed this way: a silent problem that can be fixed by talking about it.

‘Why we need to talk about miscarriage’, headlines entice. Articles reference the ‘secret pain’ and ‘stigma’. When someone shares their story publicly, they are ‘speaking out’ and ‘opening up’; we talk of bravery and breaking the silence.

I’ve done it myself. I’ve written those headlines and I’ve had them written about me when I’ve shared my own experiences.

It’s a media cycle that feels increasingly familiar. In 2018, two years before Teigen made her heartbreaking announcement, the same phrases circulated after former First Lady Michelle Obama spoke of how ‘lost and alone’ she felt after the miscarriage she’d had before her children were born: ‘Michelle Obama opens up’; ‘Michelle Obama reveals she had a miscarriage in effort to end stigma’. And the same sorts of words echoed across the internet once more when Meghan, Duchess of Sussex, wrote movingly for the New York Times about miscarrying what would have been her second child – a revelation that came less than two months after Teigen’s: ‘Miscarriage is still a taboo’; ‘The Duchess of Sussex shares her “unbearable grief ” of miscarriage – and breaks down a taboo’.

Every time there is a story like this, other women’s stories come flooding in. Journalists – like me – are commissioned for the features pages in the days following the original news story. Comments sections fill up with condolences and stories offered up in solidarity. With this in mind, I understand why an impression would solidify of a taboo that is being steadily dismantled.

But is it? Any discussion tends to be fleeting and incomplete. There is, perhaps, an illusion of increasing openness that doesn’t match up to the way miscarriage is actually experienced. Stories of miscarriage tend to be told only in certain spaces, from a certain angle, from certain kinds of people. What’s more, talking about miscarriage is often presented as a self-contained solution, rather than one small part in bringing about actual improvements to medical care or any deeper, scientific under- standing of this part of the human experience.

Widely publicized stories, like Meghan’s, Chrissy’s and Michelle’s, may well give other women leave to speak about miscarriage in a way they feel they can’t normally – and yet it seems a transient sort of permission.

For a start, it would be wrong to assume that media stories about miscarriage are a recent development. Newspaper reports on the miscarriages of public figures (or, often, the wives of public figures) can be traced back at least as far as the 1930s. Miscarriage was also a popular topic for health periodicals in the 1940s and ’50s. Articles drawing on the experiences of non-celebrity women, which frame miscarriage as a silent, unrecognized kind of grief, started appearing in women’s magazines back in the 1980s – the decade I was born.

And yet, from news cycle to news cycle, from one high-profile miscarriage to the next, the appetite and gratitude for these stories from others who have experienced miscarriage doesn’t seem to diminish.

What’s clear to me is that there is an unmet need here that runs much deeper; that there are structural, cultural, and medical barriers that are not being dismantled – however much the word ‘miscarriage’ appears in headlines. How is it that miscarriage has been written about my entire life and yet, when it happened to me, I was largely clueless? How can it be all around us – and simultaneously nowhere to be seen?

I’d heard of miscarriage before I had one; of course I had, and the reality is that most people have heard of miscarriage and they know, in the broadest sense, what it means. ‘Miscarriage’: it’s a word that seems designed to be spoken out of the side of the mouth. Hurried; hushed. It practically begs for the conversation to be over almost as soon as it has begun.

Knowing about the hypothetical possibility of miscarriage is why Dan and I were waiting to tell people about our first pregnancy until after twelve weeks, in case ‘something’ happened. In this way, the threat of miscarriage is built into the very foundations of the modern pregnancy experience. And yet it remains a tenuous half-thought. For some reason, you don’t really believe it will happen to you . . . until it does.

The gulf between what I knew about miscarriage and what it was actually like to go through went beyond the usual gap between knowledge and experience. When I miscarried the first time, I had a completely skewed sense of how likely it was to happen to me. I had very little idea what a miscarriage would actually be like, look like, hurt like. I had no notion of how deeply it would affect me.

Neither was I prepared for the fact that it could, and would, happen again and again, with no medical explanation forthcoming. I also had no idea that having four miscarriages would push me to the brink; that it would take me to a place where I wasn’t certain life was worth living any more and that, in turn, it would force me to live in a different way.

Of course, I could never have known the full extent to which miscarriage would uproot my life, or how it would permanently fracture my relationship with pregnancy, any more than any of us can predict the future.

But I should have been much, much better prepared. Because, on top of being a university-educated woman, living in a wealthy country with universal healthcare, I am also a health journalist.

For quite a while after my first miscarriage, this made me feel ashamed: ashamed that as a professional who is supposed to know about common conditions affecting the human body, I knew so little about pregnancy loss. I didn’t know what a ‘missed’ miscarriage was. I didn’t know that sometimes you had to have surgery after a miscarriage. I didn’t know what to do with the tiny body that came out of me. I didn’t know that it’s estimated that almost one in five women are afflicted with PTSD-like symptoms after an early miscarriage (defined as a miscarriage that happens before thirteen weeks, the end of the first trimester).

I didn’t know that, for people who lose pregnancy after pregnancy, there is currently no known treatment with high-quality evidence that shows it can help.

And it was only after my third miscarriage that I discovered that no official record is kept of how many miscarriages happen each year.

Perhaps you didn’t know these things either. Perhaps you, like me, only learned them through painful, personal experience. But I have come to see that this not knowing was not a failing on my part – not personally and not professionally. This is a collective failing.

In spring 2021, an editorial in one of the world’s oldest and most respected medical journals, the Lancet, called for world- wide reform of miscarriage care. ‘For too long miscarriage has been minimised and often dismissed,’ it admonished. ‘The lack of medical progress should be shocking. Instead, there is a pervasive acceptance.’

There are an estimated 23 million miscarriages globally every year. That works out at around 44 per minute – 44 pregnancies that will have ended in the time it takes you to read to the end of this paragraph. As many as one in four will lose a pregnancy in their lifetime. An estimated one in twenty will go through it more than once. How can an experience that affects so many still be so profoundly misunderstood?

This is the question I’ve written a whole book trying to answer.

Through my own experience, and through conversations with experts – from gynaecologists and embryologists to psychologists and anthropologists – I excavated the many things we get wrong about miscarriage, all the things we have yet to learn, and the scientific and social questions we have yet even to ask.

I tried to explain both how we got here and why we tolerate the status quo. More than that, I hoped to convince people that it simply isn’t good enough.

Not only is it inhumane, undermining what can be a defining and traumatic experience in the lives of millions, it’s outdated, unscientific, and more than a little bit sexist. Why do we expect people to just put up and shut up? Why do we tolerate such a seismic gap in our understanding of how women’s bodies work? Beyond that, how can we be so uninterested, so blasé, about the origins of human life?

An interesting piece of research published in 2020 that sought to examine the general public’s knowledge of miscarriage found that while 83 per cent of the people the researchers interviewed knew someone who’d experienced a miscarriage, just over one third had actually discussed it with a family member or friend. They also found that 61 per cent of people underestimated how common miscarriage is, with only 28 per cent correctly identifying that between one in five and one in six pregnancies end this way. Men were three times more likely than women to underestimate how often miscarriages happen, as were those without children.

A 2023 survey by Tommy’s, the pregnancy- and baby-loss charity, found that out of 2,000 women, 78 per cent said they felt like a failure after their miscarriage – the same percentage of women who reported feeling this way back in 2015, when the charity last asked the same survey questions. The 2023 survey also found that 29 per cent of respondents felt they could not talk to their partner about their loss.

There is evidently a gulf between the public conversation around miscarriage and the private, lived experience that doesn’t seem to have narrowed, regardless of however many women have ‘come forward’. Chrissy Teigen, the Duchess of Sussex, and Michelle Obama join a long line of famous women who have spoken about losing a pregnancy: Beyoncé, Courteney Cox, Mariah Carey, Gwyneth Paltrow, Lily Allen ... (‘Celebrity miscarriage’, it turns out, is the kind of desperate thing you google in the small, sad hours of the night.)

Two of Hollywood’s most iconic women, Marilyn Monroe and Audrey Hepburn, endured miscarriages in the full glare of the public eye – as did Debbie Reynolds, Elizabeth Taylor, and Sophia Loren. The first of Jackie Kennedy’s five pregnancies ended in a miscarriage at the three-month mark – a fact that was known and widely reported once she became First Lady. Yoko Ono and Marianne Faithfull endured the indignity of having their pregnancy losses – in the same week in 1968 – reduced to a single newspaper story, lumped together in the copy by dint of their status as rock ’n’ roll ‘girlfriends’.

In popular culture, miscarriage has made storylines in everything from Sex and the City to The Archers. Sometimes its portrayal is sensitive and probing, while in other instances it’s little more than a plot device. In fiction, miscarriage features in blockbuster novels – such as The Time Traveler’s Wife (2003), The Help (2009), and The Light Between Oceans (2012) – and in their subsequent film adaptations.

It’s the subject of the Ed Sheeran song ‘Small Bump’ (2012) and of ‘More’ (2020) by Halsey, who has spoken about miscarrying in the middle of one of their concerts. And it’s been written about by female journalists, memoirists and novelists, from Caitlin Moran and Ariel Levy to Maggie O’Farrell and Candice Carty-Williams. Miscarriage even crops up – pun fully intended – in Jilly Cooper.

You can go back further and further and still find miscarriage, hiding in plain sight, in the artistic output of women. Sylvia Plath’s 1961 poem ‘Parliament Hill Fields’ summarizes the invisible grief after a miscarriage that will be familiar to many: ‘Your absence is inconspicuous; Nobody can tell what I lack.’ Almost a century ago now, Frida Kahlo captured both the livid violence of miscarriage and the sterile emptiness you feel afterwards. In her painting Henry Ford Hospital (1932), blood spills across a white sheet, a foetus the colour of a bruise unspooling on its umbilical thread away from Frida the would- be mother, as it floats against an indifferent blue sky.

Today, there are countless personal blogs and social media pages dedicated to documenting the experience of pregnancy loss (this substack included).

In particular, the explosion in popularity of Instagram, podcasts, and email newsletters, which all confer a kind of intimacy and are less easily interrupted than other mediums, seems to have led to ever more open discussions, especially between women.

And yet we shouldn’t mistake any of this for evidence of a job done – that we have a firm grasp on what miscarriage is like or why it happens.

For all that miscarriage is ‘out there’, people continue to say the same things when they experience it for themselves. With not a little irony, miscarriage is, by all accounts, profoundly isolating. It is ‘lonely, painful and demoralizing almost on a cellular level’ in the words of Michelle Obama. The Duchess of Sussex suggested that we seem to be trapped in ‘a cycle of solitary mourning’. Why? There are more than twenty years between Michelle Obama’s experience of miscarriage and Meghan’s and yet they echo each so closely. Why has so little improved for us? Why do women continue to live in the ‘silence after silence’ that Plath described in her poem more than sixty years ago? Why are we still caught unawares by the depth of emotion – of love – that can accompany early pregnancy; ‘that someone who didn’t yet exist could have the power to create spring’, as Diana Athill once put it?

Why, for that matter, has there been so little medical progress in understanding what causes miscarriages? And why – to ask a really wild question – do we just accept that so many miscarriages still happen in the first place? Why don’t we know how to prevent them? In short, what are we not talking about when we talk about miscarriage?

Photo by Allen Y on Unsplash

If miscarriage is not a taboo in the truest sense – literally unspeakable, unheard of – what it is is profoundly misunderstood, under-researched, and under-acknowledged.

The danger, if we keep labelling it a taboo without digging much deeper, is that there’ll be a backlash before anything improves materially for those miscarriage affects.

We risk straightforward sympathy starting to feel stale to jaded palates. There is a damning eye- roll of a line sometimes deployed in response to someone sharing their experience of pregnancy or new motherhood: ‘She thinks she’s the first woman ever to have a baby.’ How long before the same knee-jerk, get-over-yourself-luv misogyny is applied to pregnancy loss, too?

How far are we from some unfathomably unkind columnist snipe-typing ‘You’d think she’s the first woman to have a miscarriage’ the next time someone in the public eye shares their grief for a baby they never got to bring home?

Yes, you know intellectually that you are not the first woman ever to have had a miscarriage, but the point is that you are made to feel as though you might be.

And, as with the realities of pregnancy and childbirth, if women describe their experience of losing a baby in ways that feel familiar to an older generation, that should give us pause to reflect rather than dismiss it as unoriginal and therefore unworthy of examination.

If women continue to express shock, pain, and loneliness in response to what is widely acknowledged to be commonplace, that should be a red-light warning that something’s wrong with the system. It suggests that there is a gap between what people feel and need after a miscarriage and what society allows for. Like couples whose arguments over dropped socks and other minor transgressions escalate and circle back, eventually reopening the old wounds of a decade’s worth of fights, what we are really saying – what we really mean when we call miscarriage a taboo – is: nothing has changed. You’re not listening to me.

Because, for all the media stories and the conversations it supposedly generates, we have yet to make proper sense of miscarriage – both in terms of the biology and its true impact on people who have one. We have not metabolized it and assimilated it into social norms and modern culture.

The convention is still to hide a pregnancy until the end of the first trimester, which these days can be a full two months after someone finds out they’re pregnant. For all it may seem miscarriage is ‘out in the open’ and increasingly talked about, it is not routinely written into HR policies, people still don’t know what to say to their friends who endure it (if they know about a loss in the first place), and scientific research, tests, and treatments for those who endure multiple miscarriages are thin on the ground.

As a subject, it is still obscured by myths, medical mysteries, and misconceptions, all of which have been permitted to go unchallenged thanks to age-old squeamishness and shame around women’s bodies, and our collective ineloquence on matters of grief. The bloody, untimely end of a pregnancy sits at the centre of a perfect Venn diagram of things that make us uncomfortable: sex, death and periods.

In the ABC interview in which she disclosed her experience of both miscarriage and infertility, Michelle Obama memorably said that ‘it’s the worst thing that we do to each other as women, not share the truth about our bodies and how they work – and how they don’t work’.

I agree. But I also think this isn’t only about what women do or do not choose to say. There’s something deeper going on here – something more than can be fixed by individual acts of disclosure, however courageous and honest. If you ask me, the worst thing we do to women as a society is to not believe them when they tell us about the things that happen to their bodies. Women have been trying to talk about miscarriage and to change the discourse around it for years.

We just haven’t been paying enough attention.

• This is an edited extract from the introduction to my book, Life, Almost: Miscarriage, misconceptions, and a search for answers from the brink of motherhood - which is out in paperback today.