I have lost babies. Well, I didn’t lose them per se. They haven’t been misplaced, like keys or something. To forgo the polite euphemisms, they died after 20 weeks.
I felt isolated, devastated, and like there wasn’t a vocabulary for what happened — clinically, emotionally, or legally.
When my writing partner and friend Colleen’s baby died around 24 weeks, she didn’t know what word to use for it. In the United States, any loss after 20 weeks is considered a stillborn. But she didn’t have to labor and deliver, she had a procedure called a “dilation and evacuation.” So was it a miscarriage? A stillbirth seemed uniquely painful and her baby wasn’t full term, so felt she didn’t “deserve” to say that. She never really found an answer that made her comfortable.
I always called my 20-week loss a stillbirth. The sonogram revealed that he had died, I labored, and I was in my second trimester when it happened. Delivering, holding the baby, and memorializing him didn’t seem to fit miscarriage. But a year later, I was pregnant again, and my 23-week-old twins received a fatal diagnosis. I called my decision an “induction of terminally ill twins.” That was accurate, and it didn’t invite any commentary or judgment, but there was something lacking about that language. When I started researching pregnancy loss, I learned the phrase TFMR: termination for medical reasons. I never knew it had a name.
But as I was researching and writing about pregnancy loss, Roe was overturned. I started to think about my “TFMR” more carefully. By medical definition, it was an abortion. By common American parlance, maybe? Some in my family say, “I do not consider what you had an abortion.” The distinction is usually because they understand the reasoning — the twins were dying. But it could also be because I was married, already a mother, and my babies were desperately wanted. I didn’t fit the narrative that is often pushed by antiabortion advocates. The stark black and white political arguments and language didn’t fit my personal medical reality — and the reality for many others like me.
Pregnancy loss has for decades been a problem of understanding, one of mental health or emotional support that leaves women like me feeling guilt, blame, and shame. Since Roe fell, my reporting has shown it is becoming increasingly dangerous. In the absence of federal abortion protections, I found through our research that there can be serious consequences for women who never intended to end a pregnancy.
Some are turned away from emergency rooms or, when they’re in medical distress, receiving subpar care in states with strict abortion bans. Others risk prosecution for miscarriage in states like Oklahoma, Alabama, and South Carolina. According to ProPublica, Amber Thurman died after her medical care was delayed in Georgia. She had traveled to North Carolina for a medication abortion at six weeks pregnant to avoid her home state’s ban, but was back in Georgia when she experienced complications. A preventable death with a common D&C treatment — one that I had in a different state, at a different time, after I experienced the same complication after a miscarriage from the same medication Thurman had taken: misoprostol. One an early abortion, one an early miscarriage. Same treatments. Very different outcomes.
Many people still don’t understand that the same procedures used in abortions are also used to treat pregnant women who are facing miscarriages, stillbirths, or medical emergencies. Medical care is the same across the reproductive spectrum; there’s no distinction in the clinical experience, doctors have told me. A loss before 20 weeks is called “a spontaneous abortion.” Someone who has recurrent miscarriages is known in the medical world as a “habitual aborter.”
This language fails people across the political spectrum. It came up repeatedly in my interviews that some women who supported abortion rights felt hemmed in by the terms of the political debate, like they couldn’t mourn their miscarriages for fear that it would fuel conservative arguments. And there were conservative women I interviewed who were shocked when doctors said a termination would be the best course of action for their health after a devastating diagnosis. An abortion was something they never expected for themselves.
Ten to 20 percent of known pregnancies end in miscarriage annually, affecting about 750,000 to 1 million women every year in the U.S. Stillbirth numbers are smaller, happening about 21,000 times per year, according to the Centers for Disease Control and Prevention. But that’s still not as infrequent as people assume. One oft-repeated pseudo statistic is that you’re more likely to get struck by lightning than have a stillbirth. But the odds of being struck by lightning are less than one in a million in any given year. A baby is stillborn in one out of 175 births.
If it’s so common, why don’t we talk about any of this?
Historians told me that in earlier eras of American history, the opposite of pregnancy was a miscarriage — whether voluntary or involuntary, spontaneous or induced. But with a series of medical advancements that led to easy, accessible birth control and the option for safe, legal abortion, women increasingly were choosing pregnancy. So if she chose it, it should work out just fine. And if it didn’t, well, there’s the American notion that hard work leads to success. Try, try again. That’s how over the past 50 years, the opposite of pregnancy became abortion.
Anything that fell in between was shushed out of existence, in part because women were made to feel like failures for losing pregnancies, and in part because miscarriage doesn’t fit neatly into either side of the growing political divide.
We can talk all day about the words and politics that influence the way we perceive pregnancy loss. But the person who is suffering isn’t likely to care about any of that when they’re grieving, or increasingly, worrying whether they can get routine, life-saving medical care. After 50 years of pregnancy loss invisibility, the lack of language and divisive politics are leaving pregnant women even more adrift.
Rebecca Little co-authored “I’m Sorry for My Loss,” available now.