Miscarriage

This article was written and presented by Sheila Sim, Social Worker in Charge at The Royal Hospital for Women, Paddington Australia, at a Miscarriage Support Group Seminar held at the Paddington Women's Hospital.

I want to begin by telling you a story - the story of my own miscarriage. I was staying over Christmas with some friends in a beautiful house in the bush - they called it Avalon - after the mythical city of King Arthur and his knights of the Holy Grail. There was water from the tank, an outside loo, but no bathroom or electricity. We'd sit in the warm evenings with paraffin lamps throwing soft shadows and encouraging the Christmas beetles to hurl themselves around the walls. The shores of Wallage Lake lapped up to the vegie garden, and in front of the house the blooms must surely have been planted by a homesick family from the 'Home Countries'. It was crammed with old fashioned rose bushes, lavender, phlox, sweet william and bushes of basil and mint.

I was six weeks pregnant. I'd known almost from the moment I conceived, and had long since gone through all the emotions that knowledge of pregnancy brings: initial shock, delight, confusion, fear: I wasn't married to my partner and in fact he wasn't even a resident of Australia; I was forty, and frightened about the risks of Down's Syndrome and Spina Bifida. I was also excited, overjoyed to be pregnant, knowing I wanted the baby and already booking him in for child care and wondering when I should start my maternity leave!

I woke really early on the morning of Boxing Day. The sky was grey and sultry, I had fierce cramps, and I was bleeding heavily. My one thought was - how am I going to get the sheets washed with no running water! - so I dashed out to the garden, holding my nightie around me, and squatted there amongst the lavender and nasturtium flowers. I stayed there for a long time, watching the sky lighten and hearing the bell-birds wake up. It was the most healing experience I could have given myself. Ever since, I've imagined that a blue-green sage bush sprang up where my baby fell, and have been comforted to imagine him growing in such a green fertile garden.

Now I'd like to spend some time giving you a psycho-dynamic perspective on grief after miscarriage, to explain why reactions are so intense, then to talk briefly about rituals and symbols that can be immensely powerful and helpful to you in your grieving. What is it, that makes the experience of miscarriage such a profound event? And why does it go unacknowledged and unrecognised, in society, often amongst health professionals, in your family, among your friends?

So let's begin with a 'Cook's tour' of Freudian Theory. Freud wrote a seminal work, Mourning and Melancholia, in 1917. He introduced two important concepts for understanding the nature of grief: the concept of 'object loss', the loss of someone to whom you are attached; and the concept of 'grief work', hard psychological work from the mourner which aims to break the bond between the mourner and the 'object' or the person she has lost. Now this model of grief is useful and vital in the understanding of what has to happen when someone's wife, husband, mother or father dies: of course a widow has to separate herself out from her husband, acknowledge the qualities in him that she loved and leant on, and learn to live without him. When a couple lose their baby, however, I feel we need a different analysis: the theory of 'object loss' doesn't quite fit the process that you experience when you lose your baby. There isn't necessarily a someone 'out there' from whom you have to separate.

So I want to introduce you to another theory: that of attachment. The researchers and writers most famous in this area are John Bowlby, who wrote a trilogy entitled 'Attachment and Loss', examining the earliest developments in the relationship between a mother and baby; and Eric Erikson, who looked at the emotional dilemmas in every stage of our lives. Bowlby recognised that for a newborn baby the capacity to relate to other human beings is as crucial as food and warmth. You all know the scene on TV: the woman is in labour pushing madly, the baby pops out, he's laid on her chest, and the two gaze into each other's eyes fondly. The just-new-born is very ready to 'say hello' to his parents, interact with them and begin a relationship. As he grows, he learns to cry for her when he is hungry, wet, awake or frightened; later he crawls after her, walks around holding onto her legs, and learns to play, but only if she's safe in sight. The whole process of growing up is about learning to separate, to develop one's individuality, without altogether breaking the bond, maintaining a 'flexible' distance between the child and his mother that allows independence and yet gives him the security and safety represented by his mother at the end of an elastic band, as it where. This swing between closeness and individuality is a lifelong process! And we develop the same kind of bonds with our partners, our friends and our children.

I find this theory of attachment immensely useful in explaining what goes on in early pregnancy, and therefore in explaining why miscarriage affects us so deeply. In pregnancy, there is a heightened sense of attachment, a fierce urge to protect and nurture what is growing in your womb, even if at the same time you are assailed with doubts about your capacity to be a good parent, or fears that you won't have a perfect baby. You spend hours talking about this baby: boy or girl? gentle or tough? like your side of the family, or your partners? The elastic band of attachment, that psychic umbilical cord, is firmly in place from conception onwards. As a pregnant woman, you are confronting a profound experience of the life-force itself. But we are mortal: nature is also death-dealing, and so a miscarriage comes as a deep experience of the death-dealing aspect of nature.

Now how can you deal with this seemingly negative, life-denying aspect of life? Paradoxically, not by ignoring it, or dismissing it, but by acknowledging and honouring the attachment you have to your baby and to your desire to become a parent. In our society we tend to see grief as a disease, and to expect recovery and forgetting from the bereaved. Your friends think you should be 'better' in six weeks; even your empathetic health professional has some kind of timetable in his or her mind, more generous than six weeks, but still a kind of mapped-out path for you to travel along the stages of grief. (Apologies to health professionals who don't operate this way.) You are rewarded when you emerge from that dark forest of grief, when you begin throwing dinner parties again and laugh at soppy movies instead of crying all the time. But what is more natural for parents than the very acts society feels uncomfortable about? Talking about your baby, holding, loving and feeling attached are all instinctual actions of parents, all manifestations of good parenting, of the life-enhancing force of nature. Recovery from your grief for a lost baby can't be as Freud says, the breaking of the bond between you and the lost baby, it can't involve a letting-go, a forgetting. At the time of miscarriage the baby is a part of you, inextricably bound up with you and your body, not a separate object 'out there' to whom you can finally wave goodbye.

I don't mean by that, that you can never recover from a miscarriage. I think the experience of pregnancy loss carries us in to a place, a dark forest if you like, an awesome psychic space where we are confronted (whether we like it or not) with the closeness of life and death, with existential loneliness, with the whole question of the meaning of life.

'He who has seen everything empty itself, is close to knowing what everything is filled with.'
(unnamed Argentinean poet, quote courtesy of Peter Barr)

When you lose a baby later in pregnancy, from stillbirth or neonatal death, you are still losing part of yourself, but you've at least begun the process of separating yourself from your baby - you've begun ascribing moods and actions to the baby. 'He doesn't like it when I play Bon Jovi', or 'She gets excited when I hang out the washing'! You've begun to imagine the labour, to visualise your baby as out of your baby and out in the world! (That old elastic band of attachment has begun to stretch, just a little). And when you lose a baby who is stillborn, agonising as that is, you are wrapped in some rituals and practices that hold you and provide comfort: seeing and holding your baby, holding a funeral, having photographs, and so on. Now there isn't a competition to see which grief is worse, losing a baby through miscarriage or stillbirth: a grief is a grief is a grief, to paraphrase Gertrude Stein. But the absence of these rituals makes the process of grieving after miscarriage incredibly complex.

What is unique to miscarriage, in comparison with loss later in pregnancy?

* Often people do not know that you are pregnant, and you find yourself too embarrassed to mention that you were pregnant but no longer are.
* You rarely see what you have lost - or it's an unidentifiable image, a blur of blood and tissue. It's illuminating that women who have seen their baby all speak of this with calmness and a sense of comfort.
* There is no funeral, no religious rites and rituals that deal with the psychological and spiritual components of this loss. You may not know what happened to your baby after he was removed in a bedpan or in theatre, and you may well fantasise, like one mother in a London study: 'Perhaps he's in some grotty little hole' - It is difficult to lay your baby to rest.
* Your baby does not have a legal identity, not even a birth and death certificate, no acknowledgement from outside that he existed and was real.
* Your miscarriage is often sudden, and so you have had little chance for anticipatory grieving and preparation.
* Linked to that, you lose your very newly-established identity as a 'mother' within hours. As Alice Lovell puts it in her London study, 'There was an instant unravelling of a woman's lived experience and rapid deconstruction of her motherhood'.
* There is often no explanation of why you miscarried . . . . . . So you develop a bad case of the 'if onlys', feeling guilty and to blame.
* As the miscarriage begins, there's a sense of helplessness and powerlessness. What can be done to prevent the bleeding and cramping? Neither the woman, her partner nor her obstetrician may have much power in this situation: the sense of helplessness often leads to despair and depression.
* And lastly to repeat: Your baby is still part of you, not a separate independent loved 'object' from which you can, with difficulty, separate and whom you can mourn. You may not even have felt the foetal movement and been able to recognise that 'someone else' was there - the pregnancy may just have been at the stage of physical discomfort and bodily changes and the baby still bound up with you as part of yourself. In essence, that's what makes miscarriage so disorienting and confusing, and it's why many parents say they feel better about their baby who was stillborn and acknowledged, than about their baby who miscarried, silently and unknown.

This has been a brief journey down the road of psychodynamic theory! Thank you for bearing with me.

Within the confines of achieving a relatively brief article I can only briefly mention the importance of exploring what can be helpful to you as you begin your 'life after miscarriage'. In terms of honouring and acknowledging your baby for yourselves (especially for those who couldn't hold or have a funeral) some parents have, for example, either planted a tree or bought a special ring to wear. I will have to leave further exploration of this most important aspect for another article!

'To know healing
is to know that all life is one
and there is no beginning and no end
and the intention is loving'

(Margaret Torrie)

Sheila Sim

Resources

SIDS and Kids WA has a number of books on miscarriage and coping with loss available in their support library at 33 Sixth Avenue, Kensington.  All may be borrowed free of charge.

Additionally, we have a handbook for bereaved parents, their families and friends following miscarriage, entitled "Miscarriage - Saying goodbye before you've said hello."  This booklet is also available free of charge.  Call (08) 9474 3544 to have one mailed out to you.