Being a 30-something female who is not (currently) looking to have a baby, I'm often the only one at the party who still favors pinot over prenatal vitamins. But among my friends' excited pregnancy announcements or subtler "I'll pass on the wine" concessions, a sharper truth looms: one in five pregnancies in the US ends in miscarriage. As modern fertility fights to make its way across our headlines, I wondered what, if anything, I could contribute to the conversation.
Think about the numbers: 1 in 5. Proximity to a woman who has miscarried is something every person on earth has in common, regardless of the life stage or lifestyle. Every one of us, at one point, has known, sat next to, or sat up all night with a woman who has experienced a miscarriage.
The problem is that we tend to fall into two camps: fixers and glossers. Fixers try to fix problems in the wake of tragedy, while glossers try instead to gloss it over entirely. And when it comes to the subject of loss, both approaches suck.
I sought to figure out what those of us on the sidelines can do. When our friends, family, sisters, co-workers, or partners goes through the haunting experience of miscarriage, what role can we rightfully play?
If there's one universal understanding that came from both my conversations and my research, it's that unless someone experiences this particular kind of loss firsthand, they'll never fully be able to understand it. But we can certainly learn how to stand beside them.
Like all good things, the best support begins with empathy. So before we start to think about how to respond to the situation at hand, we must first recognize the feelings at play: the below-the-surface, hard-to-read, heartbreaking emotions that each woman I spoke to admitted kept them up at night.
A Miscarriage Can Come With Guilt
In almost all cases, a miscarriage is no one's fault. The circumstances are usually beyond the mother's control, but too often, women can't help but feel otherwise.
Fertility specialist Dr. Alan B. Copperman, the director of reproductive endocrinology and infertility at the Mount Sinai Health System, works with thousands of women each year. "There's always a feeling of guilt," he explains. "We try and help patients understand the reasons for miscarriages. Sometimes they can be structural - a thyroid or a misshapen uterus. Sometimes they can be hormonal, an infection, a blood clotting issue, an immune issue. Most commonly, they're genetic. It wasn't a healthy embryo and therefore it didn't continue to grow. But it's never because somebody wasn't in the right frame of mind or was too anxious or worked too hard."
He continues: "A lot of women go directly into that headspace. What did I do wrong? Is it because I was stressed out? Did I lift something? Did I have a bad day of work? People question everything they've done and eaten. But it just doesn't work that way."
There's the Pain of Loss
While this person may not have existed to the world at large, they did to their families.
"At the end of the day, loss is loss, regardless of the stage. You've already built up hopes and dreams and excitement for this child."
Kiley McGrady, a mother who experienced two miscarriages before the birth of her daughter, explained, "The second you get a positive pregnancy test, your mind starts planning. Is it going to be a boy or a girl? What are we going to name them? What are they going to look like? That's something that triggers in your body emotionally. At the end of the day, loss is loss, regardless of the stage. You've already built up hopes and dreams and excitement for this child."
There was also the preparation for a major life change that's no longer happening. Especially in the early stages, many of the adaptational changes happen mentally. Corey Miller, a mother who lost her first pregnancy to miscarriage before the birth of her daughter, explains, "You go from gearing yourself up to facing a complete life change to having everything go back to as it was. Nothing is different, and if you're early enough, no one knows that anything ever was different. The world goes on, and no one knows what you're going through."
"For me, that resulted in me not wanting to be around anyone that was pregnant, or anyone who might have even mentioned wanting to be pregnant," Miller says. "For over a year I avoided being around it - I just wanted to go on with my life."
Physicians Aren't Always Flawless
Miscarriages are common by clinical definition, which can unfortunately be the way many medical professionals treat them.
Almost every woman I spoke to pointed out the shock and confusion they felt as a result of their physician delivering the news that they'd miscarried. Miller explains of her first six-week checkup, "The doctor just said they didn't hear a heartbeat. I remember leaving thinking, 'What the f*ck?' It's so matter of fact for them, they just kind of tell you and send you on your way."
Lindsay Rafalski, a mother who lost her first pregnancy to miscarriage, found out during her first ultrasound. "The technician was kind of brutal," she remembers. "She just said 'I'm so sorry, the baby doesn't look like it's growing like it should be'. She listened for a heartbeat, couldn't find anything. Followed by: 'I'm so sorry, you'll see the doctor soon but this pregnancy is probably going to terminate shortly.' Of course, I was upset. But mainly, I was confused. I had absolutely no idea what was going on."
There's Pain (and Not Just Emotional)
What many of us don't realize is that after a pregnancy results in a miscarriage, the fetus doesn't just disappear (though there is the odd case). Instead the mother is often left to decide on next steps. Whether she elects to pass naturally or with medical facilitation, either can hurt like hell.
"The world goes on, and no one knows what you're going through."
A natural miscarriage (called a "complete miscarriage") can give the mother the option to wait until the baby passes on its own (which can take days or even weeks). However, one of the more common medical options is to elect to have what's known as a D and C, a procedure that requires a hospital visit and doctor facilitation. Both can have physical effects that last well after each is complete.
Regardless of the physical route chosen, it's often attached to a parallel, emotional pain that can cause the mother to question the capabilities of their bodies as a whole. "You feel like your body is not able to successfully do this thing that it was created to be able to do. Physically, you just feel broken," explains McGrady.
A Miscarriage Leaves a Void
Losing a baby before it's born comes with a lot of the same residual pain as losing a living, breathing loved-one - and you carry it with you for life.
"Anniversaries, date markers can become true triggers," Dr. Copperman explains. "There are feelings of guilt, of disappointment, sadness. There's a mourning process and it doesn't go away so quickly."
"My girlfriend just suffered a miscarriage this past week," says McGrady. "She knew her due date would have been May 3. So now, May 3 will always be a date for her. On May 3, she'll think about that child's birthday."
That's only a small sampling of the complicated, conflicting, tangled web of emotions women experience in the wake of a miscarriage. For those of us in the wings - like in all things that skirt the edges of loss, tragedy, and heartbreak - there's little we can tangibly do to protect them from experiencing any of the above.
But when it comes to what to say, how to show up, and how to best support them in their time of need, there are certain things that are a little bit better (and just a little bit worse).
Let's start with the worse, from the mouths of those who've heard it all.
The Worst Things You Can Say After a Miscarriage
"This happens to a lot of people"
Though this is one of the very reasons I'm writing this article, this is not something that any woman whose experienced a miscarriage wants to hear at that moment.
"This was the worst for me," Rafalski explains. "It just makes it feel less personal. I already knew that this happened to a lot of people, so hearing it again doesn't always make you feel better. It may not make someone feel worse, but it certainly won't help."
"Take a vacation." "Maybe you shouldn't work as hard." "You need to just relax."
Never, ever, ever try to diagnose the circumstances of a miscarriage. This lends to the suggestion that the circumstances are somehow within her control.
"'You just need to relax' was one of the absolute worst things anyone has ever said to me. Please know that I am doing everything in my control to do exactly that and more."
"Never 'take a vacation' or 'I bet it's because you work too hard', or 'Maybe it's because you're not eating enough pineapples,'" says Dr. Copperman. "These are things that can really make somebody's feelings of guilt, blame, and shame worse, so we really want to stay away from them."
In the same vein, Dr. Copperman explained, "Don't bombard their inbox with solutions. Not only is everybody an individual, but this also perpetuates the idea that we have control over many of the things we don't."
"'You just need to relax' was one of the absolute worst things anyone has ever said to me," says one woman who has had several miscarriages on her fertility journey and who asked to remain anonymous. "Please know that I am doing everything in my control to do exactly that and more."
"I know how you feel"
This response can be a natural go-to, and while it comes with the best of intentions, it's an impossible truth. Whether we've experienced zero miscarriages or five, we'll never be able to know how anyone feels about their own. Miscarriages are like awful, uncomfortable snowflakes - no two are the same.
Another mistake to avoid is attempting to understand the scenario in order to empathize fully. "Don't be afraid to not understand something that you can't," says Miller. "You don't need to try and ask a list of questions in an attempt to genuinely understand, because you can't. And that's OK. In most cases, the person going through it doesn't even understand."
"How far along were you?"
This one stings, because it seems to want to somehow qualify the grief attached. At the end of the day, grief is big and swollen, awkward and uncomfortable, no matter how many weeks old the source of that grief was.
"This is one of the most hurtful - or maybe unnecessary - things that anyone could ask," says McGrady. "It has the tendency to make it feel like your feelings aren't validated before a certain amount of time. The reality is the second that you get a positive pregnancy test - if you were trying to have a child - your mind is already planning to have a child. It doesn't matter if it's early."
"When are you going to try again?"
Everyone's timeline is different. And timelines, like our sex life, should be private (unless otherwise offered).
Asking someone when they're going to try again is just as inappropriate as asking a woman when she's going to have a baby in the first place.
"You would never ask someone how much they make, but in this scenario people feel comfortable asking if you've had sex that week," Miller says.
Read the Signs
The most important thing to remember is to read the signs that your friends and loved ones are giving off. Most everyone I spoke to mentioned the importance of reading the signs. It's all about the particular woman you're dealing with and the type of support she wants - or doesn't.
"People weirdly feel the need to go over the top when truly all they need to do is ask how they can show up - we'll tell you."
Regardless of how close you are with her, you should be able to read the signals she's giving. If the person seems like they don't want to talk about it, you need to be ok with that. There are plenty of ways to offer quiet support. Here are some of the best things you can do:
Acknowledge Their Loss
Whether someone was on the earth for 10 or 40 years or in the womb for 10 or 40 weeks, those close to them have suffered in many of the same ways.
Feel free to put the same consideration toward a miscarriage as you would when a friend loses a loved one: a handwritten card, flowers, phone calls, kind words, listening. No gesture is too small or substantial to show someone you care.
"The best advice that I give doctors as well as family members when somebody says they've had a miscarriage is that it's OK to acknowledge their loss with a simple 'I'm sorry, how are you?'" says Dr. Copperman.
Ask How You Can Show Up
Showing up is important and powerful, but it can also be personal. Some women may want us on their doorsteps with takeout and tequila, while others may want a quiet nod or written words of comfort. Either way, just ask.
Try and avoid the broken-record sign off of "let me know if there's anything I can do" and instead ask, "How can I show up for you?"
"All you want people to do is treat you like a human," says Miller. "Be kind, be reasonable. People weirdly feel the need to go over the top when truly all they need to do is ask how they can show up - we'll tell you."
Invite Conversation With Open-Ended Questions
One of the best ways to show your support (and take your recipient's temperature on how she's handling the situation) is to pose polite, open-ended questions. Avoid anything dripping with details or that may insinuate that's what you're looking for.
"Try and delicately ask where they're at," says Miller. "Try, 'Are you super discouraged right now?' You'll know from their response whether they want to talk about it or not. But know either way that the simple fact that someone reached out is helpful."
Dr. Copperman suggests "validating, supportive, open-ended questions like 'how are you handling this?' or 'who are you turning to for support?' or 'Is there anything I can say do or say that would make this better at this point?'"
Deploy Mindful Checkins
Mindful checkins can be an extremely appreciated (and often overlooked) part of the process. So long as they're noninvasive and gentle, recurrent open-ended questions like the above can help remind our friends and family that we, like them, haven't forgotten.
"One of the best things a friend did was pop in and say, 'Hey, just checking in on you. Let me know if you want to talk about anything or not at all,'" says the woman who wanted to remain anonymous. "Each time I'd respond differently, depending on the day."
Consider the Other Party
All the focus tends to fall on the person going through the physical experience, but there may be someone suffering silently beside her. Simply remembering that there are often two people involved in the process and reaching out to support the one who's often expected to be the support can be a huge move.
When asked about what to be more mindful of, Dr. Copperman says, "It's important to be sensitive to both the patient and the partner. Often, the partner is expected to be strong and tough, but they need an outlet for their emotions too, because they've also suffered a real loss."
Take Their Mind Somewhere Else Entirely
Something that those of us who've never been there can offer is exactly that. No firsthand knowledge, wisdom, or unsolicited advice - just blissful, oblivious companionship.
"People who haven't gone through this have a lot more to offer than they think."
"People who haven't gone through this have a lot more to offer than they think," says Miller "Sometimes, it's almost more comfortable to be with these people because there's no room for comparison. I'd tell them just to say 'That genuinely sucks. Do you want to go do something completely unrelated and not think about this at all?'"
While I can do my best to provide a loose guide to help navigate these waters, there will never be an official rulebook. Like humans, every situation is different - a different story and circumstance, with a different cast of characters.
The most important thing I've learned through writing this is to pay close and kind attention to the people in your life. Take the time to ask them questions that might not be at the top of the deck in table topics, the ones that might not be the most comfortable.
"The old-fashioned way is to not talk about negative things, but in our new world people don't have to suffer in silence," says Dr. Copperman "It's OK a month later to say 'really, how are you feeling?'"
It's when we ask the real questions that we find true connection, community, and maybe - if we're lucky - comfort.