Saturday, May 22, 2021

On miscarriages

This essay was adapted into a sacrament talk at the request of our bishop. 

In April of 2021, I posted the following on social media:

“When you get married a little later in life, crossing the threshold into middle age, and have been trying to grow your family, only to experience years of disappointment in the form of miscarriages, anticlimactic observations of Mothers Day and Fathers Day, and wanting to be happy for friends and family bringing children into the world but finding it increasingly difficult when your own efforts seem all for naught, what do you do?”

Image by milli_lu
Honestly, it wasn’t so much a request for advice as it was a desire to let people know that this was something our little family was going through, especially the miscarriages—not for attention or sympathy but simply because, despite the fact that it’s something that a lot of people experience, the topic of miscarriages has historically only been discussed in hushed tones. In recent years, more people are talking about it and I think that’s a good thing. So, I decided to keep the discussion going, to try and do my part to help break the stigma.

I was prepared to hear some platitudes: “…count your blessings,” “…hang in there,” “Have you considered adoption?”

I was very appreciative of the more empathetic thoughts that were shared:

“You’re feelings are completely valid. I’ve been there, I’m still there…” 

“…Honor the grief… There is something about giving the pain room to breathe that makes it easier to bear.” 

“Adoption might not be for everyone but if one is willing to show the same amount of love to someone else’s child as their own without boundaries all the things you seek are capable of fulfillment.”

When we first started trying to get pregnant, my wife, Danica, was so hopeful for us to have children that when she was greeted with the unmistakable confirmation that she did not get pregnant, despite our efforts, she was devastated by it. The fact that we had gotten pregnant once before without even trying—the first miscarriage that we know of—made it especially frustrating.

She described her feelings to me as “grief,” which I initially had a difficult time understanding. I could understand grieving over the loss of a loved one—even the loss of a pregnancy—but how does one grieve over a thing that did not happen? “Grief” seemed like too strong a word and I thought, maybe there was something else going on that needed to be addressed. Having grown up with a family member with PMDD, I thought I was better prepared to be supportive and empathetic when it came to the typical symptoms of menstruation for my friends and partners, but I never considered “grief” as a potential symptom and I wasn’t sure I could deal with it as a recurring thing. I recognize that I was being selfish—I was probably aware of my selfishness even in the moment. I had even insisted that we see my therapist together to talk about it, thinking that he might have something to say that would put things into perspective for her. Instead, he pointed out that the problem was with my perspective, not hers.

Having worked with me for several years—thus already knowing that my answer would be yes—he asked me, “Haven’t you ever felt devastated when something that you dreamed about and tried to accomplish wound up not happening?”

Yes. My God, yes! I felt ashamed for being so insensitive. Grief was the right word after all. My failure to acknowledge it was effectively invalidating Danica’s feelings and I apologized to her.

Since that time, the recurring knowledge that we did not get pregnant “this time” has evolved from that intense sadness to disappointment—even annoyance. Of course, our feelings around it are no less complicated, and I can’t deny that I keep second-guessing myself. While there’s a degree of cultural pressure for me to bury such thoughts and feelings, I’ve been “blessed” with a condition that doesn’t allow me to do so without physical side effects. It was in reference to that when I wrote in my personal journal—which I later shared with Danica:

“I worry about not being a dad. I’m afraid that every time I feel so anxious… that I get sick that maybe that would have been the best time to get pregnant and I ruined it. There’s a part of me that thinks about not having the added responsibility of parenthood and then I feel like a jerk for being selfish.”

Like an open book... get it?
I’m very grateful to be in a relationship where communication is our first priority—neither of us are very good liars anyway. So, when there’s a problem, or things just feel off, we try our best to address it and not let it fester. To acknowledge our frustration with circumstances or even with each other so that we can get at the root of the problem and find a solution. This is probably why the teaching of “The Way of Absolute Candor”—introduced with the “Qowat Milat” on “Star Trek: Picard”—really resonated with us… well, with me anyway. I think we might adopt this into our existing collection of family mottos which includes “You’re not the boss of me!”—which sounds antagonistic but, at its core, is just about respecting each other’s autonomy and rights to make our own choices even after consulting each other—and “No secrets, just surprises,” which basically means that if anything is being concealed, it’s not for the purpose of being deceitful, it’s just about timing; ideally for a pleasant surprise, though sometimes, it’s just about choosing an appropriate time to discuss something serious.

Since we started trying to get pregnant, we’ve been through at least one other miscarriage but we also acknowledge that there may have been others that we were not even aware of. Most people seem to think that there’s always some evidence that a miscarriage has occurred but that is not the case. Statistically, as much as “…22% of all conceptions never even complete implantation,” and “…if you factor in fertilized eggs that fail to implant along with pregnancies that end in miscarriage, around 70% to 75% of all conceptions will end in pregnancy loss.” (emphasis added) We draw a great deal of relief from the fact that miscarriages are “…the body's way of stopping a pregnancy that has no chance of success.”

Whenever I want to increase my understanding of something, I try to immerse myself in the language of that thing and the principal contexts in which it functions. I have little patience for the incorrect usage of words and terminology, especially when terms have a history of being deliberately misapplied to serve rhetorical arguments. Our experience and age have motivated us to brush up on our understanding of conception and pregnancy and to learn more about fertility and the fact that there are different types of pregnancy loss. Miscarriages are losses that occur prior to the twentieth week of pregnancy. Loss after the twentieth week is considered a “stillbirth”—an experience that is considerably more difficult to endure and complicated to process.

The psychological and emotional response to any pregnancy loss, and the particular circumstances surrounding the event, can vary greatly from person to person. The experience can be emotionally devastating and worthy of grief that needs to be honored and processed, it can also be seen as something that’s disappointing but incidental. We know this because we have personally experienced this variance. The first miscarriage that we went through was sad for us. It wasn’t a planned pregnancy but that didn’t mean that we weren’t looking forward to welcoming a new person into the world. When the second miscarriage occurred, we didn’t even realize that we were pregnant. It happened in the middle of a workweek and while it was a lousy way to learn that we had been pregnant, this time it was not so difficult, physically or emotionally, that Danica felt the need to even take time off from work.

Over the years, in addition to the sympathetic bromides and the thoughtful remarks that are often shared in response to acknowledging a miscarriage, I’ve also noted a troubling presumption embraced by some that I do not find helpful at all; the notion of conflating a miscarriage with the death of a child. Frankly, I find the expression of this belief within the context of a much-needed discussion about miscarriage to be inappropriate and even harmful. With the potential to incite feelings of sadness, guilt, and self-doubt, the emotional toll that miscarriages can take are difficult enough to endure in isolation. For anyone to suggest to someone that their miscarriage—as tragic as it may already be for them—is tantamount to a child’s death, I think is irresponsible and cruel! To say nothing of the greater psychological harm it could cause in the long term.

I feel it important to emphasize that this is a belief. It is not grounded in any scientific principle or theory. Nor is it based on any theological creed that I’m aware of, nor any religious doctrine that I might subscribe to. However, it does bear a resemblance to the pseudo-spiritual rhetoric of anti-abortion demagogues, whose personal and self-righteous opinions have been used to justify the criminalization of a random, physiological process. I am not suggesting that everyone who subscribes to this belief also embraces an anti-abortion philosophy to any degree, only that said belief may be informed by it—perhaps even indirectly.

This is not to say that I don’t understand certain theological concepts that factor into those harmful notions. As a man of faith, I have chosen to embrace a particular theology that I believe to be consistent within its own context. Part of that consistency is rooted in accepting the fact that human understanding is finite and the gathering and acceptance of knowledge and truth—regardless of its source—is ongoing. To question is expected and encouraged but not all questions have been answered. We are free to speculate and to reason but we must keep our minds open to the likelihood that our limited understanding may lead us to embrace as true, notions that are, at best uninformed, or, at worst, completely false. Just because attaining greater knowledge may prompt us to reevaluate our past limited understanding of any concept, it is not indicative of a contradiction in that which purports to be true, it is simply an expansion of the context in which that concept is expressed and understood.

The concept of ethereal spirit-beings waiting for an opportunity to merge with a corporeal body for the purpose of experiencing a mortal life is shared by many different faiths. What is not known with any certainty—and remains a matter of speculation—is at what point a spirit merges with a body.

There are those who would argue that “life begins at conception.” Biologically, that would appear to be the case. It’s difficult to argue that embryogenesis is not a living process when we can watch it happening with the aid of a microscope, but at what point does a spirit enter a body? Lacking any sort of empirical evidence for the existence of a “spirit,” it’s presently impossible to answer such a question scientifically. Among theologians—even those that subscribe to the same religions—there’s no consensus. So, all we are left with is speculation, and I am of the opinion that those speculating that a spirit enters a body at the moment of conception are a vocal minority. Were this not the case, I think that funeral services following pregnancy loss—even for miscarriages—would be standard practice. Considering how such a ritual might affect those experiencing recurrent miscarriages, I’m grateful that it’s not.

Can you spot the human
at this resolution?

Among those who would argue—without evidence—that biological life is not possible in the absence of a spirit, eager to begin its mortal probation, some make no distinction between a zygote and a person. This is regardless of the fact that most people would be hard-pressed to visually distinguish an embryonic human being from any other vertebrate from the moment of initial mitosis through organogenesis.

When one considers all the possible variables that can—and do—occur during pregnancy, I see a major flaw in the belief that spirit and body are joined at the moment of fusion between a spermatozoon and an ovum.

Let’s assume that a spirit is a conscious entity with knowledge of their purpose, perhaps even being privy to knowing who their parents will be, what their life might be like, and are eager to begin their mortal existence. There are some important questions that need to be asked:

If three out-of-four conceptions result in pregnancy loss, does that mean that three-quarters of all people have died without ever actually being born? Is their mortal existence defined by whatever stage of prenatal development they were able to achieve up to that point? If the purpose of a mortal life is to gain knowledge and experience, how can one achieve that goal if they haven’t even developed the physiological capabilities to do so? If a spirit has knowledge of what their mortal life would be like, what would be the point of entering a clump of cells that will never have a chance of becoming a living person?

Consider the fates of abandoned frozen embryos. Do they all represent spirits that are trapped in long-term cold storage? Would a conscious spirit not see that as a possibility when it enters a diploid cell in a petri dish at a fertility clinic instead of a human body? A frozen embryo does not show signs of life—because it’s frozen—but it still has the potential for life. Whether or not that potential is realized is what should be considered. I think the same thing can be said for any prenatal organism—human or otherwise. They have the potential for life. If that potential for life has diminished to the point that the body in which it is developing is able to recognize that fact, it will end the pregnancy on its own. What has been lost was not a life, just the potential for one.

It is my personal belief that a spirit being with access to some foreknowledge of their mortal existence, and also having free agency that they may continue to exercise in mortality, is not going to enter a prenatal body—regardless of what stage of development it may be in—if they know that it’s not going to be born, for any reason.

A spirit being experiencing a mortal life can be compared to a person traveling in a vehicle. Life is the journey and it comes to an end when the vehicle reaches its destination or concludes prematurely because of an unexpected change in itinerary or an accident. From the perspective of a spirit being, a pregnancy loss—including miscarriages, stillbirths, and even those resulting from a medical procedure—is more akin to missing a bus than getting into a car that immediately crashes when entering traffic.

Image by, CC BY