Suggestions for how to talk about pregnancy losses

The advice on how to talk to a person who’s experienced a pregnancy loss seems generally pretty bad to me. That’s a great shame because these losses are a hard thing to talk about but also a common occurrence. Having had a miscarriage and a late term stillbirth, I’ve thought a bit about ways of communicating about them in ways that land well for people, and I thought that might be useful to share. 

‘Pregnancy loss’ covers a wide range of experiences, including early stage miscarriages, abortions and still births. Most of this is aimed at how to talk to the person who was physically pregnant. 

What follows is most applicable for people you know well - for talking to friends or colleagues. If you’re meeting someone you don’t know too well at an event who you know has suffered a pregnancy loss, it’s quite likely that the right approach is simply to let them go about the event as normal, rather than bringing it up. Talking about it can be pretty hard for people, particularly with someone they don’t know that well and when they weren’t expecting to. 

People’s experiences differ widely

People experience pregnancy losses really differently on the spectrum from ‘I’m sick in a particularly painful/private way and my future suddenly looks really different’ to ‘a person I’ve been thinking a lot about for months has died’. That means people’s ideal way of talking about it / being comforted is pretty different. On the other end you want to focus just on the people losing the pregnancy: ‘How are you feeling? Are you in a lot of pain?’. On the other end are things like ‘I’m sorry for your loss. Did you name her?’. 

The ideal is to figure out how the person is experiencing the pregnancy loss, and try to mirror that. Before that, you might want to keep with general comments along the lines of ‘I’m really sorry; that must be really tough; how are you doing?’. 

Also, people’s experiences can change day to day. And they don’t necessarily even know themselves how they’re experiencing it. So the ideal is to be open-mindedly sympathetic and hold space for the person to feel anywhere from fine to awful.

Beware of escalating grief narratives

A failure mode that happened with me a bunch after the stillbirth was a kind of escalating cycle of everyone upping the amount to treat the pregnancy loss as a death. For people talking to me, it may have seemed better to err on the side of acknowledging the loss of a baby because it’s worse to fail to acknowledge a loss than to acknowledge one that didn’t happen. But that caused me to feel callous to not match their level of acknowledging a loss. That’s actually pretty bad. The reason is that the people undergoing the pregnancy loss don’t actually know how to feel about it, feel differently at different times, and so can be quite affected by different narratives. The more other people treat it like someone you know died, the more it can feel like they did. That can feel more sad than the alternative (because you start feeling an increased sense of loss) or it can cause guilt (‘given that someone I know died, shouldn’t I be feeling more grief for them and less upset about the effects on me and my future?’).

As far as I can tell it used to be that people’s sense of ‘losing a person’ was mostly ignored, so now there are various things put in place to try to compensate for that, and medical staff are trained to try to acknowledge people might be feeling it as a death. Society also is more used to talking about good things and also to pregnancies being successful. So narratives that avoid talking about the pregnancy loss as a death feel less available/salient. 

Specific narratives people might be experiencing

Here’s some ways people might experience things, that could give you a sense of what kind of sympathy you might express that don’t assume the narrative of a death: 

• ‘Over the last many months it’s been continuously on my mind that I have to change my behaviour in a lot of ways to avoid this specific situation (no alcohol / shower not too hot / ‘can I eat this kind of cheese/fish?’ / don’t forget to wash salad and fruit particularly carefully). The precise thing I’ve been trying so hard to avoid has just happened.
• I’ve been making specific plans I was looking forward to, though with trepidation. My next year suddenly looks entirely different and emptier.
• This pain is a lot, and also kind of at my core. But I’m not really allowed to talk about the parts of me that hurt because they’re private. The hospital and midwives didn’t really want to give me as much pain medication as seemed like would usually be warranted for the amount of pain. That implies this pain is somehow good, but I don’t see a way in which it’s good. 
• Confusion: I feel like something’s changed and missing, and yet it’s actually more that nothing’s changed and nothing is going to change. Given that, why do I feel like this?

I also found that my way of experiencing it changed day by day. Eg sometimes it seemed terrible and sometimes it seemed like not much had happened and I felt guilty for not feeling sadder. That meant it was pretty good for people who I had talked to before still to approach how I was doing on a particular day with an open mind. 

What you might say

The thing I most appreciated was people being open to me experiencing this however I happened to experience it:

• Is it feeling like the world is crashing down, or is it feeling like not much has happened? 
• Would you like to be distracted by doing something fun and exciting, or go back to work, or be left alone?
• Would you like to talk about how you’re doing physically? Or about how you have to change your plans for the coming months? Or about other things entirely?
   

Another dynamic that was true of us was that my husband felt like he had had very little direct interaction with the pregnancy, so his main orientation towards the situation was something really bad having happened to me. So the relevant questions to ask him might have been things like ‘how is Michelle?’.

It can feel pretty bad talking about the specifics of what happened, whether they’re known or not. It can make you focus on things you’d rather not (‘the foetus was underweight’ is hard to say without viscerally reminding you there was an almost-baby), or remind you of ruminations (‘they don’t know why it happened; was it something I did? How long will the autopsy take?’). So rather than asking ‘what happened?’ you might want to show interest while giving full affordance not to give any details ‘would you like to talk about what happened?’, or instead focus questions on things like ‘how are you both feeling?’.