Why Does Miscarriage Feel so Isolating?

Listener 00:00:00

How can I manage anxiety with future pregnancies after miscarriage, amniotic fluid embolism, also known as an AFE, birth trauma, etc.?

Dr. Ruta 00:00:08

Welcome to So Glad You Asked, the show where real moms bring us their toughest questions. I’m Dr. Ruta Nonacs, a perinatal psychiatrist at Mass General Hospital with over 30 years of experience supporting the mental health of moms and helping them navigate the emotional highs and lows and the often unexpected challenges that come with planning a family, pregnancy, and motherhood.

Allie Hales 00:00:31

And I'm Allie Hales, a mom of four. I know what it's like to scour the internet wide awake at 2 a. m. with a million questions, wondering if what I was experiencing was normal. That's why we created this show. It isn't just for real moms, it's by real moms. Every episode is a conversation led by you. Your questions, your experiences, your mental health front and center.

Dr. Ruta 00:00:54

And we don't just listen, we provide real evidence-based answers and reliable resources from trusted experts. Because moms don't just deserve support, they deserve solutions.

Allie Hales 00:01:05

There is a specific kind of silence that comes with a miscarriage. It's the silence of a nursery you hadn't started yet, the silence of a secret you were still keeping, and the quiet heavy pause in a doctor's office when the ultrasound screen doesn't look the way you hoped it would. I had an early miscarriage after my first child. Because of my endometriosis, I was being monitored closely. Lots of blood work, early appointments, so I actually found out I had miscarried before I had any physical signs. And that was its own kind of disorienting. I had only known I was pregnant for a few weeks and suddenly I wasn't.

Allie Hales 00:01:40

I ended up needing a manual vacuum aspiration, which was physically painful and emotionally overwhelming. And what stayed with me most wasn't just the loss, it was how confusing it all felt. How quickly everything changed, how little time there was to even process what had just happened. Because here's the thing, most of us haven't told anyone yet. We've been told to wait until the second trimester, until it's safe. So we're holding this big life-changing news quietly and then we're holding the loss quietly too. Even though one in four pregnancies ends in miscarriage, it still feels very isolating. You find yourself retracing everything, what you ate, how you exercised, whether you were too stressed.

Allie Hales 00:02:20

And even if you logically know that's not how this works, it's hard not to go there. And then there's this expectation, sometimes spoken, sometimes not, that you'll just try again. But trying again isn't simple. It's not a reset, it's walking back into something that now feels uncertain and doing it while carrying fear you didn't have before. So today, we're breaking that silence. We're talking about what pregnancy loss actually feels like, not just medically but emotionally. The gap between how it's treated clinically and how it's experienced personally, and what it means to move forward, whether that's another pregnancy with a whole new layer of anxiety or sitting with the uncertainty of what comes next.

Allie Hales 00:03:00

We're joined today by Dr. Jessica Zucker, a Los Angeles-based psychologist specializing in reproductive health and the author of the award-winning books Normalize It: Upending the Silence, Stigma, and Shame That Shape Women's Lives and I Had a Miscarriage: A Memoir, a Movement. Jessica is the creator of the viral hashtag # IAhadAMiscarriage campaign. Her writing has appeared in The New York Times, The Washington Post, New York Magazine, Vogue, and Harvard Business Review among others. She's been featured on NPR, CNN, The Today Show, and Good Morning America and earned advanced degrees from New York University and Harvard University. Dr. Zucker, we're so excited to have you on the show.

Jessica Zucker 00:03:40

I am so honored to be here.

Dr. Ruta 00:03:42

Thank you so much. I know it's taken us a while to have the stars align, so we're really delighted to have you. And I think there's so much to talk about miscarriage, so common, but uh so many things uh come up with miscarriage. And uh what I've learned from my clinical practice is that uh there's so many different ways to respond to this loss and no two single people are alike. But there are certain themes, and I think uh Jessica touches upon them in her book. I was wondering if you could talk about miscarriage and the sort of trifecta of shame, stigma, and silence, because I think it's a great way to kind of understand how we experience miscarriage.

Jessica Zucker 00:04:34

Of course. Well, again, thank you so much for having me. This is such an important conversation to be having. And you know, it's a wonder to me why we continue to say that it's a silenced grief. Right? So if approximately one in four pregnancies results in miscarriage, why are we not talking about this? And so after my second trimester loss in the context of my home, I became all the more curious and outraged by the cultural silence. So I turned to the research, and as you just mentioned, it points out that a majority of women are blaming themselves, feeling a sense of guilt and shame and alienation and even a sense of body failure. And although those weren't things that I myself experienced, I felt a sort of burning desire to somehow make a difference or sort of puncture this, what I call this trifecta. So the silence that begets the stigma that begets the shame.

Jessica Zucker 00:05:48

And, you know, I really had to think this through as a psychologist, did I want to put the contents of my personal life out there on the interwebs? And, you know, have potential patients or prior patients or current patients read about what I went through. And after marinating on this for some time, I decided, you know what, actually, I'm in a perfect position to model for women around the world that we need to, it behooves us to talk about these things even as professionals in this field.

Dr. Ruta 00:06:31

I think that's really um interesting what you said about sort of your professional identity but your personal experience. And as mental health professionals, we're told to be kind of a blank slate and that sharing is not something that's in the service of treatment. Uh but I do think there's something incredibly powerful about sharing that experience, um because you have a different lens and to be able to talk about that experience is so significant and and um it always amazes me how many women who have had miscarriages or postpartum depression go on to be advocates because of that experience.

Allie Hales 00:07:15

Yeah, I would just add as well, like, I think for me, I'm not in the medical field. And so for me to hear a personal experience from someone who is in that space, it's really powerful because, you know, part of when I had a miscarriage or when I've had friends experience miscarriages, there is this, you know, I love that you identify it, like the silence leads to stigma leads to shame, because I definitely experienced that. I didn't really fully process what was happening or really why it was happening and I remember hearing something that you talked about on another podcast where when we learn about, you know, in sex ed or whatever, we learn about becoming pregnant or become, you know, and it just it's so kind of like, oh well you'll if you have sex you'll get pregnant and then you'll have a baby. And growing up, I never really learned a lot about miscarriage or infertility or, you know, any of these other complications. It just was, you know, this equals this equals this.

Allie Hales 00:08:18

And so when it didn't go according to plan for me and I had wanted it to, like I had wanted to become pregnant and it didn't happen that way, it was very confusing to process because no one had ever really opened up to me about their experience having a miscarriage. So I really appreciate that you did that and created this campaign. So I guess I would love to hear a little bit about, you know, you had this personal experience, you started this incredible #IHadAMiscarriage campaign which really connected with so many people.

Jessica Zucker 00:08:50

Yeah, you know, I was honestly terrified to put my personal story out there on the New York Times. You know, it was like I had written a lot and I had found writing to be incredibly healing over the course of my life and especially after my miscarriage, but you know, I was nervous because I wasn't sure if it was the right move professionally and how it would be received.

Dr. Ruta 00:09:20

So as you were talking, I'm thinking about, you know, someone listening to this program and thinking, yes, I blame myself, and that's why I don't want to talk about it with other people. How do you help that person get out of that sort of pattern of thinking so that they can feel more comfortable to share it with others? And what are the benefits of talking about it? I think one of the great things about your book is you really put a lot of emphasis on, you know, telling your story and what the benefits are. So how do we push that person into sharing those experiences?

Jessica Zucker 00:09:57

That's an important question. You know, it really of course depends on the individual and their unique history, but when I say to somebody who really is sitting across from me crying and truly believing that they did something wrong, and I say in a gentle, compassionate way, "What if you did absolutely nothing wrong?"

Jessica Zucker 00:10:28

It's like an aha moment, even though these are the simplest of words. They hadn't even thought about it that way. And so that can kick off, I think, you know, this kind of boomerang effect of like, oh, wait, if I didn't do something wrong, then actually maybe I'm even more entitled to my grief. I just think it's so important that we understand there's so much nuance within miscarriage because a lot of things were said to me upon sharing my news that stung.

Jessica Zucker 00:11:05

I can't even imagine living after what you've been through or these sort of, you know, I can't imagine. Well, we should help people imagine. And we can help people say softer things like, “I'm so sorry that you've been through this, and I'm here to listen if you ever want to talk.” Because sometimes when we assume that somebody is heartbroken, it actually shuts down the conversation and the sharing that they may have wanted to do. Because we're sort of making an assumption or projecting something that we think we might feel or we think they are feeling.

Dr. Ruta 00:11:51

Right, and on the flip side of that, saying, I know exactly what you're experiencing, also shuts down conversation.

Allie Hales 00:12:00

I yeah, I think both of those points are so important and there's so much you just said that I want to get to like all these different parts of what you shared because it's just so instructional and like helpful and processing even just for me personally. Um, but just going back to your most kind of recent part at the end of your what your your comment was, you know, I've had a lot of friends who have had miscarriages and even though I've had a miscarriage myself, I mean like you said, there's a whole range of experiences and emotions and it's hard to know, you know, what to say and what not to say and you did share a little bit about kind of … a suggested, I'm here, I'll listen comment to make, but just wondering, you know, what are the things that you've found helpful in ways to acknowledge the miscarriage, well-meaning phrases that have the opposite effect? You shared a little bit about, but just kind of wondering if someone's unsure of how to talk to their friend who just had a miscarriage, where do you start?

Jessica Zucker 00:13:02

Yeah, I mean, I would definitely steer clear of phrases that begin with at least. “At least you know you can get pregnant, at least you have a healthy child, at least you have a thriving career, at least you were ambivalent about growing your family.” Phrases that begin with at least kind of again shut down the conversation and really don't allow for the complexity of what this person might be going through. And I think unfortunately, it really proves how far we have to go in our culture when it comes to talking about grief. Because this kind of quote-unquote silver lining perspective of at least it doesn't do grief justice. Why can't we just huddle up with ourselves, with others and commune around grief? If you're a close friend or a family member, the connection is very meaningful.

Jessica Zucker 00:14:06

It can be so heartwarming to get a text, get a phone call that's, you know, the month anniversary or the year anniversary or if the person named their baby using the baby's name or if they had, you know, a funeral or some sort of ritual. Talking about it.

Dr. Ruta 00:14:28

I think also when you don't ask about it, you're sending the message that you should be over it by now. It's been a month, it's been six months, it's been a year. That's enough for grief. We're moving on.

Allie Hales 00:14:41

I felt that way personally too. Like my miscarriage happened, they caught it so early through blood tests, so I hadn't even experienced any symptoms yet. My doctor told me, you know, well if you hadn't done any of these tests, you probably would have been pregnant for another month and then you would have experienced miscarriage symptoms, you would have experienced the miscarriage. And so for me it was confusing because it almost felt like it didn't like count. Like I had known about it so early on, even though it was like over a short period of time, it was just like, okay, everything's done, like you're all set. And that was hard. And I think one thing that I really loved hearing you talk about is, you know, grief is part of the human experience and I think a lot of times we do so much to avoid it. Like, we just band-aid it, it's over. We're moving on, not even going to open that up. But then you do miss out on this whole part of the human experience that doesn't go away. It just gets kind of bottled up.

And I guess my question to both you and Ruta is, you know, we're always told don't tell anyone you're pregnant until after the first trimester. Like don't say anything like it's this big secret, like just in case something goes wrong. And I totally understand like it's complete personal preference. Some people might feel comfortable waiting that long. But for me, when I went through different pregnancies, like that's when I felt the absolute worst and when I felt like I could have benefited more from having, you know, a village around and like people to talk to and support and I just felt like I was experiencing really, you know, nausea and acne and like all these things, like just I felt like I was so tired, I just fell asleep everywhere. And I wasn't telling anyone why. and it just felt very disorienting and it was always kind of, okay, well you have to wait until the first trimester is over just in case you miscarry. And it was kind of always like hanging over my head. So what do you like kind of, and I feel like that's mostly just because of the stigma around miscarriage, right? That we wait to tell people we're pregnant. Just curious what both of your thoughts are on that.

Jessica Zucker 00:17:03

So I think this is an antiquated narrative that needs to be flipped on its head. I understand a majority of miscarriages do take place within the first trimester. So the medical community, even midwives, lots of people are suggesting to wait. What they don't necessarily understand psychologically that this puts on the patient is it's sort of saying wait until you are technically quote unquote out of the woods into the second trimester to share your good news so that should it become bad news you don't have to share your bad news. 

So what does that translate into? That is essentially saying we need to continue to be quiet about grief and then just go get pregnant again. And nobody ever has to know that you went through that if you do get pregnant again and stay pregnant.

Jessica Zucker 00:18:10

I find this to be tragic because again, the statistics tell us too many people are going through this for us to do that. I mean, we shouldn't do that with anything that happens that is traumatic and so deeply personal. So, I think that people should share their news when they want to.

Dr. Ruta 00:18:36

Just to sort of add my two cents, I totally agree and it's so frustrating when, um, I see, you know, whether it's my patients or my friends, really refusing to tell their support network that they're going through something. And pregnancy is difficult. Like you tell people when you're going through, you know, some other type of thing like trying to get in, you know, your kids trying to get into college and it's not going well. Like why aren't we telling people about pregnancy? It is hard. Things can happen and you don't feel good. So, you definitely want to tell your support network. 

I think there there's also something about not telling uh other people that it's a shameful thing, whether I don't you know, whether this is like something that's puritanical because, you know, getting pregnant is not something that we're supposed to talk about, but it it lays this layer of shame over it and then if there's a loss, it becomes even more shameful and it's your fault because it didn't go well. You don't have a chance to kind of process it in a different way. So I think certainly sharing with your support network is the most important whether it's your parents or your friends or your, your, you know, other doctors or whoever it is. But to say no one knows, it really puts a lot of pressure on mom and her partner.

Allie Hales 00:20:02

And I was wondering what do you wish other providers knew about the psychological impact?

Jessica Zucker 00:20:08

Oh, that's a good one. What I wish other providers knew who don't specialize in this or who do is that it needs to be compassionately investigated. Right. So we were saying before, you know, not making assumptions about how somebody feels. And I was knocked to the ground. I mean, and I thought I knew all the things, you know, and it doesn't matter how much we know about something. And I think that as therapists, as uh medical providers, it can be easy to kind of get lost in our knowledge base and even though, you know, we're empathic and we're connecting, it can be, you know, hard for us to truly put ourselves in the shoes of somebody else because it's it's a lot. And um so I think yeah, just kind of trying to better understand that a majority of women are blaming themselves, are experiencing some sense of shame, trying to connect with whatever this person is going through in that moment can make a huge difference.

Allie Hales 00:21:32

So now we're going to shift into some of the questions you all asked about miscarriage, mental health, and what this actually looks like in real life. So, I'll go ahead and ask the first one. So it says, how can I manage anxiety with future pregnancies after miscarriage, amniotic fluid embolism, birth trauma, etc.?

Jessica Zucker 00:21:56

Woo! Yeah. So in my first book, I decided again that it would be very important to be transparent about my level of anxiety and my subsequent pregnancy. I don't feel like I took a deep breath until my daughter was born and even after that, I was thrown into a whole other sort of state of anxiety that I thought would end as soon as she came out and realized that, you know, the concern continued. And so I think in therapy, ideally, you know, people can be talking about this anxiety. It can be managed, of course, with safe medications if the anxiety is so intense that uh somebody feels that would be beneficial. And then of course there's mindfulness approaches. CBT, there's, you know, so many ways that we can work with trying to be present right now. And one thing that I've said to many patients and including myself, uh, while I was pregnant after pregnancy loss was, you know, as far as I know, I'm pregnant right now. And I gave myself permission to go see my doctor as often as I wanted to. Sometimes we need reassurance and when we don't have control, we have no idea what's going on within our body. And it's such a long time to be pregnant, and if we need those answers and if it can provide some relief even though it's momentary, you know, that can go a long way.

Allie Hales 00:23:50

Oh, thank you. I guess I wanted to ask this one kind of follows up with some of the things that you said, but this question is, I had two miscarriages. I'm depressed, I'm anxious, and my therapist keeps telling me that I need medication, but I'm terrified that antidepressants may increase my risk of miscarriage. What should I do?

Dr. Ruta 00:24:11

I think that is a really common question and I think a lot of women who have had miscarriages if they're already taking antidepressants, they feel guilty that maybe the antidepressants caused the miscarriage. And you know, it can be a really tough call. As far as we know, antidepressants don't significantly increase the risk of miscarriage. If you go on the internet, there's some older data that suggests there might be some small increase in risk of miscarriage, but the data is really difficult to interpret. But I also know that if you are depressed and anxious, it is going to make the next pregnancy more difficult. It can put you at risk for postpartum depression. So I think it's balancing those two.

Dr. Ruta 00:25:07

Sometimes, what I suggest is that we try a medication for a couple of months and put the pregnancy, getting pregnancy on hold, and just allow yourself to get better because I think sometimes it's really hard to make these decisions when you're feeling anxious or unwell. And you can make those decisions much more clearly from a a non-anxious vantage point.

Allie Hales 00:25:35

Why doesn't my partner understand my grief? How do we reconnect after miscarriage?

Jessica Zucker 00:25:42

I've seen that a lot and I've heard that a lot. And I even, you know, felt that a bit in my own relationship after my loss, so this is very relatable. I think that it kind of goes back to us talking about not learning about pregnancy loss in sex ed. I think that because culture is so afraid of grieving out loud and showing emotion and particularly boys are taught from the jump to not express emotions through tears, maybe we see it more through anger. I think that in couples it can get kind of– there can be a sense of loneliness when the non-pregnant partner is kind of focused on quote-unquote fixing the situation. I think sometimes this is a way, not consciously of course, but to bypass their own sense of grief and maybe their fear of what happened. And so they're just sort of focused on, is she okay? What's gonna happen now? Okay, the doctor said we're gonna be able to get pregnant again. Okay, let's focus on the future. Okay, you're healthy. All right, so now we have all the data. And that can be a little bit difficult when you're actually just wanting to feel the pain and not sort of trying to be practical. And I think that's where the chasm gets created.

Dr. Ruta 00:27:35

I think it's really challenging, and I also think like sort of building on that, in terms of readiness to move forward, there can often be a disconnect between partners where one is ready to to move and the other is still very much grieving and sort of getting people on the same page to talk about it can be difficult, I think. I mean my approach, I'm not a couples therapist, sometimes I think that can help, but I think just to keep talking about it and say, you know, “how are things going?” 'cause I think sometimes it becomes the thing that couples don't talk about like either the grief related to the loss or what's next and couples can kind of drift apart in that setting.

Allie Hales 00:28:23

Here's another one which I can relate to. We talked about it a little bit, but can you speak to chemical pregnancies? Am I overreacting to a miscarriage this early?

Jessica Zucker 00:28:34

I don't think there's any such thing as overreacting to a loss. I think that, you know, what people who do IVF and don't have success with that, well even the word success should be removed from the glossary, but can feel like it's a loss. So of course, yeah, a chemical pregnancy is a loss and again, it's so personal how people, you know, respond and feel and we all deserve to feel whatever it is we are feeling. And we don't– I think it's important that we don't look to the literature or look even sometimes to other people to validate that. Unless it's a therapist of course, and hopefully they get it. But you know, because sometimes we turn to our friends and that's where it's minimized. It's like, oh, at least it happened early. Like at least you can just kind of start again or and no, you know, that's not how it lands for a lot of people, it's very painful.

Allie Hales 00:29:41

In that vein too, another question is, is postpartum depression possible after a miscarriage?

Dr. Ruta 00:29:50

You know, I think um depression is a common response to any loss and whether or not it's postpartum depression or just depression, um is more of the semantic question. So I think yes, it can happen, it might not be exactly related to the same hormonal changes that take place postpartum, but I think women can have anxiety. They can also have post-traumatic stress after a miscarriage because often there are many things that are very medicalized and can be very frightening like medical procedures that come emergently, blood loss, all kinds of things that you know the doctor might not think they're a big deal but from the patient perspective they're traumatic in that setting.

Allie Hales 00:30:38

And then our last question that we had is, um, how do you talk to your friend who is pregnant after a miscarriage?

Jessica Zucker 00:30:49

Hmm. How do you talk to a friend? Well, just checking in with the friend, just like you would anyway, hopefully. And, you know, just providing a sense of support and also just availability. We don't want to sort of add to the anxiety that may already exist, but we want to of course acknowledge that they've been through something difficult prior.

Allie Hales 00:31:21

I just appreciate your approach to everything, Jessica. I think I've learned so much too from, you know, the silence that leads to the stigma that leads to the shame and how we can break down, you know, each of those things to really feel support at happy times in our lives and then also really hard times. And I am so appreciative of you being willing to initially share your experience, which then led to all the good that you've done and all the people you've helped and just the education you've been able to provide to so many people is incredible. And I'm so grateful that you were willing to talk to us and share all of this with us because I think this episode in particular, I think will help so many people because one in four, that's a huge number and I just think rethinking this is something that culturally we just need to do. So, I thank you so much.

Jessica Zucker 00:32:15

Thank you so much.

Dr. Ruta 00:32:16

Yes

Jessica Zucker 00:32:17

It's been such a privilege to connect with you. Thank you.

Allie Hales 00:32:21

I wanted to reflect for a minute on this conversation with Dr. Zucker. I think one of the most powerful shifts is realizing that the silence after a miscarriage isn't empty. It's heavy. And so much of that isolation isn't personal. It's cultural. We don't always know how to process or show up for this kind of grief. For me, a turning point was realizing that naming what happened actually matters. Saying it out loud creates space to process it instead of carrying it quietly on your own. When I miscarried, I hadn't told many people I was pregnant yet, so it felt like I was holding both the beginning and the end of that experience almost entirely by myself. From the outside, I seemed fine, which somehow made the confusion even harder to understand. And that doesn't just disappear. It can follow you into future pregnancies, relationships, and the way you think about your body.

Dr. Ruta 00:33:13

Miscarriage is common, far more common than we acknowledge openly. And yet, despite how often it occurs, many people experience it in isolation, without a roadmap, without the support they need. There's no single right way to respond to this kind of loss. Some people feel intense sadness, others feel numb or disconnected, or even relieved. And all of these responses are valid. What matters is that you allow space for whatever you are feeling without judgment. And if you are supporting someone who is going through this experience, know that you don't have to have the right words. Being present and willing to listen, that is often what matters most. As our guest Jessica Zucker reminded us, the strongest step toward healing is asking for help.

Thanks for tuning in. As a reminder, please note that this podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speaker's own. Your feedback and questions drive this show, so feel free to send us an email at podcast@womensmentalhealth.org or leave a voicemail at 617-643-9232.

Allie Hales 00:34:50

You can find additional resources at our resource hub at sogladyouasked.org. This show is executive produced by Dr. Lee Cohen, produced by Mike Brown and Peri Barest, and edited by Mike Brown. This is So Glad You Asked with Dr. Ruta Nonacs and Allie Hales, brought to you by the MGH Center for Women's Mental Health and the J. Willard and Alice S. Marriott Foundation Listen and subscribe wherever you get your podcasts.