I spend a good portion of my professional life educating health professionals about “reproductive life planning,” or, basically, helping someone articulate whether or not they want any (or any more) kids and the steps they need to take to achieve their desired number of children. As a recurrent miscarrier – 7 pregnancies, but only 1 live birth – the irony is not lost on me.
I’ve always been a planner. I used to have every facet of my life planned out with such precision it would put a 5-star general to shame. When my husband and I decided to start trying for a baby, I knew exactly when I should get pregnant to interfere least with my master’s program’s comp exams and summer internship. Then the first miscarriage happened. I had to tinker with my plans, but I decided I could still make it work. Then came miscarriages two, three, and four. My plans were in shambles.
During this time I was studying maternal and child health and then working with healthcare providers to improve tobacco cessation during pregnancy, meaning my whole life was thinking, reading, and talking about pregnancy. It was painful, constantly looking at the thing I most desired, but watching it move further and further away. Everywhere I looked, all I could see were happy families with babies and children – children I was afraid I would never have.
With timing so excruciating it was almost funny, my fifth miscarriage started at a maternal & child health conference during a session on the state of the science on pregnancy loss and stillbirth. That was…a new low. My husband was several states away, I didn’t want to burden my colleagues, and I knew what was happening. I numbly made it through the rest of the afternoon and then went to bed. I’d never felt so alone.
Some of the hardest things about miscarriage, particularly recurrent miscarriage, are the isolation – isolation from your family, your peers who are successfully bearing children, and your community supports – and the loss of the illusion of control. Friends and family checking in, bearing witness to the frustration and grief, showing their love through care, meals, transportation, etc. for the women and men facing these losses can help. Acknowledgment from clinicians of the emotional toll of these losses in addition to the physical toll can help.
Infertility, which includes recurrent miscarriages, affects one in eight couples in the US. It’s a disease that affects women and men from all walks of life – rich/poor, young/middle-aged, all races and ethnicities – although, since treatment is rarely covered by insurance, we usually only hear about the experiences of relatively well-off women and their families. Those of us working in maternal and child health spend a lot of time thinking about how to help ensure all women and men are able to create and actualize their reproductive life plan, but what we usually focus on is preventing mistimed pregnancies through the provision of education and access to contraception. While that focus is important, I think that we must also become comfortable talking about infertility, pregnancy loss, and infant death and how that affects reproductive life planning, helping people access the limited diagnosis and treatment resources available and acknowledging their loss and helping them find support.
October is National Pregnancy and Infant Loss Awareness Month, and Oct 15th is designated as Pregnancy and Infant Loss Remembrance Day – the day when you are supposed to light a candle at 7pm to create a wave of light around the world. I love this unabashed acknowledgement of loss intertwined with the reclamation of hope, and I’ve got my candle ready.
Erin McClain, MA, MPH, is a Program Manager for the Every Woman Southeast Coalition and a Research Associate with the Center for Maternal and Infant Health at the University of North Carolina at Chapel Hill. She is a bio-mom, an adoptive mom, and an unofficial, self-proclaimed tour guide to the “Land of Infertility.” Erin is also co-founder of Project Pomegranate (http://projectpomegranate.org).