Why can't we talk about miscarriage?

Miscarriage is common – one in four pregnancies end that way – and yet it often remains a private grief. Laura Frykberg writes about the specific agony of a 'missed miscarriage' and how sharing her story with others soothed the pain.

"There are two possibilities here," the nurse told me as she looked at the ultrasound.

"The first, is your dates are out, and that's why there is no heartbeat.

"The second is that the pregnancy has not progressed."

Her words paralysed me.

Minutes earlier, I'd expected to hear the heartbeat of my second child. But it wasn't there.

There was a chance that my dates were out – perhaps I was five weeks pregnant, not nine – and that would explain the still inaudible heartbeat. But after several weeks of blood tests, scans and sleepless nights, the worst was confirmed: a missed miscarriage.

This kind of miscarriage – sometimes known as a silent miscarriage – is what happens when a foetus stops developing in the womb. It's no longer alive but, because the body doesn't recognise the pregnancy loss or expel the tissue, a woman often doesn't know it has happened. There are no clear symptoms such as bleeding, which is what many people think all miscarriages looks like.

Cruelly, women can also continue to feel the side effects of the pregnancy, like nausea. They often don't find out they've miscarried until their 12-week scan.

In my case, I had weeks of enduring pregnancy symptoms before I could opt for any intervention. My hormone levels, monitored over several blood tests, were still too high to allow it. In other words, my body still thought I was pregnant (hence the enduring possibility that my dates were out). Once the hormone levels finally dropped, I opted for what is called a medical mismanagement. Pills and what felt like a mini labour followed. It was not fun, but it was better than carrying around a pregnancy that wasn't viable.

I tried to rationalise the experience in biological terms. My body had tried, but the the foetus was not viable, probably due to chromosomal abnormalities. On an emotional level, it's hard to keep that rationality going.

In the weeks after I found out something was wrong; I would go from being totally fine to being in floods of tears in minutes. But when I started confiding in other women about my loss, I realised I was far from alone.

In fact it's common, very common.

"Oh, that happened to my sister," a friend said.

"My friend had that," another told me.

"It took a long time to mentally recover from mine," an old friend confided.

Then there were the stories of other kinds of miscarriages. Complete miscarriages, incomplete miscarriages, and worse still, recurrent miscarriages.

"Mine was at five and a half weeks," said a friend.

"12 weeks," said another.

"We didn't speak about it back then," a relative told me.

Frequent, unspoken pain, experienced by so many women. The anecdotal evidence of the extent of miscarriages astounded me. And it turned out to be backed up by data. Miscarriage is thought to affect every one in four pregnancies. Not women, pregnancies.

The data on missed miscarriages though is unknown.

"The variety of experiences is huge," Miscarriage Matters’ Secretary Corrine Christian says. "You get people who say, I just had my miscarriage, and it was quick, and they don't think it is a baby and they move on, it is a medical blip.

"Then you get people who say it was a baby, I named her Olive."

"However they feel is the right way for them."

It was Christian's own missed miscarriage in 2018 that led to the creation of Miscarriage Matters, a community for women to share stories, find out how to get help, and learn not to blame themselves.

"We are told all these things to be so careful of," Christian says. "Be really safe, don't have raw egg, look after your body when you're pregnant...

"Then you might think, I made a mistake, I had a little bit of raw egg, and now I have caused the miscarriage."

According to Christian, women often think they have more power over miscarriages than they do.

"I say to women going through this: you are definitely not alone and try not to blame yourself."

The most common thing Christian is asked is where to get help.

"A lot of miscarriage counselling services were available when I had mine, but I had no idea about them," she says.

Christian says GPs offer free counselling and as do hospitals, but not everyone is aware of it.

In 2021, the New Zealand government approved legislation that allows women three days of paid leave after a miscarriage or stillbirth.

Employers are legally required to care for employees going through one of life’s most common griefs – something that would have seemed revolutionary to women of previous generations.

The New Zealand College of Midwives says, despite such progress, there's still a stigma around miscarriage that needs to end. That's partly due to our old-fashioned tendency to hide the first trimester of a pregnancy. Those first 12 weeks are when about 80 percent of miscarriages occur.

“There is this convention of waiting until 12 weeks [to tell people you are pregnant], it’s a weird sort of convention,” CEO Alison Eddy says. “They might tell their family, but wouldn’t necessarily make an announcement to their employer or colleagues or wider friend group until they’re past that 12-week mark.

“As we know, most miscarriages happen before that, so for a lot of people there is still loneliness around this and it is a very sad time,

“I think there is a lot of grief they hold to themselves.”

For me, it was sharing my experience that made me feel more normal. One of the one in four.

My miscarriage does not even begin to scratch the surface of the myriad fertility difficulties women experience.

I have not endured endless rounds of fertility treatment that cost as much as a house deposit. I have not been stuck in limbo on the 18-month waitlist for publicly funded IVF. I have not miscarried more than once. I have not had to accept being childless not by choice, like many women do. I have not had a stillbirth; a horror no one should ever have to experience.

But I have felt loss and speaking to others has made moving forward easier. I feel connected to others who have experienced this often unspoken grief.

Christian agrees that one of the best therapies is telling stories of miscarriage, which helps normalise the process. "Shared knowledge is really powerful. Especially for younger women," she says.

Our parents and grandparents' generation endured the same pain, with far less support.

But we no longer have to be quiet or treat it like a personal shame or failing.

Because it is not.

The frequency of miscarriage is in many ways a testament to female strength. Our bodies and brains are hardwired to persevere –something I've long suspected about our gender.

There is power in communication, we don't have to suffer in silence.

• Healthline is open 24 hours a day, 7 days a week. If you have any concerns at all, at any time, call them on 0800 611 116.

• You are covered for free maternity service with your Primary Health Organisation up until two weeks after a miscarriage occurring.

• If you have registered with a midwife, you can call or text them for advice and any necessary referrals. Midwives are funded for one appointment after a miscarriage.

• A support group online or in person e.g. Miscarriage Support NZ (private Facebook group)

• Find your local Sands Group (a network of parent-run, non-profit groups supporting families who've experienced the death of a baby)at sands.org.nz

• Free call or text 1737 to talk to a trained counsellor or check out their website

• Search for a counsellor in your area at nzac.org.nz

• Ask your doctor about Brief Intervention Counselling and whether you are eligible

• Search for a psychologist in your area at psychology.org.nz

• Or check out these other resources: Lifeline, The Depression Helpline, Get Better - The Journal, and podcasts like The Miscarriage Hope Desk, The Miscarriage Therapist and Infertility Sisters