Abstract
“I had a miscarriage” is a poignant and beautifully written memoir of one woman's journey through pregnancy, loss, and motherhood. Jessica Zucker, a psychologist specializing in reproductive and maternal mental health, intertwines her first-hand experience of a traumatic second-trimester pregnancy loss with the experiences of many women for whom she has provided therapeutic guidance throughout her career. The book begins with, this “is really a story about motherhood” (p. ix). These words situate pregnancy loss at any stage as a normalized outcome of pregnancy that does not adhere to socially constructed notions that motherhood begins with the birth of a healthy newborn. With raw emotion, Dr. Zucker provides a vulnerable account of miscarriage and grief in the context of silence, stigma, and shame, while unraveling the emotional roller-coaster concomitantly with being a mother and then suddenly navigating loss.
Though one in four women experience miscarriage, current conversations on grief predominately reflect narratives that address responses to the deaths of children, adolescents, or adults. Perinatal loss is generally not part of the discourse. Dr. Zucker identifies the stigma surrounding miscarriage, beginning with the social sanction of women waiting to disclose pregnancy until the second trimester in the belief that silence is protective. There is a strong message throughout the text that miscarriage and associated grief must be normalized to ensure women do not suffer in silence and blame themselves. This message is achieved with the sound blending of personal and professional experience that explores the multitude of emotions experienced after miscarriage, making the text accessible to most women at any stage of pregnancy. Importantly, Dr. Zucker identifies her own social location and acknowledges that Black women or non-cisgender women often experience miscarriage in the midst of discrimination and stigma, compounded by the shame felt by many women who are unable to carry a pregnancy to term.
The text's accessibility is suffused throughout all its chapters as Dr. Zucker acknowledges the spectrum of grief and healing, the sense of control or loss of control when considering sexual intimacy after loss, and the various ways of becoming a parent after miscarriage (biological, surrogate, adoption). Though grief is suffered and expressed in varied ways, two common elements are shared by most women who miscarry -- the experience of vulnerability, and a shift in identity as women integrate their miscarriage into a new narrative of their lives and the lives of their loved ones.
Miscarriage should not be an isolating event that segregates women from relatives, friends, and co-workers’ support. Yet, all too often, it is a taboo topic, as friends, family, colleagues, and the public fail to connect authentically with women who are grieving after a miscarriage. A major contextual contribution of this book is the contrast made between the supportive social response after the death of an adult versus the unsteady and complicated nature of interpersonal and institutional reactions following miscarriage. Due to a lack of public acceptance of grief following miscarriage, women are often placated with euphemisms such as, “you can get pregnant again” or “it wasn’t meant to be”, comments which further dismiss grief and the loss of a baby. The voices of both the author and her patients assist readers to understand the power of words and the devastating impact they can have on women who are grieving. The text offers a rich list of recommendations of what to say and not say after a miscarriage to assist in breaking the silence of grief and connecting people through open communication and understanding of experience. Dr. Zucker's powerful words serve to inform others about the magnitude of losing a baby: “The length of one's life does not dictate their impact” (p.194). Readers of this text who have experienced loss will undoubtedly feel validated as they recognize their personal turmoil and relational experiences in the chapters. This book assists in changing conversations of miscarriage as significant and life-altering. Social work educators can learn from the accounts in the text and enhance education on grief by integrating miscarriage into the discourse.
The intersectionality of being a psycho-therapist and a woman who has had a miscarriage demonstrates how life and work can collide and be fluid simultaneously. The text makes an important contribution to social work as it sheds light on the humanity of clinicians and the experience of trauma that can coexist with professional wisdom. Dr. Zucker stated, “Seeing this in my patients was one thing, I knew how to reassure them…but when it was me, knee-deep in flashbacks or flooded by anxiety, I had a difficult time deciphering up from down, left from right…” (p.159). Dr. Zucker's own miscarriage renders her therapeutic practice changed from one based on professional knowledge to one of intimate understanding. As she welcomes a subsequent pregnancy, her pregnancy became a barrier for some of her patients, thereby demonstrating the human element ever-present in a therapeutic context. Dr. Zucker oscillates between hope for the future and appreciation of the pain of her patients. This is an important message for new and experienced social workers to ensure personal support and self-care while managing the pain and vulnerability of clients. Dr. Zucker's courageous and honest account is an important step in changing the cultural context of grief since personal narratives aid in fostering empathy and understanding.
It should be noted that the sophisticated writing style may slightly hinder the accessibility of the book for readers of a lower-than-average literacy level. Furthermore, while many women are adversely affected by miscarriage, women who feel a sense of relief or indifference may not identify with the text. Nonetheless, the book's contribution toward the normalization of grief at any stage of pregnancy is a powerful and creative form of support for those who have grieved in silence.
