In 2020, Colleen Long texted childhood friend Rebecca Little while both were juggling pandemic parenthood, writing, and enduring the full force of America’s indifference to caretakers, mothers, and working parents. You know, just generally having it all.
“I have an idea. I think we should write a book about all this,” Colleen texted.
“About what? Our shitty, cursed wombs?” Rebecca wrote back.
“Yes. Pregnancy loss in America. And why our culture sucks at it.”
“I’m in. We ride at dawn. Or more likely midnight when these mofos are finally asleep.”
We first met when we were ten, fourth grade desk mates in Catholic school. We had similar senses of humor, lived within biking distance of each other in the south suburbs of Chicago, and had last names that beautifully paired together for our amateur detective agency: Little and Long, Super Sleuths. Being young girls in the early 1990s, our choices were to become great friends or to wage mean girl warfare on our way to social dominance, and thirty years later, we think we made the right choice.
As we grew up, our lives ran on parallel tracks. We both became journalists (sleuths of a different sort) and were the kind of friends who would occasionally lose touch and then instantly pick up where we left off, in that way you can when you spent your childhood running in and out of each other’s houses. And if movie marathon sleepovers are the glue stick to tween friendship, pregnancy loss is the industrial epoxy to an adult one. We frequently checked in with each other, knowing there would be a judgment-free, sympathetic ear. Because unfortunately, both of us are premier members of what Rebecca calls the Dead Baby Club.
And now, our bummer bona fides:
Pregnant with her third son, Rebecca was headed to a routine twenty-week anatomy scan. She put on her favorite maternity shirt—an orange varsity-style T-shirt with three-quarter sleeves and the number 9 printed across the belly. But just before she made her way downstairs, she turned around and changed clothes, because a part of her already knew she wasn’t going to be pregnant for nine months. She hadn’t felt the baby move in days—maybe four?—despite drinking juice and doing jumping jacks to prompt some activity. She never would have said it out loud, but deep down, she knew she wouldn’t be leaving that scan with a sonogram printout of the baby.
The gel went on her stomach, the wand moved around, and instead of the spinning little spirograph she’d seen with her older two sons, there was an unmoving fetus with no heart flicker. She stared at her husband, who was leaning forward with a furrowed brow. “Is something wrong?” she asked the ultrasound tech, who said nothing. (It is a fundamental truism of ultrasounds that if the tech goes silent, you’re screwed.)
Within minutes, the obstetrician confirmed that their son was dead at twenty weeks gestation. They were whisked up to the maternity floor, through the back stairs to avoid the waiting room full of pregnant people, and taken to “the sad room,” as Rebecca and her husband referred to it, because it was tucked away from the cries of healthy babies. In less time than it would have taken for a normal ultrasound appointment to unfold, Rebecca was in a gown, on an IV drip, and gently told she needed to make a lot of decisions fairly quickly: Did they want to see the baby? Did they want to hold the baby? Did they want his remains? Would they want the complimentary hospital service to take photographs of him? Did she consent to have a D&C (a procedure that removes excess tissue from the uterus) if necessary after delivery? (They saw him, they held him, they buried him, they have photographs, and she had both a delivery and a D&C when the placenta didn’t detach.)
Rebecca has been pregnant six times. She is raising three boys and has buried three others. She had a chemical pregnancy, a missed miscarriage at eight weeks, and following this stillbirth experience in 2014, she would go on to have a medical termination at twenty-three weeks with identical twin boys who had fatal heart conditions in 2015. That delivery would go catastrophically wrong and end with a uterine rupture, a near-fatal hemorrhage, and an emergency hysterectomy that would leave her with just one ovary, which she now pictures swinging around down there like a bare basement light bulb.
Three states away in 2012, Colleen had been busy pretending she wasn’t pregnant at all. She had just gotten married and had complicated feelings of shame about being six months pregnant on her wedding day. Her new husband, though, was thrilled about their soon-to-be baby boy.
The sonogram was five days after the wedding, and she had the curious deep-down feeling that something was off. The cold goop on her stomach and the technician hunting for the heartbeat and the quiet “something must be wrong with the machine” angel-of-death speech. But Colleen and her husband were not whisked upstairs. A doctor she didn’t know came in and told them the baby was dead, and she should go see her own doctor. They were quickly shuttled into a taxi and up Manhattan’s West Side Highway, the gel still smeared on her abdomen. Their doctor was waiting for them in the lobby and brought them directly into her office, past a room full of other pregnant people, and laid out the options. Colleen could wait to go into labor and deliver the stillborn baby or, because she was still within the legal limit in New York State, head to an abortion clinic. Her doctor, though, didn’t do “that kind of thing,” so whatever they decided, they were on their own.
They chose the clinic, mainly because Colleen felt like if she had to deliver a dead baby, she’d never be able to handle being pregnant again. She didn’t calculate how she might feel after the two-day procedure, after she’d walked past anti-abortion protesters yelling at her that she was killing their (already dead) baby, after she sat there in the clinic, sobbing, while other people wondered what was wrong with her. She didn’t realize at the time—and no one suggested it to her—that it wasn’t something you could just erase with a procedure, and that she might need something more formal to help with grief.
With this first experience lodged in the back of her mind, Colleen’s two other pregnancies would be defined by anxious months of sadness and dread, expecting both babies to die while watching other pregnant people be happy, ethereal, and glowing. She felt guilty that they did not know where the remains of their first baby ended up and conflicted they’d never named him. Different circumstances, different cities, and different women, but very similar emotional and traumatic side effects, as we would discover.
The research for this book began with text messages. Quick check-ins, sharing an article with a “did you see this shit” caption, gallows humor about our unfortunate wombs. (“Lady at Target wouldn’t stop asking me when I’m going to try for a girl. I said, ‘I’m barren now. Bye.’”) We came to rely on each other as the sounding board who wouldn’t back away with wide eyes when the other said something gruesome. It was an attempt to process what happened, sure, but it was also something else: we wanted to know why. Not just why it happened but why we felt so uncomfortable and ashamed. And we had evidence that we weren’t as alone as we felt. Both of us were inundated with messages after people found out, saying they too had experienced a stillbirth, a medical termination, a miscarriage. Some from people we had known for years! It seemed like one rule for being a member of this shitty club was not to talk about this shitty club. What if the culture around pregnancy loss could take fewer (or, ideally, zero) cues from Chuck Palahniuk? What if we could put it all out in the open for everyone?
In the immediate aftermath of our respective experiences, we each read books about grief. Colleen received three copies of the memoir An Exact Replica of a Figment of My Imagination by Elizabeth McCracken from well-meaning friends. She was offered nothing more formal to help with the anxiety and sadness though, not by her doctors or by the clinic. Rebecca was given hospital pamphlets about how to process stillbirths and lost pregnancies. Generalized grief manuals don’t quite hit all the unique circumstances for pregnancy; they don’t capture the uncertain state of ambiguous loss or what it’s like to feel the weight of a political movement against a palliative choice. The handful of grief books tailored to pregnancy loss were an essential resource for Rebecca in the first ten weeks of the fog. But many of them used religious language—heaven, angels, souls—that just didn’t quite land for her and often focused on how she could simply have another baby. Suggesting she could look forward to another pregnancy felt like a betrayal, swapping one baby for the next, and there was no guarantee it was even possible.
Colleen was shocked by how infrequently people would talk about what happened; some of her family never even mentioned it once. She felt like she couldn’t talk about it either. After her stillborn son, a priest told Rebecca that he didn’t need to pray for the baby because he was already in heaven, so she shouldn’t feel sad. This was far from a comfort; it was enraging and invalidating. Conversely, the deacon who performed the funeral told her that holding a service would be hard, but she wouldn’t regret it. He told her when he visited elderly women for end-of-life counseling, many of them were fixated on babies they had lost and never got to hold or see or talk about, sometimes more than seventy years prior. (Which is to say: society has been handling this wrong for a very long time.)
Today, we have a different cultural silencing method—the trendy lexicon of “the journey,” which short-circuits any rage or sadness by insisting it was all essential to get you where you are today. That every loss has a silver lining, every misfortune is worth it, even if the ensuing road is a hellscape. America’s idea of comfort is deeply discomfiting. Particularly for assholes like us, who want to feel angry and sad and will never be grateful it happened no matter how many essential oils we sniff. (If you want to lose an hour or two of your life, say, “Everything happens for a reason” to either one of us. You will beg for death.)
And then, in the middle of our research, the constitutional right to abortion was overturned by the Supreme Court through its decision in the case Dobbs v. Jackson Women’s Health Organization. Suddenly, the system of reproductive healthcare that had been in place since before we were born was gone. It wasn’t only access to abortion that vanished; complications from pregnancies were also swiftly caught up in the legal and political confusion surrounding the ruling.
It became clear that while pregnancy, miscarriage, and abortion are all part of the same spectrum of reproductive life, they’ve never been more separate culturally. We have isolated abortion into a political and legislative box, while we’ve pumped up the idea of a perfect pregnancy so dramatically that we are striving for ever more ridiculous standards. As a society, we almost exclusively fixate on abortion and healthy, nine-month pregnancies and ignore how routinely and regularly things go south. That ignorance not only leaves out a huge swath of people, but it also helped lay the groundwork to overturn Roe v. Wade, and it is making life for pregnant people today more deadly and dangerous.
So what are we actually talking about here? What falls under the category of pregnancy loss? Among the possibilities:
Ten to 20 percent of known pregnancies end in miscarriage annually, affecting about 750,000 to one million women every year.1 Stillbirths are a smaller subset of that number, closer to 1 to 5 percent, yet not as rare as people assume.2 One pseudo statistic that often gets repeated and was mentioned by most of the stillbirth parents we interviewed is “you’re more likely to get struck by lightning than have a stillbirth.” According to the Centers for Disease Control and Prevention, stillbirth affects one in 175 births.3 The odds of being struck by lightning, also per the CDC, are less than one in a million in any given year.4 (So go ahead and swing a golf club around in a thunderstorm, we guess. That’s a lot less likely to get you than a pregnancy loss after twenty weeks.) Statistics are harder to come by for those who end pregnancies for medical reasons because abortion statistics are not really broken out that way. Abortion rights supporters purposely avoid the possibility of ranking reasons for abortion, and state policies on data gathering are greatly affected by politics. What we do know is that these terminations generally come after an early genetic screening test or in the wake of the twenty-week anatomy scan, and those for the pregnant person’s health, even rarer, come throughout the forty weeks.
Why do we consider all these to be different things entirely? Why do we act like none of this ever happens when those of us who don’t effortlessly glide from pregnancy test to delivery have a lot of company? These losses are all part of the same medical universe. The body doesn’t distinguish between them. It’s American culture that puts a premium on the intention behind it.
The state we find ourselves in has actually been the culmination of many different pressures sliding over each other like tectonic plates. The experience of modern pregnancy would be unrecognizable to women from earlier eras; even our mothers’ experiences vary dramatically from ours. For most of human history, it didn’t change much. A woman knew for sure that she was pregnant when she felt kicks, known as quickening, somewhere after sixteen weeks on the early side. Before that time, if she miscarried, she may not have even noticed. The idea of mourning a miscarriage would have made no sense at all to most women prior to the twentieth century, and abortion was largely a nonissue until the mid-nineteenth century.
Our views on reproduction have changed dramatically over the fifty years or so since Roe was first codified, shaped by the increasing ability of many people to choose pregnancy rather than have their lives dictated by the inevitability of it. This is also tied into the American notion that hard work leads to reward. “I did everything right, and I’m choosing this pregnancy, so everything will turn out OK.”
The way we quite literally see pregnancies changed again after 1980. Sonograms became more widely available, so parents were able to get a peek of their fetus on-screen, and images of a growing fetus (usually made to look more babylike than is developmentally accurate) proliferated alongside antiabortion messages on billboards, bumper stickers, and in religious literature. The gestational parent, though, was hardly present at all. That has led to the increasing notion that a fetus is a person with the same rights as the mother or birthing parent.
Today, we can find out we’re pregnant almost instantly. We’re encouraged to bond the moment the pee strip turns pink. We see ultrasound images of our growing fetus at eight weeks. We get weekly emails telling us how big our “babies” are at each stage. All this affects how we handle it when it doesn’t work out. It has led to the moment we’re living through, where we separate pregnancy loss into categories of “good” and “bad,” “wanted” and “unwanted.”
The very words we use (and the words we don’t have) to discuss pregnancy loss contribute to this problem. Medical jargon like incompetent cervix and lazy ovary add to stigma and blame, and political rhetoric has become so heated that it leaves those trying to share their experiences at the mercy of inadequate vocabulary.
If America is bad at talking about pregnancy loss, it’s even worse at legislating it. This was true even before the Supreme Court upended the constitutional right to abortion but is even more so now that there’s a free-for-all in states, some restricting abortion and others trying to make it more accessible. These regulations and restrictions go beyond access to abortion, and laws meant to curb abortion have consequences that deeply impact pregnant people who never intended to end a pregnancy. There’s already increased criminalization of those who miscarry and who seek abortions in states where it is restricted. Some providers must check every day to determine what’s legal in their state. U.S. laws around women’s bodies, pregnancy, miscarriage, or abortions are rooted in a lack of understanding of how it all works, so it’s no surprise laws don’t align with what women and doctors need in a specific situation.
We’re now at a particularly fraught moment for pregnancy in the United States. Nobody would be nostalgic for earlier eras when people could expect to be pregnant from the start of their marriage until menopause with a high risk of death in childbirth and when it was unlikely that all their children would survive until adulthood. But today, those in about half the country have no or very limited access to abortion care in their home state, which can also affect miscarriages. To give medical care, doctors in states like Texas, Louisiana, and Tennessee now must decide whether the pregnant person is sick enough with a potentially life-threatening complication to intervene on their behalf. Depending on the state where they reside, pregnant people and their doctors can be prosecuted for abortions or investigated for miscarriages, and their neighbors can earn a bounty for informing on their behavior. At nearly no other point in history was the growing baby prioritized over the mother. But now the laws are so murky and in some states so punitive, doctors tell us they don’t know what to do. Many legislators still don’t understand that the same procedures (and medicine) are used for a miscarriage and an elective abortion, and these laws are increasingly at the cost of the health and well-being of the pregnant person.
The argument against abortion in the 1970s was that it wasn’t good for the woman—it harmed her mental and physical health. (That’s been repeatedly disproven, most notably by the groundbreaking book, The Turnaway Study. Restricting access and abortion stigma has been shown to cause mental health issues including depression and anxiety.)5 Now the argument has shifted to criminalizing the woman and prioritizing the fetus, an unprecedented switch.
Meanwhile, America is also the only developed nation where maternal mortality rates are actually increasing. The United States has 32.9 deaths per 100,000 live births, the highest in the developed world.6 Maternal deaths across the United States more than doubled over the course of two decades.7 Black mothers are more than three times as likely to die from pregnancy-related issues than white mothers,8 a mind-boggling statistic that demonstrates the urgent public health imperative behind our current attitudes toward pregnancy. People of color generally are more likely to suffer miscarriage and stillbirth. Black, Hispanic, and Indigenous communities also receive worse care, are more vilified, and are less believed when they articulate suffering, physical pain, and grief. Black patients we interviewed told us of insidious systemic racism—not being consulted or given choices about whether to deliver their doomed babies or have a late-term abortion, being dismissed by their medical team, and, in the case of Black male partners, having to check their emotions in high-stress deliveries so they weren’t deemed a threat. The racial disparities of medical care and reproductive justice are inextricably linked with complications in pregnancy loss. Scientific advances have made safer outcomes more possible than ever before, which is why it’s so heartbreaking to know that access to such care is being restricted.
The helplessness and loneliness so many of us feel after pregnancy loss are not a coincidence. They are the result of a culture that is deeply uncomfortable with grief, particularly female grief. Add in the realities of the current moment—if the fetus has increasing primacy over the pregnant person’s health, it’s no wonder grief barely ranks. Politics, history, racism, misogyny, and medicine are working—separately and together—to choke off grief related to pregnancy loss, because it’s too complicated, almost un-American, to allow all these contradictory feelings into the atmosphere. We found that so many of our restrictive views on pregnancy and by extension loss come from how we view women and mothers. This is all even worse for people of color and nonbinary and transgender pregnant people who face a different subset of obstacles to medical care, safe pregnancies and birth, and parenthood.
We are both aware of how much privilege we have as middle-class, cis white women and how our experiences were not overlaid by the additional obstacles that Black, Hispanic, Indigenous, and gender-nonconforming people experience, and we recognize how much more dangerous the future is for them if federal, state, and hospital policies do not change. We sought to be inclusive in our research, and we are grateful to everyone who spoke with us. We interviewed a diverse group of more than one hundred people who experienced pregnancy loss in addition to dozens of scholars, therapists, experts, and doctors. Some wanted to share because they are actively rejecting the silence and taboo, particularly those under forty, who are speaking openly about their losses on social media and elsewhere. Others have become activists, fighting for improved care or more compassionate laws. Some wanted to feel less alone. People of color and queer people wanted their voices to be heard above the din of the white cis narrative that permeates what discussion there is. (Right now, there is little scientific or scholarly research about how gender-nonconforming people in particular experience pregnancy loss. We hope that changes.) Many felt compelled to share after the sea change in laws governing abortion and miscarriage care.
These conversations were almost sacred. Person after person shared their trauma, their grief, their hurt, their recommendations for how it can be better. Sometimes our friends and family would ask, “Isn’t it so sad to hear these stories day in and day out?” But it wasn’t. Yes, the stories are gut-wrenching, but there’s so much power in sharing them. You cannot feel empathy for people whose stories you never hear. And that’s something that we, alongside the many people who opened their hearts to us, aim to change.
Yet a lot of what we found was heartening; we learned that people have created their own mourning and grieving rituals to commemorate their losses in the absence of societally proscribed ones. This ad hoc effort includes the making or buying of totems, and there’s a growing online marketplace devoted to jewelry, keepsake boxes, and other talismans that intend to make the intangible tangible.
We want to note that this is not a book about the partners of people who suffered pregnancy loss. It’s not that we don’t appreciate and love them and recognize they also suffer from this mess, but we felt there was already too much ground to cover with the experiences of the pregnant person. We’re focused on the bodies giving birth and being legislated while giving a subtle, supportive high five to the partner who experienced a loss too.
This is also a secular book. This space is dominated by a mostly Christian outlook, and we wanted to talk about it in a more societal way. We mention religion when those we interviewed talk about their personal observance, but it was important to us to carve out a temporal space. (Most of the religious people we interviewed also created secular rituals in their remembrance.)
Just as no two children have the same parents, as the saying goes, no one has the same experience with each pregnancy. Every birthing parent is entitled to compassion for every pregnancy, whether it’s a seamless nine months that ends with a healthy baby, a devastating miscarriage after years of infertility, or an abortion that brings great relief. There is no inconsistency in the same woman feeling unconflicted about her abortion at nineteen, then relieved by a miscarriage that came too soon after her toddler, only to be devastated by a miscarriage a few years later, and then overjoyed to have her tubes tied. Nor is there any inconsistency in running a gamut of emotions within one pregnancy.
Pregnancy encompasses a vast gray area of experience that has been jammed into black-and-white definitions, which has led to worse outcomes for women medically, politically, and psychologically. Our hope is that in discussing every facet of pregnancy loss—with medical experts, legal experts, historians, linguists, marketers, therapists, grief counselors, activists, and pregnant people who know their own bodies—we can bring it all back together under one umbrella and help envision a system of compassionate care for those who experience pregnancy loss of any kind. A system that recognizes that the person giving birth—their physical and mental health, their grief, their right to choose a path for their own life—matters.