Speaking Up Over Silent Miscarriages

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

A missed miscarriage (also known as a “silent miscarriage” or a “missed abortion”) occurs when a fetus dies in utero but the woman’s body does not expel the tissue, often because the placenta is still releasing hormones and thus telling the body there’s still a pregnancy. As a result, signs of distress such as bleeding and cramping will often be absent, and many women don’t discover they’ve miscarried until they have an ultrasound.

Here are three stories of women who experienced a missed miscarriage. The first:

Please do not use my name, but I would like to add my story to this series I’ve been enjoying so much. I had a pregnancy and miscarriage last fall that brought into focus just how fortunate I am to have access to needed medical care, and reminded me how onerous, humiliating, and hateful anti-choice legislation is for women with unwanted and wanted pregnancies.

I never expected to accidentally get pregnant at 40, but I did. My husband and I were happily but not decidedly child-free, and we had been been discussing whether or not we were content that way when suddenly the decision was no longer theoretical. I knew I was pregnant even before I missed my cycle, even before I tested. I stared dumbly, delightedly at the pee-stick for several minutes then threw it away, then dug it out of the trash, then threw it away again. What should I do? Does one keep these things?

When my husband came home from work I hugged him and told him my news into his neck. He squeezed me tighter. Really? He kissed me, hugged me again. Really?! Neither of us expected it, or expected to be so pleased about it.

I called my primary care doctor, who was on vacation, so I saw the other doctor in the practice, whom I’d never met. I took another test: positive. The doctor was warm but neutral with me when he realized it was not a planned pregnancy. He asked me if I wanted to be pregnant. I told him maybe, but I wasn’t sure, since it was so sudden. I told him I worried about my age. I had taken Advil last week, drank too much at a Halloween party the week before.

He reassured me, referred me to an OB, and said, “But, this is for you to decide, and whatever your choice, you will be well cared for in this office and at the OB’s office. Your insurance will pay for this, whatever you need.” I nearly cried, because I knew how lucky I was. Pro-choice doctors, good health insurance, easy access to whatever health care I needed—either to continue a pregnancy or not. Every woman should have this.

My husband and I decided to continue the pregnancy. However, at 5.5 weeks, I experienced heavy but brief bleeding. I wondered: was that a miscarriage? I was only three weeks pregnant, after all, maybe it wouldn’t be bad? The OB examined me and said it was hard be certain but my symptoms indicated a miscarriage—but incomplete, medically referred to as “missed abortion.” This was a new idea to me, that miscarriages might be incomplete and require a D&C. My doctor advised blood work and an ultrasound because there was a chance, though small, that it was a good pregnancy.

The ultrasound was unexpectedly uncomfortable, even painful at times. This was no jelly-on-the-belly deal. As most women and few men (especially old guys making laws) realize, early pregnancy ultrasounds are internal. A long, hard plastic probe is inserted into the vagina, moved around in every possible way, rummaging your innards, for 20 minutes or more, when your bladder is full. As I winced in pain and nausea, I thought: “This is what these old farts are legislating for women: medically unnecessary, possibly painful, forcible penetration.” It’s one thing to put up with it for a wanted pregnancy, but it was sickening to think of having it forced on me.

The results were inconclusive. Two weeks, six rounds of blood testing, and another awful sonogram later, neither the pregnancy nor the miscarriage was progressing. My doctor delivers babies and does surgery in a hospital across the street from his office, so I had my D&C there, under general anesthesia—overkill, no doubt, but I wasn’t complaining. I got excellent care, had wonderful nurses, paid a total of $100 (my hospital admission co-pay), and was out by 11 am. I went back to work the next day. No sweat.

I was disappointed by the loss and made even more uncertain about whether or not I’d like to try to get pregnant. But I was so grateful for the care I got, and heartsick for women who are forced to continue unwanted or non-viable pregnancies, or who are investigated for their miscarriages and stillbirths. I thought about how different my experience could have been in another state, another town, with different insurance, with a few weeks more into the pregnancy, or with an unwanted pregnancy.

Another reader’s story:

Six years ago, I had three early miscarriages, each one more devastating than the last. I didn’t understand, prior to my first, that you could have a miscarriage and not even know it yet—a “missed miscarriage,” communicated at an ultrasound with an “I’m sorry, there is no heartbeat” or a “Your baby is measuring several weeks behind.” Ultrasound photos, everyone’s favorite method of announcing a pregnancy on social media, still cause my heart to plummet.

I underwent testing, but my diagnosis remained “unexplained recurrent pregnancy loss.” Statistically, we knew that a viable pregnancy was likely if we were willing to risk more losses. We chose to continue our family-building efforts via adoption instead.

Although I initially guarded my miscarriages as painful secrets, I became increasingly outspoken regarding the psychological toll of miscarriage, the dearth of medical research, and, especially, the politicization of pregnancy. My miscarriages were medically managed with a pill that also can induce abortions, and I was incredibly grateful to have access to it from pharmacists who didn’t ask invasive questions or refuse to dispense it. I’ve read about proposed bills in state legislatures requiring investigations of miscarriage. I wonder, if medical science can’t tell me why I had miscarriages, what would an investigator, or a jury, conclude?

This next reader provides some helpful background on such proposed bills. But first she recounts her own personal experience:

Thanks for paying attention to this issue. My miscarriage happened when I was 25. In hindsight, it was for the best, because we didn’t have the financial stability we needed to have a child. But it hurt and still hurts, even though it’s been 10 years.

Even beyond the hurt from the loss is the frustration, anger, and gratefulness that I associate with it. My missed miscarriage was diagnosed at 13 weeks and the OB I was seeing was prohibited by the hospital where she had admitting privileges to perform any procedures on a woman who was in her second trimester (note: this was NOT a Catholic hospital), because they were afraid a provider would be performing an elective abortion. Thus, the ban was applied across the board, regardless of the state of the fetus.

So I left the OB’s office the day the miscarriage was diagnosed with literally a piece of paper with the name of two doctors and instructions to call one of them. On a Friday afternoon. With a dead fetus inside of me. And an urgent command to go straight to the hospital if I started bleeding over the weekend.

I was lucky: After some false starts, I was able to get an appointment for a D&C with an OB who was the best at what he did five days after the miscarriage was discovered. He monitored me for months afterwards to make sure my HcG level had gone and stayed down, and then conducted prenatal tests when I got pregnant again.

Two things have stayed with me since then. One, proposed legislation that limits access to abortion often apply to miscarriages, as well. This is from a Georgia bill proposed in 2010: “A report of spontaneous fetal death for each spontaneous fetal death which occurs in this state shall be filed with the local registrar of the county in which the delivery occurred within 72 hours after such delivery in accordance with this Code section unless the place of fetal death is unknown, in which case a fetal death certificate shall be filed in the county in which the dead fetus was found within 72 hours after such occurrence.” This is a 2004/5 bill proposed in Virginia that intended to address what the delegate saw as an increase in unattended births and abandoned infants whom the mother, when found, claimed were stillborn. I believe another like it was proposed in 2013 in Virginia, as well.

Two, no legislator or policy maker should presume they have the right to dictate other people’s choices, especially where fetal abnormalities are concerned. I work in reproductive health tracking legislation, and right now Ohio is set to vote on a bill that would make abortion for the chromosomal abnormality of Downs Syndrome illegal. I remember my doctor telling me that babies born alive who had what our baby had (triploidy) suffocated to death. No parent should be forced into that situation by hospital or legislative policy.

Update from another reader, whose missed miscarriage seems to fall into grayer territory than the first three stories:

I found myself pregnant when I was 42 and in my second marriage. (I had two biological children, as did my husband. We previously discussed the possibility of having a child together, but after a year of trying, we decided it wasn’t in the cards.) I had a lingering cold I couldn’t get over and felt somewhat off. I took a pregnancy test that came back positive. I only told my husband and my parents about the pregnancy.

During my first ultrasound, the nurse could not find a yolk sac. My ob/gyn suggested we should wait two more weeks and have another ultrasound. However, she did feel that due to my advanced age, I most likely did not have a viable pregnancy. I processed all the possible outcomes very reasonably.

Two weeks later, the ultrasound confirmed the initial prognosis. My doctor advised me of the medical options I now faced if I did not miscarry naturally. I opted for the surgical removal of the tissue.

I reacted to this situation exactly as I type it. It was what it was, and there wasn’t anything I could do to change it. I also believed that everything happens for a reason and did not anguish over the results.

Two weeks later, I calmly went to the hospital with my husband. I told myself this procedure was similar to my prior gallbladder removal surgery and I really wasn’t too nervous. No one yelled at me or told me I was a sinner because of my choices. I didn’t have to travel more than 10 minutes to have the procedure. I did not have pictures of “aborted fetuses” thrown at me. I simply went in for outpatient surgery and was out of the operating room within 20 minutes.

As I woke up from the surgery, I asked the nurse if it was over. She said yes. I burst into tears sobbing. Just as I had no control over the outcome of that failed pregnancy, I also had no control over my emotions.

No woman should be forced to travel hours or days to have this procedure done. No woman deserves to be shamed because of this. It is painful enough as is. Every woman should have access to the very best medical care.