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Who gets to mourn a miscarriage?

Partners and family members feel the loss too.

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I hardly ever talk to men about miscarriage in my psychotherapy practice. But one day I met with Cass, who had been sent to me reluctantly by his wife, Lucy whom I had seen as a client for a while. (I’ve changed both of their names to protect their privacy.) Being a father was, as Cass later described to me, the most important thing in his life. Even as a little boy, he dreamed of the children he would have and the father he would be. So when Lucy miscarried in the ninth week of pregnancy, he was grief-stricken. But he also felt angry, envious, inadequate, and hopeless about having another child.

These were similar feelings to Lucy’s, but he often felt them at different times to her, and they weren’t so obvious to others. Cass’s profound response to this miscarriage is far from unique: It’s just that we don’t tend to recognize it.

While we can easily misjudge, misunderstand, or even avoid a pregnant individual’s experience of miscarriage, we can also forget that the loss of a pregnancy may impact a wide range of other people too. There’s usually one other person witnessing and participating in a pregnancy up close — the person’s partner, who is also a parent-to-be.

The fact that a miscarriage happens in one person’s body contributes to the tendency we have to forget a partner’s perspective. Male partners — and even more so female or gender-nonconforming partners — have largely been written out of the pregnancy loss stories that we do know of culturally, or are “written in” as an appendage or, worse, parenthetically. I hope to give such stories justice in my book, The Brink of Being.

Men’s grief is complex, nuanced, and misunderstood

Our cultural ignorance of the potentially broader emotional and psychological impacts of miscarriage is reflected by the relatively small amount of research existing on a partner’s experience. What studies do tell us about men, though, is that they can suffer an equally nuanced and complex grief as their partners, but that it may look different. In turn, this makes male grief prone to being misjudged, minimized, or deemed absent entirely — maybe even by his partner. Someone who has suffered a miscarriage can feel estranged from a partner who may not seem to “get it,” and while of course this may well be true, many men do “get it,” just in their own way, and at a different pace.

Our struggle to understand the male response to miscarriage sits in a context of confused contemporary ideas in the West around masculinity and reproduction. Despite an evolution of the role of fatherhood in recent decades into a more traditionally “feminine” and “involved” one, this has failed to usher in a safe place for men to air their vulnerabilities — which include grief, and the grief of miscarriage and infertility.

Men can still succumb to a cultural expectation to feel and to express their feelings in particular ways (not too openly emotional), and to adopt prescribed roles: to support and protect their partner and loved ones, to “act” and “do,” including telling others of bad news and making practical arrangements, as well as providing physical support if their partner is left shaken, weakened, or unwell. He may want to do all of this, and it may be appropriate in the circumstances, but the net result can be that a partner’s distress may not be noticed and his actions wrongly interpreted as a signal of being “okay.”

Of course, just as some women aren’t upset by their miscarriages, there are male partners who feel so estranged from the pregnancy they helped create that their sense of loss when it ends can feel far less acute than their partner’s. I have spoken to many men who dwell on the physical separation between themselves, their pregnant partners, and their growing baby — especially in the early weeks, when a miscarriage is most likely to happen, and before they have had a chance to see their baby on a scan or feel kicks through a swollen belly. Some struggle with their truth — and sometimes, concurrent guilt — that their baby was too abstract for them to mourn.

How some partners bond with their babies in the womb

Given that it took so woefully long for both researchers and health care professionals to realize that women can form strong bonds with their unborn, it’s no surprise that it took even longer for their partners’ perspective to be considered. In the mid-1980s, studies began to explore not only the bond between a pregnant woman and her unborn but also “paternal-fetal bonding.” The net result of the research isn’t clear at all, but some results indicate that men can bond with their baby in the womb in the same way their partner can. Cass was, in my view, one of those men.

Cass’s early bonding had been heralded partly by his participation in the earliest revelation of his much-wanted babies by buying, and then nervously watching, the pregnancy test kits for Lucy. This simple technology has helped many men forge a link to their newly conceived for years now.

More recently, smartphone apps such as Who’s Your Daddy have been created to bring prospective fathers more consciously into the mysterious world of their partner’s womb — albeit in a stereotypically “blokey” manner, and with no consideration of the possibility of a pregnancy loss. Seeing a baby on a scan screen — in the UK, where I practice, this is usually around 12 weeks’ gestation — is another potent factor for many partners to connect with their child-to-be.

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Cass had also been drawn into a connection with his unborn through his determined efforts to empathize with Lucy’s pregnancy symptoms: her exhaustion, nausea, heightened sense of smell, and strange food cravings. When she had detected changes that sparked her fear of something going awry, he felt desperately guilty for dismissing her belief so readily. Later, when she had begun to bleed — confirming her hunch that a miscarriage was inevitable — he then had to push away his terror in order to arrange child care for their son, and to get her safely to a hospital.

Then as the couple waited for many hours at the emergency room, Cass had to continue to push away his mounting fears. His role as a “supporter and protector” of Lucy and their unborn child had to play out, at the cost of his own vulnerabilities being attended to. While there was little consideration by the doctor they eventually saw that Lucy was a scared and grieving mother-to-be, there was even less that he was a scared and grieving father-to-be.

Because I knew Lucy, I came to know that the couple shared a similar mixture of sadness, yearning, anxiety, envy, and anger after their first miscarriage, but Cass felt these at different times to Lucy, and expressed them in different ways. He spoke of his bitterness toward a colleague who excitedly showed him photos of his newborn baby a day after he had returned to work. Cass hated pushing his son’s stroller, as he had earmarked it in his mind for a replacement double stroller, and he avoided the bathroom where Lucy — having been sent home from the hospital to miscarry “naturally” — had given birth in tremendous pain to their barely developed baby-to-be.

The struggle to express feelings

What little research there is on the male response to miscarriage suggests that Cass is not unusual: Men can, and do, feel very similarly to their partners and can be hit by some emotions at a later stage than their partner, after “holding it together” for them in the immediate aftermath. I’ve seen how this incongruence can set up a tension between couples when a woman can misunderstand her husband’s apparent lack of feeling. Bereavement literature has given these different ways of grieving loosely binary labels, with the typically male “instrumental style” pitted against the typically female “intuitive style.”

While a woman typically finds ways to vent her feelings more openly, through crying or talking, she is also more likely to seek support from friends and family, or from strangers through support groups, or from professionals such as talking therapists. We don’t tend to recognize a typically male “instrumental griever” so well, partly because he tends to find private times and places to let his feelings out, but also because male grief has been, traditionally, less well represented in academic and other literature.

We also have some way to go before we fully appreciate the entire emotional realm of the male reproductive experience: all that happens before conception, during a pregnancy, after a birth, and when a miscarriage happens. The templates that we do have for male reproductive narratives tend to view men as “virile” from puberty to death (even though factors in the male partner account for about half of the known cases of infertility), as generally subsidiary to the efforts involved in making a baby, and less emotionally vulnerable than women when they experience infertility and pregnancy loss.

Cass found very few outlets to talk about his feelings. Just as he felt he couldn’t talk about his broodiness before his babies had been conceived, he also felt he couldn’t talk about his reluctance to try to conceive again after their first miscarriage. He feared another heartache and the heavy weight of disappointment if they didn’t conceive soon, or at all. But he also didn’t want to let Lucy down by getting in the way of her desperate desire to be pregnant once more.

Nearly half (46 percent) of 160 partners (mainly male) participating in a survey commissioned by the Miscarriage Association about miscarriage and ectopic pregnancy said that they kept their feelings hidden from their once-pregnant partner, for fear of causing additional distress or “saying the wrong thing,” and 22 percent held back from talking about any feelings of loss or pain. In my experience, this fear of “drowning” rarely manifests: Women appreciate, and draw strength from, their partners sharing their experience with them.

This survey also found that partners wanted to talk about their feelings nonetheless — so if men feel they can’t talk to their partners, it follows that we should support them to find outlets elsewhere.

How lesbian couples experience miscarriage

We know even less about the lesbian experience of miscarriage, which makes sense given how heterosexual norms govern most of our institutional and cultural ideas about reproduction. In my experience of working with lesbian partners after miscarriage, many have described their desire, and need, to “be strong” and “supportive” while a miscarriage took hold of their loved one’s body, but in addition, they may well have to contend with social biases in a way that heterosexual male partners never will.

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While the role of fatherhood has proven changeable, and subject to the lack of certainty we have around the notion of masculinity, at least “father” has a well-defined meaning as compared to the “other mother” of a lesbian couple. Her grief may be discounted by society because of a lack of genetic link with her miscarried baby. I’ve also spoken to lesbian couples who have felt abandoned by friends and family because of the assumption, spoken or unspoken, that they can look after each other well enough, because women tend to be better at talking through their feelings and at emotional support more generally.

But for lesbian couples, trying to conceive is always complicated — no “happy accidents” can happen before their miscarriages either. The exhausting, time-consuming, emotionally draining, and often expensive processes involved in achieving a pregnancy can add up to the same heightened experience of loss described by heterosexual couples when they miscarry after fertility treatments.

In the same way that we can serve those who bear children better by taking the time to find out what a miscarriage means for them, we can and should do the same for their partners. Even if a pregnancy doesn’t unravel in the body of a parent-to-be, this doesn’t necessarily mean the relationship with the baby, and the grief that follows when it is lost, should measure any less. Nor should we assume that an unavoidable and consciously chosen “support” role is an easy one to pick up and play out.

And even if it looks like a partner isn’t in much distress — because he or she isn’t grieving in the more obvious way that women are typically thought to do — it doesn’t take much to find out otherwise: I advocate for a compassionate curiosity after any miscarriage, so that the meaning of the pregnancy to the bereaved can be truly understood.

This is an adapted excerpt from The Brink of Being by Julia Bueno, published by Penguin Books, a division of Penguin Random House LLC.

Julia Bueno is a London-based psychotherapist specializing in pregnancy loss. The Brink of Being is her first book.

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