When Dr. Lara Freidenfelds, a historian of health, parenting, and reproduction, suffered a miscarriage 17 years ago, she was shocked and distressed. But what shocked her the most, as a PhD candidate in the History of Science writing her dissertation on the modern period and menstruation in 20th century America, was just how common miscarriages were. (Around 20 percent of confirmed pregnancies miscarry) Even more surprising to her: if you take a pregnancy test as early as you can, about six days before your expected period, there’s almost a one in three chance that you are going to lose that pregnancy.
This got her “Why was the information that was out there when I was trying to get pregnant so obscure?,” she said “Why didn’t I know that just getting a positive test didn’t really tell me, yet, that I was successfully pregnant?”
Pulling at these threads, Dr. Freidenfelds dove into the history of miscarriages and came out with a brand new understanding of modern pregnancy and how market forces, medical advancements, pregnancy apps, and birth control have given expecting parents a sense of control and surety over their pregnancy that they just don’t have in the first place. This makes miscarriages more difficult and painful than they often need to be. Her new book, The Myth of the Perfect Pregnancy: A History of Miscarriage in America, is a deeply researched and thoughtful exploration of the history of miscarriages that serves to teach parents about the history of pregnancy but also lift the shame over it.
Fatherly spoke to Freidenfelds about the history of miscarriages, how birth control created unrealistic expectations for family’s abilities to get pregnant, and how men’s roles in pregnancy and miscarriage have shifted right alongside their partners.
What compelled you to write about the history of miscarriages?
I started researching this book, now, about 17 years ago when I had the miscarriage.It really made me feel better to start thinking through this. I know, as a historian, that before the 20th century, women didn’t think about early pregnancy in the same way they do now. They thought of it as a suspicion, that you could be pregnant, but not being certain about it. Looking for symptoms. But then, if you had a late menstrual period, and even if it was a crampy, heavy one, if you didn’t see the form of a child in it, then women would attribute it to either sickness or just a late period or a pregnancy that had sort of begun. That the materials had never really come together into a child.
I thought, why can’t I think about my pregnancies that way, too? In some ways, we know a lot now. We know a lot about embryology. But we’ve lost a lot of really important knowledge about how often embryos don’t actually succeed and aren’t actually viable.
And then, I wanted to know, how did we come to such a different understanding? And how did we, in the process of learning so much science and medicine, actually lose a key piece of knowledge about how uncertain early pregnancy is?
So how did we lose that key piece of knowledge?
I think that there’s some really large and important cultural forces at work. They’ve reshaped modern life in some really positive ways. Around the time of the American revolution, women and men began to want to have control over their reproduction. At least by 1960, with the birth control pill, we succeeded. We’re successful at preventing pregnancies when we don’t want them, so now, we feel like when we do decide to be pregnant, that it should be successful.
What do you mean?
Modern birth control is a wonderful thing, but it has given us a misleading intuition about how secure pregnancies are. Secondly, our vision of parenting has shifted in some really important ways. In colonial America, sure, you would like a child to love, but, parenting happens just because you got married. It was up to God and fate how many children you had, and children were for helping with household work, and working on the farm, and supporting you in your old age, and respecting God.
All of those reasons for being a parent over the last few centuries have dropped away. Today, our parenting is really focused, almost exclusively, on forming a loving bond with a child. That idea of when that bond is supposed to start has moved earlier and earlier into pregnancy and in recent decades into even the first weeks of pregnancy.
So, while I think that it’s wonderful that we focus on having a loving bond with our children now, I do think there’s been some really emotionally traumatic side effects with starting to think that way at the very beginning of pregnancy. And then, marketers have gotten in the mix and are important pieces of this.
When did this begin?
Some of this begins with the 1920s advertisements for special Sears catalogs — the baby edition. But it really gets going in the 1960s, when marketers become a lot more sophisticated about reaching specific segments, and realize that pregnant women are a really valuable group of consumers, because they’re about to make a bunch of brand choices.
Over the decades, since then, the market has gotten more and more aggressive about reaching women as early as possible in their pregnancy. A lot of pregnancy advice on websites and on apps is actually driven by marketing and advertising.
A responsible pregnancy manual author would never tell you to start browsing baby names at five weeks pregnant. But your app? Or your pregnancy website? It might very well do that, because they have every incentive to feed your excitement and your emotional attachment to your pregnancy.
It has gotten out of control.
Really out of control. So, as nice as it is that we have these wonderful baby products, the consumer culture has really gone in a direction that has not served people’s emotional wellbeing when it comes to early pregnancy.
And then we have these great medical technologies! We’ve made new rituals around ultrasounds, and home pregnancy testing, that have also contributed to making us feel like it’s a real baby at a time when in fact it may not be secure yet.
So, 150 years ago was there not a lot of grief, or even a culture of silence around miscarriage?
Nineteenth century women weren’t talking about miscarriages in letters or diaries a lot. Part of what’s complicated about this is, before people had good control of their fertility, they already had begun wishing for smaller families, and doing what they could to have smaller families. So 19th century women were commonly using douching and withdrawal and folk methods like heavy work or going on a bumpy carriage ride to try to bring on the menses, to try to not have a pregnancy this month.
So, if that’s how you’re thinking about early pregnancy — as something that you’re largely trying to avoid — you’re not that often in the situation of feeling distress about an early pregnancy loss. It took having a certain amount of control over fertility before early losses could seem like something that was clearly undesirable. So that’s part of it.
The idea that having a choice in being able to limit pregnancy makes the loss of wanted pregnancy more jarring.
Part of it also is that when women wrote about second trimester losses, they were scary medical situations. They were relieved at not dying from them. So, the loss of the child was secondary to being relieved to have survived the process. Pregnancy and birth has become so much safer that we can focus on the expected child, and not on surviving the birth or miscarriage.
We see how women’s attitudes towards miscarriages have changed over the last 150 years or so. Is there a sense that men’s attitudes have changed alongside this shift?
Historically, when women had pregnancy losses that they were confident were pregnancy losses, so later in pregnancy, husbands were part of it in the same way they were part of birth. Which is that they were responsible for calling an assistant, or a medical practitioner, to come in and assist and make sure their wife survived. Men were highly invested, and very concerned, because they had the same concerns that their spouse could lose her life. They weren’t necessarily expected to be thinking about pregnancy as an already existing baby.
What has changed today as far as men’s relationship to miscarriage?
I think that in many positive ways, the expectations about husbands and male partners being part of pregnancy is a new thing. That’s great for many couples. In some ways, some of these rituals we’ve developed around our medicine — the ultrasound, going in for the ultrasound to see the baby — is partly about helping the father feel involved, because he can’t feel the pregnancy. But this way, he has a window into what’s going on. It’s also not literally “the seeing of it.” It’s having a ritual format where you go in and start imagining yourself as parents, together.
And that’s something that fathers can participate in. That’s very nice. But it’s just really hard on people when you find a miscarriage, instead of seeing the heartbeat.
So, fathers, I think, are experiencing the losses more directly now because of that. And the same thing with home pregnancy tests, especially with websites suggesting many exciting and sentimental ways for women to share their positive home pregnancy test with their spouse or other relatives. It can be a really nice way for fathers to be involved in their future parenting right from the same time as their partners. On the other hand, that means that they’re going to face the loss as well.
When parents suffer a miscarriage, it’s often an incredibly sad time for them. The grief is real.
People grieve in different ways. Part of what’s so complicated about the situation, in terms of people giving appropriate emotional support, is that you don’t know if your friend or relative who miscarried felt like they lost a child, and are grieving a death in the family, or, if they are very disappointed, but are ready to try again next month and you’re going to make it harder for them if you say, “I’m so sorry your baby died.”
Yes, and it’s hard to know, as a friend or family member, how to discuss it. Or if it’s appropriate to bring it up. So it’s often not addressed.
I think that people are looking for certain kinds of support, because we don’t talk about it. And people don’t talk about it partly because they are protecting themselves from the burden of what people might put on them having heard of their miscarriage. We don’t have a standard ritual for handling miscarriage. We often don’t know how to feel about it, which is sort of a strange thing.
It is strange.
Thee narratives that tend to get offered are trying to support women who are grieving their miscarriage. I think grievers do need a lot of support. But, it’s not true that the only way to think about a miscarriage is as the death of a child. If you tell people that that is the way you’re supposed to think about it, it’s going to hurt people at the same time it helps others. I would like to see more discussion in our popular support literature about the variety of ways people might think about a miscarriage — and also, that how you think about your miscarriage might change over the course of your life. It’s not something that happens once, you experience it, and it’s permanently that way.
No life experience is. But this one, more than others, can change in its meaning and how you think about it in the context of your journey to parenthood, depending on how that goes.
So what do you think is the correct course of action?
We need to have this discussion enough so that people know it might happen ahead of time — so that they can go into childbearing with the information that they may get pregnant next month and have a baby in nine months. They may take six months to get pregnant. They may have a successful pregnancy the first time around or the first one may not stick and it may take another try. All of those are normal, healthy ways that people have their children and if we can go in knowing that that might be the case, we might be able to handle early pregnancy a little bit differently so that when they don’t work out, it’s not as distressing.