Time to end secrecy and face the anguish of miscarriage

A woman miscarried in an emergency room toilet at Maitland Hospital earlier this month, reprising a similar episode at Royal North Shore Hospital in September 2007. Many newspaper reports included gruesome, visceral detail, such as the fact the woman found herself having to dispose of the foetus in the toilet.

The media outrage was predictable but there's another sense in which the reports were quite unusual. Reportage of these women's experiences represents a rare occasion when the brutal reality of miscarriage is publicly discussed.

Expectant women are often advised that they should not publicly reveal their pregnancy until they are past the 12-week mark. One reason given is the high chance of miscarriage in the first trimester. The assumption is that if you were to have a miscarriage, the last thing you'd want is for anyone to know about it. It is a misfortune which we are expected to keep to ourselves.

I recently suffered a miscarriage. I was deeply shaken by the physical process and by the intensity of my grief. But because I followed the accepted wisdom, very few people were aware I'd even been pregnant. And because the pregnancy was a secret, its loss was doubly hard to broach.

Yet, as word of my "secret" slowly spread through my social circle, I was stunned by the number of miscarriage stories women suddenly had to share, as if I'd been admitted to a secret society. Some talked of long, excruciating waits before they could confirm the "failed pregnancy" diagnosis, others of their anguish as they passed a recognisable foetus. One acquaintance confided the disappointment of five lost pregnancies had been the biggest factor in the breakdown of her marriage. All the women spoke of how difficult it was to publicly express their grief, and of the silence that permeates the experience.

The Australian Longitudinal Study on Women's Health recently reported that, for every three women who have given birth by their early 30s, one has had a miscarriage. Yet despite its frequency, miscarriage is an almost invisible phenomenon. It seems our society is not geared towards grieving, or even acknowledging, the loss of an early pregnancy. As the American author Peggy Orenstein has observed, the English language doesn't even have a word for a lost foetus.

Women have always been expected to keep their biology discretely hidden in the messy "women's business" box. Menstruation is the archetypal example of this social discomfort, epitomised by the clinical blue fluid used in those often lampooned tampon advertisements.

Lost pregnancies are treated very much like menstruation - shameful, discomforting and best spoken of in euphemism. Yet when it comes to miscarriage, our collective desire for silence may have actually increased over the past two or three decades.

We live in an era in which women are supposed to have unprecedented control over their lives, including their bodies and their reproductive processes. As a result we are shadowed by the figure of the ideal women, who defies her biology by never ageing, who makes career and child-rearing look effortless.

This pressure to perform is particularly acute when it comes to pregnancy. The rise of IVF has encouraged the perception that women's bodies are things to be manipulated and controlled; if we fail to get pregnant, it's probably because we haven't tried hard enough. On this logic, a miscarriage is, perhaps, the ultimate failure of womanhood.

It seems that as we've (thankfully) gained more control over our fertility, we've become increasingly disconnected from the messy and sometimes emotionally devastating realities of pregnancy and its complications.

When the experience of miscarrying is so little spoken of, and even then only in hushed tones, it can be hard to define what you are grieving. Yet this is what most of the women I spoke to longed for above all: to make their grief concrete, to frame it in a way that legitimised it.

Without such a frame of social acknowledgment, women who miscarry are left to deal with their pain not only in silence but also in the confusion that comes from a loss that is unquantified.

The Royal North Shore incident triggered a ministerial directive that miscarrying women be taken directly to the maternity department and given appropriate care. This is an institutional move toward according miscarriage the weight it deserves. Our deeper cultural discomfort, and the social expectation of silence that still surrounds miscarriage, will be far harder to reform.