Thursday, June 11, 2015

miscarriageCARE: Finding Out, the DOs and DON'Ts

Learning that a woman you know has had a miscarriage can be hard to address, especially in your first conversation together. She might have texted you at 4:00 a.m. to let you know that it just happened. She might be your cousin and you heard it from Aunt Susan at Sunday dinner. She could be a co-worker and your boss discretely let you know that's why she'll be gone for the week. For the large majority of women who miscarry, personally telling everyone about her miscarriage just isn't possible or desirable. It's likely that she told some key people and asked them to inform the rest of her circles. If you are in one of her circles, your next interaction with her can be awkward and uncomfortable.

There are ways to lessen this awkwardness while also demonstrating your care and sympathy. Here are some DOs and DON'Ts when it comes to those initial interactions after learning a woman has experienced miscarriage.

Determine your honest relationship. 

Ask yourself what you would expect/want from this same person if you experienced loss. Does your relationship only merit an, "I'm sorry," or do you need to prepare for in-depth and ongoing support? And even if you do want to offer deep support, is it appropriate for you to do so? If you are a co-worker, subordinate, acquaintance, etc. how can you best offer support without overstepping your established, social boundaries?

Initiate a deep conversation if you are not a personal friend. 

Even if it comes from a place of genuine concern, it will often be unappreciated if she hasn't been speaking openly about her miscarriage. Carefully assess your motives for wanting to talk to her. Do you simply want details about her life, or do you want to provide care and support? If it would normally be inappropriate to discuss her love life or her health it is inappropriate to initiate a personal conversation about her miscarriage. If you still desire to provide support for her, I have outlined some practical and appropriate ways to do so.

Say you're sorry.

This statement is small but important. It can be said by anyone to anyone and will suffice when nothing else can be said. You can add that you're sorry for her loss or you're sorry she had to experience this. The phrase can be tailored to fit most any situation. Whether the pregnancy was wanted or unwanted, a miscarriage is hard on a woman. Saying you're sorry goes a long way.

Ask "What happened," "What did you do," or "What went wrong?"

Most likely, she has no idea "what happened," and in her current state it can often feel like she's being asked what she did incorrectly. Some women are able to save the products of conception for testing, but many cannot. Since it is impossible to know this information without hearing her whole story it is futile to ask her what happened. If, instead, you want to hear her story (and you feel it is appropriate) begin by asking her when it happened and go from there.

Gauge the timing.

When are you learning about her miscarriage? Hours after the fact? Days? Weeks? Months? If it has been a matter of hours or days, chances are she will need more intimate and personal support from those around her. If it has been weeks or months since her miscarriage she may instead be working on establishing some sort of memorial to her lost baby or her (new) normal routine. This can help you gauge the kind of support (if any) she may need from you.

Assume you know her grief level.

Remember, she may not have felt any grief after her miscarriage, even if it just happened. And just because it has been months since her miscarriage, this doesn't mean she isn't still deeply grieving inside. The same goes for any of the feelings a woman might have when she miscarries. A lot of things remain buried under the surface in social and professional settings. The best way to learn is to:

Ask her how she is feeling.

Even months later, she could have difficult emotions. If she doesn't feel comfortable sharing all of her feelings with you that is perfectly acceptable. By asking, the main thing you have done is communicate your awareness that miscarriage is a long process and you don't expect her to have moved on by now. Be prepared to accept her answer if she is unwilling to share deeply, but also be prepared to accept her answer if she opens up completely. If she does open up, remember you're not there to fix her. You're there to listen.

Forget her spouse/partner/other children.

The lost baby was also a family member to others, and if those others are a part of her life make sure you don't forget them. While the conversation is primarily focused on her it is still important to let her know that you care about all of her family.

Let her know if you have also had a miscarriage.

If your spouse or partner had a miscarriage, you are well-equipped to empathize with her feelings, but this shared experience will be most meaningful to her when a fellow woman reveals she has also had a miscarriage. The instant bond and sense of community created by that small admission cannot be overstated.

Tell her about your relative, co-worker, etc. 

This same advice is also given to those providing care and support for those suffering from cancer or chronic illnesses.

If you did not personally experience or live with the miscarriage process, your relative or friend's story is infinitely less helpful and/or meaningful. This seems harsh, especially if you were close to your family member who suffered. The fact remains, however, that you seem like a collector of sad stories from among your friends and relatives rather than a person who has been in the actual trenches. What you can do is use what you learned from your relative or friend's experience to help and support in the current situation.

Listen to her story.

If she wants to tell it to you, that is. This all depends on how close you are with her and how open she is naturally. You can ask leading questions such as, "When did it happen?" or "Did you have to go through this alone?" or "Did this happen at home?" Pay attention to her body language and her speech patterns. Crossed arms and one-word answers are a good indication she doesn't want to share with you at this time. If she does share with you, remember that it was a difficult experience. Also remember that the experience is in the past. Asking why she made a particular choice or if she could have done something differently is unhelpful. This is not a process she desires or plans to experience again.

Immediately offer your own story.

Your own story could be truly helpful, but it's important for her to feel that you are solely focused on her experience. Your story is always appropriate for you to share if she asks questions after learning you have also had a miscarriage. A great way to share with her is to offer affirmative statements of agreement like, "I completely understand," or "I know exactly what you mean." You can also convey parts of your experience through the questions you ask her. When you ask about the miscarriage process (the lead-up, the event, the doctor's visits, the testing, the emotions and hormones) you're letting her know that you truly have been there before. This will often prompt her to ask you questions, and you can then begin a dialogue about both experiences.

Please be aware that she is looking for empathy instead of stories. This is why it is inappropriate for you to share you friend or relative's experience with her.

Offer your support.

One of the best ways to demonstrate you care for her is to offer support, whether it be immediately or some time in the future. Not only does this convey your care for her, it also shows you're not just collecting her story. Those who experience tragedy and suffering often understand their experiences make for powerful stories, but those who are willing to participate in the painful parts are few and far between. Your support will show her otherwise. Next week's post will detail some helpful ways to provide initial and ongoing support for those who suffer pregnancy loss.

Offer your advice or psychic knowledge.

If she asks for your advice, then by all means offer her some in a gentle and sensitive manner; otherwise, telling her how best to proceed from here is almost always something she doesn't need to hear, especially if you have not been through a miscarriage yourself. For those who have experienced miscarriage, it may seem helpful to offer advice based on experience, but while shared miscarriages create bonds remember each woman's situation is unique. With so many different factors in her life, what worked for you will likely look different for her.

The other thing you should not do is offer your psychic knowledge. By this, I mean talking about her future babies. You truly cannot know that she will have future babies, and talking about these imaginary babies only communicates that she needs to move past her miscarriage. Allow her to work through her present experience, and do not push her into the future you think you see.

You may find out about a past miscarriage while she is already pregnant with another child or has already given birth to another child. Adjust your conversation accordingly, but remember that her past miscarriage was still a big life event.

Give her grace.

Especially for a woman whose miscarriage was recent, behavior and communication can be erratic or unusual compared to her "normal" self. Find it within yourself to give her grace (and space) during this time. If you can understand why she may feel a certain way you will be better able to overlook difficult behavior for a time.

This point refers to normal feelings related to miscarriage. Some feelings and actions are dangerous to the grieving woman and others and should be addressed by a mental health professional. This point does not refer to those extremes.

Try to make her feel better with "At least" statements and religious cliches. 

Many of these statements seek to minimize the scope of her suffering or the validity of her feelings.

"At least" statements minimize a miscarriage by turning it into a situation with a downside and an upside. For the grieving woman a miscarriage is much more than a situation. It is a significant, life-changing event. For women who have had multiple miscarriages, yes, a miscarriage at 4 weeks is usually less physically painful than a miscarriage at 12 weeks. For a woman trying to conceive, the ability to get pregnant is indeed a comfort. When these are compared to the miscarriage with the phrases, "At least you were only 6 weeks along," or "At least you know you can get pregnant," these things become ways to minimize her experience rather than facts about her own body.

Religious cliches can also be very, very damaging to a person in grief. They are most often things a person says when he/she has no other words to offer. This is obvious to the grieving woman, and if this is the case, simply stop with, "I'm so sorry." Unless you intimately know the grieving woman's thoughts and beliefs when it comes to the idea of religion and a God, steer clear of cliches of this nature.  If a woman doesn't believe in Heaven or a God, it's actually antagonistic to tell her that her baby is in Heaven or that God has a reason for this. A friend of mine had a co-worker tell her, "God just doesn't want you to have children right now." Whether a person believes in God or not, statements like this are incredibly insensitive and hurtful, and if a woman feels deeply betrayed by God, these things only serve to drive a large wedge between her and her shaky faith. Even a deeply religious woman whose faith remains unshaken can find these statements unhelpful, for many of them are actually shallow interpretations of her faith.

Use the same verbiage she uses.

If she refers to her loss as "the baby" or "our child," then that is your cue to use that same language. If she says "it" or "the pregnancy," then adopt those words in place of more personal pronouns. Refusing to say "baby" or "child" can add more hurt to a woman who already feels that she lost a child, while continuing to say "baby" to a woman who feels that she lost a collection of cells can also add hurt. Both women will feel ignored.

Regardless of what you believe is true about an embryo at 6 weeks gestation, this is a time when it is more important to be supportive than it is to be right. If it is more important to you to be right then perhaps you are not the appropriate person to comfort this woman.

Compare her loss to anything.

If you have never had a miscarriage, but you recently lost your beloved family pet, this is not the time to bring that up. You may use your own loss to better empathize with her feelings, but do not verbalize it. It is inappropriate and demeaning to her experience.


and finally, 

Follow up with her.

After your initial conversation, something as small as a card or a text shows you care. If she is someone you see daily, you can offer support and care in more practical and subtle ways. The more you follow up with her (without hounding her), the less she will feel like gossip or the current "sad girl."


This may be a lot to think about for one conversation/interaction, but it is necessary when your goal is to care for a person in pain.

Next week I will offer some practical and personal ways to support a woman and family who has experienced miscarriage.

Until then, keep it real.

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