Say the Word

Trigger warning: Discussion of miscarriage and pregnancy.

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It's hard to believe it's already been a year since I "went public" about my September 2018 miscarriage, but it's true - once again it's October 15, Pregnancy Loss Remembrance Day. And while this one obviously feels different from the last - thanks both to the passage of time, which dulls all grief, and to the fact that this year I'm pregnant with a healthy pregnancy - I do still have some things to say about pregnancy loss, and my experience in the months that followed mine. Today seemed an appropriate day to share those thoughts.

Throughout the fall and winter immediately following my miscarriage, I had a lot of people reaching out and checking in with me, throughout my Facebook post, my blog, private social media messages, texts, emails, snail mail cards, phone calls, and in-person conversations. These efforts made me feel loved, listened to, and so lucky to be surrounded by such a wonderful support system.

And yet, there was something about many of those interactions that I found curious (and, if I'm honest, a little annoying at times) - something I hesitate to bring up for fear of seeming ungrateful:

People really don't like using the words "miscarriage"* or "pregnancy loss." In fact, they often go frustratingly out of their way to avoid them, using all sorts of superfluous and downright mystifying phrases instead.

Over those several months, I heard my miscarriage referred to as - and this is a non-exhaustive list - "that time" and "last fall" (as if autumn is inherently a challenging time of year), "the pain and difficulty you went through," "that thing that happened to you, which I read about on your blog," and even the ultra-vague "recent events." (That last one particularly confused me, as it was said to me in February - an entire five months after my miscarriage. If it weren't for other context clues, I wouldn't have had any idea what they were referring to.)

Then there were other people who just trailed off in the middle of a sentence, unable to think of a synonym for the word they were desperate to avoid: "How have you been doing since...?" or "I know someone else who also had a... you know..."

It was hard to ignore the pattern, and it was hard not to take it a bit personally. When it happens time and time again, with a dozen different people, you begin to wonder: Is it something about me? Are they pitying me? Do they think I'm "too fragile" to hear them use the actual word? It's not a great feeling.

At the very least, their avoidance signaled to me that they were uneasy talking about it - and that put me in a bit of an awkward position. Whether they were asking me how I was doing because they felt socially obligated to, or because they genuinely wanted to know, they hardly encouraged me to give them an honest answer or start up a lengthier conversation when the topic appeared to make them so uncomfortable. I often ended up giving the answer it seemed they wanted to hear ("I'm doing fine, thanks for asking") and leaving it at that. They got to feel good about reaching out, but I ended up feeling rather alone.

(This isn't to say I needed or wanted to talk about my miscarriage all the time; I usually didn't. But there were times when I would've liked to know the option was there if I wanted to talk, and when people refused to call my miscarriage a miscarriage, it felt like it took away the option.)

I noticed this tendency to avoid the label more in people who hadn't experienced their own miscarriage. Some couples who've been through pregnancy loss of their own also avoid using the word of course (and in a society that still sees the topic as taboo, and frequently discourages showing vulnerability, it's no wonder), and there were certainly those who hadn't been through a miscarriage who were still willing to use the terminology. But more often than not, I realized that if someone was unafraid to use the word in front of me, it was because they'd been there. They knew what it was called; they knew what they called theirs. What's more, they knew that refusing to label an event does nothing to change the event itself - and that embracing the label can actually be incredibly empowering.

It reminds me (as so many things do, let's be honest) of the Harry Potter books. As soon as Harry learns about his parents' death in Book 1, after ten years of being denied the truth surrounding that night, his instinct is to refer to it every time thereafter as what it really was - murder at the hands of Voldemort - even while that decision shocks everyone around him.

"You said You-Know-Who's name!" said Ron, sounding both shocked and impressed. "I'd have thought you, of all people - "

"I'm not trying to be brave or anything, saying the name," said Harry. "I just never knew you shouldn't."

Except that Harry did know - Hagrid had already told Harry that most wizards call Voldemort "You-Know-Who" or "He Who Must Not Be Named." And as the book continues, Ron has to repeatedly ask Harry to stop saying Voldemort - because Harry keeps doing it, despite Hagrid's explanations and Ron's protests. At 11 years old, Harry hardly has the words to describe why he feels the need to do this (and J.K. Rowling doesn't come out and say it either), but I think it's because to say anything else, or to avoid speaking Voldemort's name out loud, would feel dishonest and dishonoring to both his parents and his own journey of grief. He was mad that the truth about his parents' deaths had been hidden from him for so long, and now that he knew what had really happened, he wasn't going to go back to lies, omissions, or spreading misinformation. In any case, at the end of the book, Harry's choice (and mine) is vindicated when Dumbledore tells him, "Always use the proper names for things. Fear of a name increases fear of the thing itself."

As I've said in previous posts, one of the best ways to grapple with trauma is to take ownership of it - to take something that happened to you, and make it happen for you instead. The first step in this process of moving on is often getting past denial by naming and defining your experience. Using the appropriate, Google-able terms furthermore gives you access to information about what to expect (a great help in reducing fear of the unknown), and connects you with others who've gone through something similar (paramount to helping you feel less alone in your experience and provide you with a useful support system).

On the various "What to Expect When You're Expecting" miscarriage/pregnancy loss boards, and similar boards on other apps and online forums, accurate labels are in fact so common that shorthands are used instead. MC = miscarriage, MMC = missed miscarriage, CP = chemical pregnancy, EP = ectopic pregnancy, MP = molar pregnancy, BO = blighted ovum, etc. Spend any amount of time on those boards, and you quickly figure out what all those abbreviations mean.

Granted, all of those posters are on there because they want/need a space to talk about it - and there are many who experience pregnancy loss and don't want to talk about it at all - but isn't it telling that of those eager to share their experiences, none of them choose to talk about it in euphemisms? We know the deeper truth: it happened, regardless of what creative phrase you come up with to describe it - so you might as well just call it what it is. To do otherwise just compounds unnecessary confusion and misunderstanding at best - or perpetuated fear, shame, oppression, and isolation at worst.

My doctors, too, never beat around the bush - I assume from some combination of not having time or tolerance for euphemisms. My medical chart says everything: in between comments about my high-risk status due to my diabetes, there are phrases like "incomplete abortion" (the medical term for missed miscarriage) and "multigravida" (meaning that I've had more than one pregnancy). And so, every time I saw a new doctor (or one I hadn't seen in awhile, since the start of this pregnancy), the doctor would both congratulate me on my new pregnancy and acknowledge that my first had ended in loss: "We're so glad to see you back here with a healthy pregnancy!" or "That first one was just a fluke; I hope you aren't worried. Everything looks great this time!" During an appointment early in my second trimester, when a doctor was trying to find my baby's heartbeat with a Doppler wand and having a bit of difficulty, he apologized. "I know it's hard when we can't find it right away for you, after everything you've been through. But babies just hide sometimes! I'm sure I'll find their heartbeat in a minute - ah look, there it is! Strong and healthy, at 150 beats per minute."

I assumed the people who took great pains to circumnavigate the words "miscarriage" or "pregnancy loss" in my presence meant well. They likely did it because they were afraid of offending, embarrassing, or upsetting me, or because they themselves found the words offensive, embarrassing, or upsetting to say. I don't think they did it to purposefully incite shame. But when they treated those words as if they were potentially offensive or embarrassing, that's exactly what they were doing, wasn't it? Even if they didn't mean to. They were treating my miscarriage like something I should be ashamed of, something I should take offense to others knowing about and acknowledging, something that shouldn't be said out loud.

There are a whole bunch of other words like miscarriage: rape, assault, depression, suicide. They are things that our society is afraid of and uncomfortable with, and words that erroneously have connotations of blame attached. We all want to believe that there's a reason these things happen, and ways of preventing them - and the easiest way to do that is by blaming the person it most affects. (And for trauma like rape and pregnancy loss that disproportionally affect women, this impulse is all the more frequent.) But the truth is, acts of violence can happen at any time to anybody, regardless of what that person does; mental illnesses and other chronic disorders affect otherwise healthy people indiscriminately and unpredictably; and miscarriages, which occur in at least 1 in 4 pregnancies, are nearly always just a matter of horribly bad luck. These are not things that can be prevented, as much as we wish they were, and they are not things we should let anyone feel ashamed of.

If someone says they're on medication for the treatment of their depression (or anxiety or bipolar disorder or OCD or anything else), don't call it their "condition," implying that it's some nebulous, vague, unknowable disease - use the label that they and their doctors and therapists use. And if someone has publicly proclaimed that they were raped or sexually assaulted (as so many have in this era of #MeToo), don't try to find another phrase to use instead ("nonconsensual sex," "forced sex," "taken advantage of," etc.) - use the words they use: "rape" and "assault." To do anything less is to disempower the survivor who has chosen to use that word to describe their experience.

This isn't Victorian times anymore. It doesn't do anybody any good to force these topics or words into secrecy.

Of course, I'd be remiss if I didn't admit my own faults. There were times when I wanted to use the word "miscarriage" (or at least obliquely refer to mine, even without using the word), but shied away from doing so... As I've found with so many things that open us up to vulnerability, it's easier to write it in a blog post than it is to say it out loud.

My impulse to mention my first pregnancy didn't go away once I was pregnant for the second time - in fact, it was something I often wanted to do during those first few weeks. It felt weird to me to tell people I was pregnant without acknowledging what I'd been through; I always wanted to tack on the word "again": "I'm pregnant again!" I was also frequently compelled to compare my two experiences - how did my symptoms this time stack up to what I'd felt during my first pregnancy? But I did my best to curb those impulses and keep such observations mostly to myself - even while doing so felt like lies of omission and hypocrisy, perpetuating shame and stigma just as I accused others of doing.

I was worried what others might think of me if I kept bringing up my miscarriage. Would they be concerned or even disappointed in me, that even when I was getting a second chance at pregnancy I was still "complaining" about what had happened the first time? Would they think I was somehow doing a disservice to my unborn child by refusing to let them be their own person, with their own pregnancy, untainted by what I'd experienced previously? And what if someone heard me say these things who had experienced more than one miscarriage, or someone who struggled with infertility, and was still waiting for their rainbow baby, or their first positive pregnancy test to arrive - would I come across as ungrateful, would my words spark jealousy in their hearts? I knew how difficult it could be to hear about someone else's pregnancy when you were hoping and trying so hard for your own, and I didn't want to inadvertently cause anyone else that sort of pain.

I was also worried about making other people uneasy by reminding them, in the same breath as telling them my happy news, that life also brings loss sometimes. This acknowledgement did not temper my own excitement - I would argue that knowing the worst that could happen and holding that concurrently with my hopes and dreams for my new pregnancy actually made me appreciate and value my pregnancy even more. But I was worried that others might not feel the same way I did, and think me adding that "again" to the end of "I'm pregnant!" was in poor taste.

I'm trying to be better. I'm trying to care less what others think of me, and to feel less responsible for the reactions that others might have to the things I say and do. I'm trying to prioritize myself, and say the things I want to say (even if for now that means mostly just posting them on here). I want to be a role model for my future child(ren), and exemplify the traits of self-confidence, honesty, authenticity, and openness to vulnerability that I so value and admire when I see them in others.

I hope anyone reading this post will try to be better, too. And if, in the meantime, the best you can do is ask someone "How are you doing since...?" - at least that's something. In the end, I was always touched when someone took the time to contact me, and - as stated before - felt extremely grateful that so many did.

I'd much rather someone reach out clumsily than not at all.



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*To be fair, there is some debate about the appropriateness of the term "miscarriage" - given that when you break it down into its components ("mis" and "carry") it seems to put blame on the one who was carrying the baby-to-be in their womb. Still, I think it's safe to say that if someone uses the word "miscarriage" to talk about their experience, you can assume they aren't offended by the term, and feel free to use that word yourself when talking to them about it. If you do want to avoid that particular word, "pregnancy loss" (or even just "loss") is a good substitute.

Personally, I find "pregnancy loss" to be both a more and less accurate description of my experience - it feels more accurate, in that I quite literally lost a pregnancy, and certainly didn't incorrectly carry the child I was hoping to have; it feels less accurate in that "pregnancy loss" is an umbrella term that encompasses stillbirths (losses after the 20 week mark) as well as miscarriages (losses before the 20 week mark), and I feel a bit like a fraud when lumping in my experience with others who quite literally labored and birthed a baby who may have even breathed outside the womb for a few short minutes or hours, and whom they may have had the chance to hold, however temporarily, in their arms as well as in their wombs and hearts. So while I do use both "miscarriage" and "pregnancy loss" interchangeably, I tend to default to "miscarriage" more often - just to avoid that constant internal debate with myself. (Not to mention that "pregnancy loss" just sounds clunkier in everyday conversation.)

To put an even finer point on it, I use other terms as well... I use "my miscarriage" or "my pregnancy loss" to refer generally to the weeks-long process of noting diminishing pregnancy symptoms, learning at my 8-week ultrasound that my baby had stopped growing, getting a D&C six days later, and the weeks of physical and emotional recovery that followed. But sometimes it's more convenient to reference a specific date rather than an entire process - and when that's the case (as it often was when we were trying to conceive again), I chose September 13 and called it "my D&C" (e.g. "this is my Nth menstrual cycle since my D&C"). More often, I think of the entire pregnancy, not just the end of it (and sometimes not the end of it at all), and I refer to it as "my first pregnancy" or "my last pregnancy" ("last" meaning previous, not final). Even when I was not yet pregnant again, I always used one of those qualifiers; trying to conceive requires a certain optimism and forwardness of perspective that assumes another pregnancy is just around the corner, if not already begun.

I don't care which of those terms you use with me - miscarriage, loss, pregnancy loss, your first pregnancy, etc. All of them are true, better than the verbose "that painful, difficult thing that happened to you last fall, which I read about on your blog," and refreshing to hear.

And if you're not sure what someone else wants their experience to be called - ASK THEM! I know it can be awkward and nerve-wracking, but if you want others to feel safe enough to be emotionally vulnerable around you and tell you how they're feeling, you might just have to be emotionally vulnerable around them, too. :)

Gender is a Spectrum

There are two terms that we use more or less interchangeably - sex & gender - but which actually mean slightly different things (depending on who you ask). 

As I see it, sex usually refers to someone's biological sex (as characterized by the genitalia and other secondary sex characteristics you were (or weren't) born with, or by the chromosomes you were or weren't born with), whereas gender is the outward expression of one's sex - how you think of yourself/label yourself or how you are thought of/labeled by outsiders who interpret your behaviors (how you dress, how you wear your hair, your mannerisms, your ways of speaking, how you process or express emotion, how you interact with others, etc.) through the lens of contemporary gender stereotypes.

Often (but not always), one's sex and one's gender are the same - such as when a biological female considers herself to be a woman, and embraces/identifies with many (but rarely all) stereotypical behaviors of contemporary womanhood. These people are cisgender, also known as "gender-straight" or "gender-normative," meaning they conform to the gender/sex based expectations of society. 

Other times, a person's self-concept of gender does not match the sex they were assigned at birth. These individuals might identify as transgender. They may reject the stereotypes of the sex they were assigned at birth in favor of ones that better match their self-concept, may dislike the parts of their biology that do not represent the gender they feel they truly belong to, and may request that those they interact with change the gender pronoun they use to refer to them. They may take hormone treatments or go through surgeries to transform the parts of their biology they dislike, so that their physical appearance better matches their true gender. Some individuals who are transgender know from a young age that there is a disconnect between their minds and bodies; others do not realize it until much later in life. It is best not to assume any of these things, because every transgendered individual (just like every person in general) is unique and experiences life differently. 

>> Side note #1: Rejecting some gender roles does not automatically change someone's gender - "effeminate" men and "tomboyish" women exist, and they are not less of a man or less of a woman than manly men or feminine women (unless they want to be). 

>> Side note #2: A person's gender identity is not the same as their sexual orientation. Though being attracted to women is a stereotypical gender characteristic for many men, it is only one of many. Someone could be a gay man (and therefore reject one of the stereotypes of their male gender role), or even an effeminate gay man (and therefore reject many of the stereotypes of their male gender role), but still identify as male. Similarly, a woman could be attracted to women, or even be attracted to women and reject other female gender stereotypes, but still identify as female.

Behaviors or proclivities are gender-specific only because we have made them so. Women are not inherently "more nurturing" or "more domestic" than men. All genders/sexes are capable of providing quality childcare, and in completing household chores; like any other tasks, these are tasks that one gets better at with training or practice. Behaviors that we see associated with women, and behaviors we see associated with men, are things that women and men do because of how they are brought up, what they are taught, how they are treated, and social norms they are exposed to and encouraged to emulate (whether consciously or subconsciously).

Gender characteristics are fluid, changing throughout time and differing among cultures. For example, in America, it used to be acceptable for all children, regardless of gender, to wear dresses, and the color pink used to be associated with boys and blue with girls. In another example, some cultures associate displays of emotion as exuding manliness, while others associate emotional sensitivity with femininity. It doesn't take too much research to realize how arbitrary those characteristics are assigned to one gender or another - and not too much further thinking, once one has reached that realization, to conclude that it is ridiculous to insist that women or men "should" act a certain way. There is more than one way to be a man; there is more than one way to be a woman.

Gender is therefore more of a spectrum than a simple binary between male and female. You can have supposedly masculine traits even if you're a woman; you can have supposedly feminine traits even if you're a man. In recent years, this has developed into some people choosing to identify as neither a man nor a woman, or choosing to identify as both man and woman. They are the same person they always were; they are merely looking for a more appropriate label to use for themselves - a label that recognizes the arbitrariness of gender characteristics/the lack of a gender binary, and a label that encompasses how they truly feel about themselves and what group(s) they belong to, or want to belong to, or want not to belong to.

Some terms you may hear include:

• agender: a person who is internally ungendered or who does not have a felt sense of gender identity
• bigender: a person whose gender identity is a combination of a man and a woman
• pangender: a person whose gender identity is comprised of all or many gender expressions
• gender diverse or gender non-conforming: a person who either by nature or by choice does not conform to gender-based society expectations
• gender fluid: a person whose gender identity or presentation shifts 
• genderqueer or gender non-binary: a person whose gender identity is neither man nor woman, is between or beyond genders, or is some combination of genders; often used as a reaction to/commentary on the social construction of gender, gender stereotypes, and the gender binary system

Sex characteristics seem more rigid at first glance (males have penises; females have vaginas), but are actually just as fluid as cultural gender conventions. There are different ways to define one's biological sex, and all of them are less clear-cut than the strict male-female binary we suppose. 

You could define sex by observable, external characteristics (penises and scrota and facial hair, vulvae and hip width and breast size), or by internal sex organs (ovaries, uteri, prostrates) - but to use such a narrow definition would be to exclude or shame those who have had hysterectomies or mastectomies or other surgeries, those whose secondary sex characteristics are inconsistent with their primary sex characteristics (i.e. a "bearded lady" or someone with "man boobs"), and those who were born with conflicting or absent characteristics (i.e. an intersex child born with male and female organs, or a child born without any reproductive organs at all).

A male does not stop being male just because he's had surgery on his prostrate. A large-chested female is not "more female" than a small-chested female. Nor does a starving female who starts to grow extra body hair (to keep her skeletal frame warm) or lose the ability to menstruate (due to a lack of key nutrients in her diet) stop being female because of these physical changes to her body.

Every body is different; these differences can occur naturally, from genetics or environmental factors (such as diet), or they can occur medically, due to life-saving surgeries, medications, or elective procedures. They could even occur through abuse, such as someone who has had their genitals mutilated or altered. Girls who have had their vulvae stitched shut are still girls, just as the man whose wife famously cut off his penis is still a man.

How then can we insist there is a standard body that every male should have, or a standard that every female should have? Every female body looks different from every other female body, every male body looks different from every male body, and there are still other bodies that do not fit cleanly into a male or female category at all.

You could also try to use hormones to divide humans into males and females, looking at levels of testosterone, progesterone, or estrogen. But some males or females have naturally occurring levels of hormones that are typically found in someone of another sex, and others see altered hormone levels due to medical treatments, surgeries, or medication side effects. 

Females with Type 2 diabetes, for instance, have pancreases that must produce extra of the insulin hormone - and sometimes increased production of other hormones, as well, including testosterone, which can affect ovulation and fertility. PCOS (polycystic ovary syndrome) is another common illness which can affect hormone levels and impact reproductivity. 

Should such individuals no longer be considered female, just because of hormone imbalances or fertility difficulties? Of course not! If being female only meant that one was capable of ovulation, then girls could not be considered female before menarche either, nor older women after menopause. As much as it sometimes seems like we're heading in that troubling direction, we are emphatically not living in Margaret Atwood's The Handmaid's Tale; females are worth more than their ability (or willingness) to bear young.

Finally, you could also classify people by chromosomes - XX for female, and XY for male. But there are other chromosome combinations that naturally occur in humans, including Turner syndrome (X0, or only one sex chromosome), Triple-X syndrome (XXX, or even XXXX or XXXXX, where multiple X chromosomes are inherited), Klinefelter syndrome (XXY or XXXY, where extra X chromosomes are inherited with a male Y chromosome), and XYY (aka Jacobs) syndrome. 

Some of these individuals see their fertility compromised because of their condition; others see no obvious symptoms that they have a chromosomal abnormality and go through their entire lives never knowing. 

People who are born with any of the non-typical XX or XY chromosome combinations listed above, and/or people whose reproductive or sexual anatomy at birth does not seem to fit the typical definitions of female or male are known as intersex. These individuals are proof that gender is a social construct; there are not "only" two sexes, and therefore not only two genders, either. Sex/gender is a spectrum, rather than a simple either/or. Whether you look at physical characteristics, hormone levels, or chromosomes, there is more variation than the dichotomous "female" and "male" categories we are taught.

And so, if sex and gender are divided rather arbitrarily into different categories, than it makes no logical sense to treat people differently or give people different privileges or limitations based on their sex or gender. This is what feminism is - an insistence that woman and men should have equal rights and equal opportunities. Women and men should earn equal pay for equal work, should be treated with the same dignity and respect, and should feel valued and safe in whatever realm of society they choose to inhabit. 

"Woman" and "man"; "female" and "male" - these are just words, just labels that we came up with in an attempt to understand our world. Their definitions can change, just like any word evolving over time. Furthermore, new words can be added to the lexicon if needed (and I would argue - they are needed). There should not be any controversy in this - it is just people trying to explain their experience, use words carefully and conscientiously, and have some say in how people are or aren't labeled. There is no harm to it, and in fact often a great deal of good. Discovering who you are and who you want to be, and being allowed to define yourself as you see fit, are important aspects of being human and being free.