Opinion: The problem with ‘bereavement’ leave after pregnancy loss

Last month New Zealand broke new ground with a national policy of “Bereavement Leave” following miscarriage. This is a welcome development for all who care about workers’ well-being and workplace equity. But post-miscarriage leave policies need a different name. A language of “loss,” not “bereavement,” would better support the full range of experiences and understandings of miscarriage.

The term “bereavement” dictates a particular emotional and existential interpretation of what is in fact a complicated and ambiguous event for many who experience it. Putting the term into policy unnecessarily imposes a single interpretation, forecloses other possibilities that carry less emotional burden, and may even impose a new burden of guilt and shame on those who seek a different way to understand miscarriage.

“Bereavement” is a word used to describe what occurs after the death of a loved one. For some people, this describes their emotions and their interpretation of the situation after an early pregnancy loss. For others, the loss of a wanted pregnancy may be sad and disturbing, but not equivalent to the death of a child. Pressuring those people to accept this interpretation may exacerbate their distress.

When a friend or acquaintance of mine suffers a miscarriage, I always say, “I’m sorry for your loss.” This phrasing, commonly used for condolence messages, appropriately acknowledges the gravity of the situation for someone who regards their miscarriage as the death of a child. But it also holds space for other experiences of loss: the loss of a dream, or possibility, or expectation. It can acknowledge disappointment and sadness that may not be bereavement, but is nonetheless real and deserves recognition.

Historically speaking, regarding a first-trimester loss as the death of a person is quite new. Throughout most of history, “quickening,” or the pregnant woman’s feeling of movement in her belly at around four months, marked the moment when a fetus was considered to be an “ensouled” child. Through the Middle Ages, natural philosophers (the precursors to scientists) regarded an embryo as a person once the body was fully formed and recognizably human. Until the 19th century, physicians generally understood early losses as misbegotten pregnancies rather than stillborn children.

A host of cultural and technological innovations have radically reshaped our experiences of pregnancy over the past century or so. Since the 1920s, advocates of modern prenatal care have focused attention on early pregnancy and turned illustrated fetal development timelines into a tool for encouraging bonding, not just science education. Starting in 1960, the birth control pill gave Americans a reliable and precise tool for preventing unwanted pregnancies, which meant that pregnancies were much more likely to be planned and welcomed.

Ultrasound scanning of pregnancy became routine in the 1980s, creating a new pregnancy ritual of “meeting the baby” via scan, and in the 2000s, that ritual was transplanted onto a new routine scan at around 8 weeks’ gestation, when the miscarriage rate is still high. Home pregnancy tests, introduced onto the American market in 1978, have become more and more sensitive, catching so many unviable pregnancies (many of which in previous eras would have gone entirely undetected) that a person who tests at the earliest possible moment has nearly a 1 in 3 chance of miscarrying.

Marketers have taken every opportunity to hype pregnancy in recent decades. They have worked to reach potential customers ever earlier in their pregnancies; in the scramble to beat out competitors, they have raced nearly all the way back to conception, offering due date calculators and soliciting pregnant people’s emails from the moment they have a positive home pregnancy test. Today’s pregnancy advice is largely hosted on advertising-driven websites and apps that have a strong incentive to encourage couples to become emotionally attached to their pregnancies right away, so that they will spend lots of time on the websites, dreaming and shopping.

The result of all of these cultural and technological transformations around pregnancy is that even very early pregnancies feel more “real” to many of us than they did to our great-grandparents or even our parents. That means that for many of us, when we miscarry, we experience the grief of bereavement.

Some couples may accept this new cultural understanding of pregnancy and find valuable emotional support in understanding their sadness after miscarriage as bereavement. Others, though, may wish to hark back to a not-so-distant past, and regard the loss as a disappointment but not a death. In my case, my husband and I took consolation in knowing that my miscarriage would have been considered a false start rather than a deceased family member by our forebears.

Whatever a couple’s experience, some time for self-care and healing after a pregnancy loss is valuable and important. As governments and corporations consider following New Zealand’s lead, they should create policies that provide “leave for recovering from loss,” so that our legal frameworks do not trap us in just one definition of a complicated and difficult experience.