The Brink of Being: Talking about Miscarriage

ISBN 978-0-349-01076-2, £18.99, Julia Bueno

Life begins at conception, the Korean traditional practice of ‘Taegyo’ tells us. It is one of many worldwide examples that the author includes – one senses – in an effort to broaden our lingering and shameful Victorian outlook when it comes to certain types of grief. The indigenous Maori of New Zealand say pepi (preborn child) and Japanese Buddhists mizuko (water baby), but while these endearing names offer respect to the fetus or as-of-yet unborn child, it is the Tamang women of Nepal who afford unflinching dignity, openness and pride to their reproductive experiences.

“Ask a Tamang woman how many children she has and she will answer accounting not just for her living children, but for all the miscarriages, still-births and other deaths in between”. This beautiful piece of anthropological fieldwork unearthed by Bueno from the writings of Kathryn March appears two-thirds of the way through Brink of Being and serves to remind the reader of our comparative failings as a culture/society, our entrenched beliefs regarding bonding and our general insensitivity around loss.

We have “no culturally accepted script” for miscarriage (once uncomfortably called ‘spontaneous abortion’) or still-birth; cancer – yes, old age – yes, terrible accidents – yes, but not one of the most heart-breaking, lonely and crippling episodes of a woman’s life (and her family’s).

Bueno’s quite phenomenal work – thorough, accomplished, bible-like and genre-defining – seeks to correct this. She doesn’t simply produce six seamless chapters concerning ‘A Child in Mind’, the derailing of dreams, conspicuous absence, recurrent miscarriage, the ripple effect on one’s family, and the ‘Pressure to Forget’, but rather sinks herself into a very personal journey whilst tying together an incredible array of research, statistics, stories, memories, medical/institutional malpractice and history (people who, from the 1970s and 80s, have thankfully highlighted the misguided, ill-considered and downright uncaring habits of hospitals).

The ‘psychological sequelae’ or consequences of miscarriages are said to include grief, anxiety, depression and post-traumatic stress disorder (PTSD evident in 39% of participants according to one Early Pregnancy Unit study), yet a mere thirteen years ago the then-called National Institute for Clinical Excellence (NICE) advised medical staff that “Mothers whose infants are stillborn or die soon after birth should not be routinely encouraged to see and hold the dead infant”.

It is this blinkeredness which clearly startles Bueno despite her admirably restrained tone throughout the book; physician-psychoanalysts Emanuel Lewis and Stanford Bourne writing a series of letters and articles in journals a good three decades before the NICE 2007 guidelines with Lewis suggesting that Freudian ideas around not seeing one’s baby would hugely hinder rather than help the mourning process (the unthinkable “’rugby pass’ management of stillbirth” rapidly removing the baby from the labour room – permanently away from its mother).

Cass, husband of Lucy, and part of the couple central to Bueno’s work – describes their second loss in just a few months: “No heartbeat…I was struck dumb…The sonographer turned the screen off and left the room…[Cass helped Lucy get dressed and then held her back when she tried to turn the screen back on]”. It is this disbelief, this wrenching reality, this sharing which informs the reader and “gives permission for the telling of other miscarriage stories” thus normalising this oft-unspoken grief.

“Only one person asked how I was” Cass revealed during therapy months after “…and then didn’t wait to hear my full answer”. If therapy is anything, it is this – a full answer; un-hushing one’s experience as Bueno cleverly and delicately alludes to in her campaigning.

This review was first published in Private Practice, June 2020 issue, © BACP


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