Commentary Maternity and Birthing

I Had a Miscarriage—and Needed the Help a Doula Could Provide

Yamani Hernandez

Why aren’t more providers telling us about doulas in our times of need?

My Christmas Day this past year started out lovely. I have always been ambivalent about the holiday, having grown up Buddhist and with a birthday the day after Christmas. However this year brought a few blessings: It was my year to have my children as outlined in my divorce decree; my sister was in town with my nephew and hosting dinner at my house; and I had very recently learned that I was pregnant.

While this was very much a wanted and planned pregnancy, it seemed serendipitous that it came in time for my 40th birthday, the mystical deadline age for pregnancy after fertility has taken a nosedive. I’d made it just in time; everything seemed to be falling into place.

Being the mom of two now 17- and 12-year-olds has been my greatest joy. But for many years, I’d waited and pined away to friends about having another baby. As a trained doula and reproductive justice expert, I couldn’t wait to be giving birth and parenting with the knowledge and wisdom I have acquired since my last pregnancy. At the same time, my relationship status with my would-be co-parent had been alternating between deep love, friendship, and profound differences in values that would require an entire book about self-worth to describe. Even though I know intimately well that babies don’t save relationships, this seemed to finally be a resolution to the perpetual uncertainty. More than the wedding guest list document we’d created, this was permanent. Or so it seemed.

We picked first and middle names—names that held deep historical and familial significance; that honored a lynched ancestor and a child friend gone tragically too soon; and that, for me, signified reverence, rebirth, and legacy. I looked forward to calling those names each day in libation with someone who I loved with every fiber of my being and who I’d hoped would finally be my partner for life. For me, having this baby was going to be a healing balm. But the universe had other plans.

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I’d been having some spotting the entire pregnancy and a few days earlier at my birthday party I’d been extremely dizzy. I chalked it all up to an overzealous wardrobe choice—my leather birthday party pantsuit—and assumed it was ongoing implantation bleeding as I started scouring Pinterest boards, buying onesie versions of my favorite movement t-shirts, looking for new places to live, and thinking about how I would tell my sons and my existing co-parent.

Life was going to change in a lot of ways for everyone and my head and heart were full of dreams of everything I’d “do better” this time. But a few days after my party, after a glass of hibiscus tea, my spotting turned to bright red blood and I knew something was wrong.

I got dropped off at the emergency room at 8 p.m. by my sister, who had the flu and was not well enough herself to stay. I was there for five hours of continual bleeding with nurses and doctors who seemed to treat this like this devastating loss was inconsequential. Doctors or nurses who likely didn’t want to be there on Christmas night, didn’t reach out to touch or console me, and said very sanitized things like, “No, you can’t see the ultrasound” and “You’re having a threatened abortion,” which was confusing to me, even as a person who works on abortion every day. Another friend picked me up and took me home.

I ended up at the hospital because there is a two-month window in “early” pregnancy during which virtually no provider will see you if you’re carrying your pregnancy to term, aside from confirming the pregnancy via a blood test. Most providers will tell you they won’t see you until eight weeks because the risk of miscarriage, also known as spontaneous abortion and pregnancy loss, affects about a quarter of pregnancies before then. This two-month period without explicit care can be confusing and agonizing for many people, and I was no exception.

It turns out, if you’re in the midst of losing a pregnancy in this window, it can also be hard to be seen by a provider as well. It’s a gap in care and, looking back, I wish I had a doula during that time. Friends offered groceries, sent flowers, and other care packages. But the kind of care I needed was the care of a doula, partner, parent, or other elder. I needed a loyal and reliable person who was committed and focused solely on supporting my physical and emotional healing. Some may find this in a partner, but this kind of support is not something everyone has access to in a mutual storm of grief, pain, anxiety, and insecurity.

A doula could have calmed me and reminded me that miscarriage is an invented term to describe the biological process of expelling a pregnancy without the political baggage and stigma. They would have reiterated that a “threatened abortion” is not final and there’s a small chance the pregnancy can survive. Though mine lasted several more days, the pregnancy ultimately ended. A doula would have helped me create an after-care plan and coordinate it with the other people who were willing to help.

So I’m left wondering: Why didn’t the hospital staff or other providers with whom I came into contact make that suggestion in my moment of need, when they saw me alone in the hospital for five hours on Christmas? When all of the training and education I had received over the years failed to activate in my mind, why couldn’t they have been the strength I didn’t have? For others who may find themselves in the gap of care before having a birth doctor or abortion provider, I am calling on health-care professionals to take some responsibility for the ways in which the needs of people experiencing miscarriages are overlooked. If you cannot address our concerns, recommend someone who can.

Pregnant people experiencing a miscarriage need an impartial and nonjudgmental party or an elder who has seen this before and knows what a grieving person needs and can provide it. Doulas can serve this function during birth, postpartum, and even during abortions. They understand that a few weeks after a pregnancy, no matter the outcome, a person’s mental and physical health need continuing and careful attention.

Unfortunately, my already years-unstable relationship ended abruptly, and for the last time, just three weeks after my miscarriage. It was on the day I got a memorial tattoo for our “peanut.”

On the day before my new tattoo, I found out I had a uterine tumor. My OB-GYN, who I had been seeing each week, casually mentioned the tumor on my ultrasound, saying, “lots of people have them.” But they didn’t offer monitoring or a treatment plan despite the pain that has followed since the discovery.

I did go to grief counseling at the Chicago-based Blossom Method, an amazing place focused on pregnancy loss. It’s where the person whom I thought had intended to be my partner broke up with me during our third session, as we contemplated trying to conceive again. For him, my existing co-parenting obligations and my inability to center his feelings about them during the miscarriage infringed on his ability to feel “happy, loved, and respected” in his life with me.

I continued to go to Blossom Method and it was my saving grace for many days. But I also needed the things that I had done in the past as a doula that I could not say yes to or coordinate on my own amongst friends who offered to help. I needed to be able to not be functionally OK every day and for someone to hold space for that with me. I needed meals, back rubs, help breathing through episodes of anxiety and depression, someone to watch and entertain my kids and take them to and from school for weeks. I needed to be able to sob in bed and be held and be able to count on care without having to be graceful or in charge for once. I was unprepared for the extent of physical incapacitation that I experienced while my hormones dramatically changed and I bled for nearly 30 days.

Instead of a doula, every pregnancy and miscarriage message board site was my best friend in trying to cope with and understand what my body was going through. I would have loved a person who would’ve provided that educational and informational and emotional support instead.

It’s been three months and neither my body nor spirit has been the same. My once asymptomatic periods now feel like I’m being split in two and I’m still devastated by the loss of that particular pregnancy, the opportunity for a pregnancy at my age (though I know the facts and that one could still happen), and the abandonment of a love of my life at a vulnerable time. Each month that I see blood, I feel a mixture of retraumatization from the initial sight of blood following the pregnancy test and desperate hope that my tumor has disintegrated and is leaving my body.

As the end of World Doula Week nears, I wanted to highlight how despite the many gains our society has made in increasing access to doulas, we still have a great distance to go, speaking from personal experience. I have had four pregnancies: one resulting in an abortion, a vaginal birth, a cesarean section, and now a miscarriage. In all cases I had had theoretical and book knowledge, but I had no idea what to expect from my body in the moment. I believe that I would have made different decisions and experienced less trauma with the support of a doula.

A doula’s role is explicitly and exclusively to provide emotional support to a person navigating pregnancy and its outcomes. So why aren’t more providers telling us about them in our times of need?

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