Abstract
We do not speak openly and honestly about the physical and emotional pain of miscarriage, which significantly affects women’s experiences. Early miscarriage is pregnancy loss before 20 weeks’ gestation (∼10–20% of known pregnancies; Mayo Clinic, 2020), while late miscarriage (i.e., still birth) is loss after 20 weeks (∼1 in 160 pregnancies in the United States; Centers for Disease Control and Prevention, 2020). In The Brink of Being: Talking About Miscarriage, psychotherapist Julia Bueno (2019) challenges norms of silence and invites the reader to learn, develop compassion, and become curious about miscarriage. Although Bueno attends to early and late miscarriage in separate chapters, where she delves into the significant differences in treatment and care that women receive, she also uses the term miscarriage to encompass both early and late experiences. I will do the same in this review.
In her introduction, Bueno provides a context for her use of the word “baby” instead of “embryo” or “fetus.” She acknowledges that using baby to describe early pregnancy loss can conflict with feminist and pro-choice perspectives (Bueno, 2019, p. xxvii). She chooses to use baby because it is the term her clients use the most, and like other scholars (e.g., Layne, 2003, as cited in Bueno, 2019), she argues that personhood is culturally and individually constructed. For example, Bueno argues that women have the ability to envision, even have hopes and dreams for, a child that has not yet come to be. They can build relationships and bond with the “child in [their] minds,” the one that is hoped for, even the one that was “barely conceived” (p. 1). Therefore, this “child in [their] mind”—no matter the gestation—can be a child, and mourned as such. Using baby centers the reality of women who are grieving. Bueno wholeheartedly validates these losses that are often ignored because of the lack of open discussion surrounding miscarriage.
Bueno’s subsequent chapters reveal the depths of early, late, and recurrent miscarriages, which are heavily medicalized, yet health care professionals seem woefully underprepared to support patients. Also described is the impact of miscarriage on partners and support networks and the lack of empirical research in this area, especially with regard to LGBTQ+ folx. In Bueno’s final chapter, she describes the importance of remembrance, whether it be a funeral, memory box, memorial, or some other creative ritual. Because there is so much pressure for women to forget and move on, Bueno acknowledges how difficult it is for women to honor and remember their loss in a way that supports their grief process.
Bueno fulfills her promise of writing honestly, including details about physical symptoms, emotional devastation, and postmortem decisions. She shares her own intimate experiences with miscarriages and weaves in narratives she has heard within and outside of the therapeutic setting. Although Bueno mentions having heard hundreds of stories, there are only a few shared in detail, leaving the reader wondering how these few stories compare to the hundreds of others. There is no formal analysis, and demographic information is rarely included, making it difficult to understand the sociocultural context. There are many interesting historical references; however, they sometimes interrupt the emotional impact of the narratives.
The Brink of Being was appropriately written for those affected by miscarriage or those who simply want to learn more. Bueno’s truthful declaration that miscarriage deserves the attention that all other deaths receive will be validating for many. Health care professionals working with women who have experienced miscarriage, child loss, or infertility will also gain more empathy for their patients from reading this book. Bueno includes tangible ways in which doctors and support networks can support women experiencing a miscarriage. Advocacy groups and researchers are working hard to create more resources for women. Meanwhile, we can show up for women with compassionate curiosity, for they lost someone they loved who was on the brink of being.
