Interview with Dr. Jessica Zucker

Last year I was thrilled to find out that I would be an aunt to another beautiful baby boy. His parents, along with myself and everyone else who knew about the pregnancy, began to plant little seeds of hope and expectation for this new life that would enter the world with nothing but endless opportunity. Because to me, and so many others, pregnancy = baby. What I mean to say is that when I know that someone is pregnant, I automatically think that this person will push out a little ball of life and everything will be okay. What I didn’t know is that 20% of pregnancies result in pregnancy loss. I was shocked when I got the phone call that my brother’s wife had miscarried. There was no explanation. One day she was pregnant, and the next she wasn’t. And that was it.

Dr. Jessica Zucker is a clinical psychologist that specializes in women’s reproductive and maternal mental health. She has written extensively about many topics regarding women’s health and is now putting tremendous effort into shedding light on pregnancy loss, a subject that is uncomfortable for most and often just not talked about. After experiencing a miscarriage herself, Jessica decided to launch a line of cards and the #IHadAMiscarriage campaign. While the campaign encourages women to share their stories and creates a sense of community amongst those who have experienced pregnancy loss and even those who haven’t, the cards also bridge a communication gap between a woman experiencing loss and those who want to be supportive but might not know quite what to say.

Were you always aware that you wanted to help other people in your career?

I knew from a pretty young age that I wanted to do something that was about interpersonal community level change. I was passionate about change and about social justice. When I was an undergraduate student  (I was a psychology major) I read Dr. Carol Gilligan’s book  In a Different Voice. (This is a gender studies book published in 1982 that sets out to refocus the view of the female personality and female moral development.) Her perspectives awoke something in me that was profound. It lit a fire and took me in a direction that looking back now set me on my path dedicated to women’s health and female psychology. After college I spent a year in Israel on a social service program. That experience inspired me to pursue public health and piqued my interest in global women's reproductive health issues more specifically. Soon thereafter, I pursued a master's degree in public health with a focus on international health and even more specifically on reproductive rights and women’s health.

Was there a specific moment when you realized you wanted to specialize in women's health?

I was naturally drawn to women's health issues. The things that I was reading and writing were very much connected to women's health and specifically to women’s reproductive health. While doing my masters degree, I did an internship at Mount Sinai Medical Center in New York City working with teenage mothers. Another part of my internship while completing my master’s degree was spent at Planned Parenthood.  Years later, when I was pursuing my PhD in clinical psychology and putting my thoughts together about what I wanted to specialize in, it seemed like a perfect opportunity to marry my public health background with my psychology degree--to be able to do similar work but on an individual level, and have the opportunity to work one-on-one with women - with a focus on female identity development, fertility, pregnancy, pregnancy and baby loss, perinatal and postpartum mood disorders, postpartum body image concerns, etc.

There's a lot of taboos surrounding pregnancy loss and the conversation surrounding a loss. Where does this come from?

Part of this taboo stems from living in a culture that is not well-versed in actually being compassionate and supportive in an ongoing way after someone has experienced hardship, particularly an out-of-order loss like a pregnancy or baby loss. It can be tough to know what to do or what to say after losses like these occur, but I think it behoves us as a culture to try. To stretch. To challenge ourselves to support one another in an even more loving way.

With your pregnancy loss cards you are addressing this taboo and challenging it in order to create conversation. Why did you decide to make these cards and what was the process like?

I specialized in women’s reproductive and maternal mental health long before experiencing my own 16-week miscarriage. In my practice as well as in the literature, research has found that a majority of women who lose pregnancies tend to blame themselves, feel ashamed, and tend to feel guilty about the loss of their child. They think that somehow they did something wrong or did something to deserve this loss. Approximately 10-20% of clinically recognized pregnancies result in loss, but even if you are aware of these statistics, when it happens to you it feels shocking and devastating. One woman might have a six-week loss and move on and not have residual feelings about it whereas another woman might have a six-week loss and be completely devastated. Loss has the potential to stir up very different things for different people. This is why it is that much more important that as a culture we create a conversation that includes all perspectives and works to listen rather than assume or potentially minimize experiences.

Soon after my 16-week pregnancy loss I started writing more from a personal perspective about the pain and the social etiquette of pregnancy loss. Because of my profession, and my relationship with my patients I wasn't quite sure how comfortable I felt putting my own story out there. I realized that because there's no shame in pregnancy loss, and because this is something we shouldn’t be quiet about, I should be an advocate and insodoing, share my story as a way of modeling that there is NO SHAME in losing something longed for. Soon thereafter, I launched #IHadAMiscarriage campaign with my first New York Times piece. A viral essay and campaign. I decided to share my story and ask people to join me in sharing their stories, and for those who would prefer not to share, I hoped that seeing the sheer numbers of people who have experienced loss would help women feel less alone, less isolated, in seeing that approximately 1 in 4 pregnancies result in loss. It was a call to action. In being more open about loss we help shift the cultural ethos of silence and shame. We can help melt this into something more productive and more profound.  I wanted to model this idea that that there's nothing to be ashamed of, this is not something we need to be quiet about, this is not something we need to minimize.

I created a line of cards that would help people connect after someone has experienced loss. Right now I have 11 cards that appeal to varying demographics. The through-line is trying to convey a sense of consistency in care as well as the range of potential feelings that arise after pregnancy or baby loss.  

What has the community response been like to your campaign? do you feel that women are being more open and empowered about their experiences with loss? is it accomplishing the goals you had in mind?

The response to the #IHadAMiscariage hashtag campaign as well as the pregnancy loss card line has been incredibly powerful. My work joins the work of other women and organizations around the world aiming to normalize grief and de-stigmatize pregnancy loss. If my work can impact culture even just a little bit then I have reached my goals. From the feedback I continue to receive, it seems like women feel a greater sense of support having received the messages included in the pregnancy loss cards.

My hope is that my children, if they have children, grow up in a society where talking about pregnancy loss is as normative as talking about what they are going to have for dinner. In other words, talking about loss, though potentially uncomfortable and sad, is something we would benefit from getting better at since it's not going anywhere. We can de-stigmatize this important conversation by daring ourselves to be less afraid of a normative life event.

So with the hashtag and the social media and all the things that are happening online do you feel like this is a safe space?  Have you experienced any negative cyber activity related to your work?

I have not had that experience at all. I made a card that says “Fuck Loss”  and some people love it and some people don’t because they’re like “how can you say fuck?” What I wanted to do with that card is help to normalize the emotion of anger because it can be part of the process of losing a pregnancy/baby. In our culture we’re not necessarily very adept at handling anger or allowing it to be one of many emotions that is likely to arise during a grieving process. But, from my clinical experience, it is quite clear that anger is normal and an expectable part of the mourning process and therefore something we benefit from discussing more easily in our culture.

One word that keeps coming up in my mind is privilege. Does this apply to pregnancy loss?

Privilege and other things like educational background, race, class, age, etc do not create a "healthy" or “unhealthy” pregnancy. A majority of miscarriages are due to chromosomal abnormalities.   This just happens. This isn't something we can change because we come from privilege or have an extensive educational background.  Pregnancy loss is not altogether curable. It will continue. And this is partly why I am wholeheartedly dedicated to this women’s health issue and the grief that can follow.

So what do you have planned for your advocacy in the future?

For now I’m focusing on pregnancy loss. I’ve written extensively about other women's health topics such as sexuality, perinatal and postpartum depression, perinatal and postpartum body image, etc... But right now I want to primarily stick to exploring pregnancy loss because I feel like we need to talk about it over and over again, in all different ways, from all sorts of angles. It’s not enough to say there shouldn't be stigma or shame. It’s not enough to make a hashtag. This needs to be a global conversation aimed at helping women and families feel more at home in their bodies as they navigate these challenging experiences. This is a topic that needs to be talked about without fear or shame. People need to know that this happens, have the resources to deal with it, and the support they need. Loss isn’t going anywhere, so we would benefit greatly from getting better at dealing with it. My hope is that the pregnancy loss card line provides a meaningful and concrete way to do so.