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It is commonly estimated that one in four pregnancies fails to thrive, and ends spontaneously in a miscarriage — most before they have been revealed to the world, or even suggested by the hint of a pregnancy bump. This can be emotionally devastating. And yet despite its prevalence, we have been long unable to talk about the psychological impact of miscarriage in any adequate breadth or depth.

Until the 1980s, there was a tragic lack of research interest into the psychological and emotional impact of the loss of a baby during pregnancy or during or after birth. Women had long been expected to endure all sorts of pain and suffering as an intrinsic part of their reproductive lot, and the loss of a baby at any gestation was a part of this. But miscarriages were also silenced and ignored, because it was assumed that a woman couldn’t bond with her unborn baby in the way that she actually can and often does, as I know from my work as a psychotherapist. While it may have been conceded that a woman might be more upset if a baby died later on in gestation, it was long thought that she shouldn’t really grieve for a pregnancy that hadn’t confidently established itself. One of the first influential research papers on the subject of a woman’s relationship with her unborn was published in 1970.

Its authors, Kennell, Slyter, and Klaus, wrote about the responses of mothers of babies who had died at birth, and suggested that their obvious grief provided evidence that a relationship could exist between a woman and her baby during pregnancy. Its summary paragraph states, with a subtle note of surprise, that of the 20 women interviewed after the death of their newborns, “every mother mourned even when her baby was nonviable and lived for only an hour.” Around the same time, two physician‐psychoanalysts at London’s Tavistock Clinic, Emanuel Lewis and Stanford Bourne, began publishing a number of articles in medical journals about their concern for the emotional health — and wish for better care — of women who lost their babies at birth. Although they explicitly cautioned that miscarriage shouldn’t be “magnified into a catastrophe,” believing that a woman’s resilience after an early loss would be greater, their pioneering and compassionate work paved the way for new thinking about how women related to their unborn babies of all gestations.