Kate Clancy on Her New Book: Pregnancy Interrupted: The Science and Stories of How Pregnancies Really End

Trigger Warning: Miscarriage and Pregnancy Loss

“One of the most prevalent myths about human pregnancy is that of all possible outcomes, a baby is the most likely. Pregnancy Interrupted challenges the misleadingly linear narrative that begins with two lines on a pregnancy test and ends with a newborn. Kate Clancy shares her own deeply personal stories of pregnancy loss and moving interviews with others, and reveals how the frequency of loss and miscarriage is far more common than most realize.”

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Pregnancy Interrupted: The Science and Stories of How Pregnancies Really End
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Transcript

Jennie: Welcome to rePROs Fight Back, a podcast on all things related to sexual and reproductive health, rights, and justice. [music intro]

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Jennie: Hi, rePROs. How's everybody doing? I'm your host, Jennie Wetter, and my pronouns are she/her. So, y'all, I told you that I was going to try and hit some of the AMA questions that I didn't get to previously, and I have a book related one, and that felt perfect for today since we are talking about another book. But somebody asked me if I had a month of time off and I could go anywhere I wanted and had, like, a box of books with me. Like, where would I go and what would I take? So, I had a couple of thoughts. So one, I'm feeling a little homesick and, like, I would love to spend some time in Wisconsin. So, thinking of, like, going to my mom's house and spending some time there, but I also really have a love of just going to like a nice resort and laying on the beach and having like frozen drinks and reading, and that just is like perfection. So, I'm kind of thinking of that as well. What books would I take, y'all? This is like such a hard question for me. I am a person whose TBR is endless. So, I was doing a little bit of looking on that to see what I would take with me while I was away. So, one of the ones I've been thinking of is I really want to catch up on The Unselected Journals of Emma M. Lion. I like powered through the first like six, I think, and I have not finished. I'm trying to savor it. There's only eight out right now. There's gonna be 24 when it's done, supposedly. So, I'm trying to not read it all right away. I would like to read books seven and eight. Hopefully, you know, get all the rest. The next thing that I was thinking of is actually a book I finished this weekend, which is The Knave and the Moon by Rachel Gillig. It is part of her Stonewater Kingdom duology, and it is maybe a perfect duology. I loved both books. There were tears, there was, it was just so delightful and highly recommend for people who like fantasy. So definitely check that out. I also have books that I've been like have started the series but maybe haven't finished. So, The Tapestry of Fate Book, which is book two and The Adventures of Amina al-Sirafi by Shannon Chakraborty. And I really loved book one, and book two has been out for a little bit, but I have not read it yet. So, I really would like to read that soon. I also thought This Kingdom Will Not Kill Me by Ilona Andrews also sounds really delightful, and I can't wait to read that. I feel like I've also had I, Medusa by Ayana Gray on my TBR for a long time. So, I would definitely take that with me so that I could finally get it read. Tempest by Victoria Aveyard just came out, and I really want to read that. It's like a pirate fantasy, which sounds absolutely delightful. I think it sounds it it's being billed as a little bit like Pirates of the Caribbean, which sounds like a lot of fun with uh some romance and pirates. It sounds delightful. I can't wait. I've also been wanting to read Blood Over Bright Haven by M. L. Long. So, that has been sitting there for a while, so I would take that with me. I also feel like I've had a Chloe Liese's book sitting in my TBR for a while called Happy Ending, so I really need to read that. I really love her books, and I just haven't read it yet. And same, I've been sitting on Heir by Sabaa Tahir for a long time, and now the second book in that series, Empire, just came out. So, I would take both of those so I could read them. Honestly, y'all, I have so many books on my TBR, and I’ve been really trying to not buy more so I could read down what I have on my e-reader. But Barnes and Noble had like 25% off pre-order sale, and so there were like a bunch of books that I'm gonna buy anyway. So, I went and bought pre-ordered a bunch again, which I probably shouldn't have, but y'all, they weren't on sale. So, my TBR has gotten exponentially longer. But yeah, I'm sure I have more. This is why I have an e-reader when I go on vacation, y'all. Because if I have to take physical books with me, my suitcase would be all books. But with my e-reader, I can have hundreds on it and can read them. So, those are the ones I was thinking of taking with me on vacation. So yeah, I think that is a good segue into today's book. And I am gonna start by saying, y'all, this episode probably needs a trigger warning. We are talking about miscarriage and pregnancy loss. And if you are not in a place to hear those topics today, we'll see you next time or come back later. But it's a really great conversation with Kate Clancy. She's the author of a new book called Pregnancy Interrupted: The Science and Stories of How Pregnancies Really End. We have a really wonderful conversation, and I think it is definitely worth checking out. But I understand if that is not something you are in a place to listen to right now. So, with that, let's go to my interview with Kate. Hi, Kate. Thank you so much for being here today.

Kate: Hi, Jennie, thanks for having me.

Jennie: Before we dig into your book, would you like to take a second and introduce yourself?

Kate: Sure. My name is Kate Clancy. I'm a professor of anthropology at the University of Illinois. I'm a biological anthropologist who studies uteruses, menstrual cycles, has spent a lot of my career studying the non-pregnant uterus, though I also have a very big part of my lab that also has historically studied sexual harassment in the sciences and in academia more broadly.

Jennie: Wonderful. Yeah, reading your book, it made me want to go read your other one on the period. So, definitely might have to dig into that. Although I'm perimenopause, so maybe I'm, like, past that time where I need to really focus on it.

Kate: But I think it's never too late to study periods. I'm perimenopausal too, so I hear you.

Jennie: Yeah.

Jennie: Okay, I am very excited to talk to you about your book. This is something we haven't talked about a lot on the podcast. So, I am very excited to, I mean, I guess excited. Oh, it feels like a wrong word for a heavy topic, but I am excited to dig into the topic of miscarriage and pregnancy loss. And I think one of the things that really came through in your book was like the hard hardness of drawing lines around all of this. Maybe that's the place to start of like getting a better understanding of miscarriage. I think you also talked about media portrayal. So, I think all of that kind of leads into the— what are we actually talking about?

Kate: As someone who's been a scientist, right, for I mean my entire adult life at this point, I'm actually very comfortable, and I think most scientists, most people who practice science and it's a part of their daily life, are very comfortable with uncertainty. We're very comfortable with complexity and not knowing the answer to things. And in fact, that's kind of the joy and the gift of being a scientist, is that things are actually quite messy. At the same time, when we then try to explain our science or write it up for publication or translate it into clinical work, we start imposing all sorts of things on our science. So, while tons of people will very readily say, you do not know very much about what's gonna happen in a pregnancy by looking at a three-day embryo, we then have to grade them if we're in an IVF situation, right? And some embryologist is looking at these three-day embryos and saying, well, which one is gonna make it to five days? Which one is high enough quality at five days that it's gonna make it if implanted? And we start telling stories that are not as predictive as what we're sort of making them out to be. And so, these progress narratives and these certainty narratives get layered on top of what we all know is like a whole bunch of uncertainty. And so I think that one of the fundamental issues we have with pregnancy is that we narrate it as a stepwise process that starts with gamete fusion that leads to a successful embryo, that leads to a successful implantation, that leads to successful placentation and growth and becoming a fetus and becoming a full-term baby and being born, as though that is the common narrative, when I think it might actually be the least common, or at least one of the less common ones.

Jennie: And it's sometimes it even feels like more than that, right? It feels like it's the narrative, right? Like this is the way it happens, and it makes people who don't experience that feel often stigma and and and shame if their narrative isn't the same.

Kate: I think it can be shocking even, right? The many people who spoke to me who experienced miscarriage or stillbirth experienced shock when it happened to them. Like, why, and a lot of like why me, which then internalizes the experience. So, when you have an experience that people have told you is not normative or you've never been told might be common, instead of externalizing and saying, what are the factors outside in the world that might have led to this phenomenon or made this more likely, or what kind of crap luck just made this happen, you turn inward and your first thought is, well, what did I do? What have I done wrong? What did I how did I misspeak? How did I move wrong? What did I eat wrong? Did I have one drink before I knew I was pregnant? Did is that what set us on this terrible course? Right? And you immediately turn it inward. It actually reminds me, you know, I mentioned at the beginning that sexual harassment and studying is something that my lab also studies. And that's in a lot of ways like an environmental variable, right? And environment is sort of the thing that dictates a lot of my work. It's like, what are the things outside of the body that have impacts on the body? Because that counteracts the narrative we often have about menstrual cycles, which is what is it about menstrual cycles that are ruining your life? And it's like, well, what is it about the environment that affects your menstrual cycle? Let's ask that question first. So similarly, sexual harassment, we have this one paper that came out a number of years ago where we did focus groups with women of color and uh women of color who were science faculty. So, you can imagine that they have mostly fairly isolating experiences where they're the only woman of color in their department, or in some cases they were one of a couple. The women who were the only in their department would experience racist sexist behavior and internalize it, and they would say, well, this must be happening to me because my pedigree isn't as good, or this must be happening to me because I was the diversity hire. Like they tell these stories about themselves that are absolutely not true, but that they've convinced themselves of because they're all alone. And nobody, and so they start to see this as, well, I'm having the non-normative experience because I'm the problem. Whereas the women who had at least one or two other buddies, they had a text, you know, a group chat, they had a set of friends, they had people they could check their thinking with, were better able to recognize racist, sexist behavior as external to them. Like, no, it's not that I'm a bad person being targeted, it's I'm being targeted because that person's a racist jerk. Right? You can say the problem's not me. I'm having what is maybe a what is not a non-normative experience. I'm talking to my friends and they're all having this experience too. There go. I can now conclude the problem's not me. The problem is all you jerks. And so, I think again, like with miscarriage with any of these stigmatized experiences, if you don't have someone to check with, you turn inward and you blame yourself. Whereas if you recognize the commonality of your experience, you can start to identify the external factors.

Jennie: Yeah, I was thinking of that of basically just what you said with the sexual harassment study is the thinking that for so long miscarriage was one of those things that was in silence, right? Like, you didn't talk to people about it. So, then it makes it easier to then blame yourself because you feel so alone. So, it's clearly something I did because you're not hearing about all of these other experiences that may be similar to yours.

Kate: The other thing that really struck me, I interviewed a ton of experts. I actually was trying to figure out because I have to ship out free copies to the many, many people who helped me with this book. And I think I came up to a count of 52 people I spoke with for this book, about two-thirds of which were experts, and about one-third, well, everyone was an expert, but one third who were who had lived experience expertise, and two-thirds maybe scholarly expertise. And all of those folks with the lived experience expertise who had been through miscarriage or stillbirth, I think every single one of them said, you're the first person who's asked me about this. These are people who have partners, loved ones, sisters, mothers, best friends. And in no case had anyone ever said, tell me what really happened. I actually want to hear it. And in that way, they were desperate to tell me. I was sometimes the very first person who had actually heard from beginning to end that entire lived experience from the moment of finding out to all of the pain and blood and contractions and terror. Not a single other person had ever been witness to that story. And that was actually kind of, I mean, that was shocking to me until of course I realized, well, I've had two failed embryo transfers and told almost nobody. I'd had two bleeding episodes during my last pregnancy, and I had basically told no one. And I realized that, you know, even in my own life, it just I hadn't sought that validation, but also nobody had asked.

Jennie: Yeah, I was thinking about that as I was reading, and I was really struck by the stories, and I'm so glad you incorporated so many stories, but so many of them made me so angry on behalf of the people who experienced them. And I think it ties into something you talk about later in the book, the dehumanization and pregnancy. But just thinking of some of those people who were just the one that just like is burned into my brain is the person who was miscarrying and bleeding, and they just put her in a wheelchair in the hallway and left her there for hours and didn't address her for so long, other than to make sure she was sitting on a pad because she had been bleeding on the chair, and like just horrifying to think that there was so much lack of humanity in the way that that that person was treated.

Kate: Yes. What I'm reacting to is I'm remembering that interview, and I know and care about that person that you're speaking about very much. They're a colleague of mine, and I just remember her tears and my tears during that interview because oh I mean, in all of them we cried. I don't know that there was a single one of these that I didn't cry during it at some point, that I was like fighting to sort of maintain my composure so that they could be the ones to have their feelings and they weren't feeling like they had to manage mine, right? So, I'm, like, trying so hard to not seem too to be compassionate without overdoing it, you know? So, I'm trying to like experience it internally as much as possible. And the just this idea that you could be going through this terrifying, painful experience, bleeding through your clothes, and someone just hands you some incontinence pads and is like, go sit on that wheelchair because we don't have time to deal with you.

Jennie: Yeah.

Kate: And the fact that that's not, again, that that's actually not uncommon. That what I the other thing that shocked me were the number of times I interviewed people and they all described the same number of hours. I was like, people are going to think I'm lying because every single person has a four-hour wait. They're like, I waited for four hours. And I was just like, it's not like I'm going back to the transcripts to make sure I'm not, I wasn't confusing stories, and I was like, no, they all waited at least four hours. And ERs, I get that ERs are busy, challenging places. I'm a fan of The Pitt as much as the next person, but the fact that you could be going through an emergent experience like that, sometimes, you know, if you don't know if that's an ectopic pregnancy or not, the clock is ticking on how dangerous that is to you. And yet you're still waiting for hours to be seen. Like that just seems like a dangerous and terrifying thing.

Jennie: The other thing that really stood out is the chapter where you were talking about the options that people are given and the uncertainty in that process. I think uncertainty seemed to be a very large theme through the whole book. There's just so much uncertainty and people wanting firm answers, but when people were trying to make the decisions about what the right step was for them, that that uncertainty really stood out to me in a number of places. Do you want to maybe talk a little bit about that process?

Kate: Sure. Do you mean like the management options sort of questions?

Jennie: Yeah.

Kate: Yeah. So, there are typically three sort of big bins, and there's variable care within each of these, but broadly speaking, there's three main ways to handle a miscarriage if there isn't some kind of emergent situation that has to be handled within it. One is wait and see, the next is to deal with it chemically with mifepristone and misoprostol, and the third is a surgical option of some type. And so again, there's variability in each of these, but that's broadly the three categories. A lot of people choose wait-and-see because it is the least, it involves the least intervention. And there are good reasons why one might be wary of intervention or uninterested in it. So, it makes sense that a lot of people choose wait-and-see and are just like, well, let's just see if this happens on its own. That said, it is often a relatively painful process that can take a long time. So, unless it sort of starts on its own and does a real textbook sort of a thing, there's what's called “missed miscarriage,” which it just never- it just sort of sticks around and you really have to have it removed. So, a lot of people who choose wait-and-see end up needing some form of additional support anyway. Dealing with it chemically with mifepristone or misoprostol is probably also one that people often choose because they're like, this will allow me to get through, but I don't have to go get surgery. And now this way of terminating a pregnancy is much more common and much more accessible for all sorts of reasons, and I'm really glad that mifepristone and misoprostol are more, misoprostol in particular, are accessible. I am, of course, very against the various restrictions that our government is trying to put on it, and the many governments that do put additional restrictions on these drugs. At the same time, they hurt a lot. And again, people are not informed, so then when it is shocking how much it hurts, and they've been told nothing aside from take some Tylenol, or if it's real bad, alternate Tylenol and ibuprofen, then they are dealing with all of this suffering for no reason. Intense waves of pain for some people, and then they're also just doing it at home without medical care, right? You take the pills and you go home. And then you miscarry at home. So, and then again, some percentage, it's a smaller percentage, but some percentage of the time, it's still insufficient and you still have to go in for surgical care anyway. So, still a long bleeding process, more pain, and some percent, a small percent, but some percent you still have to go back for additional care. And then you have the surgical option, which is in a lot of ways, as far as I can tell, actually a pretty good one because it's kind of a you get it all done at once. You have the vacuum aspiration or the removal of some kind, all at once, you have a much shorter period of bleeding, almost no need for any follow-up care, the percentage is minuscule, but it's the one that is hardest for everyone to access because we are destroying abortion care all over this country, right? So, the surgical option, the one that we think of as the most interventionist, may be the one we really should be considering and making the most accessible, but thanks to trap laws and all sorts of other types of anti-abortion laws, abortion clinics are being legislated out of existence. So, you're forced, whether you would have preferred that option or not, you're forced to go with wait-and-see or chemical options, even if the surgical option might have allowed you to kind of handle it all at once.

Jennie: It is amazing how much miscarriage and abortion have become part of a very similar conversation, whether somebody has started the process, but there is still a heartbeat. So then in states where it is banned, it's a wait and see or a game of chicken to like with the pregnant person's health, which again goes back to that dehumanization of the pregnant person. And it has just I don't know, it has just become one of those things that is feels so shocking in many ways, while it shouldn't be, that this is just basic health care that people need, and that seeing people being unable to access it is just so infuriating and putting their lives and health at risk.

Kate: Exactly. And that's the thing is that people are in more for both for miscarriage, stillbirth, and abortion and medical terminations for all of these different types of pregnancy endings. People are typically in more pain than they should be or need to be. There are pain options for all of these, but people are not informed. In many cases, they are having to encounter. More pregnancy tissue and embryonic tissue than they are informed of ahead of time, which doesn't allow them kind of a chance to decide what to do with that tissue, which is a whole other thing we could talk about. And then there's sort of the fact that because of the types of care that we have legislated out of existence, like dilation and evacuation, intact dilation and evacuation, which also has been called "partial birth abortion," because we don't have that particular methodology available to us, we make all stillbirth parents go through labor. And we make people who are having medical anomaly, like who are having to terminate for medical anomaly also have to endure, you know, a type of abortion that is, I don't know, the term, I mean barbaric, I don't know, you know, that is far worse and does not leave them with any type of grievable fetus at the end. I mean, again, depending on what you want, I can go into more detail on that, but it's a really, it's a gruesome, terrible thing that we do to these families and to these people entirely because all anti-abortion legislation is short-sighted and anti-life fundamentally.

Jennie: Yeah, that feels important to point out, right? Like that it is just so anti-what is best for the pregnant person and like making their decisions for what is best for them and their family. I think the other place that it really stuck out to me was talking about the various things that can cause an abortion and some of the uncertainty, especially when you were focused on the risks section and like pregnant people having to do that balancing act of like this this is not, you shouldn't do this, you shouldn't do that, and again putting all of that on the person, and so then feeds that I did something wrong mentality. I think that chapter really stood out to me.

Kate: Yeah, and that was a really- that might have been one of the hardest ones to write because I felt like I was really trying to figure out how I can talk about these data with nuance, share the places where yes, there are certain things that increase risk. That is absolutely true.

Jennie: Yeah.

Kate: While also recognizing that we do not make any of these choices in a vacuum. These are not contextless choices. And so, is it true that if all things being equal, a person who is pregnant who wants to sort of reduce risk for their embryo, that they should be fully abstinent from caffeine and alcohol? Yes, I would say that. All things being equal, with it being possible to do that and no other concerns on the table, yes, that is those are those that those are those are harm-reducing choices to do that. But is that feasible in every situation? And is that necessary, you know, for every person to be made to feel bad if they're not always choosing the 100% harm reduction choice? That's where I think that we have to be careful in how we talk about things, that we should provide the right information without necessarily being prescriptive with that information. This is where I differ from, say, Emily Auster, right? Where she's like, oh, the data say it's no big deal. Go ahead and have a glass of wine. It's like, no, no, that's not what the data said. Am I then demonizing the choices that you make? No. But that is not what the data say. And we have to be clear with people so that they feel good about their choices, whatever they may be.

Jennie: Well, and I think that was part of that's part of the problem, right? Is there's so much conflicting information or hard to understand information of what is the what is the risk if I do this versus this, and it's really hard for people to sift through all of that to make informed decisions, and then you know, you may get so bogged down in the I can't do all of these things, and then you're adding stress, which is also itself a risk. So, it really just felt like, again, that uncertainty.

Kate: And it just it does feel like you can't win. Yeah. Having been pregnant a couple of times, right, and given birth, I can say that there is this, and I mean, I feel this way about- there's also a chapter that I talk about infectious disease where I quote from a paper that then quotes a woman who's talking about the Zika epidemic, and she's from Puerto Rico, and she's like, What do you want me to do? Put a bag on my head? You know, because this is a mosquito-borne, you know, this is a vector-borne disease from mosquitoes. And yes, of course, there are things you can do to mitigate risk and reduce your risk of being bitten by mosquito, but who in this world has ever, living in a place with mosquitoes at a time of year where there are mosquitoes, been able to 100%, without, again, just living with a bag on their head, been able to live in a way that 100% protects them from mosquito-borne disease. It's just not possible. And yet, that is the standard pregnant people are held to is what are you doing to make it so that your pregnancy has absolutely no risk? While we are living in an environment where that is on an individual level completely impossible. We have people all around us choosing to not mask and cough in our faces. We don't have transmission-ending vaccines for all sorts of torch pathogens. We have plastics in all of our food and being used in the packaging and drinks of everything we have. So, we're being composed, we're being exposed to endless endocrine disrupting chemicals. And then we're having food recalls left and right. And most of those food recalls are for things that are also, if not torch pathogens, incredibly dangerous for a pregnant person and potentially pregnancy ending, regardless of whether it passes the placenta.

Jennie: Things that people are choosing because they are the healthier options, right? Like, you should have lettuce or fruit.

Kate: And like, I have frozen blueberries every morning. Like, I put- I have a smoothie every morning. So, I mean, like that, yeah, there are ways in which some of these things that we now have to, you know, it used to be that pregnant people just had to really avoid lunch meat.

Jennie: Right.

Kate: Now, what could a pregnant person eat safely? I mean, if all of us are navigating feeling like we can't eat anything safely, imagine what it's like to be a pregnant person who is now doubly concerned for themselves. And also, a pregnant person is themselves immunologically at greater risk of all sorts of things. Or like you have a I remember towards the end of my first pregnancy, I got a stomach bug, and I was maybe 37 weeks, 38 weeks pregnant, something like that. And I started having contractions from the force of, sorry for the graphic description, I was vomiting so much, right, that it caused me to start getting contractions, and I was panicking. I'm gonna give birth to this baby too early, and that something's gonna go wrong with the baby. So, like, getting any type of illness, even if it's one that doesn't damage the placenta or damage the fetus, is still one that by being pregnant, you yourself are at greater risk. [With] COVID, more pregnant people were more at risk of ending up on a ventilator, right? And is it because- and does that additionally harm the fetus? Yes, but we're also, we should also care about that pregnant person who is now on a ventilator and may or may not come off of it.

Jennie: Yeah, I think there was that stream that really came through a lot was kind of that paternal fetal conflict, right? So much is focused now on like protecting the fetus that often the pregnant person is like the afterthought. Like, they’re just the vessel.

Kate: Like, maybe I don't want cyclospora because I don't want cyclospora. Yeah. Regardless of what it does to a fetus. Maybe I just don't want it, right? I mean, I don't think it actually has is a parasite, so it’s not something that passes the placental barrier. But if can you can imagine if you're dealing with massive nutrient deficiencies from that terrible infection that sounds like can take months for people to recover from, that is gonna happen. I mean, that's as dangerous, if not more dangerous, than something like hyperemesis gravidarum, where you can't another time that you but you basically can't keep food down, dealing with multiple like massive nutrient deficiencies for yourself, having profound health impacts on yourself as well as profound impacts on your embryo or fetus.

Jennie: I think the one other thing I wanted to make sure we touched on, just because it is something that is close to my heart, is talking about violence. This would be an incomplete conversation around miscarriage if we did not talk about violence. Do you maybe want to touch on that and how and I think there's a number of ways you could take it, but I think that was a top chapter that was near and dear to my heart.

Kate: Absolutely. One thing that I think it's important to say is that one of the media portrayals of miscarriage is like you push a woman down the stairs and she miscarries. No. It turns out the body is quite durable; the uterus is quite durable. A single terrible experience like that is not almost never going to be the sort of thing that causes a miscarriage to happen. However, we are talking about a huge range. You're pointing out before, these decisions can themselves be stressful, which stress is also not great for pregnancy. Yeah. So, the psychosocial stress, the toll of intimate partner violence, even when it's only, even not only, but you know, even when it is verbal. Right. Or physical, but not pushing down the stairs level of physical, right? Like any type of level that we permit is going to cause, one, is going to permit escalation. This is one of the things that sexual harassment research shows, is when you tolerate low levels of harassment, it escalates, it allows that person to believe they can escalate and do whatever else they want, and they keep doing more and more, which is why I hate workplace policies that are like, well, the only type of harassment we're gonna fire you for is if you actually sexually assault somebody, right? So, when we're talking about intimate partner violence, that's one thing to think about is that the lower levels actually still have profound impacts on the bodies. They can leave traces even if they're not leaving marks. The other thing that is a terrible and important thing for people to understand about intimate partner violence is that pregnant people are actually at greater risk of homicide than non-pregnant people. All other things, so if we're looking at, say, two cisgender women of a similar age and one is pregnant and one is not, the pregnant person is actually at higher risk of being murdered than the non-pregnant one. Pregnancy itself is a risk factor for homicide. And that has only gotten worse in recent years. So, I spoke to Maeve Wallace, who's an epidemiologist who studies pregnancy mortality, and has been able to study the rate at which pregnant people have been murdered, since we started finally putting a check mark where you could say, has this person been pregnant? Is that person pregnant or have they been in the last 12 months when looking at death certificates? And since we started regularizing that across the country, she's been able to see this profound difference in pregnant and non-pregnant murders. But on top of that, it's gotten worse in the last couple of years. So, I apologize for having to explain this, but it used to be that pregnant people were stabbed more. And now that gun ownership has skyrocketed since the pandemic, more pregnant people are dying through gun violence because there are more guns. And even when there are policies to remove guns from places at high risk of gun violence, people with records of IPV, there's evidence that a lot of times those policies aren't followed through. And so, those people still have those guns and are still, of course, then using those guns. And I just people need to reckon with the fact that pregnancy is vulnerable in a lot of ways. It's vulnerable in terms of how you're judged in the world, how you're treated in the world, the long-term health implications of what it does to your body and your immune system. I could talk about the destruction of my pelvic floor for anyone who wants to listen. But then it also literally can kill you. And not just in the ways that thankfully places like ProPublica have brought to the fore around issues of sepsis and hemorrhage and hypertension, but also literally through murder.

Jennie: That is one of the ones that really stood out to me, and it also made me think back to the Turnaway Study where they talked about, you know, if people weren't able to get a wanted abortion, they were more likely to stay in contact with a violent partner. So, there's just so many connections between all of these things. Okay, I want to be cognizant of being respectful of your time. I would love to maybe ask a couple kind of final things. One, what would you like to see happen to improve outcomes, but just maybe what your research has shown, what are some things that you would like to see put in place to ensure better outcomes or better experiences? Because I think some of the experiences really stuck out to me as well of where things could have been done better.

Kate: My first thought is to step back from that question a tiny bit and look at the information landscape that we have right now and say, you know, we haven't spent a lot of time talking about sort of the first part of the book that is uh has a lot of science in it, right? And it does. It and it's intentional. It hits you over the head with a lot of stuff that I think is really cool about mammalian reproduction and genetic aneuploidy and mosaicism versus chimerism, and really trying to give people a basic understanding of the physiology of pregnancy, the evolution of what got us there, and therefore having that understanding underlie how we can better understand miscarriage and how miscarriage is just simply part and parcel of how our reproduction developed the way it did. So, you should blame this on the evolution of the placenta, not on any individual person who's experiencing a miscarriage. This is just, you know, or blame it on those of us who decided we were gonna make a million eggs at five months gestation. That was a many, many millions ago decision, millions of years ago. And it was not a decision, right? This is because evolution is just not, it's we can look back and narrate it, but as it's happening, there's no directionality or intentionality to any of it. So, I say all of that to say one of the things I would love is just for more people to be comfortable trying to learn the underlying evidence for any given thing that they care about. If you are a policymaker, if you are a legislator, if you are a lawyer or a judge, and reproductive rights is a big part of your wheelhouse, I actually would like you to understand the science a little better. You can just remember 10% of what I wrote about but at least remember 10%. You know what I mean? And use the book as a resource. Go back to it and be like, wait, what am I, you know, do I need to worry about substance use? If a person is a cocaine user and they're being charged with criminal negligence of this fetus, is that a real concern? Let's go look at the evidence. Actually, no, unless we can point to, you know, this substance being not only present in this fetus's body, but shot, you know, can show harm in some feasible way, it probably has nothing to do with whatever we're seeing, right? Or whatever. Like, but I would just encourage like we are so divorced from looking at evidence in this, you know, the whole post-truth situation that we're in. I just, that's the thing that I actually wish the most is that more people would be comfortable deciding to learn from experts the evidence base, the underlying understanding of whatever it is that they deeply care about and would like to affect change around. Related to that, I'll just say one more thing related to that in terms of taking this step back, is when we encounter people we care about who, even in an offhand way, share with us a story of something stigmatized, if the time is right and the time is safe, to actually say, hey, I noticed that you just mentioned in an offhand way that you yourself has had a miscarriage. If you'd like to share that story with me, I would love to hear it. If it's in an offhand way at the end of a meeting, maybe that's the wrong time, but maybe the next day or a few days later you're having lunch together. I noticed that you told me that you have crippling periods and that that's why you have to take a few days off of work every month. I would, you know, if you'd be comfortable telling me, I'd love to hear more about your story. I just think that the more that we offer curiosity and compassion to the people in our lives when they dare to disclose in a very vulnerable way some teeny thing around their own suffering, it's a real gift to decide to hold a little space for it and say, if you've started to share, maybe I'd like to hear more. And I think if we can get to that point, I mean, it's been so interesting the last book versus this book, because periods, people have been like, oh, sure, come give a talk on periods. Hee hee. You know, it is stigmatized. Periods are very stigmatized, but people can chuckle about them. And so, plenty of people have wanted to hear me talk about periods. They’ll admit to reading the book, they'll learn about periods because they can, the stigma is a different type of stigma. There is a different, there is a shame stigma and a silencing stigma that is so much greater and more personal around miscarriage and stillbirth, to the point that people have told me, they're like, I don't, Kate, I want to support you, but I don't know if I can read this book, or I don't know if I'm ready for this, or I don't know if I want to hear this. And if we can't open our hearts to hearing about the worst days of people we care about, I'm worried about what that means for the connections that we need to be building as we're working towards these radical, beautiful futures that I know we all want to build.

Jennie: Yeah, and it's such an important part. And I've definitely been remiss about not doing an episode talking about miscarriage before since I talk about so many things related to sexual and reproductive health. So, I'm so glad that this book came in to fill that spot and that we were able to have a conversation about it, and it definitely should not be the last. We should make sure that we we talk about it more because it is again, yeah, it has that shame and stigma around it, and we are so out there in making sure we're busting that around abortion, but we should also be in the same space doing the same for miscarriage.

Kate: And I think that's because when we do that for both, I think it helps destigmatize both. When you see the parallels, it allows you to see that abortion is simply healthcare.

Jennie: Yeah.

Kate: Part of what motivated this book was a conversation I had with a loved one who said a lot of unhinged stuff about abortion that angered me as a pro-choice person. But also, and this gets to why I care so much about the evidence base, I had this little moment where I went, I mean, I'm pro-choice, but I actually don't know anything about abortion aside from I think it's a good idea. But what more do I know? And I decided I would educate myself. I actually made a calendar hold for an hour a day called "Abortion Hour." And it was in my Google Calendar every single day. And I just used that time to read the literature and read and read until I realized there was a book idea there. But what it led me, I went from someone who was like, I'm pro-choice in a general way, like actually the majority of the US population, to I am completely, completely in favor of 100% unrestricted abortion access for all people at all times, at literally all weeks of pregnancy. And the way I arrived at that was reading the literature. From seeing that it is inescapable to see this as anything but health care. And I don't restrict other forms of health care. Why restrict this form? It is necessary, it saves lives, it is something that a person should be able to decide for themselves, and we have tons of evidence that people are making the best decisions they can with this, you know, even with the crappy access they have. So why would we further restrict it? And I think when you come to that conclusion is when you open up and see how this has harmed every type of pregnancy ending, including for full-term pregnancies. Because full-term pregnancies, you know how they get induced sometimes? misoprostol or mifepristone. So, if we can't access those drugs, what happens to induction? I'm not a fan of inductions generally, but it's not like they're never needed. And so, when they are needed, why are we closing off access to certain types of the chemicals that we need in order to do it?

Jennie: Yes. Kate, thank you so much for being here. I will just note for our audience, we usually end with asking, what can the audience do? But I think you already gave a really beautiful answer to that. So, thank you so much for being here. I had such a wonderful time talking to you.

Kate: Of course. Thank you so much.

Jennie: Okay, y'all. I hope you enjoyed my conversation with Kate. Like I said, it was kind of a heavy topic today, but it was a really important one, and I'm glad that we finally talked about miscarriage more fully on the podcast. So, with that, I will see everybody next week. [music outro] If you have any questions, comments, or topics you would like us to cover, always feel free to shoot me an email. You can reach me at jennie@reprosfightback.com, or you can find us on social media or at rePROs Fight Back on Facebook and Twitter, or @reprosfb on Instagram. If you love our podcast and want to make sure more people find it, take the time to rate and review us on your favorite podcast platform. Or if you want to make sure to support the podcast, you can also donate on our website at reprosfightback.com. Thanks all.