It is estimated that approximately 1 in 5 known pregnancies end in miscarriage, 1 in every 200 births is a stillbirth, and 2,000 terminations for reasons of foetal anomaly are performed in the UK each year. Often unexpected and unexplained, pregnancy loss engenders complex emotions that are difficult to articulate. A powerful way of exploring such experiences is to consider how bereaved parents use metaphor to communicate and make sense of what are extremely challenging situations and feelings.

Pregnancy loss is still a taboo subject in many situations and cultures, therefore the voices of those who have experienced it are often not encountered outside of restricted settings. As a result, our understanding of the relation between how people conceptualise their experience and how they navigate this difficult terrain can be limited. Death Before Birth, a 2-year ESRC-funded project, has looked in detail at how individuals who have experienced pregnancy loss articulate what they are going through at different stages. In doing so, our aim has been to gain useful insights which may enable more effective and consistent provision of support to bereaved parents.

Metaphor is a device by which a concept, experience or object is described in terms of another, for example people may talk about women’s careers hitting a ‘glass ceiling.’ While traditionally seen purely as a literary or creative device, contemporary researchers of metaphor consider it to be a fundamental element of human language and thought; an important device by which we understand and express our feelings and lived situations. Metaphor is therefore a particularly useful mechanism for working through experiences that are not widely shared as it frequently involves the use of something that is familiar, tangible or common to describe something that is unfamiliar.

Through interviews with bereaved parents, we have found that metaphors used to express the situations and decisions they encounter are numerous and highly idiosyncratic, but often revolve around a range of key themes, such as movement, space or the body. For example, individuals may describe the process of undergoing a termination as a ‘rollercoaster,’ or understand ones sense-of-self following a stillbirth as needing to be ‘rebuilt.’ By examining how metaphor allows individuals to articulate these unfamiliar experiences, the project has highlighted a number of concerns regarding our understanding of the grieving process, how people respond to their grief, and ultimately their recovery.

In particular, our findings have a number of implications for those who are in a position to support people who have experienced pregnancy loss. It is important to understand that, as a result of going through pregnancy loss, people are often in a completely different place psychologically. This is exacerbated by the fact that the loss is as much physical as it is metaphorical, and the bereaved are likely to experience grief as something permanent, which may change in form but never goes away. Some of the experiences described by the bereaved through metaphor may appear at first sight to be ‘illogical’ or inconsistent to those who have not been through the experience, however they make sense in the context of bereavement following pregnancy loss and therefore need to be respected and understood.

The research has shown that such feelings of disorientation described through metaphor have been found to be aggravated by unclear or overly-directive communication from healthcare professionals. This is also compounded at times by a lack of consistency in provision across different support networks. Working with our partner organisations – the Human Tissue Authority, Miscarriage Association, Stillbirth and Neonatal Death Charity (SANDS), Antenatal Results and Choices (ARC) – the project is currently integrating the findings into a number of processes and outputs, in the provision of, and advocacy for, improved care for the bereaved. In doing so we are identifying the best ways of using our findings to inform training for supporters, to provide an evidence base for formal guidance produced by the Royal Colleges (e.g. RCN, RCOG), and to contribute to public awareness about pregnancy loss

Jeannette Littlemore, Professor of English Language and Applied Linguistics, University of Birmingham.