Doctor-Author Book Chat: Lara Freidenfelds, PhD

This month is Pregnancy and Infant Loss Awareness Month, and women’s health historian, author, and friend Lara Freidenfelds just published a sensitive and practical book about pregnancy loss: The Myth of the Perfect Pregnancy: A History of Miscarriage in America. I am glad that I had the chance to chat with Dr. Freidenfelds about the book, her own personal experience that inspired her, and the significant challenges she overcame to complete this work:

Me: Tell us what your book is about and how it will help people?

Dr. Freidenfelds: “The Myth of the Perfect Pregnancy is about how Americans came to expect that every pregnancy should end in a full-term birth, so long as we did everything ‘right.’ In fact, about 20% of pregnancies end in miscarriage, mostly in the early months, and the majority of miscarriages are unpreventable. But we have built a culture that encourages us to feel like we have control, and pushes us to bond with our expected babies from the moment the two lines appear on the home pregnancy test. The result is a lot of emotional distress for many women at the very beginning of their childbearing journey.

At a time when we are legitimately anxious about an out-of-control pandemic, I think it’s important to hear a message of absolution for bad outcomes that we genuinely can’t control. No one should be made to feel guilty or ashamed for their miscarriage; early pregnancy losses are a normal part of childbearing for healthy women.” 

Me: This can be a difficult topic to write about. How did your book come about?

Dr. Freidenfelds: “I started working on this book when I miscarried my first pregnancy. I was shocked and sad, and upset that no one had warned me this could happen. I was also an expert in the history of women’s health (I was in the final stages of my dissertation that would become my first book, The Modern Period: Menstruation in Twentieth-Century America), so I knew what I had to do. If even I didn’t grasp how common pregnancy losses were, I needed to write about miscarriage and get the word out.”

Me: What challenges did you face in bringing this book to exist?

Dr. Freidenfelds: “Happily, the hardest thing about getting the book written was that I had two children! I took a non-traditional career path, because I have multiple sclerosis, and I didn’t have the energy to raise children and pursue an academic career simultaneously. I stayed home with my kids while my husband became a law professor, and researched and wrote during naptimes and school hours. I had a postdoc with a light teaching load at Wellesley College for two years, that allowed me to work more intensively for a time, too.

When I was close to finished with my research, and had about half the book drafted, my multiple sclerosis flared up and severely damaged my vision. Since then, I have only been able to read with the right half of my visual field in both eyes. It took about two years and vision therapy from The Lighthouse in New York City to figure out how to work on my research and writing again. It was an ironic setback: I had always kept up my part-time modern dance career, figuring that when the MS finally ‘got’ me, I’d fully focus on writing.

Not being able to skim is a major problem for a historian, and I am still pondering how I will manage research for a next book. Interestingly, though, my new limitation made me a better critic of my own writing. With a visual impairment, convoluted sentences drive me nuts. If I trip over one of my sentences, I know it will hamper my readers too, and I edit. 

Me: What are some major points you want the reader to take away after reading your book?

Dr. Freidenfelds: “Most importantly, I want my reader to come away knowing that miscarriages are common, and are not the pregnant person’s fault. We ought to see early pregnancy losses as an expected part of childbearing. I also want my reader to feel empowered to take a ‘go slow’ emotional approach to pregnancy, if that feels right to her. It is important to seek preconception and prenatal care, but we can think in terms of nurturing an early pregnancy rather than bonding with an expected child. Knowing that pregnancy is not so predictable as we might wish, we might want to think in terms of ‘prepared’ parenthood rather than ‘planned’ parenthood. For healthcare providers, the book gives an understanding of where patients are coming from, and why the level of distress over early pregnancy loss seems to have risen steadily over the past few decades. 

The larger historical perspective shows that responses to early pregnancy loss are not merely psychological, but are also shaped by history and culture. We can shift the historical trajectory slightly, keeping the benefits of reliable contraception, affectionate parenting, snazzy baby gear, and modern prenatal care, and yet accepting that the early months of pregnancy remain out of our control.”

In a post about her book on Nursing Clio, Dr. Freidenfelds shares the downloadable images below, free for people to use on social media. She says: “We need a new way to think and talk about early pregnancy and early pregnancy loss, so that we can discuss it openly and without shame. We can create a longer emotional ramp-up that correlates with the increasing security of the pregnancy over the course of the first trimester.”