Lost: Miscarriage in Nineteenth-Century America by Shannon Withycombe (review)

In Lost: Miscarriage in Nineteenth-Century America, Shannon Withycombe explores two intertwined narratives: the social history of women’s pregnancy loss and the evolution of medical approaches to miscarriage. Although Americans today are taught to think about miscarriage in terms of grief and loss, Withycombe explores letters and diaries to show that women in the past often regarded pregnancy loss with satisfaction and even joy. She argues that women’s perceptions were shaped by a range of factors, including their previous childbearing experiences, their health and well-being, their family and support networks, and their economic situations. Alongside women’s experiences, Withycombe outlines a series of significant transitions in medical involvement with miscarriage. She argues that through the early nineteenth century medical experts tended to regard miscarriages as nature’s way of relieving women of a false or unhealthy pregnancy and that this process was of relatively little medical interest. But beginning in the 1840s doctors became increasingly invested in studying the process of miscarriage, and within a few decades miscarriage had been redefined as a problem requiring medical intervention.

Withycombe begins her narrative by profiling the childbearing experiences of a handful of individual women, allowing her to explore in detail the myriad factors that led women to regard miscarriage with sorrow or satisfaction. From there, her analysis proceeds chronologically as she examines the evolution of medical approaches to miscarriage and their intersection with women’s experiences and beliefs. Medical involvement in miscarriage began to accelerate in the 1840s as physicians redefined it as a medical problem and began to discuss causes and treatments. In particular, Withycombe highlights the ways in which physicians began to identify miscarriage as the result of excess—of emotion, of diet, of exercise, of socializing, and so on. Yet Withycombe is quick to point out that women them-selves did not act on these medical claims, and she offers ample evidence to show that women continued to go about their lives without fear that their actions could result in pregnancy loss. By 1870, Withycombe argues, physicians began to treat substantially more cases of miscarriage as part of the overall expansion of medical authority over childbearing, and they began to advocate for more consistent and dramatic interventions. As they became more involved, they also became more invested in the fruits of miscarriage—the fetal and placental tissues that could be collected, preserved, and studied in order to answer key questions about human development. The emerging science of embryology, in short, depended on physicians’ increasing authority over miscarriage.

As with any study that seeks to combine the complex narratives of both medical and social history, Withycombe’s analysis leaves some lingering questions. For instance, previous scholars such as Judith Walzer Leavitt have shown that women themselves (particularly middle-class and elite women) spurred the medicalization of childbirth by demanding new technologies and practices that they hoped would make delivery safer.¹ Yet Withycombe suggests that in the case of miscarriage, physicians “attempted to convince the American public to look to them for aid” (p. 60). Miscarriage left women vulnerable to dangers such as hemorrhage and infection, much like childbirth, so why did they not actively pursue medical intervention in the same way that they did for childbirth? Withycombe suggests that women believed their doctors had little help to offer with miscarriage, but it was equally true that the medical technologies introduced by male physicians did not actually make birth safer for most women. Perhaps there was something about women’s perceptions of miscarriage that made them see medical intervention as less desirable; or perhaps their demands for safer childbearing experiences simultaneously fostered the growing involvement of physicians in miscarriage. The question of who led the way in changing medical practice has been an important one for historians of obstetric medicine, and it would be interesting to see Withycombe weigh in more fully on this debate. Nevertheless, Withycombe’s...