JULIEANN THOMAS
March 1, 2022
Rear Admiral Eric Jones
Assistant Commandant for Human Resources (CG-1)
United States Coast Guard
Washington, DC 20593
United States of America
Dear Admiral Jones,
My name is JulieAnn Thomas. My husband, CDR * * * * (ret.) served for 20 years in the US Coast Guard (CG) as a cutterman, an admiral’s aide, a Senate liaison, and finally as a finance officer. I was active within the Coast Guard family, serving as an ombudsman, a CG representative for the Military Officers’ Association of America, and as a board member at Coast Guard Mutual Assistance. I always took my role as a Coast Guard spouse seriously and continuously advocated for our Coast Guard families.
I am writing today because I have been reflecting on my experiences in a new light and want to discuss the Coast Guard’s policy on miscarriage. Before I get too far, I’d like to add some context to this discussion. After my husband retired, I decided to go back to school. I’m presently in a MSc Medical Anthropology program at University College London. It has been an excellent opportunity and I have enjoyed learning about how the body and culture interact with one another and influence each other. The heart of the program is learning to observe, examine, and question structures in place to help better the health of all.
I am currently taking a class that asks us to create an advocacy letter on a topic that we are passionate about. I care about women experiencing miscarriages, as I have personally experienced three. My husband was active duty when we experienced our losses, and he did not receive any time off from work. In fact, he wasn’t aware of any policies in place for miscarriage and assumed that it was something that must be dealt with on a personal level. In regards to federal law, the United States does not have any policy in place to mandate leave for a person experiencing a miscarriage, but I hope that changes. It would be immensely helpful if a Coast Guard member was granted bereavement leave for a miscarriage whether it is themself or a partner who was experiencing the loss. A first step could be simply granting bereavement leave for the shipmate who personally experienced a pregnancy loss. A miscarriage is a major life event, and both a woman and her family need time to process the event.
A miscarriage is defined by the World Health Organization as “premature expulsion of an embryo or fetus from the uterus up to 23 weeks of pregnancy” (Murphy and Merrell, 2009: 1584). The Centers for Disease Control and Prevention says the United States establishes the loss as happening at 20 weeks of gestation or before (CDC, 2020). Miscarriages are fairly common events, with about one in five pregnancies ending before birth (Melo and Granne, 2020). These clinical terms don’t adequately describe the life-changing experience of a miscarriage – physical events usually have larger effects, their influence rippling across a person’s life. Medical anthropology has taught me that biological events are never only biological – the physical and the social are tied together and although we sometimes try to separate them, they are never truly distinct (Kleinman and Kleinman 1994). A pregnancy loss is an event experienced both within the body and amongst others. The body needs time to heal and the social body needs time to grieve.
Therefore, due to the multifaceted nature of the event, the pain of a miscarriage is multi-dimensional. There is often significant physical pain, which women have said is sometimes worse than labor pains (Layne, 2007). Blood loss from a miscarriage can be minimal or it can even be life-threating (Murphy and Philpin, 2010). After a miscarriage, a woman is often expected to continue on with her life as if nothing had happened. But miscarriage is frequently exhausting and physically painful, and a woman’s body needs time to recover. Additionally, after a miscarriage, women regularly say that medicine has treated their body, but neglected their emotions (ibid). A woman needs time to process the emotions she is feeling after pregnancy loss and her body needs time to recuperate. The combination of physical and emotional events require time for recovery. The Coast Guard should give these women a safe time to heal.
There is also social pain. American society doesn’t know quite what to do with miscarriages. We remember the deceased by holding a funeral and in doing so mark the end of the deceased’s earthly life; it is the living person’s way of mourning the memory of the past. Such social rituals persist and are used to guide actions and reestablish social order. However, American society does not have a culturally prescribed ritual for recognizing miscarriage, in part because it is hard to define when exactly life begins and ends, so it is difficult to say what exactly is lost by miscarriage. One woman said after a miscarriage “we had a child – sort of. Our child died – sort of” (Layne, 1990: 74). What the living mourn here is something from the future. Additionally, there are no rituals to help reintegrate the families who have experienced miscarriage into society. This loss, which is often viewed and dealt with as a personal matter, is more likely to add to people’s suffering in the absence of social support.
Miscarriage combines many cultural taboos, each of which affects our perceptions regarding what is lost, acceptable ways to move on, and a person’s role in society – death, matter “out of place,” and perceived failure to reproduce, among others – and can create a place of isolation, shame and silence (Letherby, 1993). American culture in particular avoids discussing death, especially that of a baby, as if speaking about it will cause it to happen to others. Blood (and even the fetus) breaching the bodily boundary is perceived as becoming a pollutant that must be dealt with away from society’s gaze until wholeness is restored. American culture values completing a task once started; and miscarriage feels like a failure to do so (Layne, 2001). Though the self wants a child, it feels as the body is unable to fulfill its role. Additionally, achievement is seen as individual, as is failure, so women often self-blame for pregnancy losses (ibid). Women mourn that in our current culture the experience of miscarriage feels like a separation from society rather than a coming together of support (Reinharz, 1988). One of the major ways to combat the taboo of miscarriage is to discuss it, which begins to take away some of the stigmatization. Creating a clear and proactive miscarriage bereavement policy would honor families, lessen stigmatization, individualization, and isolation, and create space for the family’s recovery on all fronts.
American society often thinks of pregnancy as a controllable event. People often try to plan when to have children, and the advancements in medical technology make it seem like it is a controllable process (Neiterman, 2013). However, a large amount of pregnancy is uncontrollable, especially the loss of a baby. Much about miscarriages is unknown – from the exact causes to the best, least painful treatments for products that remain in the womb. The lack of knowledge surrounding miscarriages also contributes to its stigmatization and isolation. Proactive policy from the Coast Guard can be an effective action to both remove stigma and come alongside a family, offering them acknowledgment and support through a difficult time.
Implementing a policy to automatically grant bereavement leave to the woman or partner experiencing a miscarriage without penalizing annual leave would align well with the Commandant’s guiding principle of Duty to People. Women and their partners are often hesitant to discuss miscarriages due to their taboo and connected shame. The Coast Guard could be Responsive in recognizing a societal vacuum and responding in a caring manner to look after its members, honoring the dignity of those who serve within the greater Coast Guard family.
The current Coast Guard policy, as stated in COMDTINST 1000.9 says “Following a spontaneous abortion (i.e., miscarriage), the service member’s health care provider may recommend a period of convalescent leave when clinically indicated” (USCG 2011: 7a2a). I am advocating for a minimum bereavement leave of 3 days to be implemented, for either a female Coast Guard member or her active duty partner, with additional medical leave given as prescribed by a physician. Three days of bereavement leave would mirror the ground-breaking policy implemented by New Zealand lawmakers surrounding pregnancy loss (Wamsley, 2021). Miscarriage is not just a women’s issue, but affects her partner, family, and a community at large. Current policies continue to individualize and gender the loss, which often further isolates women. A proactive policy reflecting the social nature of pregnancy loss would acknowledge the shared loss experienced in miscarriage. Granting leave to a partner of a person experiencing miscarriage would be an excellent step in recognizing the broader effects on a family.
I have seen first-hand how the Coast Guard cares for people. The Coast Guard Pregnancy and Resource Guide states “The Coast Guard is committed to providing world-class support to its workforce and leading the way as an employer of choice” (USCG, 2019), and I believe it. I have found the Coast Guard to be an excellent supporter of its members and their families personally and also evidenced by the considerate Resource Guide mentioned above, that thoughtfully and caringly addresses sensitive topics such as postpartum mental health, discussing breastfeeding options with commands, and postpartum weight and fitness standards. Yet, the same booklet makes no statements about what happens when a member experiences pregnancy loss. The Coast Guard has always been at the forefront of developing modern human resources policies to take care of its own. Creating an innovative and thoughtful policy to help Coast Guard families handle the challenge of miscarriage will set an example for the other military services, and the United States at large, to follow. Thank you for your consideration.
Very Respectfully,
JulieAnn Thomas
Author’s note: This letter was originally written in the spring of 2022, before the US Supreme Court’s decision in Dobbs v Jackson Women’s Health Organization that overturned the previous decision Roe v Wade. The author acknowledges that the landscape surrounding reproductive rights and women’s bodies has completely changed.
References
CDC (2020) Pregnancy and Infant Loss | CDC, Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/ncbddd/stillbirth/features/pregnancy-infant-loss.html (Accessed: 20 May 2022).
Kleinman, A. and Kleinman, J. (1994) ‘How Bodies Remember: Social Memory and Bodily Experience of Criticism, Resistance, and Delegitimation following China’s Cultural Revolution’, New Literary History, 25(3), pp. 707. doi:10.2307/469474.
Layne, L.L. (1990) ‘Motherhood Lost’, Women & Health, 16(3-4), pp.69-98, DOI: 10.1300/J013v16n03_05
Layne, L. (2001) ‘In Search of Community: Tales of Pregnancy Loss in Three Toxically Assaulted U.S. Communities’. Women’s Studies Quarterly, 29(1-2), pp. 25–50. http://www.jstor.org/stable/40004607
Layne, L. (2007) ‘Designing a Woman-Centered Health Care Approach to Pregnancy Loss: Lessons from Feminist Models of Childbirth’, in Reproductive Disruptions. 1st edition Berghahn Books. pp. 79–97.
Letherby, G. (1993) ‘The meanings of miscarriage’, Women’s Studies International Forum, 16(2), pp. 165–180. doi:10.1016/0277-5395(93)90006-U.
Melo, P. & Granne, I. (2020) ‘Does Twenty-First-Century Technology Change the Experience of Early Pregnancy and Miscarriage?’, in Navigating Miscarriage. 1st edition Berghahn Books. pp. 33–58.
Murphy, F. and Merrell, J. (2009) ‘Negotiating the transition: caring for women through the experience of early miscarriage’, Journal of Clinical Nursing, 18(11), pp. 1583–1591. doi:10.1111/j.1365-2702.2008.02701.x.
Murphy, F. and Philpin, S. (2010) ‘Early miscarriage as “matter out of place”: An ethnographic study of nursing practice in a hospital gynaecological unit’, International Journal of Nursing Studies, 47(5), pp. 534–541. doi:10.1016/j.ijnurstu.2009.10.011.
Neiterman, E. (2013) ‘Sharing bodies: the impact of the biomedical model of pregnancy on women’s embodied experiences of the transition to motherhood’, Healthcare Policy = Politiques De Sante, 9(Spec Issue), pp. 112–125.
Reinharz, S. (1988) What’s missing in miscarriage? Journal of community psychology. [Online] 16 (1), 84–103.
United States Coast Guard, COMMANDANT INSTRUCTION 1000.9, Washington DC, Issued 29 September 2011, https://media.defense.gov/2017/Mar/06/2001707433/-1/-1/0/CI_1000_9.PDF (Accessed February 28, 2022).
United States Coast Guard, Coast Guard Pregnancy and New Parent Resource Guide, Washington DC, Updated April 2019, https://www.dcms.uscg.mil/Portals/10/CG-1/cg111/docs/pdf/CG1_Pregnancy_and_New_Parent_Resource_Guide_v15.pdf?ver=2019-06-26-122711-810 (Accessed March 4, 2022).
Wamsley, L. (2021) ‘New Zealand Approves Paid Leave After A Miscarriage’, NPR, 25 March. Available at: https://www.npr.org/2021/03/25/981309826/new-zealand-approves-paid-leave-after-a-miscarriage (Accessed: 20 May 2022).
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