Men’s Experiences of Miscarriage: A Passive Phenomenological Analysis of Online Data

Abstract

Miscarriage is a pervasive health care concern for couples. The impacts of miscarriage on men have not received adequate attention in the literature. The aim of this research was to understand the lived experience of 31 male participants whose partners had miscarried a child. This study analyzed online data using a passive phenomenological methodology. Researchers found four overarching themes including isolation, overwhelmed, protector, and coping. Results found that health professionals might overlook men when a woman experiences a miscarriage. Results suggest that professionals working with these couples could provide greater care by addressing the experiences of both men and women following a miscarriage.

Keywords:

• Miscarriage
• phenomenology
• perinatal loss
• men’s experience
• online data

According to the American College of Obstetricians and Gynecologists (2017), miscarriage occurs in 10% of all pregnancies. Miscarriage, a perinatal loss before the 20th week of pregnancy, is often overlooked as a serious loss for couples and families. While not all couples experience distress in the event of a miscarriage, loved ones and even medical professionals may discount the parents’ grief or emotional reactions to miscarriage (Lang et al., 2011). The majority of extant literature on miscarriage focuses on mothers, as they are the partner who experiences the physical loss, along with the psychological and emotional loss (Lim & Cheng, 2011). Although fathers do not physically experience miscarriage, as fathers experience their own grief and pain, they act in a supportive role and experience the sorrow that accompanies witnessing their partner’s pain (McCreight, 2004). Due to the ambiguity of the loss and the variety of reactions from couples, their community, and medical professionals, it is important to understand the experience of miscarriage and how it impacts fathers who suffer this type of loss.

Paternal impacts of miscarriage

The majority of research on men and miscarriage focuses on the couple or family experience of loss (Callister, 2006). Too often these studies note that women experience higher levels of symptoms associated with grief and loss (Badenhorst & Hughes, 2007), which perpetuates the focus on the mother’s experience while the father’s feelings and struggles are often minimized. However, most studies on men and miscarriage have contradictory findings, making it difficult to determine how and to what degree men are impacted by miscarriage (Brier, 2008).

The studies done indicate a variety of experiences and impacts on fathers. Some studies have found that vividness and length of gestation moderate a father’s grief (Brier, 2008; Johnson & Puddifoot, 1998). Men who have viewed an ultrasound photo are more likely to experience grief following a miscarriage (Johnson & Puddifoot, 1998). While the majority of previous studies investigating the male experience of miscarriage indicate that men experience grief for less time with less intensity than women do, one study suggested that men experience similar levels of grief (Brier, 2008). Another study, comparing how males and females express grief, showed that men tend to exhibit lower levels of grief, anxiety, and depression (Badenhorst & Hughes, 2007), indicating that such measures may not be an appropriate way to assess for men’s grief, as the results may be more indicative of the difference between the affective reactions of men and women rather than an accurate measure of the severity of grief for men and women (Brier, 2008). These mixed results demonstrate the complexity of a miscarriage loss, suggesting further research is needed to understand the experience of the paternal parent.

While some researchers have taken an interest in better understanding the paternal experience of miscarriage, little has been published to date. Studies employing qualitative methods have found that men often feel devalued by their support system and feel as though their grief goes unnoticed (McCreight, 2004). Additionally, men report feeling marginalized by hospital staff and underprepared for the overwhelming tasks such as informing family and friends, and making funeral arrangements (McCreight, 2004; Murphy, 1998). In this context, men often feel that they must set aside their own grief and emotional needs in order to support and comfort their partner (Murphy, 1998). Despite efforts to ignore their grief, many men experience feelings of self-blame and guilt for not being able to prevent the loss (McCreight, 2004). While existing qualitative studies provide important insights concerning the paternal experience of miscarriage, there have been great medical advancements in the last 20 years, as well as a change in the perception around men’s roles. These technological and societal changes influenced the importance of reexamining the paternal experience of miscarriage again, using a different method of data collection. To address the gap in the research, we investigated the research question: How do men experience miscarriage? The purpose of our study is to give voice to the lived experience of men who, with their partner, have suffered a loss through miscarriage.

Methods

Procedures

To investigate the paternal experience of miscarriage, we used passive analysis of online data for a phenomenological analysis of the data. Passive analysis occurs when the participants are unaware of the study and do not actively participate in the study (Creswell & Poth, 2018; Eysenbach & Till, 2001). The focus of phenomenology is to address the lived experiences of individuals who all experience the same phenomenon: in this case, the phenomenon of miscarriage from a paternal perspective. The phenomenological approach is both objective and subjective as it directs attention to how individuals subjectively make meaning of the objective world (Daly, 2007). This type of analysis allows researchers to investigate the lived experiences of individuals in relation to the phenomenon.

This study specifically utilized the transcendental method of phenomenology and the data analysis method of Colaizzi (1978). This transcendental approach involves looking at a human experience while setting aside assumptions and biases. In this study, we incorporated this method by first having the researchers identify the paternal experience of miscarriage as the phenomenon of interest (Creswell & Poth, 2018). Before data collection and analysis, the researchers engaged in bracketing, a method which helps researchers set aside their bias in order to approach the data with a fresh perspective (Creswell & Poth, 2018).

The research process continued as the researchers collected data from others who experienced this phenomenon, reduced the data into statements, and then combined these statements into themes (Creswell & Poth, 2018). Researchers coded by identifying significant statements made by the participants related to their experiences of the phenomenon of interest (Creswell & Poth, 2018). The statements were then organized into themes and subthemes that show the essence of the participant experience (Creswell & Poth, 2018). This method allowed the research team to be able to identify the phenomenon of interest, obtain men’s experiences of miscarriage, and gain insight into prominent themes and subthemes of the participant’s experiences.

Participants

The data for this study came from a secondary data collection from public blogs, chat rooms, and web forums, specifically subthreads on a popular forum website, Reddit. The research team collected the data from October 2017 to July 2018, with the posts spanning between February 2016 and July 2018. Participants were purposefully chosen as men who reported having an experience with a miscarriage in their romantic relationship(s). The participants had either posted a public blog or responded to a question on a public forum about their particular experience as a man who had experienced a miscarriage. The data were found by searching for terms and phrases such as, “men and miscarriage,” “men’s experience with miscarriage,” “pregnancy loss and men,” and “men who lost a child.” Each participant went by a unique username that masked his or her identity and provided anonymity. The research team assessed each username to ensure, to the best of our abilities, that there were no repeated participants. If a participant mentioned names within the post, the research team changed the names to ensure anonymity.

The sample consisted of 31 participants. While the majority of participants posted the initial post in the online forum, some participants shared their experience of miscarriage as a response to another individual’s post. The demographics of the sample are unknown due to the anonymous nature of public online data collection. The researchers did not obtain informed consent for this sample due to the public and anonymous nature of the data, which made the research team unable to identify and contact participants who operated under pseudonyms.

Ethics of using online data

Using online data requires researchers to consider the ethical implications that may be unique to Internet communities (Eysenbach & Till, 2001). The prevalence and expansiveness of the Internet together provide new ways of gathering and collecting data (Jowett, 2015). The benefit of using these types of sources includes lack of researcher influence, which can be especially impactful when seeking to understand the experience of a phenomenon (Jowett, 2015). However critical aspects need to be considered to ensure ethical research. To further evaluate the appropriateness of our data collection from the Reddit website, we considered several important factors: intrusiveness, perceived privacy, vulnerability, potential harm, informed consent, confidentiality, and intellectual property rights (Eysenbach & Till, 2001). In keeping with recommendations by Eysenbach and Till (2001) concerning intrusiveness, and to honor the user agreement guidelines of Reddit, we chose to use passive phenomenological analysis. Reddit participants agree to user terms that specify that submitted user content is public and even private services may become public at any time (Reddit Privacy Policy, 2019). This suggests that Reddit users do not expect privacy and that boundaries around privacy are subject to change. However, to maintain confidentiality, we chose to de-identify any information obtained during data collection.

To avoid intrusiveness and potential harm, we felt that directly contacting the participants would violate Reddit’s User Agreement (2018), which requests that users refrain from interrupting services in a way that could inhibit or overburden the functioning of a service. The research team had no interaction in the threads or with the participants to avoid interrupting the service (Eysenbach & Till, 2001). We also chose not to seek informed consent due to the public nature of the forum and to avoid becoming intrusive.

Likewise, when assessing the vulnerability of our sample population, we assessed the possibility of identification and whether there were legal, financial, or social ramifications should a person’s identity be confirmed. Due to the large number of couples who experience miscarriage and lack of legal, financial, or social consequences associated with the paternal experience of miscarriage, we felt that this population would not be considered vulnerable. Lastly, we elected to use verbatim quotes to preserve the meaning and honor the experiences related to the investigated phenomenon. Because the present study is “for nonprofit educational purposes,” we believe that the doctrine of fair use applies to the reproduction of content obtained from the Reddit website (U.S. Copyright Office, 2019). These ethical considerations were taken to protect the participants of the study.

Analysis

The data was conceptualized using Colaizzi’s phenomenological method (1978). The research team identified blogs and forums that were public as the locations for data collection and compiled the data. According to Colaizzi’s method, analysis includes six steps as follows: (a) reading responses to get an overview of the experience, (b) identifying key statements, (c) creating meaning statements for each key statement found, (d) organizing statements into theme clusters, (e) organizing theme clusters into subthemes, and (f) creating a description for each theme found. Following this pattern, two researchers read all the data separately to get an overview of how the men were making meaning of their experience. The researchers then reduced the data down to statements, which reflected their experiences. These statements were organized into categories. The categories were then organized into themes that emerged from the data. These themes were defined by placing similar categories in a group and deciphering what aspect of the experience they were describing.

The research team created memos throughout this process to track the decisions they made throughout the data analysis process. The memos outlined not only how the decisions were made, but also possible biases that influenced these decisions. When the themes and categories became consistent throughout the data, and no new themes could be found, the researchers decided that saturation was reached (Creswell & Poth, 2018).

Researcher reflexivity and trustworthiness

The research team for this study implemented several components in the research process to ensure reflexivity and trustworthiness throughout this study. Anfara et al. (2002) describe four essential methods for ensuring trustworthiness in qualitative research: credibility, transferability, dependability, and conformability. The research team ensured credibility by utilizing peer debriefing. This included consulting with one another about ideas and how we as individuals were influencing the process. Transferability was ensured through the thick description of the phenomenon and by selecting a purposeful sample that highlighted the paternal experience of miscarriage. Dependability was established through coding and recoding strategies. Conformability was established through memo writing and reflexivity. Through the process, the researchers frequently reflected on their personal biases as they discussed and wrote about how their own culture and beliefs are influencing the research process.

The authors of this study specifically identified with this phenomenon in various aspects. The researchers all have personal or familial experience with miscarriage and have been trained as marriage and family therapists. The members of the research team were both male and female. Both researchers that analyzed the data were female and wrote memos throughout the process about their experience analyzing the data about participant’s experiences. Members of the research team have a specific interest in medical family therapy, which focuses on the intersection of biological, psychological, social, and spiritual factors. Many members of the research team have worked with this type of loss, and have experiences connected with it. These personal attributes of each author were bracketed out through discussion and memos prior to and throughout the data analysis.

Results

Theme I: Isolation

Throughout the data, participants expressed being isolated from the experience of having a miscarriage as the male partner. As one participant described it, “The hospital treats me as luggage that the wife brings.” The theme of isolation appeared in two subthemes of (I) disconnection and (II) lack of support.

Subtheme I: Disconnection. Thirteen participants discussed feeling disconnected, explaining feeling disconnected from their wife, and the experience of the miscarriage. One participant stated, “It’s gotten to the point that I don’t talk to Sally as much.” Another participant talked about seclusion in general terms: “I felt very alone.” The participants felt in some way disconnected from what had happened.

Subtheme II: Lack of Support. Participants described how other people failed to acknowledge their experience or offer support throughout the miscarriage. The men discussed feeling a lack of space to talk about their experience. One man commented, “Support is what I definitely need no matter how I act outwardly.” Another mentioned being treated differently than his wife, saying, “I just can’t imagine someone being so rude as to tell someone that something painful in their life shouldn’t matter because of my gender.” Another participant stated, “It was the third or fourth miscarriage before someone at the hospital even thought to ask if I was okay.”

Theme II: Overwhelmed

In this study, we found that the unexpected event of a miscarriage was often an emotional experience for those involved. Participants specifically mentioned ways that they felt overwhelmed during the experience. One man talked about the “horror that is the M-word.” There are four subthemes or ways the participants talked about the sense of being overwhelmed for this theme: (I) intense emotions, (II) trauma, (III) denial, and (IV) loss.

Subtheme I: Intense Emotions. Twenty-one participants talked about the intensity of their emotions within their posts or blog entries. They used descriptive language to portray the emotions they experienced regarding the miscarriage. One man said, “Our lives are being torn into pieces, our souls crushed.” Another shared, “I’m angry at the universe, upset, depressed, confused, defeated—and a number of other feelings—all at the same time.” A third participant described, “It is the worst pain that I have ever been through.”

Subtheme II: Trauma. This subtheme emerged as men talked about going through the trauma of the experience, many of whom described feeling numb and guilty. Of the 31 participants, 13 described traumatic experiences. One man shared his experience of being admitted to the hospital for passing out during the miscarriage. Similarly, a participant iterated, “I will never forget what I saw. I can’t. It’s burned into my mind forever.” One man wrote about the trauma of telling others: “My dad answered and started screaming in horror. He told my mom who was upstairs and I could then hear her screaming and crying.”

Subtheme III: Denial. Tied to the experience of being overwhelmed, some participants discussed the reaction of denial. Five men wrote about denying that the experience was happening, especially as they first found out. One man stated, “I refuse because this can’t be real.” Another expressed, “This can’t be happening.”

Subtheme IV: Loss. Another way participants described the grief was describing a sense of loss. Fourteen participants wrote about the loss and devastation of the miscarriage. One man said, “I was going to be a father. I was that proudest father on the planet. I’d told all my friends, all my family, hell, even the people on the street. And now? Empty.” Another participant described, “The world collapses on me. Our baby that we were so utterly excited about is not going to be here.” One father lamented, “We mourn what could have been.”

Theme III: Protector

The protector theme involved the way that men tended to protect and sought to care for the women. The protection referred to both the physical and emotional well-being of the females. One participant described, “The helplessness that sets in knowing no matter what I tried to do for my girlfriend, there was nothing I could do to really help.” The three subthemes were (I) duality, (II) need to provide, and (III) helplessness.

Subtheme I: Duality. Thirteen participants discussed the duality of wanting to protect their partner while simultaneously experiencing their own grief. One man stated, “It’s almost like a battlefield where I’m fighting and don’t have time to stop and feel because I have to keep fighting.” Another described an internal conflict, stating, “I am trying to stay positive, but seeing her hurt so much just makes me want to cry.” Another, when talking about holding his deceased child, said, “It was the most difficult yet meaningful thing I have ever done in my life.”

Subtheme II: Need to Provide. Nine men wrote about wanting to protect or be strong for their partner. One participant mentioning gender said, “I cried a little when I first found out, but sucked it up because men don’t cry, or at least that’s what I was raised to believe.” Many of the participants wrote about being concerned about their partners. One participant stated, “I do everything to shield and comfort my wife.”

Subtheme III: Helplessness. The eight participants that wrote about helplessness described a sense of not knowing, not knowing about their role, how to move forward, and how to help. One man admitted, “I don’t know what to do at this point. I don’t know how to help her.” A participant stated simply, “I’m so lost right now.” Describing the situation, one participant posed the question: “Ever been in a situation where you know the person you love uncontrollably has something terribly wrong and you can do absolutely nothing to help?”

Theme IV: Coping

Coping involved the way the men wrote about handling or dealing with what was happening to them. It involved ways of seeking to finding meaning in their experience. One man said, “Seeing the good is helping to dull the pain.” The three subthemes of this theme are (I) desperation, (II) connection, and (III) change of outlook.

Subtheme I: Desperation. Ten participants wrote about seeking help and doing whatever they could to process the experience. They described writing about their experiences as feeling a sense of urgency to process their experiences and receive support and help from others. A man sought support stating, “I could use any words right now.” One person spoke of a desire to talk about the experience: “I need to get my thoughts out. I need to remember this.”

Subtheme II: Connection. The subtheme of connection emerged clearly in the data as 26 of the 31 participants discussed wanting to connect with others who had the same experience. The participants did not clarify if it was the community of miscarriage or of other men that they were seeking to connect with; however, they often thanked others for reading or having a space to write about their experiences. In talking about one of the nurses, a man said, “[T]his woman cried with us. After all those years and women she’s seen go through this, she cried with us.” In talking about what he needed, one participant said, “I needed to talk about my son, I needed to acknowledge his existence, I needed to know that he mattered to other people. I needed to read others’ experiences of loss and grief.” Another man stated, “So here I am, reaching out to you guys, in a [forum] that none of us want to be in.”

Subtheme III: Change of Outlook. Eight participants wrote about how the experience changed them. They described the change or growth from their experience and the way it influenced their perceptions. One described a deepening:

It can become a lens for how you approach others with compassion, knowing that everyone suffers. Some suffer how you are suffering now, others in different ways. But if you can use your grief to open compassion inside of you, it will be a profoundly deepening experience as well as a profoundly sad one.

Another wrote about the way he changed: “My son couldn’t see my fatherly smile, but sure he changed me deeply and forever. To this I say, he will always be my son, I will always be his dad.” One participant described the change to his relationship. He said, “I know that it happened for a reason and in the end, everything is going to be okay. My wife and I are going to grow stronger as a couple and hopefully never have to endure this again.” See Table 1 for descriptions and examples of each theme.

Table 1. Theme Descriptions and Examples.

Theme	Subtheme	Meaning	A sample of coded text
Isolation	Disconnect	Disconnection from experience and others	“I felt very alone.”
	Lack of Support	Not having loss acknowledged by others	“I have no where else to turn to about this.”
Overwhelmed	Intense Emotions	Showing emotion	“This situation has certainly wrecked me.”
	Trauma	Talking about traumatic experiences	”I will never forget what I saw. I can’t. It’s burned into my mind forever.”
	Denial	Denying the miscarriage is happening	“This can’t be happening.”
	Devastation	Intense emotion due to the loss of something	“Our baby, that we were so utterly excited about, is not going to be here.”
Protector	Duality	Internal conflict	“She doesn’t want me to leave. But I can’t stay with her. I just can’t.”
	Need to Provide	Partner coming first	“I do everything to shield and comfort my wife.”
	Helplessness	Not knowing what to do	“I’m so lost right now.”
Coping	Desperation	Seeking help	“I could use any words right now.”
	Connection	The desire to connect with others	“She was my rock just as I was hers.”
	Change of Outlook	A change in thoughts or acknowledgment of growth	“He changed me deeply and forever.”

Discussion

For many years pregnancy loss has been primarily considered a “women’s issue,” with fewer studies examining the men’s experiences of pregnancy loss (Due, Chiarolli, & Riggs, 2017), although studies support the concept that men are impacted by miscarriage (Due et al., 2017). Men often have intense emotions that they do not share or know how to share with others (Abboud & Liamputtong, 2003). Common themes within past data and our findings further demonstrate the complexity of men’s experiences.

One unique aspect of this study was that the data were collected from men who chose to write about their experiences. The demographics of this population is unknown since the researchers were unable to contact the participants. The inability to contact the participants also resulted in only understanding the experience that the men were willing to write about on these public domains. However, the men in the study wrote about their experiences, including themes of isolation, coping, grief, overwhelmed, and protector without prompt or influence from researchers. The data covered a variety of perspectives of what happened to them.

The men in this study tended to feel that they were alone in the experience and disconnected from the experience. They felt as if their sense of loss was not acknowledged. Due to this disconnect, many participants included either seeking connection in writing or experienced deepened connection from others around them.

There was an element of the participants being overwhelmed, manifested in intense emotions, trauma, denial, and devastation in the men. These emotions described by the men are similar to what studies have reported women experiencing during a miscarriage (Lim & Cheng, 2011). This shows that both the men and women are experiencing intense emotions after the loss of an unborn child.

With these emotions that the men reported experiencing, we also found that there was a duality of emotions happening for the men. They had a need to protect as well as a sense of not knowing what to do. Both men and women experience grief after miscarriages (McCreight, 2004) but the men in this study seemed caught between being there for their wives and experiencing their own grief. This internal conflict went beyond the need to provide and helplessness; it also included numerous conflicted emotions of the men.

The men in this study not only shared their emotional experience of their partners having a miscarriage but they also shared how they coped with this experience. The men coped by desperately seeking help. They also reached out for connection and showed this desire to connect with others who have gone through a similar experience. Finally, this study showed an overarching theme of men being impacted profoundly by miscarriage.

Clinical implications

The results of this study suggest that men feel overlooked by professionals when a couple experiences a miscarriage. Our findings indicate that often men might mask their grief as they try to help a grieving partner. Mental health professionals and medical professions should consider and be mindful that men may cope with grief differently and may not always communicate about their experience due to a desire to protect their partner whose grief is more openly expressed and recognized. Therapists and medical professionals can create a space for men to process the miscarriage by checking in and asking the male partner how he is doing. Professionals who work with the couple or the father should regularly check in, as grief is not a linear process (Boss, 2010), as well as seek to provide resources for both partners who have experienced the loss.

Limitations and future directions

One limitation of this study was the lack of follow-up with participants. The researchers’ decision to not contact participants, so as to not intrude or cause harm to the functioning of the online forum, also prevented the researchers from being able to access the depth and richness that often accompanies in-person interviews and member checks characteristic of phenomenology (Creswell & Poth, 2018; Daly, 2007). Since the researchers were not able to follow up with the participants, further information about the nuances of their experiences with grief was not obtained. This restricted the study to only understanding the experiences that the participants were willing to write about on public domains. Though the online data set limited the ability to go deeper into the participant’s experiences, the anonymous nature of the data set provided raw descriptions that allowed for a qualitative study using a phenomenological approach to the paternal experience of miscarriage. This data provides valuable information to researchers and clinicians concerning potential areas for future research with this population.

Another limitation of this study was the lack of demographic information about the participants. As this was a passive analysis study, we were unable to obtain demographics about the participants. In order to contribute content to the online forum on Reddit, the participants created user names with Reddit. However, Reddit does not collect or share information concerning user demographics (e.g., sex, gender, age, race, religion, socioeconomic status, geographic location, etc.). Thus, we do not know if the results are for a specific demographic or a diverse demographic. While we identified 31 distinct usernames, and the associated content with each username suggested that the participants were persons who identified as men who had experienced perinatal loss with their partner, it is possible that users could have more than one account or that someone falsely identified as a male who experienced grief due to a miscarriage. Without specific demographic information concerning the participants, our findings lack transferability and replicability. Despite these weaknesses, the results still provide new insight as to how men experience miscarriage and what they may only share in anonymous online settings.

Another limitation of this study was that the researchers did not know about time for the miscarriages. This includes how much time had passed since the time of the miscarriage to the time of the blog post, the time within the pregnancy that the miscarriage occurred, or the number of times the participant had experienced a miscarriage. These elements of time would bring another layer to this data allowing the researchers to understand if the passing of time after the miscarriage influenced how men described their experiences. Future studies on men’s experience of miscarriage should incorporate the passage of time. The added information on timing within miscarriage would benefit understanding the different contextual factors that influence both partners. Future research may consider the need for resources for men when their wife’s experience miscarriage, especially within the marriage and family therapy field.

Acknowledgments

The researchers have no acknowledgments to include.

Disclosure statement

The researchers have no conflicting interest in the research and have received no funding to produce this research.