Residues and remains: an anthropology of practices around pregnancy endings

Understanding the practices around miscarriage

Dandelion Project January 2019 - 2026

Funded by the Wellcome Trust as part of a University Award in the Humanities and Social Sciences (Grant number: 212731).

The research explores the practices around pregnancy endings and their remains, including acts of forgetting and remembering, and asks what do these reveal about the status of foetuses, women and mothers in contemporary England?

Pregnancy endings provide opportunities to interrogate anthropological assumptions about the contemporary family, motherhood, personhood and kinship. To analyse this, I will focus on the practices in the aftermath of a pregnancy ending to understand what they reveal about the values afforded to the remains in different contexts (clinic, home, burial site, crematorium, grave site etc) and by different stakeholders. My research will explore how reactions to and practices around pregnancy endings and remains reflect wider cultural trends in the UK, particularly around motherhood as highly moralized and notions of foetal personhood. I ask how does grief (or the absence of it) intersect with the relationship of the materiality of the remains and the woman’s body.

The research involves in-depth, embedded and analytic ethnography at and Early Pregnancy Assessment Unit (EPAU) in England and other relevant clinical, community and domestic sites.

Project members

• Susie Kilshaw

Advisory Board

The project includes a group of academics and stakeholders who will help to inform the project throughout its duration.The Board consists of:

• Dr Ingrid Granne
• Prof Lynn Morgan
• Prof Linda Layne
• Dr Sheelagh McGuinness
• Prof Naomi Pfeffer
• Mandy Meyers, Director of Operations British Pregnancy Advisory Service
• Ruth Bender-Atik, National Director of Miscarriage Association

Objectives

• By focusing on remains and associated rituals, as well their absence, I explore what work is being done by such practices.
• The physical matter of remains (both as part of the woman’s body and separate), but also emotional remnants (hope, anticipation, investment) of pregnancy endings will be explored.
• Explore how reactions to and practices around pregnancy endings reflect wider cultural trends in England including the contemporary context of ‘anxious reproduction’ (Faircloth and Gurtin 2017) and motherhood as highly moralized (Faircloth 2013; Taylor 2008; Gammeltoft 2007).
• How does grief (or the absence of it) intersect with the relationship of the materiality of the foetus and the woman’s body.
• To widen the discussion of miscarriage to include remnants more broadly: I explore both the materiality of remains and the imaginations linked to them.
• Interrogate whether national guidance and local policy is in line with women’s requirements by considering complex and diverse expressions of pregnancy endings.
• Assess the Human Tissue Authority (HTA) Guidance on pregnancy remains and local policy and contribute to revisions, if necessary.
• I seek to understand what practices reveal about the values afforded remains in different contexts (clinic, home, burial site, crematorium etc) and by different stakeholders.

News

Health Research Authority Ethics approvals (IRAS Reference: 261330, Research and Development Reference: 14448, Research Ethics Committee Reference: 19/SC/0428) and subsequent site approvals were received in January 2020. Fieldwork/ data collection is now underway.

Publications

• Kilshaw, S. (forthcoming). “It’s a clump of cells that has hopes and dreams attached to it… but it’s not a baby”: The insensitivity of “sensitive” care, bureaucracy of pregnancy tissue disposal in England, UK. Anthropology and Medicine.
• Kilshaw S. (2024) Women’s experiences of the consenting process for pregnancy remains disposal following early miscarriage BMJ Sexual & Reproductive Health 2024;50:99-106. https://srh.bmj.com/content/50/2/99
• Kilshaw, S. (2024). ‘Now I’m a weird mother who doesn’t care’: Women’s experiences of pregnancy remains disposal following miscarriage in England. Mortality, 1–18. https://doi.org/10.1080/13576275.2024.2319748  https://www.tandfonline.com/doi/full/10.1080/13576275.2024.2319748?src=exp-la
• Middlemiss, A. L., & Kilshaw, S. (2023). Further Hierarchies of Loss: Tracking Relationality in Pregnancy Loss Experiences. OMEGA - Journal of Death and Dying. doi:10.1177/00302228231182273 https://journals.sagepub.com/doi/full/10.1177/00302228231182273

Online publications:

• Kilshaw, S. (2024) 5 misconceptions about miscarriage. https://www.naturalcycles.com/cyclematters/misconceptions-about-miscarriage
• Kilshaw, S. (2023). Nine women share what it's like to have a miscarriage. The Conversation. Retrieved from http://research-reports.ucl.ac.uk/RPSDATA.SVC/pubs/UPI?orderby=type
• Kilshaw, S., & Middlemiss, A. (2022). Sharing the burden of miscarriage knowledge. Retrieved from https://heathertrickeyprize.org/2022/01/30/sharing-the-burden-of-miscarriage-knowledge/

Events and activities

We are dedicated to ensuring the research findings are able to make a difference to the care of women experiencing pregnancy ends. Over the past year we have been engaging the local NHS trust where the project was based and are working with them to change their policies and practices around pregnancy tissue disposal. We have organised a series of workshops , which have brought together NHS early pregnancy experts, pregnancy loss charities, and national bodies to discuss the research findings. In the final workshop we worked as a team to revise two of the most influential national guidance on pregnancy tissue disposal practices. To support this work we were awarded additional funding to support knowledge exchange and impact activities:

• 2023   Research England’s Higher Education Innovation Fund (HEIF), administered by UCL Innovation &Enterprise (£14 420) ‘Developing consistency in pregnancy remains disposal consent process’.
• 2023   University College London, Innovation in Women’s Health Grant, Engineering and Physical Sciences Research Council (EPSRC) Impact Acceleration Account (IAA) (Grant Reference EP/X525649/1) (£4000). ‘Natural Cycles Miscarriage Care: Providing information, education, and support for Cyclers experiencing miscarriage’.