"Miscarriage happens in up to 15 percent of pregnancies. Why aren’t we talking about it?"
By Jyoti Madhusoodanan| April 16, 2020
Photo: Kit Agar
"Lizette Galvan’s home pregnancy test was positive a few days after her expected period. But at her first ultrasound, she heard the words: “This is where the heartbeat should be.” Just six weeks into her first pregnancy, Galvan — like approximately one in 10 pregnant women — had miscarried.
Most early pregnancy losses occur within the first 12 weeks. Although the risk drops with each passing week, a miscarriage can occur any time until the 20-week mark. (Later losses are considered stillbirths.) About 10 to 15 percent of all pregnancies end in such an early loss, according to the American College of Obstetricians and Gynecologists. “Miscarriage is the most common complication in pregnancy,” said Dr. Courtney Schreiber, M.D., an associate professor of obstetrics and gynecology at the University of Pennsylvania. “Many occur even before a woman has connected with a prenatal care provider.”
Thanks to improved home tests, women like then 38-year-old Galvan learn sooner than ever if they’re expecting. “In the past, women would not even have known about a lot of pregnancies that would’ve ended in a miscarriage,” said Dr. Pamela Geller, Ph.D., an associate professor of psychology, ob-gyn and public health at Drexel University in Philadelphia. “They might have had a bit of pain and bleeding but would have just thought of it as a heavy menstrual cycle.”
This early knowledge also means more women grapple with the emotional consequences of early pregnancy loss — which are often no different than the grief of losing a loved one.
For this guide, I read through the science, and spoke with three practicing ob-gyns and a researcher who studies miscarriages to help you understand early pregnancy loss, treatment options and ways to optimize recovery."
"The pain of pregnancy loss lingers and can take a toll on your relationship."
By: Mira Ptacin| April 19, 2020
Photo: Mira Ptacin and her husband, Andrew, wed one month after a pregnancy loss.Credit...via Mira Ptacin
"Five months into my pregnancy and moments after we went in for a sonogram, a deafening silence filled the air. The image on the ultrasound screen revealed the child in my womb had a constellation of birth defects and no chance of survival outside of my body.
Right after doctors gave me the diagnosis — holoprosencephaly — I was given three options: terminate the pregnancy, induce and deliver a doomed fetus or wait for the tragedy to unfold on its own terms. Ten days later, I was no longer pregnant. One month after that, my fiancé, Andrew, and I got married. My breasts were leaking milk, I was wearing a trampoline-sized maxi pad and still bleeding when I said the words “I do.”
Since this loss 12 years ago, I’ve seen my share of therapists and bereavement experts. As Andrew and I waded through the bleary stages of our sorrow, many of these professionals warned us that divorce rates after experiencing child loss are staggeringly high. “Up to 90 percent” was the common refrain — a statistic most likely drawn from one of the earliest books on grief and child loss, Harriet Schiff’s groundbreaking “The Bereaved Parent.”
But this book was published in 1977, and Schiff’s study is hardly conclusive. First of all, she cites little empirical evidence. Also, it’s hard to statistically control for all the variables in a relationship; separating the influence of child loss from other causes of marital problems in bereaved couples is essentially impossible. Still, professional therapists, grief counselors and couples can agree on this: Marriage is difficult, and managing to stay married after the death of your child is incredibly, incredibly difficult.
“You’re the only two people who have shared the loss of your child, and it feels like you can get lost in the pain,” said Anne Belden, M.S., a family planning coach who runs a private practice that focuses on women and couples who are going through infertility, adoption and child loss. “To look in the eyes of your partner and see equally deep despair — it magnifies your pain and can almost be too much to bear.”
Being with your own grief is hard enough, Belden explained, but sometimes, sharing our sorrow with the person who has experienced the loss with us fails to promote healing. Quite often, the opposite occurs."
By Jennie Agg| May 5, 2020
"After losing four pregnancies, Jennie Agg set out to unravel the science of miscarriage. Then, a few months in, she found out she was pregnant again – just as the coronavirus pandemic hit"
"I stepped out of Oxford Circus tube into mid-morning crowds and cold, bright sunshine. The consultant’s words were still ringing in my ears. “Nothing.” How could the answer be nothing? This was January 2018, six months since my third miscarriage, a symptomless, rather businesslike affair, diagnosed at an early scan. The previous November, I’d undergone a series of investigations into possible reasons why I’d lost this baby and the two before it.
That morning, we had gone to discuss the results at the specialist NHS clinic we’d been referred to after officially joining the one in 100 couples who lose three or more pregnancies. I had barely removed my coat before the doctor started rattling off the things I had tested negative for: antiphospholipid antibodies, lupus anticoagulant, Factor V Leiden, prothrombin gene mutation.
“I know it doesn’t feel like it, but this is good news,” he said, while the hopeful part of me crumpled. We were not going to get a magic wand, a cure, a different-coloured pill to try next time.
Now, my husband, Dan, was back at work and, for reasons I can’t really explain, I had decided to take myself shopping rather than go home after the appointment. I stood staring down the flat, grey frontages of Topshop and NikeTown and willed my feet to unstick themselves from the pavement.
I ended up wandering the beauty hall of one of London’s more famous department stores. I let myself be persuaded to try a new facial, which uses “medical-grade lasers” to evaporate pollution and dead skin cells from pores to “rejuvenate” and “transform” your complexion. Upstairs in the treatment room, the form I was handed asked if I’d had any surgery in the past year. I wrote in tight, cramped letters that six months ago I had an operation to remove the remains of a pregnancy, under general anaesthetic. When I handed the clipboard back to the beautician, she didn’t mention it. I wished that she would.
As I lay back and felt the hot ping of the laser dotting across my forehead, I thought how ridiculous this all was; that this laser-facial is something humans have figured out how to do. How has someone, somewhere, in a lab or the boardroom of a cosmetics conglomerate, conceived of this – a solution to a problem that barely exists – and yet no one can tell me why I can’t carry a baby?
There is no doctor who can reverse a miscarriage. Generally, according to medical literature, once one starts, it cannot be prevented. When I read these words for the first time, three years ago, after Googling “bleeding in early pregnancy”, a few days before what should have been our 12-week scan, I felt cheated. Cheated, because when you’re pregnant you are bombarded with instructions that are supposed to prevent this very thing. No soft cheese for you. No drinking, either. Don’t smoke, limit your caffeine intake, no cleaning out the cat’s litter tray. I had assumed, naively, that this meant we knew how to prevent miscarriage these days, that we understood why it happened and what caused it; that it could be avoided if you followed the rules.
You learn very quickly that the truth is more complicated. After a miscarriage, no medic asks you how much coffee you drank or if you accidentally ate any under-cooked meat. Instead you find that miscarriage is judged to be largely unavoidable. An estimated one in five pregnancies ends in miscarriage, with the majority occurring before the 12-week mark. Seventy-one per cent of people who lose a pregnancy aren’t given a reason, according to a 2019 survey by the baby charity Tommy’s. You are told – repeatedly – that it’s “just bad luck”, “just one of those things”, “just nature’s way”.
Just, just, just. A fatalistic shrug of a word. But this is not the whole story. “There is this myth out there that every miscarriage that occurs is because there’s some profound problem with the pregnancy, that there’s nothing that can be done,” says Arri Coomarasamy, a professor of gynaecology and reproductive medicine, and director of the UK’s National Centre for Miscarriage Research, which was set up by Tommy’s in 2016. “Science is trying to unpick that myth.”
Unfortunately, the roots of this myth run deep. It’s an idea reinforced by the social convention that you shouldn’t reveal a pregnancy until after 12 weeks, once the highest risk of miscarriage has passed. It goes unchallenged thanks to age-old squeamishness and shame around women’s bodies, and our collective ineloquence on matters of grief. The bloody, untimely end of a pregnancy sits at the centre of a perfect Venn diagram of things that make us uncomfortable: sex, death and periods.
An impression persists that, while unfortunate, miscarriages are soon forgotten once another baby arrives – that you’ll get there eventually. It’s true that the majority of people who have a miscarriage will go on to have a successful pregnancy when they next conceive (about 80%, one study carried out in the 1980s found). Even among couples who have had three miscarriages in a row, for more than half, the next pregnancy will be successful. Accordingly, the prevailing logic seems to be that not only is miscarriage something that cannot be fixed – it doesn’t need to be fixed. There is little research or funding for trials, and only glancing attention from the healthcare system. What is not being heard, in all this, is that miscarriage matters."