Miscarriage/ Spontaneous abortion
Both terms are used to describe the spontaneous termination of a pregnancy before the 24th week, the loss of a foetus before it is able to survive.
To lose a baby in the early weeks of pregnancy can be quite shocking. I say ‘baby’ because that is how most women refer to a confirmed pregnancy. To them it is exciting to realise that they are going to have a baby; no one normally would feel the urge to tell anyone that, oh ‘joy of joys’ they were going to have a foetus. Would they?
I will dwell on the planned and wanted pregnancy, the baby to be.
The confirmation of pregnancy with a positive test can send a woman on an emotional roller coaster. The world looks different, feels different, and is different. A sense of inner happiness consumes her, together with an often-overwhelming desire to tell every one, including the postman. This smugness in the knowledge that you’ve made the grade and are up there in the exciting world of mothers and babies, is hugely satisfying. Suddenly shops seem only to sell baby goods, television and radio presenters talk about parents and mothers and babies, all the time. No paper or magazine gets beyond the first few pages without reference or photos of beaming babies, proud and happy couples, and nappies. Bliss is an inner secret to puff you up with joy, as is a caring solicitous partner who enfolds you in cotton wool and becomes more hands off than on. The world is full of smiles. You proudly make the announcement to your nearest and dearest; they, along with you and your partner are ‘over the moon’. The reaction of potential grandparents is equal to your own.
Imagine then the distress and concern if pains come and go where your baby lies hidden from view. You may bleed a little.
Initially you have a mixed reaction of fear and disbelief. You are frightened, your heart pounds and suddenly you are aware that you could be losing your precious baby. An unemotionally attached doctor or midwife may answer the nervous phone call for help. The advice is nearly always the same – sit tight, do little, and await events, let nature take its course for you are probably having a miscarriage. In the obstetric world a miscarriage is not anything more than an unfortunate occurrence. It is a matter of concern of course to the sensitive practitioner, and there will be a reaction in clinical terms: the examination, the scan, and the follow up.
What about you?
If, in the event that you do lose the baby, guilt may enter your world. You ran, you walked, you tripped over a cat, you lifted a bucket, you put up wallpaper, you ate cheese, you drank wine and you had intercourse. You will blame yourself for all these things. The phone calls to waiting grandparents, brothers and sisters, will be a tearful affair. Sorry you say, sorry that we’ve lost the baby; sorry you aren’t going to be a granny, an uncle or an aunt. So why the apology? Why the guilt? You certainly never intended to harm your baby. Often it is the thoughtless question that adds pain to your whirring brain of emotion. Well meant comment really does touch a nerve. Yes, you did walk up the hill when the car broke down. So, you really were to blame? No, of course not.
You will grieve. Your partner will feel the guilt too, especially if intercourse is mentioned. Of course you will get pregnant again the world announces. It does not help at this moment; you wanted the baby you lost. The sight of babies and pushchairs and happy parents are hurtful now, bitterness and some resentment will overwhelm you.
Does it help to hear statistics? Generally, I think not. Nothing is going to get you back in to that happy world. It can help a little to realise that it is not uncommon. It will help to meet and talk to others that have suffered a miscarriage, empathy is easier to absorb. Once the miscarriage is confirmed the medical profession will offer advice. They are trying to be as helpful as possible and it may be conflicting.
The advice will be along these lines:
Try again as soon as you feel you want to. Leave trying to get pregnant for a couple of months. Wait until you have had another period. Get fit and healthy, rest, exercise, eat well, no alcohol, no smoking, take Folic acid tablets, avoid sheep at lambing time and attend pre pregnancy sessions.
I spoke to many couples after a threat of miscarriage, or actual miscarriage. Words were never adequate for the sadness that enveloped them. Many had not for one moment contemplated the possibility of losing their baby; such thoughts never entered their mind. Many knew about miscarriage of course, it happened to other people as most tragedies do.
Suffice to say that there is wisdom in all the advice meted out by doctors, midwives and well-meaning friends. Only you will really be the best judge of when you are ready to try again to make a baby. Try, you will, and eventually I hope that blissful state of hope and expectation will once more enter your soul. You will be fertile again by the time you restart your periods.
It may be easier to come to terms with this emotionally devastating loss when you realise that nothing you did caused you to lose this baby. You can also take comfort in the knowledge that this is not considered an abnormal event and that you actually were pregnant, an achievement in itself.
Your partner has experienced guilt, fear, disappointment and failure too, though his main concern will be to protect you from further harm. Together your relationship will be strengthened by this sad experience. It is to be hoped that you will hold a new baby in the future, and that it will not harm either of you to grieve for the baby you have just lost. That little one was not meant to be.
Research continues in to the causes of miscarriage. Genetic faults and a failure of the baby to implant in the womb securely are possibilities. Contributory factors of multiple pregnancy, age, illness, smoking, extreme stress and anxiety are recognised. The renowned Professor Regan pioneers much of this work with her studies into recurrent miscarriage.
The emotional trauma experienced by couples when they have a miscarriage is much more appreciated by the medical profession now. Women themselves feel more able to discuss these issues and though no single cause is likely to be found, thoughtful preparation for pregnancy is one way that all women can contribute to their own health and well being.
Janet Menell has been a qualified nurse and midwife since the early 1960s. She retired from community midwifery in 2002, having practised in the same area since 1974. Her new book, Waiting for Charlie, is available online at www.miltonpublishing.co.uk