I haven’t blogged for a few months for a variety of reasons but mainly because life got in the way; school holidays, training for a half marathon and crossing over in to the world of GP partnership. I wanted my next post to be about something that inspired or interested me and I didn’t want to write something just for the sake of it. This week is Baby Loss Awareness Week and I felt compelled to write about miscarriage – from both a personal and professional view point.
I have two wonderful children, aged 6 and nearly 3, but not everyone will know I was pregnant in between. I recall finding out I was pregnant for the second time, I was due to go to a friend’s wedding so was keen to do a test beforehand so I could avoid alcohol if I needed to. It was positive, I was a bit freaked out to be honest, I had a 13 month old daughter and was having to get used to the idea of potentially having two children under the age of 2. My due date was early July (in fact it was the day of the Tour de France coming through York) and I soon felt the familiar excitement of early pregnancy.
I experienced some mild ‘spotting’ (bleeding) when I was about 7 weeks pregnant and I had a scan in the Early Pregnancy Assessment Department (EPAD/EPAUs) at the hospital. All was fine, the dates matched up and a healthy heartbeat was racing away. I relaxed and enjoyed another 3-4 weeks of pregnancy. I was just over 10 weeks when some mild bleeding started again, I wasn’t too concerned as felt otherwise fine. My 12 week dating scan was booked the week later so I decided not to arrange another early scan via EPADs.
Then it happened.
One Tuesday in December…a week before my birthday…not long before Christmas…I had the miscarriage. Heavy bleeding and I passed ‘the products’. It wasn’t very painful which surprised me. It lasted a few hours and then the physical side seemed to suddenly end.
The events I described here happened 5 years ago and I’m quite surprised how well I can remember how it felt. The physical side of miscarriage was one thing, the emotional side was quite another. I had never felt emptiness like it. There was an element of feeling like a failure. There isn’t sadness like it. I already had a daughter and felt guilty for being selfish for wanting more but at the same time, grateful that we had her. I felt guilty that maybe it was my fault, had I done something to risk the pregnancy? The thoughts go round and round. And then came the guilt related not to being able to work in the busy pre-Christmas period.
Emptiness. Failure. Guilt.
A few weeks later came a little relief and the start of acceptance. I started to consider that maybe the miscarriage had happened for a reason; was there something wrong with the baby? Maybe it wasn’t the right time after all? It can take a long time to come to terms with miscarriage. I found it especially difficult when people would ask ‘when’s number two on the way?’. It is a loss, there is grief but for me there was thankfully a Spencer at the end of the rainbow.
I cannot pretend that my third pregnancy with my son was easy. I was quite detached from it all in the first trimester, trying not to get too close in case the pregnancy was also destined for miscarriage. I was really surprised at the huge relief I felt at our dating scan, seeing that heartbeat ticking away on the screen was a special moment. One friend told me recently that she didn’t want to get ‘too excited’ about her second pregnancy as her first had ended in miscarriage. She wanted to ‘protect her heart’ in case the outcome was the same. This really resonated with me and I am sure it will with some of you who have also been through miscarriage.
So that’s my story, now a few facts about miscarriage…
- 1 in 4 pregnancies end in miscarriage
- Miscarriage is defined as a loss of pregnancy up to a gestation of 23 weeks and 6 days, a loss beyond that would be considered a still birth
- There are many causes of miscarriage but most are unknown (more info here)
There are different types of miscarriage
- Early (<14 weeks) vs late (14-23+6 weeks)
- Missed – when the pregnancy is not viable on ultrasound scanning but you have no symptoms of miscarriage
- Incomplete – despite heavy bleeding or treatment for miscarriage a scan shows that the miscarriage is incomplete. Medics use the term ‘retained products of conception’ to describe the tissue left over (not my favourite medical term I have to say). If this happens there are options for the next step; letting nature take its course, medical management (taking medication to encourage completion of the miscarriage) or surgical management (having a surgical procedure to remove the ‘products’).
- Recurrent – when a woman suffers three or more miscarriages we recommend referral to gynaecology for tests to see if there is an underlying cause.
The signs and symptoms of miscarriage can vary hugely from a light period with some cramps to massive haemorrhage and severe abdominal pain with dizziness. It can last a few hours or several days, many women staying home and some requiring hospital admission. Some women will note a loss of pregnancy symptoms (e.g. sudden change in morning sickness) but this isn’t a very sensitive symptom to suggest miscarriage but may warrant an early scan in some. Miscarriage is generally diagnosed on ultrasound scan; if the scan is inconclusive you may be asked to come back for a rescan a week or so later to check for growth/change. I will not go in to all the detail here but this is a useful link about how to recognise and manage miscarriage.
In summary, miscarriage is tough whether it occurs a week after a missed period or a later gestation. The parents of that baby had plans for them, they had started to think what they might be like, are they a boy or a girl, the due date is probably etched in their minds. Let’s normalise what is a common process, there is no shame in miscarriage. One in four, 25%, a quarter. That means whether you realise or not, you know someone who has gone through a miscarriage. We need to talk about it, let’s stop hiding the sadness away and increase awareness to stop women and families going through miscarriage feeling so alone.
It took me a while to talk about my miscarriage but I soon realised that being open about it could help others and also help me process what had happened. Friends were going through the same and I could support them through it or at least show them that I understood. Initially it was difficult to find the right words, verbalising what had happened is entirely different to ruminating about it in your own head. I started slowly and the rest followed, telling my story helped me to heal.
I sometimes disclose my miscarriage to patients when they are suffering the loss to make them realise that they aren’t alone and there is hope. I can empathise when a woman says she can’t look at pregnant bumps in the street, when she admits she gets a pang of jealousy when a friend announces their new baby news or if the due date passes and no one else realises the significance, a mother with no baby in her arms but a memory of what might have been.
So, please, miscarriage happens, it happens a lot…let’s all talk about it.