Friday, August 17, 2018

Miscarriage


First, I wanted to apologize for not posting last week. Things were crazy, and I couldn’t give the proper attention to my writing that I needed to, especially on so sensitive a subject. The last couple of weeks, I’ve been focusing on the complications of building a family. Before I introduce the topic, I wanted to say a huge thank you, from the bottom of my heart, to everyone that read my last post. Writing about infertility was such an eye-opening experience for me, and I feel like talking to people and doing the research truly brought home what a devastating situation it can be for those that are currently struggling or have struggled to have a baby. Because of all of you, my last blog got over 530 hits…more than almost all my other posts combined! I am so grateful for everyone that took the time to read it, and I hope some of you will continue on with me on this journey. This week, I’m tackling another tough subject. Again, it’s an unspoken topic that is just now beginning to get some recognition for the part it plays in our lives. This week, I’m discussing miscarriage, stillborn, and newborn death.

Just like with infertility, miscarriage is rarely talked about. It’s something most people shy away from talking about. Yet, just as with infertility, chances are we know someone that has suffered this loss. I say loss for lack of a better, more complete word. The truth is, miscarriage, like infertility, is deeply personal. It’s a life altering, painful experience that often gets ignored. However, if you’ve ever known someone dealing with miscarriage or loss, you know that it should be discussed. Once again, I’ve spoken with some brave ladies that were willing to share their stories with me, and have allowed me to share those stories with all of you.

There are many misconceptions about miscarriage, and the biggest is that the mother has done something to cause a lost pregnancy. However, that’s simply not true. The rate of miscarriage isn’t even truly known, because so many take place even before a woman knows she is pregnant. The truth is, upwards of 50-75% of all pregnancies could terminate at some point after fertilization, mostly due to genetic error.  Most sources I looked at agree that somewhere between 10-30 percent of known pregnancies end in miscarriage, but that only accounts for pregnancies lost after a woman discovers she is pregnant. That means that the majority of pregnancies are lost before a woman is even cognizant that she is pregnant, and may never know that a pregnancy terminated. It is believed by some experts that half or more of fertilized eggs die before implantation, or are miscarried. Most of these egg deaths and miscarriages are due simply to faulty genetics. The fetus (or embryo, depending on how far into the pregnancy a woman is) just simply doesn’t develop correctly, and therefore can’t survive. A mother, whether she knows or not, did not CAUSE the miscarriage.

That doesn’t mean that outside factors can’t affect a woman’s chances of miscarrying, however. Things like uncontrolled diabetes, thyroid disease, advanced maternal age, infections, hormonal issues, and uterine or cervical problems can also cause or increase the chance that a woman will miscarry. Of course, things like illicit drug use, alcohol, and smoking can also cause miscarriage, as well as exposure to radiation, trauma and maternal weight extremes (obese or anorexic, for instance).  While it’s true some of these factors are within a mother’s control, such as drug use, the majority are not. Yet, somehow, there is still a stigma that remains attached to miscarriage. It is thought that if a pregnancy is lost, a mother must have done something wrong. It is even a common misconception still today that things like sex, exercise, and working can cause miscarriage, but those are myths. Unless a job includes chemicals or something else life threatening, it’s not going to affect a pregnancy.

So, what exactly is a miscarriage, and how is it different from a stillbirth? A miscarriage is a spontaneous loss of pregnancy, at any point from conception to 20 weeks’ gestation, as stated by medicinenet.com A stillbirth, on the other hand, is the death of a baby before or during birth. Regardless of the timeline of the loss, however, it’s a traumatic event for the mother, and one that effects not just her, but the entire family. Within women in their childbearing years, the chance of miscarrying is between 10-25%. Even in healthy women, the chance is between 15-20%. Stillbirths effect about 1% of pregnancies, and while that may not sound like a lot, that’s about 24,000 babies a year.  The numbers are sobering, aren’t they? It’s a terrifying thought, knowing that even if you are in top health, doing all the right things, that chances of losing a pregnancy are that high. Yet, still, even with rates that significant, miscarriage and stillbirth aren’t really talked about in our society.  A quick Google search will bring up articles and blogs about this same topic, with the same question: why don’t we talk about it?

 In short, I think it comes down to a sense of shame. Women are told from the cradle almost that one of our main purposes is to have children. It’s almost expected, and if we deviate from that destiny, we are held to questions. That’s not to say that a lot (or maybe even most) women don’t want children. However, that pressure and that desire to have a baby quickly turns to shame whenever there’s a loss. Women blame themselves for things that our out of their control, thinking that they must have done something wrong that caused her body to terminate a pregnancy, or go into labor early. The experience can feel like a failure at the most basic level of being a woman.

A great article I found on the American Psychological Association provided a lot of insight into the way miscarriage effects not just women, but families as well. It speaks of the way that women heap guilt among themselves, asking the question ‘what if” repeatedly, as if their actions somehow caused their loss. While that’s fundamentally not true in most cases, this way of coping by trying to reason out the why’s of the situation are harmful to the psyche. This is especially true for mothers that may not have wanted the pregnancy to begin with, or were unsure if they did. A whole other layer of guilt is placed on their shoulders, as if their negative thoughts had somehow caused the miscarriage.

Added to all this is that a woman’s grief may not even be validated by her circle, especially if it’s an early loss, or even a failed IVF cycle. When I was speaking to Y, one of my brave ladies that told me of her story in my last blog, she explained to me her decision to undergo IVF herself, and the devastating struggles she had along the way. She said, “We were successful into getting to the egg retrieval phase. We retrieve 17 eggs, 13 fertilized and 5 made it to day 6 to use one for implantation and freeze the rest. Six days of torture waiting to see if the miracle of science can help you become a mom once again. Implantation day was a success and we put back one embryo, now the two week wait period starts, waiting to see if it worked, waiting to see if I’m pregnant, taking every precaution to ensure I don’t mess it up. I started bleeding two days before my official pregnancy test was supposed to be done...I knew it was over, we were devastated once again. Two months went by and my husband asked what we were doing with the 4 frozen embryos we had, our potential children. I was numb and had refused to talk about it for weeks. I was ashamed that I didn’t make it work, that somehow I screwed up somewhere.” Folks, that is a heartbreaking statement, isn’t it? Yet, for so many women, this is their struggle. If a pregnancy is lost, no matter how early, and these days we can know almost as soon as it happens, women torture themselves with wanting to know the reason why, or felling as though their body somehow failed.

Yet, more than failure, losing a pregnancy is a deeply personal loss. What a lot of people don’t seem to understand is that a miscarriage is a death.  Bonding begins early in women, as her body changes. I don’t pretend to speak for all women, as I know that we are all different, and hold different emotions and thoughts and feelings about pregnancy. Speaking from my own pregnancy, I know that as soon as I discovered I was pregnant, I was filled with emotions. I was over the moon happy, scared, nervous, elated. From that very first day, I felt as though the ever growing ball of cells in my core was the center of my universe. I already loved her so much, even though I didn’t know it was a her yet. Still, the word “pregnant” on the test meant that my life wasn’t just mine anymore, it was my child’s too. It’s the start of a new way of thinking, and in my mind, I could see our new lives unfurling before me. This isn’t by any means universal, but I think it may ring true for others as well. To lose a baby, at whatever stage, is devastation. It’s not only the loss of cells or a fetus. It’s a loss of a forming person. It’s the loss of dreams, and a future. That loss is just as real and just as substantial as losing a person at any other stage of life. Just because breath hasn’t been drawn doesn’t mean that life wasn’t lost.

A lot of people may try to offset that awful loss with advice, such as to not worry or that a woman will get pregnant again. That advice, however well meaning, hurts. It completely discounts her loss, and says to her that her grief is misplaced. Studies have been done showing that there is no difference in grief whether a baby is lost at 22 weeks or 2. However, for whatever reason, society tends to discount that loss the earlier it is, as if losing a pregnancy the day after it’s discovered matters less than a fully formed baby. To her, it matters. To her, it causes her anguish. It affects her emotionally, mentally, and physically. The emotional scars of miscarriage don’t just disappear overnight. In fact, studies have shown that women and their families are affected by miscarriage for YEARS after it occurs. Having more children doesn’t erase the loss that was experienced, either, and that option shouldn’t be thrust upon a grieving couple as a way to cope with their grief or loss.

Men also struggle with a lost pregnancy. They also suffer from depression, anxiety and anger about the loss, but also contend with the physical and emotional loss of their partner. Men struggle with how to support their partner when a miscarriage or stillbirth happens, as they can’t fix what happened or prevent her pain. If loss in women is understudied and recognized, this same loss in men is even more unrecognized.

K, a friend of mine that I spoke to about her loss, spoke about things that she wished people knew about miscarriage and stillbirth. She said, “[Do] not to let anyone tell you that you should be "over it" in a certain amount of time. You never get over it.” We seem to have some idea as a culture that there is a time limit on grief, and after a while, that we should stop feeling sad and hurting. That simply isn’t the case, no matter who was lost, or however long their life span. A loss is simply that: a loss. What was once there is no longer, and it isn’t coming back. K shared her entire story about her son, who she lost eleven years ago. At 36 weeks, she went into labor, and upon arrival at the hospital, it was discovered her son had no heartbeat. She says, “the people in the operating room didn't know that my baby was not going to come out kicking and crying, which I think is terrible on the hospital's part, because I had to answer the same questions any expectant mother would. "Is it a boy or girl?" "I know you are so excited!" I remember telling the anesthesiologist while fighting back tears that it was a boy.  Coming out of surgery I was taken to a room on the same floor as all the other mothers and their babies. My son was brought to me all cleaned up and wrapped in a warm blanket. I was told to take my time. I could see him as much as I wanted. He was perfect. I cried for two days straight. I did have wonderful nurses that cried with me. The hardest part was leaving the hospital empty handed. The nurse that pushed me out hugged my neck and cried hard as I was. The evil thing that took my baby was placenta abruption. Mine was a total abruption and it was silent. No symptoms until it was too late. I was angry at myself for a while. Thinking maybe I should have known something was wrong. I finally let that go but the pain never goes away. I still about him and it was almost 11 years ago. Expect it to get better but never to go away.”  Even though it’s been 11 years since she lost her son, K’s pain still radiates in her words.

Personally, I remember when K went into the hospital. I remember hearing about what happened, and feeling my heart absolutely ache for her. I remember so clearly thinking, “How do I help her? What do I say? What CAN I say?” Standing in the cemetery that day, witnessing so many hearts being broken, looking at the ever so small coffin was an experience I’ll never forget. It’s a pain that is unfathomable unless you watch someone you care about going through it. That funeral was no less heartbreaking than any other I’ve been too, and in some ways, it was even more so. For mothers that suffer through stillbirth, they have a tangible proof or source for their grief. For other mothers, those that miscarry, their grief isn’t something that can be displayed. There are no funerals, or ceremonies where the child is honored. In some cases, friends and family may not even know that there was a loss, if a woman chooses not to share her pregnancy. These women suffer in silence. Each experience is horrible in its own way, and every woman that suffers these losses deserves to grieve however she has to. Her pain should be respected.

Why this subject is still so taboo today, I don’t really know. I think a lot of it may be fear. I think when something so tragic happens, like with K and Y, we simply don’t know what to do or say. We can’t bring back what was lost. What we can do is offer understanding. Offer time. Cook a meal. Be the shoulder to cry on. By simply showing solidarity, and support, I feel like that can help in the rough moments. Women should be allowed to share their stories without fear of judgement, and men should as well. Even if a woman has 10 more children after a miscarriage or stillbirth, she’s never going to forget the one she lost. She’ll always carry within her that memory, and all the hopes and dreams she had for that baby. Men should be supported as well, because they are suffering the loss off their child as well, and trying to support their partner who is going through something traumatic. Maybe if women are able to share their stories, suffer in the light instead of in silence, and have their grief validated and understood, then miscarriage and stillbirth won’t be such a taboo subject.

I hope that by sharing this information, and the experiences of K and Y, we can all come a little closer to understanding even a fraction of what they’ve gone through. Below, I’ve listed some of the sources I used when researching this blog. Thank you for reading, and I hope that if you liked this post you’ll check out some of my others.








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