Miscarriage

“I felt so lonely and wanted to know how other people coped.” That’s why Lea agreed to share her story. And miscarriage, the loss of a pregnancy before 20 weeks gestation, is a more widespread story than most of us imagine.

One in five babies take the chapters of parenthood back to a blank page within the first twelve weeks of their life.

Maybe more. Up to 20% of women who know they are pregnant have a miscarriage some time before 20 weeks of pregnancy, advises worldwide clinical information resource UpToDate. But many women who have very early miscarriages don’t realise they are pregnant, and when detected and included, increase the total miscarriage rate to 31%.

Fertility Specialist and Gynaecologist Petra Ladwig tells her patients at the outset that miscarriage is not unusual. “We re-assure them it is normal and the chances in the long term of a normal pregnancy are good,” Dr Ladwig says.

Many people have had a miscarriage, people who have been trying a long time, she explains. “If you have been trying for five years to fall pregnant, it is a very big loss, there has been a big investment,” she says.

Past the twelve week mark though, the figures plummet. 80% of miscarriages happen within those first twelve weeks, UptoDate advises.

Wondering why

Integral to miscarriage recovery is freedom from self-blame.

“People often do wonder if it was their fault. They ask me, was it because I did this?” Dr Ladwig says. “Often we need to tell them it was not the jog they went on or the tablet they took,” she explains.

Miscarriage causes and ‘medical unknowns’ co-exist.

So what do we know? An undeveloped embryo accounts for one-third of miscarriages that occur before eight weeks. In other cases, the embryo develops but is abnormal. Chromosomal abnormalities are common, they account for around 41% of early miscarriages, UptoDate advises. Medical conditions, or structural problems in the reproductive tract, like uterine fibroids, can also lead to miscarriage.

More than one miscarriage usually prompts medical investigation.

“In the old days when people had five or six children, they may have had three or four miscarriages before it was investigated, but these days, we do investigate after two miscarriages,” Dr Ladwig explains.

First time around

First pregnancy, first ultrasound. “I had a deep-down dread that something would be wrong,” Lea says.

And during that ultrasound she was told the baby had no heartbeat and was the size of a 6-week-old. Lea knew her dates; she knew she was 11 weeks pregnant. “We hadn’t told our families, as they were coming to our place in 2 days’ time for Mother’s day lunch, where we were going to announce our exciting news.”

Instead they called their families to tell them they had lost a baby. Lea thinks deep down she knew when something was not right. She dreaded both the ultrasounds where she found out the babies had died.

“Yet I was looking forward to the ultrasounds of the three that resulted in my children!” Lea says.

Reactions

Miscarriage might be ‘normal’ and it probably does not mean anything is wrong medically, but what about how we feel?

Now-mother-of-three, Lea, felt an overwhelming sadness when her first baby died. It was her first pregnancy and she knew friends who had lost a number of pregnancies.

“There was that fear, ‘what if we can’t have a baby?’ ” Lea says.

After her first miscarriage, Lea had a successful pregnancy; she welcomed her first baby girl into the world. But 18 months later Lea had her second miscarriage, which led to a secondary infertility. During this time she had a number of friends having children.

“It was very hard to separate my sadness and frustration from my happiness for them,” she says.

The ticking clock

The subsequent miscarriage hit Lea hard. “I think because I had a baby and it was more real to me that I’d lost a baby,” Lea says. Her idea of what her family would look like (she’d always wanted a less-than-two-year gap) was changing. The first time she felt her plans had just been delayed, she’d try again.

“But with the second one, I felt acutely that the age gap between my children was increasing with every month that I was infertile,” Lea says. Lea’s first three pregnancies had only resulted in 1 baby. It was a real discipline to enjoy early pregnancy and to stop herself wishing the first trimester would hurry up. “It was even harder for my husband,” she says, because they both wanted to be excited. So Lea would say ‘until I know any different: we’re going to have a baby!’

Lea’s third pregnancy was successful; she has a three-and-a-half year gap between her first two children.

A helping heart

“A kindy mum told me ‘remember, it’s not your fault’ - boy that helped” shared mother-of-two, Jill. Talking, listening, healing.

Lea tells of a friend who, after Lea’s miscarriage, sat with her and asked questions, like when her baby was due. And then offered support around the time of the due date.

Support groups advise if you cannot find the right words to say to a friend or family member who has lost a baby, it is better to say “I’m sorry” than nothing at all.

Lea’s own experience taught her how to support friends who then had miscarriages. She was able to sit and cry with them “to listen to their story and share their sadness,” she says.

But she says if people don’t want to talk, it is best to just acknowledge their sadness and let them be.

“It’s just such a personal sadness and I really didn’t believe anyone could understand it unless they had experienced it themselves,” Lea says Lea recalls how difficult it was to share her grief with friends the first time around. “It was too raw and I couldn’t talk about it without sobbing. I couldn’t tell anyone but my very closest friends until I had my first child,” she says.

For family and friends sometimes there is just nothing to say. Just be quiet, be with them, hold their hand, touch their shoulder, or give them a hug, support groups advise.

When Lea could not share her grief, journaling helped. “I wrote to the baby, I wrote about my feelings and my sadness that we weren’t going to be mother and child together, after all,” she explains.

Lea also kept the photographs of the flowers her sisters gave her, and the ultrasound.

Eventually, after she had her first child, “I think that happiness finally surpassed the sadness,” Lea says.

Her first miscarriage was 12 years ago now and Lea says she is so busy with her children she rarely stops to think about it.

Good signs

“To have conceived is a positive sign for the future,” Dr Ladwig says.

Once people talk to others, they may discover family members or people they work with who might not have talked about their own miscarriage. Dr Ladwig explains, “They find out it is quite common …they find out others have gone on to have a normal pregnancy, and that their own chances are high.”

Dr Ladwig highlights to her IVF patients that to have reached pregnancy shows plenty. “For the embryo to have the potential to reach that stage is a good prognostic sign in terms of the future,” she says.

People are told the chances of miscarriage are about one in five, Dr Ladwig explains. “Just because it’s IVF does not make it higher, it’s more age related.” Chromosomal abnormality tests are available for those in the older age-group, to at least help them understand why it happened, Dr Ladwig explains.

Regardless, “we try reassuring them that to have conceived in the IVF cycle is a good sign for the future,” Dr Ladwig says.

Stage of loss:

Stages of pregnancy loss present very separate challenges. Here, we have discussed early pregnancy loss – miscarriage – the loss of a pregnancy before 20 weeks gestation. Later loss presents its own heart-rending challenges. The contacts below may also assist those who have experienced later loss.

Art therapy

Heart2art provides angel-baby tribute paintings of babies lost through miscarriages, stillbirths and neonatal death. For Heart2art’s owner Missi Woollard her work is about turning her own loss into a positive by helping others with theirs. “Through losing my baby I found myself painting again... It was the only way I could control my anger, as I didn’t want to wake the next day with my first thought being, I lost a baby,” she says.

Missi paints lost baby ‘angels’ the way parents want to remember them, as tiny sleeping babies. She has painted 100 of the tributes in seven months and feels mothers who have lost babies have coped better by remembering their babies and being able to talk about them. “People out there do want and need something for themselves when they have nothing physical to show in remembrance,” she says. (Heart2Art.info)

Missi supports a small local Sunshine Coast Charity, Jakes Gift which raises funds to provide ‘memory keeper’ tins to hospitals for grieving parents who have lost a baby due to heart disease. (Jakesgift.org.au)

For more information:

www.health.qld.gov.au – to find local hospital and health professionals’ contacts
Grief counsellors are available at IVF Units, and local hospitals have extensive local contacts for patients, appropriate for the type of loss they have experienced.
Fertility Specialist and Gynaecologist Dr Petra Ladwig, Suncoast Women’s Centre 07 5437 7244.
Medical Helpline 13 HEALTH (13 432 584) – medical advice and assistance from a registered nurse, available at any time.
National Pregnancy Support Helpline 1800 422 213 – a national 24-hour-a-day, seven-day-a-week helpline which offers peer support services for those experiencing grief following miscarriage, as well as other losses.
Angel Babies Foundation www.angelbabies.org.au - free counselling through psychologist trained volunteers to those challenged by infertility, touched by the loss of a baby through miscarriage, stillbirth and neonatal death, as well as supporting parents of premature babies.
The Small Miracles Foundation 1300 266 643 - provides free telephone, online and face-to-face counselling for Australian families dealing with fertility issues, miscarriage, neonatal loss, still birth, premature birth or infant loss.. Or visit www.smfoundation.org.au