As pregnancy progresses, you also begin to face the prospect of the loss of a baby which is already developing an identity and personality in your mind. Miscarriage, defined as the loss of a pregnancy in the first 20 weeks, affects 15-20% of all pregnancies. Before 12 weeks, this is referred to as ‘early miscarriage’. Considering that, by 12 weeks, you may have already picked out names, this doesn’t make the loss any less devastating.
While it is difficult to say why miscarriages occur, the vast majority are due to chromosomal abnormalities – which may have an array of different causes. As your baby grows, it is working its way through the 23 chromosomes from you and 23 from your partner. If there is a problem with one of those, the baby can’t develop any further. Like doing up a zip, one little break will mean things must stop there.
Stillbirth, the loss of a baby after 20 weeks, has been in the news a lot lately with experiences of Kelly Brook, Amanda Holden and Lily Allen. While, like miscarriage, stillbirth is usually caused by problems with the baby or womb environment (such as problems with the placenta or umbilical cord), losing a baby at this late stage can bring huge distress. Reminders such as breast milk coming through, and having to go through a delivery, make stillbirth especially distressing. In fact, many women who have experienced both early miscarriage and stillbirth would suggest that the experiences cannot be compared.
Sadly, there are few traditions for dealing with the loss of a baby at any stage, and in fact you may find others are invalidating of your grief – from the medical professional who coldly says that the foetus ‘wasn’t viable’ (it was more than viable to you), to friends and family who tell you ‘you can just try again’. Loss of a baby through miscarriage or stillbirth is unique in leaving you tackling concepts of birth and death simultaneously. While coping with the physical distress of the loss, you must also confront the loss of the ideas and fantasies you had developed of this baby and yourself as a mother to that child.
Even for those who may never experience miscarriage, the fear of loss can greatly colour the experience of pregnancy. This isn’t helped by our lack of knowledge about how common early bleeding and cramps are, which may just be implantation bleeding and your ligaments stretching. The weight of your growing uterus can lead to a worry that your body will be too fragile to manage, and stories about others’ losses can create a sense that miscarriage is likely. These fears often come through in nightmares or a more general sense of anxiety and preoccupation with your baby’s survival. Whether or not you have experienced a loss, anxieties can create a barrier to bonding with your growing baby. Acknowledging and talking through these fears can allow you to put them to one side and focus on planning and dreaming about what motherhood will bring.
If you have experienced a loss, it is crucial to remember that this doesn’t necessarily mean it will affect your chances of getting pregnant again. In fact, some medical professionals talk about miscarriage in a first pregnancy as being a ‘trial run’ to prepare your uterus to carry a strong, healthy baby to full term. Repeated miscarriages, which affect 1 in 100 women, are inevitably distressing and require specialist support. Frustratingly, causes frequently cannot be found, but you should be offered any combination of blood tests, ultrasound and pelvic examination to try and identify a cause. Don’t be afraid to ask questions and hassle your GP for a referral for further examination.
While often information about miscarriage focuses on what can be done to prevent it (cutting down on caffeine, avoiding strenuous exercise, staying away from drugs and alcohol and so on), such information can emphasise a sense of blame. Loss can often lead to recrimination, with women questioning the bodies that they feel let them down and wondering whether anything could have been done differently. Although loss usually happens for a reason, the cause may not be found – and it’s not likely to be you.
However, as many women are intuitively aware, one factor affecting a successful outcome in pregnancy is supportive care. Liddell and colleagues studied outcomes for women in a recurrent miscarriage clinic in New Zealand in 1991. They found that, of those who were offered formal emotional support and close supervision during pregnancy, 86% had successful deliveries, compared to 33% of those who had usual care (although this group was very small so these findings may not be statistically significant). In the UK at present, with under-resourced and overstretched maternity services, often women experience minimal care with a different midwife who may not have the opportunity to get to know you well. The charity Sands has recently launched a campaign to lower the number of stillbirths in the UK (currently 11 babies per day – with the UK ranked second from the bottom for stillbirth rates in the developed world). As 50% of these stillbirths have no known cause, Sands is campaigning for increased antenatal care to identify at-risk babies earlier. You can read about the campaign here http://www.why17.org/About-the-Campaign.html
If you do experience a loss, you must grieve for that baby however you want. For some, this may involve drawing a line under the pregnancy and moving on without looking back, for others grieving may be a lifelong process where the loss may always be remembered and acknowledged. You may want to have a ceremony to say goodbye to the loss of both your real baby and the fantasies you had become so used to, you may wish to name your baby, put together a box of mementos – anything which feels right to you. Don’t feel pressured to move on, no matter how others feel you ‘should’ be dealing with the loss. Miscarriage and stillbirth are often seen as taboo subjects which people find difficult to talk about. With this in mind, many women find the most helpful thing is to talk to another woman who has experienced such a loss. If this is difficult to do with someone you know, you can find support through the Miscarriage Association (www.miscarriageassociation.org.uk ), Sands (www.uk-sands.org ) or through forums on www.Netmums.com and www.babycentre.co.uk