MISCARRIAGE AND THE HIDDEN GRIEF
A miscarriage can be a distressing experience. Apart from the emotional trauma of expecting a baby and then losing it, your body has been adapting to the changes of pregnancy and has to return to normal.
A miscarriage is not a clear cut event, you probably felt frightened and helpless, and usually there is nothing you can do to prevent it from happening. Often there is a series of phases
· Thinking it may happen, but not knowing if it will
· Perhaps ignoring symptoms in the hope that they will go away
· Worrying and waiting for your worst fears to be confirmed
· Having your hopes raised only to be dashed later
· And finally facing up to the fact the pregnancy has ended
You will feel helpless during the period of uncertainty, it is frightening because there is Nothing you can do to prevent it happening. Some cope well at the time, but then find a great sadness engulfs them later on
After an early miscarriage you may find yourself struggling to make sense of what has happened to you. It is difficult to talk about but knowing the nature of your physical loss can help you understand and make some sense of the experience. In some cases there is an identifiable foetus, but for the majority of women there is no foetus only blood clots or tissue. If you didn’t see the loss you may be left wondering, and it may be difficult to get information from the staff involved in your care. If this bothers you talk to your GP.
Late miscarriage after 16 weeks is physically different from a loss earlier in the pregnancy. It is much more unusual and generally happens because the baby has died in the womb or because labour has started too early. A much smaller proportion of late miscarriages are due to abnormalities in conception.
The longer you are pregnant the more time you have to adjust to the idea of becoming a mother to think about the baby within you as a separate from yourself.
Most women miscarry after about 18 weeks of pregnancy and some before feel they have given birth. The baby may or may not have died before the miscarriage, but labour is essentially the same process as for a full term birth although the baby may be much smaller for many women this comes as a great shock.
Miscarrying at this stage of pregnancy is physically, as well as emotionally painful. Not being prepared for labour combined with the emotional pain of losing your baby often seems to make it harder. You may be uncertain about how much you want to know about what is happening, and the staff caring for you may go along with this, because they too find it a distressing process. You may feel that you want to put all your energy into holding onto your baby, when in fact you have let go.
If you have a late miscarriage, knowing as much as possible about your baby can make the pregnancy and the baby more tangible and real. Many women say how important it is to have time with their baby, an opportunity to say hello and goodbye a time to remember, seeing your baby also removes the fear of the unknown. You may have fears, probably unfounded, that the baby is deformed in some way. What you imagine is usually far worse than the reality.
You may decide that you would prefer not to see your baby, but most women who do see their babies, however early they were born, seem to find it immensely helpful and they have no regrets.
If you do not see your baby it may be helpful to know its sex, as this is a crucial part of your baby’s identity. You might not think about this at the time, but later it may be important to you to be able to refer to your baby as he or she.
Many hospitals do have a policy of trying to meet the mother’s wishes as far as possible. In some hospitals the mother is asked if she would like to see the baby, and some will routinely take a photo, which will be kept with the mother’s notes until she wants it.
If you are able to think about these things at the time, talk to the staff involved in your care, don’t be hesitant about asking questions or making requests.
Normally 1 in 4 pregnancies ends in miscarriage, it is usually difficult to determine the cause. Many women are left asking the question why? and find it hard to accept that no one can give a definite answer. It is unlikely that it is anything that you have done the main causes are thought to be:
· Genetic defect: about 50% of early miscarriages occur because of some kind of abnormality
· Hormones: it is thought that if the balance of pregnancy hormones is not quite right, the body may find it difficult to keep the baby
· Entopic pregnancy: this is when the fertilized egg implants outside the cavity of the womb, most commonly in one of the fallopian tubes.
Once you are pregnant the process of involvement with and attachment to your unborn child begins. For some women this can start even before conception, other women find the baby takes on a reality of it’s own with a pregnancy test, or with a scan.
For others this does not happen until they feel it move, but most women get attached to their babies much earlier than those around them may realise, and you will be somewhere along this path of involvement when you miscarry.
If you have thought of your pregnancy in terms of a baby from an early stage, it stands to reason that when the pregnancy ends you feel as if you have lost your baby, regardless of what you have lost physically, or what anyone else tells you.
Your emotional experience may be at odds with the physical reality.
Clearly a miscarriage at 10 or 12 weeks is not the same as losing a baby at 22 weeks. But the loss of a baby at any stage of pregnancy is an experience with a unique meaning for each women and her partner. Every women needs to be able to work out the meaning of her own experience. This may not be easy if those around you do not recognise your need to do this. The reaction of family, friends or professionals may be to avoid the subject, or to offer misplaced encouragement along the lines of, ‘never mind, you can always try again’.
The word disposal, a horrible word but there really is no other, it is not something you think about until you need to, and it is not easy to talk about, yet it is an issue that bothers a lot of women who miscarry. Disposal arrangements vary but most babies are likely to be incinerated by the hospital. There is no reason why your baby cannot be buried or cremated if this is what you wish and some hospitals will organise this on your behalf or help you to arrange it yourselves. There is a legal requirement for any baby born after 24 weeks and a baby born live before 24 weeks to be buried or cremated.
Of course, not every woman or couple wants to arrange a funeral, but if you feel it would be right for you, it can be a way of acknowledging your loss, and of saying goodbye with dignity. It does not have to be religious ceremony a funeral can make many forms.
For many women it is important to mark the pregnancy and the loss of the baby in some way. Where there is a baby to hold and perhaps a funeral is organised, there are often memories to cherish. When this doesn’t happen, there may be other ways of marking the event, and its importance in life.
Naming can help. It means you no longer have to talk about ‘it’ or ‘the baby’. It doesn’t matter if don’t know the sex you may have a stronger feeling that a particular name feels right for your baby.
Some hospitals organise a memorial service each week or month, at a set time, which parents who have had a miscarriage are welcome to attend. There is usually also a book of remembrance in which you can write if you want to.
There are also other ways of remembering, planting a rose bush or a tree, perhaps a scrapbook or folder to keep all the things to do with the pregnancy together.
Not everyone finds these things helpful. You may feel that they are inappropriate, and you are content with the memories you have. But if you do think it would be helpful, you should find a way of creating your own special memorial. I t doesn’t matter if you don’t do it around the time you lost your baby.
Grieving is the healthy response to any loss/death of someone close.
Grief after miscarriage is complicated. You grieve for the lost baby, for the lost pregnancy and for the lost motherhood. Because miscarriage is not seen as an important loss, those around you may not understand your feelings. The loss in miscarriage is unique because you know very little about whom you are grieving for. The baby was part of you and
it is as if you are grieving the loss of part of yourself. The loss is private and hard for others to share.
Not everyone grieves after a miscarriage, you may see it as an illness or physical mishap, rather than a loss, there will be nothing to grieve about, but most women feel empty and bewildered.
There is often a initial phase of shock and denial, of carrying on as if it hasn’t happened, followed by a phase of feeling that your life has fallen apart. It is common to feel out of control, vulnerable, unable to cope and do the things you would normally take in your stride. You may find that you feel very angry, your moods are extreme and change very quickly and you feel guilty. This then gives way to a great sense of loss and loneliness and often depression, before it is possible to re-establish yourself and move forward, perhaps in a different direction than before.
If other people do not acknowledge your loss or recognise your need to grieve, it can make it hard for you to make sense of your own feelings. The reaction of others may make you feel that your grief is unacceptable and that you cannot express your feelings. After the initial sympathy there is often pressure to get back to normal quickly, to pretend it never happened and to resume to your normal responsibilities.
Grieving is difficult for some women. If you are not used to expressing your feelings, it can seem easier to brush them aside or suppress them. You may be afraid of losing control if you let go. Some women need time and space for their feelings to come to the surface. Not everyone wants to express their grief openly, but is important to acknowledge your feelings, denying them or bottling them up can be very painful.
Depression is often part of the grieving process. Many women go through a phase of feeling low, tired or lethargic with no energy or interest in life. Feelings of worthlessness or hopelessness are common. Changes in appetite and sleeping habits, headaches and other unexplained aches and pains can all be symptoms of depression. Many women lose confidence in themselves and go through a stage of feeling unable to cope with people, with work and with daily routine. Other signs may be lack of concentration, irrational fears or irrational behaviour, feelings of panic, or uncontrollable crying.
Depression may last for a few days only, or for weeks and months. It usually passes of on its own accord, but it may take some time. When you are depressed your ability to solve problems is reduced. If you withdraw from normal activities you are also withdrawing from things that might make you feel better. It may help to do something positive to break this cycle.
If you feel severely depressed and unable to cope, it is important to get professional help to see you through this crisis.
Many women worry that they are to blame for their miscarriage. It is very unlikely that the miscarriage was caused by anything you did, but when there is no clear medical explanation, we feel a need to search for a reason. It is very easy to be unnecessary hard on yourself, to criticise and almost punish yourself for what you feel is your failure. These feelings are understandable, but you cannot change what has happened. It is important to eventually be able to leave them in the past where they belong and not to carry them into the future.
Grief tends to peak and then fade, as the feelings about the miscarriage become less intense and the times when you are upset less frequent. For some women this happens earlier, for others it takes longer, there is no set time scale. Grief has to take it’s own course, for some it takes longer than others.
For many women, sharing their experience is a turning point. Talking about the miscarriage makes it a shared event rather than a purely private one. Often whatever anyone says will not take away the pain, but you need someone who will support and understand, to know how you feel, and allow you to express your feelings, to cry and to be sad. Some women get this from their partner but they to may be struggling with their emotions and trying to support at the same time.
Some women find that the experience of miscarriage brings them closer to their partner. It may be only you or your partner who feel the loss of the baby and who can help each other through bad times. On the other hand, it may come as a shock to find that your partner seems unable to understand your feelings or support you in the way that you might have expected.
Men show their feelings different to women, you may think that your partner is not showing his emotions when in fact he is just not showing you how he feels. He may have seen you in pain and distress and felt helpless to do anything. He may be confused and worried about your behaviour over the coming weeks. If you have never experienced grief before, watching someone close to you going through extremes of emotion can be very distressing. Some men feel that they have to be strong and keep their feelings to themselves, some cope by shutting out what has happened.
If you have another child or children, the miscarriage will affect them too. Different families deal with this depending how open they are about the miscarriage and the extent to which they feel children should be involved in or protected from an experience they are too young too understand. If your child knows about the pregnancy and knows that something is wrong, some explanation may be necessary. We all want to protect our children from difficult situations, which are painful, but often the truth is far less frightening or bewildering than a child’s fantasy.
Parents sometimes underestimate a child’s ability to understand loss or bereavement. It is important to try and make the time to talk with your child, answer any questions honestly although you may find this painful, children sometimes worry that they are in some way responsible for the miscarriage, and may need reassuring that they are not to blame.
To many women they may find their children a great source of comfort. It can be a very positive experience for your child to be able to help you. Other women find the demands of their children difficult to cope with. If this becomes a problem for you, it is important to arrange some time for yourself without your children.
The physical health of both partners are very important factors as smoking, alcohol and stress can affect the chances of becoming pregnant. It is therefore worth ensuring that you and your partner are in good health before conceiving again.
Don’t take drugs or medicines unless you have checked with your doctor that they are safe to take during pregnancy or when you are trying to conceive. If you or your partner are taking medication for a long-term illness find out from your GP or Consultant what effect it could have on pregnancy. Ask whether your medication should be changed or it should perhaps be reduced or stopped.
Common drugs such as alcohol, tobacco, caffeine and tranquillisers all affect the body’s chemistry.
Drugs such as cannabis, heroin, crack and cocaine are likely to affect fertility, increase the risk of premature or low birth weight babies and cause possible damage to the developing baby.
The safest course of action is to avoid using any of these drugs before and during pregnancy.
Certain infections may increase the risk of miscarriage or damage to the baby during pregnancy.
German measles can seriously damage your baby if contracted in the first months of pregnancy. Before trying to conceive, ask your doctor for a blood test to check your immunity, even if you have been vaccinated or have had the illness before.
After a miscarriage many women will blame themselves and their lifestyles for the loss of their baby, couples will want to try their best to make sure the next possible pregnancy has the best possible chance of success.
The emotional and physical health of both parents in the months before the pregnancy can affect the women’s ability to become pregnant, and may also affect the health of the baby in the crucial early weeks when the major organs are developing.
Make sure you are both in good health physically and emotionally, it may also help you feel more confident and relaxed as your pregnancy develops.
Women’s feelings vary after the experience of a miscarriage. Some feel they want to get pregnant straight away others need time to recover physically and emotionally. You and your partner will know when it is he right time. You both may want time on your own to grieve and come to terms with what has happened. A new pregnancy means looking forward to the future, but for many women this can be quite an anxious time overshadowed by past experience of miscarriage.
You and your partner may have mixed feelings about the future, fears, excitement, and apprehension. All of these are normal just allow yourselves time and talk to each other.
Unless your doctor advised otherwise, it is probably advisable to wait until you have least one normal period after your miscarriage before trying to conceive again. If you have suffered from repeated miscarriages, it may be necessary to obtain pre-conceptual advice from your GP or Hospital Consultant before trying again.
A well balanced diet is the basis of good health, and good health will influence your partner’s fertility and your ability to become and stay pregnant. A healthy diet before and during pregnancy helps to protect against toxins, such as high levels of lead and other damaging minerals.
Try to eat from each of these four groups every day:
Vegetables and fruit 5 portions
Meat, fish, pulses ,egg 2 portions
Cereals and bread 4 to 5 portions
Milk, cheese 3 to 4 portions
Try to eat some fresh foods such as vegetables, fruit, salad or milk every day.
Try to eat plenty of unrefined foods, for example wholemeal bread and wholegrain cereals.
Folic acid supplements are now recommended by the Department of Health as they reduce the risk of neural tube defects such as spina bifida – an abnormality in the development of the baby’s spinal cord. These should be taken pre-conceptually and up to 12 weeks of pregnancy.
If you are very underweight or very overweight, you may have difficulty conceiving, drastic dieting in the months before or during pregnancy could deprive your baby of essential foods.
Smoking can make a man less fertile by reducing the quality and quantity of sperm. A women who smokes may run a greater risk of miscarriage than a non smoker also smoking during pregnancy affects the baby’s growth, and a small baby is likely to have health problems in the weeks after birth.
Research now indicates that heavy drinking can also reduce the quantity and quality of a man’s sperm. For women, heavy drinking may affect fertility and increase the risk of miscarriage. Alcohol can also affect the baby’s development during pregnancy. Because it is difficult to define what is heavy and what is reasonable drinking, it is safest if you both cut out or cut down on alcohol when you are trying to conceive.
Moderate exercise before conception and during pregnancy will help to give the baby a good start, walking and swimming are 2 healthy options.
If you don’t get time to relax, try to allow yourself some time during the day to switch off and relax. You may find it helpful to read, watch television try yoga or meditation.
Studies have shown that women who have previously miscarried are more likely to have a successful pregnancy if they feel well cared for and supported before and during the pregnancy. This is a good time to think about what support and care you would like during your next pregnancy.