A Journey through Miscarriage
by Sandra Glahn, Ph.D. and William Cutrer, M.D.
“A person’s a person no matter how small . . .”
—Dr. Seuss, Horton Hears a Who
Six hundred thousand U.S. women experience miscarriage each year.
One in every 50 couples trying to have children experience multiple miscarriages.
As many as 120,000 couples each year suffer at least their third consecutive miscarriage.
Typically, when a couple faces a pregnancy loss, they find themselves constantly analyzing what they could have done differently. They chide themselves with “I shouldn’t have used that disinfectant,” or “I shouldn’t have gone camping.” “Grandma told me not to lift my arms above my head, but I did.”
To better understand some of the anguish, we need to begin with some medical facts.
What causes it? There is no evidence that excessive work, reasonable exercise, sexual intimacy, having been on birth control pills, stress, bad thoughts, nausea, or vomiting are responsible for miscarriage. The most common reason for pregnancy loss is random chromosomal problems. Knowing this, people often say, “Miscarriage is God’s way of taking those children with serious birth defects.” This is both cruel and unhelpful. At a time like this, logic doesn’t help. It only raises more questions: “So why couldn’t God take this child before I found out I was pregnant?”
Other factors include uterine structural imperfections, environmental causes, infections, blood incompatibility, and immunologic problems. While a single pregnancy loss is more likely the result of chromosomal abnormality in the fetus, maternal factors are thought to trigger repeated losses. But in most cases, the specific reason remains unidentified. Nevertheless, it is extremely difficult to convince a woman who has lost a pregnancy that she could not have somehow prevented this tragedy.
What are the types of pregnancy loss? In the case of a biochemical pregnancy, the “pregnancy hormone” (hCG) is detectable in the blood. In a biochemical pregnancy loss, the pregnancy has ceased to develop in the early weeks. A so-called “blighted ovum” occurs when the placental portion of the embryo develops, but not the fetus. Using the term “blighted ovum” is both sexist and inaccurate, as it blames the female (ovum), when technically, once fertilized, it isn’t an “ovum” any longer. “Miscarriage” is a more appropriate label.
And the case of an ectopic or tubal pregnancy, the embryo implants in a fallopian tube or extra-uterine site, necessitating removal, if possible, before the tube ruptures. An ectopic pregnancy can be life-threatening to the mother, and is virtually always fatal to the child. There are the rare instances of implantation on the intestines (abdominal pregnancy) and occasionally a baby can make it, but this is very risky and highly unusual.
Unfortunately, it is currently impossible to take an embryo from the tube and “re-implant” it into the uterus. Well-meaning people who suggest prayer and waiting upon God to “see if the pregnancy will ‘migrate’” are misguided. This is the equivalent to telling someone with crushing substernal chest pain to pray and wait for the pain to move. If cholesterol plaques clog your arteries causing a heart attack, hopefully you rush to the emergency room for angioplasty or bypass. An ectopic pregnancy is just as dangerous to a mother’s life, and close medical observation is required. In addition, the embryos don’t move from the tube to the uterus.
Although seventy-five percent of miscarriages occur before the end of the twelfth week, they can occur at any time during the gestation period. Some couples experience added grief because they’ve believed the misconception that “once you get past the third month, you’re home free.”
Why do we feel so terrible about it? Depending on personality and background, each person’s response differs. Men and women in general have different feelings about these losses as well, with women tending to feel more of a bond with the lost child. The intensity of pain depends on a number of factors, the most significant of which is the psychological investment in the pregnancy. Often the longer couples have been trying to conceive, the greater their sense of loss.
According to one psychologist, the wave of grief often crests between three and nine months after the loss, although some report that it takes between 18 months to two years for the scars to heal. And the healing process can be disrupted by other life difficulties.
Those who have experienced failed IVF cycles, failed adoptions and the loss of one or more children in a multiple pregnancy have identified many of the same feelings as those who have miscarried.
If you are called upon to support someone who has just lost a pregnancy, the key here is not to be the “answer person,” but to provide time, empathy, patience, informed care, compassion, kindness and the encouragement to talk without trying to find solutions. Ethics here require the appreciation for the sanctity of life—respect for the life lost, concern for the pain, and the need for healing through community.