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Not ‘just a heavy period’ – a Spotlight on the Emotional Impact of Miscarriage

In recognition of Pregnancy and Baby Loss Awareness week (October 9th-15th 2021), I wanted to focus on the emotional difficulties women face during miscarriage.  I spoke to five women about their experience of miscarriage and the impact it had on them.

Sadly, around 1 in 4 pregnancies ends in miscarriage, and so it is likely that most women have had at least one miscarriage, and yet it is not widely talked about.  Sarah said she had never discussed her miscarriage that happened 20 years ago with anyone before me.  It was a huge shock and she felt it was almost a taboo to discuss.   Possibly she said due to feelings of shame and failure.  Chris said she felt ashamed because her body had let her down and not done what it should have done. She felt disbelief and guilty that she had done something to cause it. The shame she felt was on a par with the shame she felt after being sexually assaulted.  It took years before she could talk about it.

Yet, surely, if we don’t talk about miscarriages; what really happens in a miscarriage; women will continue to feel shocked, ashamed, and guilty.  People will continue to behave like we haven’t had one as they are uncomfortable or say insensitive things so our feelings aren’t validated.  I think that needs to change.

Miscarriage is when a baby (or foetus or embryo) dies in the uterus during pregnancy. I will use ‘baby’ throughout, as I feel it is important to recognise that to many women, no matter when the loss occurred, this is a baby that have often already planned a future with and may love.  For those who prefer not to think that they have miscarried a baby, I apologise. In the UK, the legal definition of miscarriage applies to pregnancies up to 23 weeks and 6 days. Most miscarriages happen during the first 13 weeks of pregnancy. A late miscarriage (when the baby dies between 14 and 24 weeks) is much more unusual. A late miscarriage is not the same as a silent or missed miscarriage, where the baby died before 14 weeks, but the miscarriage does not occur until later in the pregnancy (although these can also occur in the second trimester).

Whenever a miscarriage happens the emotional impact can be devastating. There is no right or wrong way to feel afterwards; it depends on your circumstances, your miscarriage and what the pregnancy meant to you.  For some people, hearing the loss of their baby later in their pregnancy called a miscarriage can make them even more distressed; especially as miscarriages cannot be registered as a death. In the UK, any loss from 24 weeks is classed as a stillbirth and a baby born alive, even for a few minutes before 24 weeks is considered a neonatal death. By law, stillbirths and neonatal deaths must be registered as a death and be buried or cremated. There is no law concerning miscarriages. After a late miscarriage most hospitals offer a simple funeral, with burial or cremation. Some hospitals do this for all babies, however early the miscarriage. A chaplain came to see Ann and told her what could happen concerning her missed miscarriage at 12 weeks. There could be a blessing and cremation with other babies, or she could take the baby home.  The Miscarriage Association and SANDS both provide certificates you can ask the hospital to sign if they don’t provide their own that notes your baby’s name and the date of miscarriage.

It seems that women are unprepared for what miscarriage can physically be like and this impacts on them emotionally.  Some people assume a miscarriage (especially an early one) will be like a heavy period.  The gritty reality is that you can experience contractions, a huge amount of bleeding, breastmilk (in miscarriages after 14 weeks) and hormonal imbalances for some months afterwards. In her mind, Sarah knew she wasn’t pregnant but her body still felt it.  Jane said the same and that this was one of the hardest aspects for her to deal with. It took a while for both of them to get their bodies and heads aligned due to the pregnancy hormones still being present. Some women experience flashbacks and are triggered by their subsequent periods. Others choose not to look at their baby (whenever the miscarriage happens) or regret not looking. The trauma of miscarriage can increase your sadness and fear at the time and for a long time afterwards. Maggie told me looking back it was like a horror movie, slightly eased by her subsequent pregnancy.

The Miscarriage Association says, ‘miscarriage is a different kind of loss. It’s not like grieving for someone you knew. Instead, you might mourn the loss of your baby’s future and your own future as that baby’s parent. This can be hard for others to understand and relate to’.

Chris said that for her, from the moment she suspected she was pregnant, she felt a mother to that baby; even though it was a surprise pregnancy for her.  If family and friends do know, they don’t know what to say and will often say inappropriate or shocking things; or even ignore discussing the miscarriage entirely. Chris told me that you don’t tell anyone that you are pregnant in case it goes wrong but when it does its exactly that time that you need support.  Chris’s mother asked why she was so upset when the pregnancy wasn’t planned, and when another family member had their baby shortly after, Chris had to put on a brave face whilst being torn up inside. No one acknowledged her miscarriage and or how hard it must have been for her.

However, Sarah didn’t want to see anyone or have their sympathy.  Jane felt no one understood.  She said her miscarriage felt sacred and private; precious in a funny way and she didn’t want to share it with anyone who didn’t understand the emotional impact it had on her.  People said ‘you’ll have another baby’ – but she said; ‘I didn’t want another one, I wanted that one’. Jane was surprised at how emotional and down she felt for a few months afterwards. She said her heart was broken.  Other people said to her ‘oh that’s a shame, I just sailed through my pregnancy’.  This added to her worry that she had done something to cause the miscarriage and her feeling that her body had let her down. Jane had suffered a missed miscarriage where her baby died at around 8 weeks but she did not know until she started bleeding at 17 weeks.

It can be a comfort if you have a child or children already. But it doesn’t always make this loss easier to deal with. A frequent comment made is ’at least you have a child already’.  Maggie and Ann were shocked that their second pregnancies ended in miscarriage. Both Sarah and Maggie said that as they had young children they just had to get on with life.  Jane said it was important to her that she was pregnant again by her due date.

Subsequent pregnancies can cause anxiety and distress too. Ann was anxious all the way through hers, with nightmares that she didn’t have a baby.  Jane said her miscarriage took the shine off her next pregnancy even past 12 weeks as she didn’t know if she could get past that stage again. It must be unbelievably difficult for those who go on to suffer further miscarriages or cannot conceive again.

It should be assumed that the insensitive comments people make are not malicious, said more from a place of not knowing what to say, possibly not understanding what a miscarriage entails and trying to make things better by saying something…anything. But they are not helpful for the grieving woman nor does it help her process and recover from her experience.

Medical staff often use very clinical language and terminology and the treatment of women can add to their distress.  Chris’s friend was told the baby she had delivered at 23 weeks was ‘clinical waste’ when she wanted to see her baby (it is usually possible to see the baby if you so wish).

When Ann’s 12-week scan didn’t look right and there was no heartbeat, she was given the option of waiting to miscarriage naturally (which could take up to a month to occur) or to have a D&E (Dilation and Extraction).  She opted for the latter, but as it was not classed as an emergency, she had a ‘really difficult weekend’ knowing her baby had died. The D&E was carried out in the maternity unit with Ann having to sit in the waiting room with pregnant women.  Ann was unaware that this type of miscarriage could happen and it was a complete shock. The male consultant she saw told her to calm down as she was crying.

Chris’s scan was also done in a maternity unit where she had to sit with pregnant women knowing after a weekend of bleeding that she had probably lost her baby.  Sarah was very shocked when she started to bleed when she was 11 weeks into her second pregnancy.  With this one she felt different; no nausea this time.  She said she just knew. She phoned the doctor and they told her they didn’t need to check her and to crack on with it.  Sarah was left feeling that their attitude was ‘well that’s just what happens’.   She was told that it was ‘early days as it was only 11 weeks.  That dismissed her feelings, implying that the emotions she felt were not valid.

Chris’s miscarriage was the most recent of all those I spoke to.  And still she was unaware of what a miscarriage would involve and no one told her what to expect.  The intense contractions surprised her – not as severe as labour but worse than a period. Chris had PTSD after her first labour and had amazing support.  But that was in complete contrast to the support she had with her miscarriage and she was very depressed for a long time afterwards.

Maggie was followed every time she went to the toilet so that, as the nurse put it, they could catch ‘the products of pregnancy’.  An experience she understandably found humiliating.  She went on to have a D&C (Dilation and Curettage) the next morning, booked for her without an explanation of what that involved.  She didn’t know she was going to be internally scanned until a nurse approached with a large probe.  She felt like she was just being processed.

What has struck me from talking to women (and reading accounts online) is that it appears that miscarriage care has not really changed over the last 30 years. I’m sure that there are compassionate staff working in obstetrics.  But it is obvious that being in the dark about what a miscarriage might entail, using terminology that does not do justice to what is happening to women, them having to sit in waiting rooms with pregnant women or your late miscarriage being delivered on a labour ward where you can hear babies crying is going to add to women’s distress.  Perhaps more understanding and humility from everyone involved in supporting a miscarrying women could alleviate some of this anguish.

If you know someone has had a miscarriage, it is important to listen to their experience. Acknowledging the loss of plans they made for the future and understanding the physical process they have gone through can help validate their feelings. And understand that there is no set time to grieve. Jane told me that 30 years later she remembers what would have been her due date and it still makes her feel very sad although she has mixed emotions as she would not have had her subsequent child.

Thank you to everyone who shared their experience with me.

If you have been affected by this article Baby Loss Support can be found no matter when your miscarriage was.

Aching Arms – offer support to recently and longer ago bereaved parents after a loss during pregnancy, birth, or infancy. Call or text07464508994 or email[email protected]

Alternatives Listening Rooms – Dundee-based charity supporting parents who have a lost a baby at any stage of pregnancy or at birth with counselling and support that is free and confidential.
Support can be face to face, telephone online or webchat.

Phoneline: 01382 221112 (24 hour answering service)
Textline: 07599 955231 (Text now to make an appointment)

ARC: Antenatal Results and Choices – specialised bereavement support around termination of pregnancy after a prenatal diagnosis. Contact Number: 07875480076 Email: [email protected]

Children of Jannah– supporting bereaved parents who experience baby loss, holding at their core the Muslim belief that all children who die enter Heaven (called Jannah in Arabic).

https://www.childrenofjannah.com/contact

Cradle – supporting anyone that has experienced baby loss, run by a dedicated team of volunteer ambassadors, of which all have experienced early pregnancy loss.

Zoom support available via email: [email protected]

Daisy’s Dream – professional support service which responds to the needs of children and their families affected by life threatening illness or bereavement. Available in Berkshire, the surrounding areas, and East Cheshire. Please note: the service is primarily focused on the children in a family, they are sadly unable to support parents unless there are already older children in the family.

Phone: 0118 934 2604

The Ectopic Pregnancy Trust – The Ectopic Pregnancy Trust supports women and their families through the devastating ordeal of ectopic pregnancy loss.

Information and support via call-back helpline and email.

Helpline: 020 7733 2653
Email: 
[email protected]

First Light – professional counselling support for bereaved parents and families in Ireland

Contact Number: 1850 391 391
Email: [email protected]

Held In Our Hearts – providing virtual baby loss counselling and also befriending and regular support groups online for bereavement support, dads’ support, twin and multiple loss support, antenatal results and choices support, grandparents’ support, pregnancy support and parenting after loss.

Email: [email protected]

The Lily Mae Foundation – is a UK registered charity providing much needed support to parents and families who have lost a baby to stillbirth, neonatal death, miscarriage, or medical termination.

Email: [email protected]

Lullaby Trust – support for bereaved families who have lost a child through SIDS.

Bereavement Support: 0808 802 6868
Email: [email protected]

Information Line: 0808 802 6869
Email: [email protected]

The Miscarriage Association – support and information for anyone affected by miscarriage, ectopic pregnancy or molar pregnancy with helpline, live chat, email service and online support available.

Helpline: 01924 200799 (Mon-Fri, 9am-4pm)
Email: 
[email protected]

MISS (Aberdeen) – Supporting anyone impacted by miscarriage. Open to any region & currently providing online support packages, as well as continuing their phone service.

Helpline: 07808 638428
Email: [email protected]

Muma Nurture – supports fertility, pregnancy and related loss through counselling, holistic therapies, and support groups.

Contact Number: 07460775495

Email: [email protected]

Petals – the baby loss counselling charity, offering free specialist counselling to women and partners who suffer psychological distress from trauma and grief related to pregnancy or baby loss.

Helpline: 0300 688 0068
Email: [email protected]

Sands – stillbirth and neonatal death charity. Up-to-date information and support available for bereaved parents, families, and healthcare professionals.

Helpline: 0207 436 5881
Email: [email protected]

Simpson’s Memory Box Appeal (SiMBA) – memory boxes and baby loss support for bereaved parents and professionals.

Support Groups via Zoom: https://www.simbacharity.org.uk/support/support-groups/

Teddy’s Wish – support for bereaved parents and families through care packages and fully funded counselling.

TimeNorfolk – the pregnancy loss charity, offering free specialist support to women and partners. Covering all pregnancy related issues.
Phone: 01603 927487
Email:
 [email protected]

Together for Short Lives – support for bereaved families and professionals working to support children.

Tommy’s – health information for parents-to-be, and funding for research into the causes of pregnancy loss.

Email: [email protected]

Twins Trust – the Twins Trust Bereavement Support Group (BSG) exists to support all parents and carers of multiples who have experienced loss whether it was during pregnancy, at birth or at any point afterwards. Email: [email protected]

 Marking your loss

The Miscarriage Association suggests ways in which you can mark your loss whether you have a funeral for your baby or not.

  • It may be important to you to name your baby. If you do not know whether your baby was a boy or a girl, you could choose a name that could be given to either.
  • Some parents gather mementos in an album or a special box: for example, a scan photo, a hospital bracelet, letters, or cards, and maybe toy or clothes that they had ready for their baby. Some hospitals offer to make hand or footprints of babies miscarried late in pregnancy and may put them in a special memorial card.
  • Other parents mark their loss in other ways, perhaps planting a bush or tree, donating to charity, or creating something else in their baby’s memory.
  • Your hospital may have a book of remembrance where you can enter your baby’s name and the date of your miscarriage. Some hospitals hold regular remembrance services for babies who died during pregnancy or around birth.

Article first written for This is Me!, Well Woman Network Magazine.