Miscarriage and stillbirths
By Janis McMath, Editor-in-Chief
In the 1970s, magazines and parenting books featured miscarriage articles with images of joyful mothers who looked positive about their future.
As technology and society have progressed, the length of our expected lifespans have grown. Many of us have been spoiled by the safety modern medicine offers, and this has changed our understanding and relationship with our own bodies. For example, people with chronic ailments can grow into their old age instead of being given a death sentence, surgeries can reconstruct previously broken bodies, and pregnancy is a significantly safer process for women who are capable of conceiving. Previously, pregnancy could easily lead to death or permanent complications for expecting mothers—but now the process is commonly viewed as a nearly “guaranteed” experience for parents. And while there is no doubt that maternity has evolved, our culture’s perception of pregnancy has a concerning blind spot for how normal miscarriages are.
Miscarriage is defined as the end of a pregnancy before 20 weeks. After 20 weeks of pregnancy, the fetus’ termination is called a stillbirth. While both experiences are similar, stillbirths occur much more infrequently; approximately 25 percent of pregnant women will experience at least one miscarriage, and in comparison, stillbirths occur in an estimated one to five percent of pregnancies. The number of stillbirths is not negligible though; data from Statistics Canada shows that in 2019, of the 44,018 babies born in BC, a total of 528 babies died before or during birth. After the baby has grown for 12 weeks, the risk for miscarriage drops significantly; around 90 percent of women’s miscarriages will occur in the first 12 weeks. The mother’s age has a clear connection to miscarriage risk; women that are between the ages of 40 and 44 have a 50 percent chance of miscarrying.
THE TREATMENT OPTIONS
There are several options when it comes to dealing with a miscarriage, but there is no way to reverse or stop a miscarriage once it has already begun. Medical intervention is sometimes necessary as infection and excessive blood loss are concerns for the mother if the uterus does not properly dispose of the remnants—and these are called “incomplete miscarriages.”
Those experiencing a miscarriage have several options: expectant management, medicine to clear the uterus, a surgery by the name of dilation and curettage (D&C), and in some cases, induced labour. Letting the miscarriage run its course is the safest option—and most who choose this option experience success. When Global News interviewed director of the Tommy’s National Centre for Miscarriage Research Professor Arri Coomarasamy, he stated that between 50 to 75 percent of miscarriages will happen during the early “chemical pregnancy” phase when embryo cannot be detected on an ultrasound. Miscarriages that occur during this stage do not require any assistance in completion as they will happen around the same time the female would’ve experienced her period. Considering this, it is easy to understand why it’s common for women to be oblivious to their early miscarriages.
A natural miscarriage often takes two weeks, but sometimes it can take six to eight weeks for the cervix to completely clear out. And while expectant management is commonplace, nearly one in four who choose this method will need surgical intervention. D&C is a short 10 to 15 minute procedure that involves opening the cervix and suctioning the fetus into a tube. It is appealing as it is 99 percent successful, but the surgery does come with the risks of pain, infection, a puncturing or scarring of the uterus, an anesthesia-related reaction, heavy bleeding, ongoing bleeding, and in some rare cases, a need for a blood transfusion. Some say that the surgery itself is painless—and that they primarily struggle emotionally.
Choosing medicine involves taking two different drugs that achieve up to 92 percent success in finishing a miscarriage. This option allows women to potentially go home and finish their miscarriage and avoid anethesia and other surgery related risks, but the downsides include lots of cramping and bleeding, nausea, vomiting, and even having to do surgery if the pills fail.
WHY HAS THE NARRATIVE ON MISCARRIAGES BECOME DARKER?
Fortunately, even though up to 25 percent of women will experience a miscarriage, it is estimated that only five percent of women will have recurrent miscarriages. And there’s more positive news: an estimated 75 percent of women who have three miscarriages (that don’t have a clear reason) in a row will continue on to give birth to a healthy child. These silver linings should remind us of the drastically different reputation miscarriages held in history: a well-known, well-discussed, and non-taboo issue much more commonplace. About a century ago, the discussions about miscarriage revolved around death. It was abnormal to name your fetus or view it as a person. In the 1970s, the narrative was focused on miscarriage as a medical issue and natural occurrence; magazines and parenting books featured miscarriage articles with images of joyful mothers who looked positive about their future. As the 20th century ended however, the problematic narrative that all pregnancies are planned and will succeed was born—and this ill-prepared pregnant people to deal with how normal miscarriages are. Now stories about miscarriage are associated with a much sadder and depressed tone; without warning, the unexpected loss of a child has become much more traumatic for expecting parents. Married with our culture’s tendency to humanize fetuses more, miscarriages and stillbirths have become a mental health issue. A study from Imperial College London found that 40 percent of their sample of women who had experienced the loss of a pregnancy reported symptoms often found in those struggling with PTSD. Another unfortunate aspect of miscarriage is that a mother may still appear pregnant for an extended period after the loss—and this can certainly add more anguish. A way to offer some peace to the mourning parents of stillbirths for example is called a cuddle cot. The cot keeps the baby cool and slows the changes that occur after death—as these transitions happen rapidly in infants when compared to adults—and this allows parents more time to grieve their baby.
THE REASONS WHY MISCARRIAGES HAPPEN
Most articles on the topic of miscarriages emphasize that they cannot be caused by exercise, stress, or sex as some misinterpret—and also that women should not blame themselves as they likely did not cause the miscarriage. (Important to know is that some over the counter medicines like ibuprofen can increase the risk of miscarriage!) Modern medicine has a lot to offer expecting mothers, but unfortunately the reason for many miscarriages is unknown and undiagnosable. However, the BC Women’s Hospital highlights that it has been shown that 70 percent of miscarriages are “caused by random genetic errors that occur before or during the development of the embryo.” An example of such a genetic error is aneuploidy: an irregular number of chromosomes. (The chances of encountering this genetic abnormality increases with age.) Others who are expecting may experience a miscarriage because of diabetes, thyroid diseases, autoimmune diseases, and specific genetic variations from the biological parents. These cases are rare—but unfortunately generally lead to subsequent miscarriages.
THE SOMETIMES-MISTAKEN SYMPTOMS
There are several commonly recognized symptoms of miscarriage: vaginal bleeding, pain/cramps in the stomach, pelvis, and lower back—and tissue passing through the vagina. If you or someone you know is expecting, it is essential to be able to identify these warnings. But it just as important to remember is that many of these symptoms can alternatively just be the healthy functions of a woman’s body. For example, light bleeding in the first trimester is normal and can occur after sex or when the cervix changes. Tissue passing through the vagina is also very normal for women who have their periods—and is easily to confuse with an early miscarriage.
In an interview with the Other Press, Douglas College student CJ Sommerfeld discusses her experience with a mistaken miscarriage. “A few days after my period was supposed to arrive, I was peeing, and a large clear blob came out of me. I am aware that it is normal for bloody tissue to come of your vagina both pre-menstruation as well as during. Very little blood was in this blob, it was also the size that I convinced myself a one-month-old fetus would be.” As previously mentioned, most miscarriages happen early and often happen when the female was not even aware they were pregnant. “I Googled miscarriages in the toilet, and everything I read in those quick minutes convinced me that I did in fact just have a miscarriage.” All signs pointed to miscarriage, but a smart trip to the BC Women’s Hospital clarified what the issue really was: pre-menstruation vaginal tissue. Sommerfeld mentions that she previously felt uncomfortable talking about these sorts of issues as vaginal health is a taboo topic—and even was unsettled discussing the topic with doctors.
On the other end, these symptoms can represent other serious threats to a pregnant woman such as an ectopic pregnancy. When a fertilized egg mistakenly grows anywhere but the uterus it can propose serious issues for the mother—and vaginal bleeding and pelvic pain are symptoms of this. It is recommended that an expecting mother always contact her healthcare provider if any of these potential signs of miscarriage present themselves. BC Women’s Hospital offers a list of times when a pregnant woman should immediately go to the hospital: sudden and severe abdomen pain, feeling like passing out, very heavy bleeding (i.e., three soaked maxi pads in three hours), and a high fever.
A helpful resource for parents that have miscarried in BC is called Empty Cradle. Patty Lou started the foundation in 1991 when she had lost a pregnancy of her own and could not find any support. Membership is free and looks to validate the grief of suffering parents. In the case of miscarriages, our current society’s dialogue on the topic could use a reminder from the past; our lack of discussions on this common issue is causing problems for women everywhere.