Miscarriages: more common than you think

New research has found that about 10% of women worldwide have experienced at least one miscarriage in their lifetime, Dr Emanuel Gracias elaborates on this common phenomenon

A hush-hush topic from time in memorial, miscarriage has been a taboo word probably since it was first uttered. We have come a long way since then with celebrities like Michelle Obama, Chrissy Tiegen and Meghan Markle opening up about their miscarriage stories, in turn upending the myth that miscarriages are rare.

According to studies, 44 women lose a pregnancy every minute; that is about 23 million miscarriages every year. This leads us to the simple conclusion that miscarriages are more common than we believe. Miscarriage is when an embryo or fetus dies before the 20th week of pregnancy. This usually happens early in your pregnancy with 8 out of 10 miscarriages happening in the first trimester i.e the first 12 weeks of a pregnancy. The most common signs of a miscarriage are bleeding and cramping. Although not all miscarriages are physically agonizing, a majority of women experience cramps. For some people, the cramps are quite severe, while for others, they are mild (like a period or less). Vaginal bleeding is also typical, as are huge blood clots up to the size of a lemon. Sometimes there are no signs or symptoms of a miscarriage, and you don’t find out until you have an ultrasound or no longer feel pregnant.

Depending on how far along you are in your pregnancy, doctors diagnose which type of miscarriage you are facing. A threatened miscarriage is one where there is some bleeding and/or pain but the cervix remains closed, and the baby’s heartbeat is present. In such a scenario the fetus stays safe but there is a threat of an impending miscarriage. Doctors usually do an ultrasound to confirm and then put you on progesterone, which is considered as the glue that holds a pregnancy together.

Then there is the inevitable miscarriage, where a little to a lot of bleeding is seen. When the uterine mouth opens, the miscarriage becomes permanent in this case. In some cases women undergo an incomplete miscarriage where some of the pregnancy tissue comes out of the uterus, and some stays inside. This requires dilation and curettage so that all the parts that remain within the uterus are taken out so as to prevent infections and sepsis. Patients are generally called back in seven days time to ensure that no particles have been left behind. The other type of miscarriage is a complete one, all pregnancy tissue comes out in this case and you usually don’t need any extra treatment.

While the exact cause of loss of pregnancy is unknown, there is almost never a link between something a pregnant woman has done and a miscarriage. Miscarriages in the first trimester are thought to occur due to the unviable genetic material of parents combining or chromosome anomalies in the embryo. Incorrect implantation of fertilised egg in the utero or underlying problems in mother can potentially lead to a miscarriage. Basically, a number of reasons, including environmental factors can lead to pregnancy loss. It is important to understand here that neither parent is responsible for any of the causes. Miscarriages, according to most experts, are just the body’s way of terminating a pregnancy that is unlikely to result in a healthy foetus.

We understand how devastating a miscarriage can be for a couple; especially the woman and we are here for you. You are not just a vessel to bear children or a carwash that we clean out your uterus and end the process; healing takes time but, what you need to know is that while it does feel lonely, you are not alone. It’s also very crucial that you remember not to blame yourself, miscarriages do not happen because of something you have or have not done. Perhaps, it was just not the right time for you and destiny has something better in store for you. Medically we recommend 3-6 months before you start trying to conceive again but, a woman must take as much time as she needs emotionally to heal and recuperate.

As an obstetrician and gynaecologist I find it is fundamental to talk about and raise awareness about pregnancy loss. It is important for women to know that they are not alone and to educate others that there is no one to blame for a miscarriage. We try our best to talk and make clear to relatives not to focus on something a woman has done that resulted in a miscarriage or blame her for it.

Miscarriages have always been a part of nature, it is only now that technology has improved making it easier to detect. Pregnancy tests are also more accessible enabling women to determine if they are pregnant or not very early on, which leads to them recognising and coming to doctors with a miscarriage. It is thus important for us now to have and improve our conversations around miscarriages, un-shrouding this phenomenon from its harmful secrecy.

The writer is an obstetrician and gynaecologist at Gracias Maternity Hospital,Margao. Email: emanuelgraciasmd@gmail.com

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