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Miscarriage

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Twenty five percent of women will miscarry. Yet none of us ever talk about it. Stylist investigates the last taboo.

It’s a situation of bleak sadness. Pregnant with a much-wanted baby, weeks spent hiding the constant nausea, growing cup size and overwhelming fatigue from colleagues. Then in one devastating moment, more often than not for no reason at all, the pregnancy suddenly goes away. “Sorry, we can’t see a heartbeat”; a spot of blood in your underwear; a gnawing pain in the stomach. And for many women, through the heartbreak and the guilt and the endless internal questions, the only option is to put on a brave face. To pitch tomorrow’s presentation like nothing has happened, to coo over a friend’s new baby with a smile. Because while losing a friend or relative activates an immediate support network of sympathy and understanding, losing a baby can bring a lonely silence.

The figures related to miscarriage are shocking. Although there are no official government statistics held on women who miscarry (the figures that do exist are only collated for women admitted to hospital; for those who go to the GP after a miscarriage, nothing is recorded), pregnancy charity Tommy’s says one in every four women will miscarry a baby; a quarter of all your female friends. And the chance of losing a baby increases with each miscarriage. For example, if you miscarry your first pregnancy (a chance of 5%), your chances of miscarrying a second rises to 19%. And if you miscarry that second time, your chances of a third rises to 24%.

Despite these stark statistics, while Holland and Canada begin medical investigations after two miscarriages, we begin after three. On the research front too, miscarriage is fighting for prominence. A spokesperson from Tommy’s explains, “[It] tends to be the poor relation of research, compared to other areas such as heart disease or cancer.” The easy answer seems to be, keep trying, however should the funding increase, says Deborah Mason from Wellbeing Of Women, “We could be seriously looking at a future where fewer women miscarry.”

STAYING SILENT

So why is miscarriage shrouded in such secrecy, especially considering how many women will experience it in their lives?

Alison, a 34-year-old educational psychologist who found out her baby had died during her first scan believes that the 12-week ‘rule’ is one of the primary reasons we don’t talk about miscarriage. “Every baby book and doctor says you shouldn’t tell people you’re pregnant before your 12-week scan ‘In case something happens’. But that infers that you’re also not supposed to tell people that something did happen. It reinforces the idea that miscarriage is something that you should feel guilty about and keep secret,” says Alison.

The culture of secrecy that the 12-week rule creates makes life at the office particularly difficult. Although most miscarriages happen between six and 10 weeks after your last period, the loss of a baby is not considered a still birth until 24 weeks. Trying to put on a brave face every day in front of your colleagues is almost impossible. In the end Alison was forced to tell her boss what had happened as she needed surgery following her miscarriage. “He offered to tell my co-workers and I was so thankful. The grief and pain was so huge I couldn’t have pretended nothing had happened – but I didn’t think I could put into words what had happened either.”

But the 12-week rule isn’t the only reason women don’t talk about miscarriage in the office. The reality is that it’s not always viewed as sympathetically as it should be. Despite the advancement of equality laws in the UK, many women fear that telling superiors about a miscarriage may risk marginalisation or being overlooked for promotion or training opportunities as, once the news is out, they’ll inevitably be seen as a mum in waiting who will soon be on maternity.

It’s a scenario Jennifer*, 33, a marketing manager who has suffered three miscarriages feared. “The second time I miscarried I had to do a presentation to important clients knowing I was bleeding. I was an emotional wreck; my mind was off the job. I didn’t consider telling my boss why though. I knew she’d view me differently. Business is business and there was a chance she’d overlook me for promotion if she knew I was trying for a baby and be mentally tallying up how much my maternity leave would cost the company. So I didn’t tell anyone at all. It was an incredibly difficult experience.”

When television presenter and actress Amanda Holden, 39, miscarried, last year she told only two close girlfriends, returning to the final of Britain’s Got Talent just two weeks later. She didn’t tell her male colleagues what had happened. “There’s no way I would have told Piers [Morgan] or Simon [Cowell] – they’re a pair of boys.”

PANIC AND GUILT

The guilt surrounding miscarriages also creates the feeling in some women that miscarriage is something to feel embarrassed about or ashamed of. “In all the women I have seen there have been universal feelings of shame, embarrassment and guilt,” says GP Dr Carol Cooper. “Why? In life we don’t necessarily expect to have the highest salary or get to the very top of our careers, but we take it for granted that we will be able to do the most simple thing, and reproduce. Women who have miscarried feel imperfect, they feel malfunctioning. And because we live in an information age, we are used to getting answers, when women can’t find out what has caused the miscarriage the questions turn in on herself. The blame is all focused on what she did, or didn’t do.”

Consequently many women berate themselves for everything they think they could have done wrong and surfing the internet for causes: Was it the three cocktails before you knew you were pregnant? Sex? “I picked up a television the day before my first miscarriage and felt a twinge. Even though the doctor said it was nothing to do with that I spent days thinking about it,” admits Jennifer. “I just needed to know why.”

And the feeling of guilt tends to increase as women get older as the nagging feeling that age possibly could be the cause creeps in. Sally, 37, a TV producer says, “I’d never given a second thought to being an older mother until I miscarried twice. I suddenly felt incredibly guilty that I’d put my career before having a child. Why had I been selfish? My body was now rejecting my baby. It was irrational – I’d spent my 20s and 30s building a successful career not just having fun, but I felt like it was my fault. So I didn’t tell anyone.”

There is no denying that age does play a role in miscarriage. The chance of miscarriage is 10% in mid-20s, 12% in early 30s, 20% in late 30s and 41% in the early 40s. The reason is that chromosomal abnormalities, which account for the majority of one-off miscarriages, become more common the older a woman is. But what are the other possible causes?

Due to the lack of research and openness surrounding miscarriage, the whole topic is shrouded in mystery meaning the information available is sketchy. Indeed, despite research and calls to relevant organisations, Stylist found it almost impossible to get any concrete answers on straightforward questions. Research shows that one-off miscarriage is most commonly caused by something wrong with the foetus. In fact, a recent study from St George’s Hospital in London found 100% of foetuses affected by miscarriage were underdeveloped for their age. However, for 1% of women, there’s not just one loss, it happens again and again. This is known as recurrent miscarriage and it’s something even medical experts are still learning about. “The potential causes of recurrent miscarriage can be divided into four main areas,” says Dr Hassan Shehata from The Miscarriage Clinic. “Problems with the immune system, problems with blood clotting which can starve the foetus of oxygen, hormonal problems and anatomical issues in the reproductive system.”

WHY DOES IT HAPPEN?

If you’re referred to a miscarriage specialist, which normally happens after three miscarriages – although Dr Shehata points out that if you’ve lost a baby of over nine weeks of age, or are over 35 and have had two miscarriages, you may be seen sooner if you ask – you’ll be given a barrage of tests that check these areas and, in many cases treatments can be administered. Alison, for example, was suffering from excessive blood clotting. “My treatment consisted of 150mg of aspirin and some extra folic acid,” she explains. “I can’t believe I lost five babies and the cure was that simple.” Another example is Christine, a 33-year-old PA, who had a weak cervix. The problem was rectified simply by adding a stitch to support the cervix and stop it opening too early.

Other factors have been found to play a role: the age of the father for example, as women with a partner over 35 have a higher risk of miscarriage than those with a younger man, however old she is. Being overweight at least doubles the risk of miscarriage; “Heavy women produce higher levels of male hormones which may interfere with pregnancy,” says Dr Shehata. Smoking reduces blood flow to the baby and therefore increases risk – even second-hand smoke is linked to a higher risk. Too much alcohol and recreational drugs before conception and during pregnancy are also linked to problems with carrying full term.

Stress has been found tobe a potential factor too. In 2004, scientists found that when pregnant mice were stressed by loud noise, it created an imbalance in hormone levels. This led to the immune system becoming more hostile to the foetus, leading to the placenta coming under attack. The foetus was then rejected because its blood supply can’t be sustained.

Good health is also key. Problems many of us ignore like fatigue, weight gain, bloating and upset bowels might actually indicate the presence of problems linked to miscarriage. “In general, 15% women have abnormal levels of thyroid hormones in their blood, in a miscarriage clinic it’s 70%,” says Dr Shehata. Coeliac disease (an intolerance to the protein gluten found in grain based foods that most commonly manifests as digestive issues) is also linked to miscarriage. It’s estimated that one in every 100 people in the UK has ceoliac disease but only 12.5% know it. Polycystic ovary syndrome is also linked to miscarriage. “I’ve seen women who have had more than 20 miscarriages but still haven’t been tested for common conditions like these,” says Dr Shehata.

Coeliac disease (an intolerance to the protein gluten found in grain based foods that most commonly manifests as digestive issues) is also linked to miscarriage. It’s estimated that one in every 100 people in the UK has ceoliac disease but only 12.5% know it. Polycystic ovary syndrome is also linked to miscarriage. “I’ve seen women who have had more than 20 miscarriages but still haven’t been tested for common conditions like these,” says Dr Shehata.

Low levels of vitamin D have been found to be more common in fertility issues, including recurrent miscarriage, says conception specialist Zita West. “Since we introduced vitamin D testing in our clinic we’ve discovered up to 68% of the women we treat for fertility problems are deficient in it.”

FUTURE SOLUTIONS

However, we still don’t have all the answers. “About one third of recurrent miscarriages are referred to as idiopathic – which means we don’t know the cause,” says specialist Luciano Nardo from London’s BMI Fitzroy Square Hospital. “It doesn’t however mean there isn’t a cause – just that science hasn’t yet found it.”

But there is hope he says, “With two, five or 10 years of research we might [have answers]. There’s a lot of promising work being done.” Nardo is most excited about a trial looking at the role of a procedure aiming to correct a common cause of miscarriage called septate uterus, where a ‘wall’ of muscle forms in the womb. This wall has no blood flow, so any embryo implanting into it can’t get the nutrients it needs to survive. “It’s the equivalent of trying to plug something into a partition in the middle of your office that has no electricity. Nothing will work,” he explains. Other experts have mooted the theory that the uterus of women with recurrent miscarriage is ‘less fussy’ than that of other women.

The team at Imperial College London have found that women who have repeated miscarriages often become pregnant very quickly, leading them to believe their body is allowing abnormal embryos that wouldn’t implant in other women to take hold, only to be lost later down the line when the body realises there’s an issue. They’re hoping to develop a test that identifies women with the problem.

Dr Shehata is more interested in the immunology angle. His pioneering work sees him using steroids prior to conception (most doctors only treat after conception) to normalise issues in the immune system. “Normally, immune cells called natural killer cells protect our body from foreign substances. In the lining of the womb these usually protect a pregnancy but in some women they become aggressive or increase in number and attack the foetus,” he explains. His clinic is currently achieving an 85% success rate in helping women conceive.

Also making news is the PROMISE trial linked partly to Tommy’s. “It is going to look at whether progesterone pessaries (hormone treatments used to stimulate fertility) can help stop miscarriage loss by keeping hormone levels stable in the first weeks of pregnancy,” says research midwife Annette Briley from the charity. It’s expected to report back in 2012.

Perhaps the most overwhelming thing about miscarriage is the lack of control and feeling of helplessness. Frustrated by the lack of medical support available, many women look towards alternative treatments – from Chinese medicine and homeopathic remedies reflexology to acupuncture. While there’s no conclusive proof they can prevent miscarriage, many of the women we spoke to had had success with these treatments.

The only way to lift the secrecy surrounding the issue is to begin speaking more candidly – that way the research, sympathy and openness that miscarriage deserves will finally be granted.

For more information visit tommys.org or to speak to a midwife call Tommy’s freephone on 0800-014 7800

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