Pregnancy loss is devastating, yet the pervasiveness of the ’12-week rule’ and a misunderstanding of the physical and emotional toll can leave many who experience it feeling alienated and depressed.
Now new research confirms that the psychological impact of miscarriage can be so severe that many women experience symptoms of post-traumatic stress disorder (PTSD).
Published in BMJ Open, the study by Imperial College London surveyed 113 women who had recently experienced a miscarriage or ectopic pregnancy (the majority before 12 weeks), and nearly four in 10 (38%) reported symptoms of PTSD three months after the loss.
Dr Jessica Farren, lead author of the research from the Department of Surgery and Cancer at Imperial College London, said the study demonstrates that pregnancy loss can have a “profound effect” and there’s a need for effective support systems.
PTSD, as the NHS explains, is caused by stressful, frightening or distressing events, and symptoms often include sufferers reliving the event though nightmares, flashbacks, or intrusive thoughts or images at unwanted moments. Further symptoms are problems with sleeping and concentration, and feelings of isolation, irritability and guilt, often severe enough to have an impact on sufferers' day-to-day life.
“We were surprised at the high number of women who experienced symptoms of PTSD after early pregnancy loss. At the moment there is no routine follow-up appointment for women who have suffered a miscarriage or ectopic pregnancy,” Dr Farren said in a press release.
“We have checks in place for postnatal depression, but we don't have anything in place for the trauma and depression following pregnancy loss.
“Yet the symptoms that may be triggered can have a profound effect on all aspects of a woman's everyday life, from her work to her relationships with friends and family.”
Ruth Bender-Atik, national director of Miscarriage Association, describes the research as “important”, especially given that many still “assume that early loss isn’t a big deal emotionally or physically”.
While previous research has suggested women who experience stillbirth may develop post-traumatic stress disorder, this is the first to focus on early pregnancy loss.
“It confirms what we already know from our work at the Miscarriage Association: that for many women and their partners, miscarriage and ectopic pregnancy mean the loss of a baby and the associated hopes and plans and dreams,” Bender-Atik tells stylist.co.uk.
“The physical experience can be equally distressing, with pain and bleeding that can be both shocking and frightening. And those aspects, especially blood, are often underplayed or simply not discussed out loud.
“Good and sensitive care along with clear information can make a major difference in helping women through, but as the research demonstrates, there is also a real need for support after the loss and in the next pregnancy. “
Specifically, 45% of the women who suffered a miscarriage experienced symptoms, and the figure was 18% among those who suffered an ectopic pregnancy.
Ectopic pregnancies develop outside the womb, usually in a fallopian tube, and either miscarries or requires medical intervention to end the pregnancy. Ectopic pregnancies always end in loss and can be life-threatening, and Bender-Atik points out that the psychological impact of these is often overlooked:
“Ectopic pregnancy is often dealt with as an emergency with the focus on saving the woman’s life. That’s fine, but afterwards she is still likely to be thinking about the loss of a baby, not just grateful to be alive.”
Jane Brewin, chief executive of Tommy's, which part-funded the research, said: “This study gives a voice to many women who have suffered miscarriage in silence and the often significant consequences that follow. The message is clear: in a civilised society it is not acceptable for women to suffer in this way.
“Following this study there must now be added impetus to change miscarriage treatment and care; many women need more support following a miscarriage.”
The study, titled Post-traumatic stress, anxiety and depression following miscarriage or ectopic pregnancy: a prospective cohort study, also highlights the discussion around the tendency to keep a pregnancy secret until after the 12-week scan – something many do as they see the 12-week mark as being out of the danger zone, given most miscarriages take place within the first three months.
However, if it does fail, the secrecy can amplify feelings of disconnection and alienation, and also mean that mental health symptoms are missed.
Dr Farren says: “There is an assumption in our society that you don't tell anyone you are pregnant until after 12 weeks. But this also means that if couples experience a miscarriage in this time, they don't tell people.
“This may result in the profound psychological effects of early pregnancy loss being brushed under the carpet, and not openly discussed.”
Professor Tom Bourne, senior author of the study, said the team are planning larger follow-up studies to confirm the findings and help identify at-risk women and the treatment they may benefit from.
“Not all women who suffer a miscarriage or an ectopic pregnancy will go on to develop PTSD or anxiety and depression. Therefore we are now investigating why some women may be more at risk than others, to help medical professionals identify who may need extra support.
“We know that talking therapies, such as cognitive behavioural therapy, have been successful at treating PTSD. However we need to investigate how this treatment should be tailored to women who have suffered an early pregnancy loss.”