A very private grief

Is miscarriage on the increase? In miscarriage awareness week, that's the most obvious question to ask, but the rather surprising answer is that no one knows. "There's no evidence," says Ruth Bender Atik of the Miscarriage Association.

Lamentably, it seems no one is counting. It's true that charting the true number would be difficult, since some women mistake a miscarriage for a heavy period, and others don't tell their GPs even when they know they've suffered one. But the rather surprising news is that even if you do present at your doctor's surgery or your local hospital casualty with an ending or ended pregnancy, your experience goes unrecorded.

The best the medical profession can tell us, based on small-scale studies, is that up to 30% of pregnancies are miscarried. In the absence of evidence, though, you could be forgiven for thinking that miscarriage may be a growing problem. It's certainly a common one: I have had three myself, and at least two of my closest friends have also had them. In the past week two high-profile women, Annabel Heseltine and Lauren Booth, the prime minister's sister-in-law, have written of their pregnancy losses.

So, are more of us losing babies, or are we simply more likely to talk about it? Atik believes that, although a minority of women do speak out, most still want it to be a private grief. For some there are practical considerations: if they don't yet have children, they may be unwilling to divulge that they're trying to have them now. For others, there's the problem of not knowing where to go; and of not knowing how far it's OK to mourn a baby who was maybe hardly a baby at all.

On top of that, there's the feeling of failure. All of us who have miscarried, at whatever stage of our reproductive lives, have felt it, and it's a particularly abject and stark failure. A few weeks before, you were laughing and crying over your positive pregnancy test, making plans, imagining the little person you would be cuddling a year from now. Your pregnancy is the first thing you think about every morning, the last thing you think about every night.

Then one day, without warning, there's the blood; for me, every time, it was just the tiniest drop, the merest hint of heart-stopping red. Then the terrible wait at the hospital for an ultrasound scan to check whether it was all over. Finally, in a scene almost too painful to recall, the frozen image on the screen of a baby whose tiny heart had for some reason ceased to beat.

Why? That's what you want to know, but if they can find a reason you're one of the lucky ones. Most women who suffer one miscarriage, and then two, are simply sent home to "try again": it's only when you reach three consecutive losses that you qualify for help, and even then the likelihood is that, like me, you will be told the tests show nothing abnormal.

According to Roy Farquharson, consultant obstetrician at the Liverpool Women's Hospital and an authority on miscarriage, a cause will be found in only around half of the women investigated. That's partly because it's under-researched. "It's always been a Cinderella cause," says Farquharson. "It hasn't attracted much grant money for research."

As a consequence, he believes, research into miscarriage and its prevention is around 20 years behind research into infertility which, by contrast, has attracted lots of funding. What research there is has uncovered two factors that are most significant in predicting whether a woman will miscarry: maternal age and previous history of losses.

The first, of course, is bad news at a time when many women postpone childbearing because although even a 19-year-old can have a miscarriage, a 40-year-old is at greater risk. The truth is, of course, that some pregnancies will always end in miscarriage, and indeed a proportion are due to gross abnormalities in the chromosomal make-up of the baby.

But, contrary to popular belief, these "abnormal" foetuses by no means account for all miscarried pregnancies. In many cases, doctors like Farquharson believe, the "mistake" is in the placenta, not in the baby itself. It's in this area that research has been concentrated and significant steps forward are being made, partic ularly with regard to blood clotting abnormalities which appear to interfere with the smooth workings of the all-important placenta.

For several years, doctors have believed that taking low-dose aspirin might iron out these clotting deficiencies, making a successful outcome much more likely. Although the studies have not conclusively proved the usefulness of aspirin, the evidence seems to suggest it is beneficial, and I am one of probably many thousands of women to put my baby's life down to the taking of low-dose aspirin.

There is another factor, too, harder to pin down, more difficult to describe. It's a kind of confidence that pregnancy will work out, a sort of self-belief. There's no medical reason why your psychological state should affect pregnancy outcome, but studies seem to back up the argument that it does.

Studies in Norway and elsewhere have shown that if women are given regular reassurance via ultrasound scans that their baby is alive and well, they are more likely to make it through the crucial 12-week barrier - and by that stage, if the baby's heart is still beating, there is a 99% chance of success.

In my most recent pregnancy, weekly trips to the local hospital for a scan became a kind of lifeline: in many ways I existed from one week to the next and, as the weeks went by and the news was always good, I started to believe, slowly, that this time my baby would survive - as indeed she did.

• The Miscarriage Association: 01924 200799

Thanks to guardian.co.uk who have provided this article. View the original here.


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