Monday, September 14, 2009

Miscarriage- Tragedy of Now...Hope for the Future

My heart sinks almost immediately after I start the trans-vaginal ultrasound. I desperately look for a flicker or a movement where the heart beat would be.

At the same time my mind is rehearsing what I may have to say. “I’m sorry but the pregnancy has stopped growing”. No, that doesn’t make sense. “I’m sorry but the baby has passed away”. Don’t like that either.
What do I say? She should be about 7 weeks pregnant. Just missed her period a couple of weeks ago. Like most couples they didn’t want to allow themselves to get too excited. I am sure however, that like most couples from the moment the home pregnancy test gave them the positive signal, the cautious day dreaming began. What names for boys and girls? Which color for the baby’s room? Daycare or babysitter at home?
“I am very sorry but I don’t see a heart beat on ultrasound today”. I then explain the miscarriage process but mainly try to listen.
This is not something that is usually taught very well in medical schools. I made mistakes at the beginning of my career and placed my foot several times in my mouth before settling into what I know now.
What I have learned over the years is to separate the tragedy of the moment from the hope for the future. Too many people resort to minimizing the emotional effects of an early miscarriage as a way to comfort the grieving couple.
All the stages of grief apply to an early pregnancy loss, from denial and guilt through to acceptance and hope. It is not unusual to feel isolated with these emotions because the couple may not know anyone else who has had a miscarriage. It is not exactly a topic that comes up often during dinner parties and family gatherings.
Unfortunately miscarriages are very common. Approximately 15% of known pregnancies will end up in a miscarriage. However if you include all the pregnancies that are lost before a woman even misses a period, the number is a staggering 50%. Most of these are due to chromosomal abnormalities which are sporadic in nature. This means that in most cases it appears to be a chance event.
“Is it because of something that I did or didn’t do, maybe something I ate?” The feeling of guilt is inevitable. You cannot cause a miscarriage by lifting something heavy or having sex and no it wasn’t that second glass of wine you had before you knew you were pregnant. The list goes on.
As reassuring as it is to know that the woman did not cause this miscarriage, it is disturbing to live with the lack of control. “How can I make sure that this does not happen again?”
There are a few things that can help minimize the risk of having a miscarriage. The most important thing is to be in an optimal state of health. If you have chronic illnesses such as diabetes they should be well controlled. With the help of your provider you can identify any environmental factors such as excess alcohol and cigarette smoking. You will probably need practical help to manage both of these habits.
There are some suggestions that moderate consumption of caffeine may increase the risk of miscarriage in the first trimester.  One cup of coffee a day should not pose an increased risk, as long as you take into account your entire intake of caffeine (including that in caffeinated sodas).
Guess what?! Exercise is good for you! As long as your provider has not identified any reason why you cannot exercise, it has been shown that not only is it safe but it may lower the risk of miscarriages.
Despite all of these adjustments there are a minority of women that experience recurrent early pregnancy losses. The guidelines at this time recommend starting to look for potential reasons after two to three consecutive miscarriages. I’ll leave this topic for another day.

I have been present and shared this emotionally devastating time with a few of my patients. I have also been privileged and have had the pleasure to deliver their healthy newborns sometime later. I cannot help but wish that I had the power to show them the future as a way to ease their pain. But I can't. I know that for now we should mourn the loss.

1 comment:

  1. Loved reading your sensitive perspective on this emotional topic...