Each day 282 Australian women experience miscarriage.
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That's about 103 000 a year. Yet pregnancy loss is shrouded in secrecy.
Ladies, it's time to talk, share stories and end the stigma.
“Now that you’re married, when are you going to have kids?”
“So when are you going to try for a second?”
“Don’t you want a girl to go with your band of boys?”
These questions are not uncommon; and while on the surface they seem harmless (albeit nosy), they can be haunting for many women.
The truth is you never know what is going on behind closed doors.
Miscarriage is not something many choose to talk about, but that doesn’t mean they haven’t experienced it.
Sitting in Dr Lang Lang Yii’s Shepparton Women’s Health Centre office there was a sense of normality.
It was just two women talking about miscarriage.
“If there were three other women in the room, one of us would have experienced miscarriage,” she said.
So why is this not a conversation we often hear during coffee catch-ups and girls’ nights?
“People don’t know that miscarriage is quite common,” Lang said.
About one in five women in Australia will lose a pregnancy.
But this does not account for chemical pregnancies where a woman miscarries before she even knows she is pregnant.
Miscarriage is defined as a loss before the 20-week mark of a pregnancy, whereas after 20 weeks — the point at which the developing baby is considered a full foetus and can possibly be delivered — the loss is known as a stillbirth.
The first 12 weeks are the most risky.
Lang said 90 per cent of losses occurred in the first trimester.
While this is in line with society’s unwritten 12-week rule, she said there was no such thing as the ‘safe zone’.
So, why does miscarriage happen?
Lang said chromosomal abnormalities were the leading cause, with age, lifestyle choices and other medical conditions also contributing factors.
And little can be done to prevent miscarriage or stillbirth.
“One miscarriage is common and, unfortunately, it really is bad luck,” Lang said.
“We’ve found that 90 per cent of the reasons are because of the chromosomal abnormality and there’s nothing to do with the mums.
“Even the healthiest women can experience miscarriage.”
But that does not soften the loss.
Feelings of guilt and a flood of thoughts like ‘I’ve failed as a woman’ are not rare.
“Women think it’s more about what they have done, but having a miscarriage is not their fault,” Lang said.
“Unfortunately the chromosomes just go haywire and there’s nothing much we could really do to avoid it.”
This guilt is part of the grief process.
Lang said it was normal to struggle emotionally but talking about it could help.
“Generally people don’t talk about it so much at 12 weeks, but people talk a lot about it at 38 weeks,” she said.
“The grief and the emotional impact on the mother who has lost a baby as a miscarriage at less than 12 weeks is quite the same as someone who lost as a stillbirth at 38 weeks.
“Thirty per cent of women have been commonly diagnosed to have perinatal anxiety or depression or postnatal depression, even after they have another baby.
“A lot of times people forget about the father.
“If it is possible, we get the partner and patient together and acknowledge their problems and concerns and talk about the grief so that they don’t keep it in and then carry it to have anxiety later on.”
For most women a single miscarriage or stillbirth does not affect their ability to give birth to a healthy child in the future.
But hearing the words ‘you’re pregnant’ after a loss can be met with both joy and fear.
Lang said it was natural to worry about losing another pregnancy.
“It’s common to feel that because you’ve lost one, but we reassure them there’s a good chance to have a normal and healthy pregnancy,” she said.
Announcing a pregnancy is a personal choice and Lang said it was not a doctor’s duty to tell a woman who she should tell or when but building a support network was crucial.
“We find that it is worthwhile to talk to your family about pregnancy in the first 12 weeks because sometimes you may need some help and support,” she said.
Then, if you are one of the one in five women who experiences pregnancy loss, the people closest to you will be there to support you through the grief.
And the more women talk about their experiences, the more they understand they are not alone.
“Sometimes I think (peer support) is the best because then you know that actually there are other people that have had miscarriages too, not just you,” Lang said.
Life after loss
A single miscarriage or stillbirth is followed by check-up but Lang said there often was no need for extensive further investigation, with more than 70 per cent of women going on to have a healthy baby.
“We do consider further testing after they have consecutive three miscarriages with the same partner,’’ Lang said.
The body will take its time to come back with a cycle and Lang said it was important for a woman to wait until she was physically and mentally ready to try for another pregnancy.
Lang also recommended pre-conception counselling and adjusting lifestyle choices.
“We always say (wait) one or two cycles afterwards and see how you feel, because some people may have to handle their emotions first.’’
The stats
The chance of miscarriage and stillbirth increases with age.
One in four women under the age of 30 will experience pregnancy loss.
This increases to one in three for women between the ages of 31 and 39.
For women 40 and above, the chance of miscarriage and stillbirth is one in every two.
Support
After a miscarriage or stillbirth, support is crucial for the mother and father.
Lang said maternal nurses and your GP were the first point of call while Goulburn Valley Health also offered a perinatal emotional help program under the mental health triage.
There is also a plethora of support online.
Lang recommended SANDS, Pink Elephants Support Network and PANDA (Perinatal Anxiety & Depression Australia).
The cause
The overwhelming majority of miscarriages and stillbirths are caused by chromosomal abnormalities.
Lang said the other 10 per cent of miscarriages and stillbirths occurred due to medical conditions while there were also lifestyle factors that could increase the chances, including:
- Smoking five or more cigarettes a day,
- Drinking more than three standard drinks a day,
- Consuming more than 500 milligrams of caffeine — three to five cups of coffee — a day,
- Obesity.
“They can contribute to that but it doesn’t mean that they are the main cause, the main cause is still chromosomal abnormalities,” Lang said.