It wasn’t until we shared our story that people revealed theirs – “we had one too,” “it’s so hard, isn’t it? – it took us ages to recover,” “you never forget that baby, we certainly haven’t.” I looked at my friends, and even family members, in disbelief. “You’ve had a miscarriage? How did I not know?”
We suffer silently. We suffer a tragic loss, perhaps the most painful kind, but we don’t share it. So many of us trudge through the darkest patch of our lives without the extended support network we would lean on in any other type of tragedy in our life. My question, why?
Before we conceived Miss S, Will and I had a miscarriage. Our baby was due on the 26th of December 2015 and at five weeks I started to bleed. I knew from the get-go that the likelihood was that this was not a viable pregnancy but I had already envisioned holding this child and burying my face in his or her neck. Our world had already enveloped this little life, and now it was being ripped away. What bothered me most was that I had no control over the situation – none. I had been on all the right supplements pre-pregnancy, ensured I was as healthy as possible, followed all the textbook advice but it was failing and I was devastated and angry.
As GP, I deal with countless pregnancies, but also miscarriages. I have women come in for the “guess what Preeya, we’re pregnant” appointment (one of my favourites, especially when I’ve worked with a couple preconception). Unfortunately, I’ve also dealt with the “something isn’t right, I’m bleeding” moment. I’ve had women have uneventful first trimesters only to have a scan at the 12-week mark that shows no heartbeat; breaking that news is heart-shattering, but nothing compared to what the parents sitting opposite me are experiencing. I know this process well from a doctor’s point of view – but none of it helped me when I went through it myself.
I know the facts like the back of my hand. Up to 1 in 5 women experience miscarriage before 20 weeks of pregnancy – in fact, the rates are likely even higher given many women miscarry without realising they are pregnant and so they think they are slightly late for their period. It is common, much more common than what people realise. Whilst there are things a pregnant woman can do to reduce risk like avoiding alcohol and smoking, in most cases, a miscarriage occurs because of serious chromosomal issues within the embryo so the pregnancy is not viable. In many cases, there is nothing the woman could have done. I reassure lots of patients with this where I can but, having been on the other side, the reassurance can do very little to alleviate the ruminating thoughts. It is worth noting, however, that bleeding in the first trimester occurs in 20-40% of pregnancies BUT not all lead to miscarriage – many go on to have healthy uncomplicated pregnancies (the bleeding can be due to cervical issues or implantation for instance).
“ After our miscarriage, I questioned for a long time if I had done something to cause it. I had not consumed alcohol or smoked but I had been to the gym and I had drunk a cup of coffee here and there. That was enough to drown me in a pool of guilt. ”
After our miscarriage, I questioned for a long time if I had done something to cause it. I had not consumed alcohol or smoked but I had been to the gym and I had drunk a cup of coffee here and there. That was enough to drown me in a pool of guilt. As a GP, I have told women countless times “it is nothing you have done.” I had my husband, friends and colleagues telling me exactly the same things – “Preeya going to the gym did not cause this,” “Preeya you know full well that a cup of coffee in pregnancy is fine,” “Preeya what would you say to a patient in your position? You know you didn’t do this”– but I couldn’t hear their words. Well I could, but I chose to ignore them because I was very much of the view that I could have controlled it. It took me a good four weeks to gain some insight and realise that this issue had been out of my control. It took much longer to deal with the grief.
Many people are not aware of what happens when a woman miscarries. I recently heard of a horrific experience a woman in the media shared about her GP googling how to manage a miscarriage as she sat in the consulting room devastated. Let’s talk about the medical aspect for a moment; miscarriage can be managed in different ways. For some women, they have a heavier than normal period – we usually monitor the pregnancy hormone in the blood (and sometimes do ultrasounds) until it goes to zero to ensure no remnants of pregnancy remain in the uterus (this can cause pelvic infection down the track if left untreated). We call this expectantly managing the miscarriage – we let the body do its thing and monitor to ensure no complications arise. Not all women can attempt to have a natural miscarriage – they may be too far along in the pregnancy (so the contents of the uterus cannot pass through the cervix easily) or they may choose to proceed to a medical or surgical approach because the bleeding and pain are unbearable. The medical approach involves taking a medication called Misoprostol which helps to evacuate the contents of the uterus. For some they attempt to have a natural miscarriage but it fails (the pregnancy hormone remains elevated, material remains in the uterus or the bleeding is too heavy or the pain is too much) and so they can go on to have a dilatation and curettage (D and C) – a procedure performed by a surgeon to empty out the uterus. Some women go on to have surgical management straight away if they choose to or are further along in the pregnancy. That’s the crux medical stuff.
I had a natural miscarriage. I had a heavier than normal period and I sobbed every day for about two weeks. I drowned in a pool of guilt, lost dreams and the fear of it happening to us again. Thank goodness for my husband and my mother is all I will say. When I was able to face the world again, Will and I decided to tell some of our friends – it was obvious something had happened in our lives and people were asking if we were OK after missing several social events and being distant. I’ll be honest, I had a moment of “do we share this?” – would I be perceived as less “womanly” because I couldn’t sustain a pregnancy? These are, honestly, the types of guilty thoughts I was plagued with and I strongly suspect I am not alone. I felt somehow inadequate and ashamed. Seriously. Some women will share their experience and inner thoughts and some will not and that’s OK. I’m sharing these thoughts because, as a GP, I have sat in a room with women who feel their womanhood is in question, that they are to blame – and I want you to know, despite all my training and knowledge, I had the same inner dialogue – you are not alone.
I’ve had women sit across from me devastated at their loss. And only since my own experience can I truly sympathise. I don’t know why but there is some sort of comfort that comes when a person says they’ve experienced a similar loss – you look at them, I know I did, and think “that gives me some hope, maybe I will survive this too.” Recently, I’ve told two patients that I suffered a miscarriage but now have a healthy daughter – I saw the hope on their face, I saw their shoulders go back just an inch – I had given them a glimmer of hope in a dark time and perhaps that’s the best therapy of all.
Sharing our stories (if we feel comfortable) can help. It’s hard as a doctor sharing our own journeys with patients – there are some of my colleagues who would look at me sharing this or my story of anxiety on my blog and think I’m pushing the boundary. There are lots who are supportive though. My personal view is that a doctor is no different to anyone else. I am not immune to anything and I don’t want to portray that to my patients. I respect the doctor-patient relationship and its boundaries but I also know that sharing the right story at the right time might just give someone the hope to get through. Sometimes it’s the human aspect of being a GP that is the best treatment – no pills or treatments, just an ear to listen to and a shoulder to lean on.
There should be no shame in sharing our stories of miscarriage. To the woman who might be reading this, drenched in tears thinking “will I survive this?” – you will. It takes time, lots of it, and the emotional scar remains but you will survive. Boxing Day is always a day Will and I have a moment to reflect on our loss, but also be grateful for our beautiful gain in Miss S.
To read more from Dr Preeya Alexander, go to www.thewholesomedoctor.com.au