RUMS Review Vol. VIII Issue I - January 2023

Researcch
Why we need to talk more
about miscarriages
By Elizabeth Kallumpuram
Imagine that you’ve just been given
your dream job. The last few years
have been building up to this moment
and you’ve worked so hard to achieve
it. You have already envisioned your
future ahead of you and all the things
that you would now be able to do. But
then a few days later, you get a letter
saying that the company is unable to
hire you at this time and can no longer
give you a timeframe for when this
might happen.
This scenario may provide a small
insight into the experience of having a
miscarriage, but a miscarriage is much
more devastating than that. It’s the
crushed hope of something that could
have been. For many women who
have been physically and mentally
preparing for motherhood, which is
viewed by many as the most fulfilling
‘job’ in life, the experience of
miscarriage can be unexpected and
incredibly distressing.
Despite this significant emotional
burden, miscarriages have in some
ways become very normalised in both
general society and the medical
profession. This could be owed to the
sorrowing statistic that around 1 in 10
women go on to experience
miscarriage in their lifetime. But this
high rate only amplifies the reasons
why it should not be taken lightly.
Almost 20% of these women go on to
suffer from depression and/or anxiety
soon after and this can last for up to
three years.
A comparative study conducted in
2018 by Zahra Tavoli at Tehran
University of Medical Sciences
showed that these levels were even
higher for women who had
experienced recurrent miscarriages.
It is also common for women to suffer
from feelings of guilt and self-blame
after a miscarriage, which can
exacerbate the grief they experience.
Therefore, it is understandable that
some women may need time to
recover, but it can sometimes be
challenging to get days off work. As
the psychological effect of
miscarriage is often not discussed it
can be hard for women to request
days off for this reason. This stigma
can only be tackled by having more
conversation around miscarriages , be
it in online forums or in the workplace
with other women who have had
similar experiences. Support - and
even just an open discussion with
people who understand their
experience - can help women feel less
isolated and provide a safe space to
express these complex emotions.
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Miscarriages are defined as the loss of
a pregnancy in the first 24 weeks of
gestation (taken from the NHSinform
webpage). Sometimes the loss of a
baby during the first three months of
pregnancy can be due to
chromosomal abnormalities or issues
with the development of the placenta,
but this can vary between people and
most often it is incredibly difficult to
ascertain the root cause. The different
factors that must interplay
successfully for the correct
development of a baby is a highly
complicated process (as those of us
who have studied embryology will
know!) and, due to its complexity, has
a high chance of going wrong. Some
women unfortunately experience
recurrent miscarriages and someone
who has previously experienced a
miscarriage has a 50% higher chance
of experiencing another, with the
likelihood of this increasing with age.
However, the most significant result of
miscarriage is often not the physical
and biological factors, but grief.
The study also analysed other aspects
of life affected after miscarriage, and
highlighted the detrimental effect to
many women’s social functioning and
emotional resilience in the succeeding
years. This clearly illustrates the longterm
psychological distress that is
brought on by having a miscarriage
and the multi-faceted impact on a
woman’s social, work and home lives.
The effects of this psychological
distress are worsened by the societal
norm of not revealing a pregnancy
before the 12 week mark. Most
miscarriages occur in the first
trimester and, although there are
some women who aren’t aware that
they are pregnant at this point, those
that are may feel isolated, as only a
few people may be able to support
them through their miscarriage.
The NHS still has a lot to learn about
how to support women suffering from
a miscarriage. There can sometimes
be a hierarchy of grief associated with
losing a baby according to how far
along in the pregnancy it occurred.
This can sadly be reflected in the
differing amount of mental health
support given to women by healthcare
services.
Currently, women in the UK can only
receive psychological support and a
referral to a miscarriage clinic if it
occurred after 24 weeks or if they
have experienced three miscarriages.
Although there are many charities that
can be of support, such as Tommy’s
and the Miscarriage Association who
offer services like support groups and
a telephone hotline, more support
needs to come from healthcare
services.