- The Washington Times - Sunday, March 26, 2000

When Amy Robertson miscarried 11 weeks into her pregnancy, she was, among other things, surprised, devastated and annoyed by the reaction of others.
"It was almost impossible to find anyone who had been through the same thing and wouldn't say stupid things to me," says Mrs. Robertson, 31, of Kansas City, Mo. "My mother kept saying, 'There will be lots of babies for you.' But I didn't want lots of other babies. I wanted this one.
"I had just started to let myself think about what the baby might look like and what it would be like to pick him or her up in the morning and to hold her body next to mine. And then, suddenly, the nurse was telling me that mine wasn't a viable pregnancy."
Indeed, the reaction to pregnancy loss, even if it occurs just days after a positive pregnancy test, can include a surprising spectrum of emotions. Even though a woman who suffers a miscarriage is mourning a baby she never met, the daydreams about what kind of person the baby might have been already were well under way. Sometimes the broken bond needs to be mourned.
"It is a loss," says Mary King, a licensed clinical social worker with the Women's Center in Vienna. "It may not be the same as someone you already knew, but it is the loss of a living thing. I think it is especially hard because no one expects to have a miscarriage. If they have been trying to conceive, they are so happy, and then they are blindsided with bad news."
About one in four pregnancies ends in miscarriage, according to the American College of Obstetricians and Gynecologists. However, some doctors estimate the actual number of miscarriages is even higher because many women suffer losses so early they did not even know they were pregnant.
Still, in this society, pregnancy loss is kept quiet. It is taboo to spread the good news of impending motherhood until a woman passes the first trimester, when the chances of a loss reduce dramatically.
"After my miscarriage, it turns out that several women I have known for years told me they have had one, three, five miscarriages in their lives," says Stephanie Larsen, a 30-year-old Texas woman who suffered an early miscarriage in January.

What's to blame?

Even with today's medical technology, at least half of all miscarriages especially first-trimester losses remain a mystery, says Dr. Keith Blauer, a reproductive endocrinologist at the Genetics and IVF Institute in Merrifield.
The most common cause of first-trimester loss is problems with the fetus's chromosomes, Dr. Blauer says. Other known causes are illnesses in the mother, such as lupus, diabetes or a uterine infection; a progesterone imbalance; immune system disorders; and uterine abnormalities such as uterine fibroids and congenital uterine defects.
Women older than 35 are at a higher risk for chromosomal abnormalities and thus pregnancy loss, as are women who are carrying two or more fetuses.
In searching for the causes of a loss, it often is easy for the woman to think back about things she did or didn't do that might have "caused" the miscarriage. However, it is important for women not to blame themselves, says Dr. Michael R. Berman, clinical professor of obstetrics and gynecology at Yale University and founder of the Hygeia Foundation, a miscarriage support and resource group.
"I am very careful to explain to my patients that short of very serious trauma or drug use, whatever they did did not cause the miscarriage," Dr. Berman says. "Medications, intercourse there are many variables, but none of them cause early miscarriage."
After two or three losses in a row, many tests can be run to determine the cause of the miscarriages and determine a potential treatment. Chromosomal abnormalities also can be determined by studying the miscarried fetus, Dr. Blauer says.
It is common for women and men to go through the stages of grief associated with any loss. After shock and denial come guilt, anger, depression and acceptance.
"I felt very angry," says Sybil, a 32-year-old California woman who asked that her last name not be used. In the past two years, she has suffered losses at 12 weeks and 16 weeks. She is now 22 weeks pregnant.
"I was angry that people who don't want their kids or abuse their bodies while pregnant can have kids so easily," she says. "I exercised. I didn't smoke or drink, ate well, had been taking prenatal vitamins, all to no avail. My body still failed me. I was sad at the loss of my son, who is unique. I will never know what he would have looked like or what his personality might have been."
Paula, a 37-year-old Maryland woman who also didn't want her last name used, lost twins last July and suffered a singleton miscarriage in November.
"There were no medical reasons given to me for the losses," she says. "It is hard to accept that nothing was wrong. My response has been extreme sadness that I cannot push away. It is the first thing I think about in the morning and the last thing at night. It is difficult, too, since both of my sisters had babies in the last few months. We were supposed to have the cousins together. They had no problems, and I lost both of mine. It has been difficult to accept the contrast."
Mrs. Larsen says she "cried like I've never cried before," even though she had only known about the pregnancy for two weeks before miscarrying.
"I never felt angry," she says. "I never felt jealousy. Who could I blame? It didn't hurt to see other babies because to me they didn't seem quite real. They still weren't my baby. I just mainly felt a gut-wrenching pain and later emptiness. I think maybe it wouldn't have been quite so painful if it hadn't been my first pregnancy. I was up in the air, thinking about becoming a mother for the first time, and then it was yanked away."
Though many women say their husbands are supportive, the impact of the loss isn't as significant to most men as to women, Ms. King says.
"The reaction of the husband varies," she says. "A lot of times, the men don't feel the same as the women. They never had something growing in them."
In addition to the miscarriage at 11 weeks, Mrs. Robertson also suffered a first-trimester loss last month. She said her husband has been supportive, but the losses affected them in different ways.
"[The second loss] seemed to totally not affect my husband," she says. "He didn't talk about it unless I brought it up. I had to really force myself to get up and get moving. I just couldn't seem to get dressed without crying. But for my husband, it was like nothing was happening. I am feeling better now. I guess I don't have any lingering resentment, but it just highlights that this is really something women go through. For men, it is all so abstract."
Mrs. Robertson's husband, Joe, says he was deeply affected by both losses, but he also noticed different coping styles between him and his wife.
"I was surprised at the overwhelming sadness that came over me when I tried to tell my parents what happened," Mr. Robertson says of the first loss. "The notion that we might actually lose the baby was very abstract. I had imagined setting a little boy square in front of the batting tee or taking a little girl for walks in the park. My imaginations of the child and our plans had taken a stronger hold on me than I realized."
"The second [loss] remained more abstract in my mind because I was much more guarded in my expectations," he adds. "After about three days or so, I had moved on to a different emotional plane than my wife. This was difficult for a while, because even though I listened to her and spent time with her, I was no longer as sad as she was, and that made her feel more lonely."

No magic words

After Mrs. Robertson's first miscarriage, a friend sent her a houseplant and explained that she thought it would be nice to have a living thing.
"How simplistic and ridiculous," Mrs. Robertson says. "Of course a plant can live. It is a heck of a lot less complex than a human baby and pregnancy. How dare she think a plant could comfort me just by the fact that it was alive. I wish she hadn't said anything."
Though friends and relatives mean well, they can inadvertently be insensitive. Often, the loss is acknowledged with words such as, "It was for the best," or "You'll try again."
"Those of us who have miscarried know that none of these comments ever help," Mrs. Larsen says. "Would you say these things to a woman whose infant dies? I realize it is not quite the same thing, but to us, these are our children, even if they haven't been born yet."
The best thing to do is just be there to let the woman express her feelings, Ms. King says.
Paula says the most comforting words she longed to hear after her losses were "Sorry," and "I'm thinking of you." What she got instead was a mixed bag from well-wishers.
"Some people said nothing," she says. "One guy said he knew what I was going through because he had been in bed all weekend with a bad back. I didn't want to hear platitudes about trying again or it would be better next time."
Sybil, who says she is hopeful but "will not breathe a sigh of relief until this baby is born healthy," says it is comforting to talk to those who have been there. She is a member of several Internet support groups as well as a local group called Empty Cradle, where she has befriended women who have been through similar losses.
"Without these relationships, this whole process would have been so isolating and lonely," she says.
Sybil also says having a doctor who can meet emotional needs as well as physical needs is key to making it through a pregnancy after loss.
"My doctor's office lets me come in whenever I want for a heartbeat check," she says. "A pregnancy after a loss is so much more stressful; you really need a doctor who is attentive to your needs."
Through Hygeia, Dr. Berman has worked to raise sensitivity among medical professionals that miscarriage is not just a biological incident.
"There are no magic words you can tell a patient to make her feel better," he says. "It is important to not treat it as a surgical procedure or to say, 'You'll have others.' One baby doesn't sub for another. Some women have lost babies 10, 20 years ago, and they still think about that loss."

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