In today’s post, I’d like to directly address one of the biggest “elephants in the delivery room”: miscarriage.
Miscarriage is the loss of a pregnancy before the baby has reached 20 weeks gestation. An important thing to note here is that these days, the age of viability, or the earliest age where babies have any real chance at surviving outside of the uterus when born pre-term, is at about 23 weeks. So by default, a miscarriage means the end of a pregnancy in which the baby is not yet old enough to survive on his own.
Now, while you might breeze right past the 0-20 weeks part, stop and back up a moment: that’s a remarkably long timeframe. In 20 weeks, you go from being a tiny little speck of a human being to a little person of about 10 inches long–roughly the size of a banana. The sheer number of developmental milestones that happen in 20 weeks’ time is nothing short of astounding.
To better grasp the range of loss that falls under the broad category of “miscarriage”, consider that pregnancies that end in miscarriage early on (before 5-7 weeks gestation) are called chemical pregnancies–so named because it’s too early to see a sac via ultrasound and the only visible indicator that a woman was actually pregnant is a positive pregnancy test. As you advance into the 2nd trimester (13 weeks gestation) and closer and closer to 20 weeks, however, a woman typically goes into labor, experiences contractions, and may deliver a baby that is both big enough and developed enough to hold his mother’s finger, move his limbs, and could attempt to breathe on his own for a little while after birth if born alive.
So why talk about miscarriage, you ask? Well, to be honest, it’s remarkably common. Though the numbers vary, experts estimate that anywhere between 15-30% of known pregnancies end in miscarriage.
In L&D, we typically don’t see patients before 20 weeks gestation. However, miscarriages tend to be the exception to this rule, especially if they’re late miscarriages. The closer to 20 weeks that a miscarriage occurs, the bigger the baby is, and the bigger the baby is, the more likely it is that mom will need monitoring and possibly intervention to ensure that everything goes as well as possible both during and after delivery.
Miscarriages, while they may vary widely from one to another, do have a few things in common, and they’re things that professionals, parents, and the friends and families of those experiencing a miscarriage need to know. Based on evidence, past professional experience and personal experience, I have worked up a code of conduct for myself–a basic list of things I will or will not do for patients–who find themselves miscarrying and under my care.
#1: I will never tell you it is OK.
I know it’s not OK. To be quite frank, it probably won’t be OK for a while. So when you’re under my care, you don’t have to pretend it’s OK, and I won’t, either.
#2: I’ll roll with your moods.
Going off item #1, you won’t surprise or offend me if you go from acceptance to grief to anger to despair and back again from the time it takes me to walk from one side of your room to the other. I not only expect it, but I encourage a healthy venting and demonstration of the phases of grieving, even if they hit you rapid-fire. Now, this doesn’t mean I’ll allow for verbal or physical abuse of any kind of anybody. But I understand if you need to drop a few words en français in the process of mourning, just as long as they’re not aimed at anyone in particular.
#3: I’ll never tell you it just was/wasn’t meant to be.
I know people say this in an effort to try to explain why horrible things happen, but I’m aware that this is one of the worst things someone can say to a woman who is losing/has lost a baby. And I will never try to explain away the unexplainable.
#4: Conversely, I’ll also never tell you it was part of God’s plan for you.
Not only is this an incredibly insensitive thing to say to someone who has lost a child, but it’s also something I have no way of knowing. What lies ahead for you? Why did your little baby have to be the one who died? Being that I’m not God, I don’t know the answer to those questions in your case specifically, so I won’t endeavor to speak on His behalf. The effort of finding meaning in your loss–that’s between you and Him.
#5: I’ll never suggest that you can have other children in an effort to replace this one.
You can’t replace the baby you lost. Just like you can’t replace a mother or father or sister or brother or grandparent or friend who has died. Can you imagine having a friend whose 6-month-old died and trying to comfort her with, “Oh, it’s OK, Betty–you can always have another one!” It’s just as rude and insensitive to say that to a woman who miscarried.
From zygote to fetus, preborn babies are individuals just like the rest of us, and I’ll never imply that having another child will take the place of the child you’ll never know.
#6: I’ll never suggest it was your fault.
Implication of blame can come in several different forms.
“Oh, well did you drink at all when you were pregnant?”
“Did you take your prenatals every day without forgetting?”
“Were you really stressed out when you were pregnant or something?”
Yes, that includes mothers who come in addicted to certain substances that are known to cause miscarriage.
Why?
Most women blame themselves automatically, whether for logical reasons (such as substance abuse) or illogical (such as forgetting a vitamin one morning). It is one of the hardest parts of loss. I’ve had patients who have gone through every day of their pregnancy and reviewed what they did: Did I eat bad food? Did I get too little sleep? Did I not go for a walk?
I won’t perpetuate a cycle of questioning that often cannot be answered.
#7: I’ll never suggest that you’ll forget about your baby over time (and that will somehow make it better).
Quite the opposite, really. Grieving is a process that can take a years. Losing a baby may be one experience in a lifetime of countless, but it is one experience that can–and for many, will–affect the rest of your life.
That first year will be difficult. There will be memories of what should’ve been–the trimester marks you should’ve met, the ultrasounds, the due date. After all that, then you re-enter the time when you first found out you were pregnant and all the shattered dreams that go along with those memories. All of that leading right back up until when you miscarried. Believe me when I tell you that it will be an intense, difficult year.
However, I’ll offer you this: it will get better. Things will improve and with time, you won’t feel the crushing grief that can seemingly consume you for the first few weeks after you miscarry. But bear in mind that sometimes, those feelings can come back to haunt you without warning, even in the years following your loss.
#8: I’ll never refer to your baby as a “fetus”, “embryo”, “products of conception” (shudder) or any other ‘physiologically-correct’ medical term.
You can thank the abortion industry for this one. While some of these terms may be technically correct, I’m aware that these same terms referring to the very developmental stages of human beings have (ironically) been used for years to dehumanize the unborn.
In my experience, mothers and fathers experiencing miscarriage are at a serious disadvantage when it comes to grieving in public. Did you have a stillbirth? Did you experience a fetal demise? Did your newborn die shortly after birth? I would never diminish how tragic that is, but on the same token, at least most people will acknowledge your loss and usually treat you with a modicum of compassion. For parents who miscarry? It’s a shot in the dark.
In a country where abortion is legal and the unborn–especially at early gestations when natural miscarriages (termed “spontaneous abortions” in the medical field) also commonly occur–are viewed as disposable “clusters of cells” that can be unceremoniously scraped, scooped or saline’d out of their mother for a reason as simple and cold as convenience, how do you explain to your neighbors that you miscarried and as a result, you lost a baby? How do you explain to your family that this growing life, at an age where it would be legal to kill him or her via elective (or “therapeutic”) abortion, is still your child? How do you explain that profound sense of grief to a culture that won’t even acknowledge that your gestating baby is a human being with inherent value apart from whether or not he or she is wanted?
Those are some of the struggles you’ll face when you leave the hospital. I hope and pray you don’t experience anything like this under my care. I will do my best to shield you from it as you tackle your first few days of grief. But it is out there.
As a result, I will always refer to your child as you will forever see him or her: as your baby.
#9: Because of #8, I will find a way to give you with the most precious gift I can: memories and physical reminders of your baby.
Before your baby is born, if he or she is still alive, I will hold that ultrasound there as long as you want me to so you can hear the sound of his or her heartbeat. I’ll make sure you get a good recording of it on your phone. I’ll make sure you get a copy of our EFM strip for your memory box.
When your baby is born, if he or she is big enough, I will make footprints and handprints in a clay keepsake and put them on several commemorative cards in ink. I will dress him or her up and let you hold him or her as long as you want. If you want, we’ll take pictures–you and baby, you and your significant other and baby, your family and baby, your wedding rings and baby–whatever you want. I’ll go through our gift box for parents who have lost a baby and explain everything.
You will have few memories of your child and even fewer physical reminders of him or her. So in the years to come when you pause in the middle of your day and think of your kiddo, it’ll have been my honor to have given you the physical representations of your baby’s short life within you.
#10: I won’t forget about you, Dad.
In Obstetrics, the focus is usually on mom–and why not? She’s the one whose body is changing daily to support a growing baby. It only makes sense.
But when a baby dies, there is a natural tendency to focus on mom and forget about dad. Again, it makes sense given the field. As the person physically carrying the baby and experiencing the visceral trauma of miscarriage, a great deal of the attention will rightly focus on the mother.
However, it has been my experience that many men suffer silently as they watch the woman they love the most deal with the physical, mental and emotional consequences of loss. As a result, many of them fail to grieve appropriately as they are often overlooked by healthcare providers and desperately needed by their significant others, giving them little time to deal with their own feelings.
Dad, I’ve got you. Just as much as Mom will have my full attention, support, and compassion, so do you. You will get the same keepsakes, ultrasound photos and EFM strips as your partner. I’ll be sure to bring both of you water, snacks, and whatever else you need from our fridge. And you bet I’ll have an eye on you during delivery to make sure you’re handling it all as well as possible. We both know you’re not Superman, so don’t try to be. Instead, focus on being with your wife/fiancé/girlfriend, and I’ll take care of everything else.
#11: I’ll never suggest that you miscarried because you weren’t ready for parenthood.
I find this is something that teenagers are often told. Regardless of one’s emotional maturity, many, many people carry babies to term before they feel they’re “ready” to be parents. The idea that a miscarriage occurred because of some suspected unpreparedness on the part of the parent(s) suggests that people who weren’t “ready” for parenthood are instead better off coping with the death of a child. That’s not an idea I can get behind.
#12: I’ll never suggest that miscarrying is better than having a child with special needs or physical deformities.
People with disabilities are no less human than anyone else, so I would never imply that the world is a better place without them or that they are somehow less deserving of a parent’s love. Simple as that.
#13: I’ll never try to comfort you by saying something like, “at least you know you can get pregnant!”
Because that’s really not the point. And every woman who’s ever been told that will automatically jump to the next logical conclusion: “What’s the point of getting pregnant if I can’t carry a baby to term?”
#14: I’ll be honest with you about jealousy.
After you miscarry, especially if this was your first and only child, there often is a lot of jealousy to follow. Your sister, best friend, or someone close to you will invariably become pregnant and give birth shortly after you lose your baby. It’s even harder if this person is calloused about your loss or if she isn’t doing things “right” in some way (ie, smoking, some amount of alcohol or drug use during pregnancy, etc.), but things still turn out all right.
These feelings are normal, and it’s important to expect them and work through them as best you can before you find yourself in a social situation with someone who is expecting and you morph into a simultaneously angry, jealousy mess and an excited, supportive friend/relative.
#15: If you need something I haven’t thought of, I will do my best to get it for you.
Everyone works through grief differently. As much as I try to be prepared, I keep learning new things from mamas experiencing loss, and I’ll continue to take the things I’ve learned from you and your babies and incorporate those experiences into my practice to make myself better prepared for the next grieving mama who comes through the hospital doors.
#16: I’ll point you in the direction of support groups, online groups, creative crafts and methods of healing.
One of the best ways to heal from loss is to be around others who have experienced it. There is a certain kind of comfort that comes only from a mama who knows firsthand what you’re going through. Taking your memory box items and making them into a picture box to hang on the wall, a scrapbook, or some other form of display-able keepsake can also help you work through the pain of losing your baby and simultaneously let guests in your house know that there’s someone missing from your home who should be there.
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This post is in memory of Z.C., who should’ve been turning six this month. Mama loves you, sweet baby. Until we meet in heaven. ❤
Cervix With A Smile 