Miscarriage - women's silent suffering
It happens to one in four pregnant women but you wouldn't know it because women tend to suffer in silence.
In fact, silence means the rates of miscarriage are likely to be even higher according to Danielle Herbert, research fellow at the University of Queensland's school of population health.
"It may happen at home and they may never report it clinically," she says.
Also, because most miscarriages happen within the first 12 weeks, many women do not even realise they're pregnant and, if they do, it's likely that they haven't shared the news. This makes it hard to then share the grief.
"Historically, people don't talk about personal events and a norm in society is not to announce until after the first trimester," Herbert says. "Also, couples often wish to grieve in private."
As understandable as this is, it means many women feel alone in their ordeal and are unaware of how prevalent it is.
At 42, Sian's risk of miscarriage verges on 50 per cent, but because women so rarely talk about it, she had no idea. "I was oblivious that miscarriage was so common and that there was such a thing," she says.
That was until she experienced it herself. She was left devastated by two miscarriages, the second one only late last year. "I found out at the 12-week ultrasound that the baby had died," she says. There were no symptoms. "It just sort of stopped [growing].
"It was taking [the nurse] ages to find the heart beat and I still wasn't even worried. Then she said, 'Look, I'm really sorry - the baby has died.'"
Sian says she was overwhelmed by a sense of shame and failure. "I felt that there was something wrong with me - that I couldn't do something so simple. It felt like if you can't do that, what can you do? You've failed."
But, Herbert, who is a researcher on an ongoing longitudinal study tracking Australian women's fertility, says that miscarriage is part of the biological process of pregnancy.
"There are two types of miscarriage," she explains. "In the first trimester, it's often [because of] genetic abnormality. The body self-checks. It can pick up high degrees of genetic abnormality and expel the pregnancy. The second trimester is more likely to be some other [inexplicable] factor."
Herbert says there are ways to improve your fertility. "Smoking is associated with miscarriage, obesity is a major problem in regards to pregnancy complications and poor lifetsyle [of the partner] means sperm can have a lot of damage."
Having said this, she stresses that "miscarriages are a random event and it's important that [women know] they couldn't have done anything about it. Many pregnancies are lost."
Like Sian, Emily*, 31, was surprised to learn just how many. She miscarried at 28, when she was 10 weeks pregnant. An ultrasound after a heavy bleeding episode detected no problem and she was told that the baby had a strong heart beat. "I knew [something was wrong], I just didn't want to admit it," she says. "I hung onto [the hope] because I wanted it, but I just kept bleeding." At the 12-week ultrasound she was told there was "nothing there".
"I spoke to my obstetrician and he said it's very rare for someone to have babies and not have miscarried ... I didn't realise how common it was ... because no one talks about it, but as soon as you start talking about it you realise."
While she understood that it wasn't her fault, "you've done nothing wrong. It's just part of baby-making, it's part of the game," she also acknowledges that "nothing makes you feel better ... I just sort of sucked it up and pushed it down.
"That's the way I coped with it and my husband hated it because he was trying to mourn it ... [But] I just wanted to focus on something else."
Similarly, Sian didn't allow herself to feel and says it was "punishing" for her partner.
"We broke up three times," she says.
"But, to face it would make it real - a permanent state of mind. And I was worried that I couldn't have a baby at all. My instinct was to retreat ... I didn't even want to go there. The emotion is so huge it feels ... like a thread on a jumper - if you pull it, it will unravel."
Humans have a strong tendancy to try and avoid the overwhelming pain of grief, writes Dr Penny Brabin in this SANDS report. "To distract from it through work or keeping busy; to minimise its depth [or] to imply that a baby was not a real person, thus, the grief not a real experience."
"In Australia a distinction is made at 20 weeks," says Herbert. "Before 20 weeks, it's called a miscarriage, after 20 weeks it's called a stillbirth and you can get a birth certificate and a death certificate, which you can't at 19 weeks."
This lack of a marker complicates the sorrow, says Kate Bourne, chairman of the Australia and New Zealand Infertility Association. "It's a messy grief," she says. "Women often wonder whether they are entitled to grieve because there's no baby to hold or say goodbye to."
Neither Emily or Sian marked the loss. They both just bottled up and tried to block it out. "I just thought 'my life will be my work,'" Sian says. "I had a back-up plan. It's not going to replace the baby, but it's a survival mechanism. It's the hope and fear that breaks you."
The reality is that most women do go on to have babies. Only around 3 per cent don't, Herbert says. Those that can't, but want to, bear it differently.
In a piece for the Guardian Bibi Lynch wrote: "Give women like me, who wanted children but don't have them, a break. You mums do not know how blessed you are – so please just be happy and quit complaining. You got the prize. You have the child. Rejoice.
"I will never be pregnant, never be protected by the father of my child, never be loved as the mother of his child, never love like you love, and never be loved as you're loved. I will never mean as much to anyone as you do. Imagine that, mums. Believe me, you don't know you're born."
Nancy Rome, on the other hand, tells people who ask, "that I love my friends' children and my nieces and nephews and spend as much time with them as I can''.
''Family gatherings become more bearable every year, and Christmas will be easier than it used to be. And these days, I can almost bring myself to hold an infant. So my life is hardly childless."
As for Emily. she became pregnant again quickly after her miscarriage. She says she was "OK", but during her third pregnancy she " freaked out, because there was blood." Despite her fears she gave birth to a healthy baby girl. "I was a lot more scared the whole time but, a lot more thankful too," she says.
Sian has also become pregnant again, but has found the dormant fears much more debilitating.
"When I found out, every single day I was worried. It was torture. I didn't get help, I just worked harder."
"Women often have ambivilent feelings, which can be difficult to manage," Bourne says. "They want to love this baby, but don't want to feel any more pain."
It's a catch-22. The fear is natural yet an expanding body of research indicates that prenatal maternal stress and anxiety impact negatively on the developing foetus.
Sian is consciously taking steps to emotionally engage with the baby. At five months she is finally allowing herself to accept that it might all be OK. She still goes to the toilet "twenty times per day and checks the toilet paper for blood," but she also says she's feeling positive for the first time and is starting to prepare herself and her home. "I'm even considering opening a bag of baby clothes a friend gave me."
Dealing with the grief of miscarriage or the fears that arise during pregnancy post-miscarriage is hard. Kate Bourne suggests:
- Living in the moment and practising mindfulness.
- Acknowledge that the feelings are normal and it's natural to feel tentative.
- If you are pregnant and feeling fearful, "You might try talking to the baby and saying 'hang in there, I'm doing the best I can.'"
- Mark it. Donate, plant a rose bush, the partner might buy a piece of jewellery that marks the baby that she can always wear.
- It's worth acknowledging 'I'm feeling stressed about this and that's normal, but I'm going to let it go.' You can't just stop feeling stressed. That's like saying to someone to stop breathing.
- Guys have a very difficult time of it, she says. "It's overwhelming to see your partner go through that level of distress. Often they don't feel the loss as much because it wasn't in their body. But, it's just endless listening and cuddling."
*Name has been changed to protect privacy.
New Zealanders concerned with issues of pregnancy, baby and infant loss can contact support group sands.org.nz.