things we may not know

Myths, misinformation, misconceptions and ignorance around pregnancy loss and what can cause it, still persists today despite the prevalence of medical and other information. Myths especially vary from culture to culture but beliefs are also reflected in the general level of education available. If women have particularly limited access to information, and instead believe ‘old wives tales’ or religious dogma, there is then a higher likelihood of them blaming themselves and each other for bad pregnancy outcomes. Only a very low percentage of people continue with critical attitudes when they have more information and also women usually cope with their grief in a healthier way and are then less likely to self blame. Guilt feelings around miscarriage are very common.

The following are some observations around miscarriage collated from various sources, including medical, and we have endeavoured to present them as fully and impartially as possible.

Age:
Although miscarriages occur more often in first time pregnancies, no matter what the age, women in their late teens and early twenties are most suited to pregnancy. Statistics show that miscarriage occurs more often in older women, numbers beginning to rise from approximately 30 years old and after the age of 35 increases to 25% until at 40 it is 33% and over 45 at least 50%. If a baby does survive, the chances of a healthy pregnancy are also reduced. The Government run ‘Recurrent Pregnancy Loss Clinic’ in Auckland, NZ do not treat women over 40 years old. Research shows problems caused by men’s age runs reasonably parallel to women’s - older fathers means older sperm. For them it is about the sperm quality and quantity, affecting fertility as well, which is on the increase in western societies. There are always exceptions, for instance, Rupert Murdoch and Rod Stewart.

Advice that another baby will fix this:
Others don’t always understand it is this lost baby that was wanted, not a future one. They have already moved on and just assume another baby will replace this lost one, which is often not so, and women can still be stuck in their sorrow and cannot think past it. A healthy grief does not require that this baby be forgotten but it is necessary for the grief process to take place (see our ‘Grief’ section). For those women whose overwhelming desire is to be pregnant again quickly, from their basic driving need to be fulfilled now, as well as also thinking another baby will fix how they are feeling – it is best to give yourself time to grieve first, allow your body to process your emotions and seek professional advice/help if necessary. Our experience is that another baby does not fix unprocessed grief.

Amniocentesis:
This test is when doctors insert a thin needle through the pregnant mother’s belly to get a small sample of amniotic fluid. This fluid surrounds the baby in the womb and the test is used to check for the risk of genetic conditions such as Down syndrome. In NZ it is usually done when there is a negative outcome of the 12th week scan added to age based risk. Consent is required from the parents and counselling should be offered prior to their decision.

In a 2006 study in Obstetrics & Gynecology researchers, including Keith Eddleman, MD, of New York’s Mount Sinai School of Medicine, studied 3,000 women who were 10 to nearly 14 weeks pregnant and the amniocentesis-related miscarriage rate by 24 weeks of pregnancy was 0.06 percent, or about one in 1,600. The researchers note that that is lower than the rate of 0.5 percent, or about one in 200 pregnancies, from studies done in the 1970s, before current amniocentesis techniques were in place.

Assisted reproduction:
Is a medical area that is constantly being researched and, although statistics show there is a higher percentage of miscarriage within the IVF field, there is also a higher percentage of multiple pregnancies and the miscarried baby is often a twin. Women who have repeatedly miscarried and go on to seek help to have a baby, can find after the procedure that they experience a threatened miscarriage, do miscarry or go into spontaneous early labour in the late second or early third trimester of the pregnancy – this is usually connected with fluctuating hormonal levels of progesterone that fails to 'hold' together the pregnancy.

Birth control pills:
Concerns that birth control pills still being taken immediately before pregnancy or unknowingly afterwards, causes a higher risk of miscarriage, have proved to be largely unfounded as despite years of this accident happening, there's very little evidence that exposure to the hormones in birth control pills causes birth defects. However, do stop taking the birth control pill immediately you learn that you're pregnant.   

Car Accidents:
It depends entirely on the degree of the impact and accident. The baby is well cushioned within the uterus - it is the location of the placenta that is more important. If the placenta is badly banged, then there is a risk of suffering a placental abruption that can happen from 12 weeks on (which is when the placenta takes over in nourishing the baby) so the incidence of miscarriage is extremely high. Similarly, if the lower back is hurt and the kidneys are involved, be aware of the possibility of blood in the urine (haematuria) and a subsequent urinary tract infection. This can cause spontaneous labour at any stage of pregnancy. Prior to 20 weeks and the baby weighing <400g, the result would be a miscarriage. Being checked out by a medical professional regardless of the degree of the force of the accident is recommended.

Computer screen/VDU:
Recent larger and much better designed studies than the 1970’s ones which are now considered flawed, failed to find a connection between use and miscarriage and/or birth defects. If you are worried, the American College of Obstetricians and Gynaecologists advises sitting at least 18 inches away from your computer to minimize potential exposure.

D&C & Medical Side Effects:
Possible side effects a)to a D&C - an anaesthetic reaction, bleeding and/or infection b)to medicines/antibiotics helping the womb contract – an allergic reaction, a rash, an upset stomach and abdominal cramps.

Didn’t want this baby:
There will always be a percentage of women who have accidentally fallen pregnant and then suffer a miscarriage and are initially thankful. However, the 'thankfulness' can fall away dramatically after the physical recovery.
Their emotions may kick in and the grieving becomes apparent when one of the questions being asked is ‘what sex would it have been?’ The same situation can apply initially for women who have undergone a termination for a ‘fetal incompatibility with life’ but many also feel they have been forced to ‘kill their baby’ - this pain is enormous and private. Sensitivity and understanding are vital for these women.

Drinking Alcohol:
Although research is still on-going, it has been declared that the drinking of alcohol (even one glass of wine - especially on the 19th day of conception) can alter the genetic formation of the growing cells/fetus and cause Fetal Alcohol Syndrome. At birth it is very noticeable and when the neonatal check is carried out, the baby then has to be referred on to a paediatrician for treatment. Alcohol is a very potent drug that is absorbed directly through the stomach wall and into the blood stream. It then crosses into the baby’s blood circulation and alters normal development. Listening to women who candidly and almost arrogantly state, 'I drank and smoked throughout my pregnancy and look at him/her now - nothing wrong at all', does not mean others will be so lucky. Maybe their baby was fine, but there is the possibility that genetic development in their grandchildren could be hindered.

Exercise:
The rule of thumb for a normal pregnancy is ‘everything in moderation’ so that the baby is happily oxygenated through the placenta. The baby's heart beats twice as fast as an adults’ so exercising to extremes, becoming overheated and hot and sweaty (especially in spas or saunas) causes their heartbeat to increase also (tachycardia). While the adult is able to cool down quickly, especially if outside, it doesn’t happen the same way with the baby. The passive blood flow that should go to the baby is diverted to feed and energise the adult’s muscles, so the baby is at risk of being under-oxygenated. If the baby’s heart beat remains high, further investigations are required. A midwife should be able to explain the range of fetal heart rate. You will not miscarry if you reach your arms high over your head, ride a bicycle or drive over a bumpy road.

Falling or being hit in the stomach:
The same as for ‘Car Accidents’. The moment that anything untoward happens such as a bad fall or being a victim of violence, speak to a medical professional and request a scan to confirm that baby is still alive and growing.

Forgetting and feeling better shortly:
Humans are all very different and deal with grief in various ways, men tending to grieve differently to women as well. Although miscarriage can ultimately be a shocking experience with a woman never forgetting the feelings associated with being pregnant and then knowing that her baby has died, finding out from a scan seems to be especially distressing. For others, it could take several weeks before a reaction sets in and may not seem so devastating, but with the unexpected ending of a pregnancy at any stage, some level of grief is normally experienced. Miscarriage grief is often minimised and invalidated but grief cannot be measured, so whatever your feelings, accept them as appropriate for you. Grief needs to be dealt with and given time to recover from (see our ‘Grief’ section). When the pregnancy ends and it is expected, as in a termination for medical reasons, the same criteria applies.

Genetics:
Without doubt familial history carries significant influence to the reproductive system. If a grandmother, mother, auntie and sister all miscarry, it does not necessarily predispose anyone to miscarrying but the chances are higher. If it is possible, finding out the reason behind relatives’ miscarriages can be helpful. The internet has various websites that refer to research on a ‘miscarriage gene’ - nitric oxide synthase (NOS).

God or the Gods are punishing me:
Nobody and nothing is punishing you. 1 in 4 women miscarry (several websites now quote 1 in 3) so that would be a lot of women who are being punished. Guilt and miscarriage go hand in hand and it is a human reaction to immediately want to blame someone. Just because a pregnancy is all about what is happening inside you, it does not mean that you are the one to blame. Recent statistics now quote up to 60%, from a previous estimate of 50%, of miscarriages (which are also usually higher in the first few weeks of pregnancy) happen because the egg or the sperm or combination of, have faulty chromosomes. This miscarriage was not your fault. Having a faith can be a tremendous support in times of pain, worry and equal happiness and this is one of those times when you deserve your faith’s support.

Hair Dye/Spray:
Although there is no evidence that hair spray or hair dye increases the risk of miscarriage, there are conflicting reports about its safety suggesting that there may be. As a precaution, some physicians advise avoiding it until after your first trimester (the period when your baby's vital organs, head, body and limbs form). Colorants made from vegetable dyes such as henna are preferable to the chemical dyes used in permanent and semi-permanent formulas. Check the product label and avoid high levels of lead acetate that could potentially affect the foetus’ nervous system and brain.

HIV and Aids:
Anyone with aids will be deemed high-risk and should consult with their medical professional as soon as possible. An unhealthy blood circulation will not be able to sustain a health pregnancy. The blood components will all be affected by the virus and will therefore effect the baby’s development.

IVF:
Recent information (‘NZ Helps Develop IVF Embryo Test’ Herald 29.09.12) about the optimum time for implanting an embryo by sampling a tiny amount of tissue from the uterine lining first should make the traumatic experience of RPL (recurrent miscarriage) mothers less stressed and miscarriage less likely.

Japanese Culture:
In Japan acknowledging a miscarriage or stillbirth is ingrained in the culture.  There are gardens where mothers can place a tiny knit cap on baby statues and mourn openly.

Lifting something heavy - including small children:
Pregnant women often complain of back ache, pubic pain and ligament conditions. Aggravating any part of this natural process by lifting something that will cause further pain, and possibly affect a pregnancy, is not advisable. Generally, 15-20 pounds is not too much for a healthy, pregnant woman. Although most people would probably drop anything too heavy before causing harm, lifting heavy weights regularly or as part of a physical job, can be a cause of miscarriage.

Lying down can stop miscarriage:
Unfortunately and as difficult as it may be, once a miscarriage has begun there is little to do but wait and see. Miscarriage may not be inevitable with some bleeding (see ‘Threatened miscarriage’) so it is advisable to take it easy.

Maternal thoughts and actions and bad pregnancy outcomes:
Pregnancies often surprise us. Women can initially feel ambivalence, which is normal, but after a miscarriage it can lead to thinking “the baby ‘knew’ it wasn’t wanted”, especially if a woman has considered having an abortion before deciding to continue the pregnancy, but many planned (and desperately wanted) pregnancies end in miscarriage and are inevitable. There is evidence to suggest that a developing baby with a mother who tends to be fairly passive and who perhaps plays appropriate music, along with regarding a labour and birth as being a normal and natural event, will have a passive, happy baby. Unfortunately, a good proportion of the population, in particular women with no history of negative experiences themselves, still believe a bad mood or a fright could contribute to birth defects or miscarriages. This happens, despite advances in medical interventions and evidence that most defects and miscarriages result from circumstances beyond a woman's control.

Medications:
Check with your health provider about medications. Many conditions can be treated although you are pregnant. Do not suffer unnecessarily.

Morning sickness:
Although a wholly unpleasant side effect of pregnancy, it is often a healthy indicator in the first trimester that the pregnancy is fine and 70% of pregnancies are less likely to miscarry. Morning sickness affects women differently. It can be manageable by requesting a health professional to prescribe 10mg of maxalon as an anti-emetic or by sipping flat ginger beer and eating dry toast or 2-3 crackers before getting out of bed in the morning. Relative to high hCG levels that stabilize the pregnancy and low blood sugars in the morning, know that morning sickness usually subsides around 14 weeks. If it is unbearable and ruining your life then it should be investigated. The extreme is hypermesis gravidarum when there is a likelihood of being admitted to hospital for IV fluids to stabilize electrolytes and blood sugars. Morning sickness could also be a sign of a hydatidiform mole (molar pregnancy) or a multiple pregnancy. A common worry for women is that the baby will not get enough nutrients but unless vomiting continues through-out the pregnancy and is extreme, only your own body will be affected.

Mother's fault:
We always want to know why, and if there is no one else to blame we will attack ourselves and analyse our thoughts and movements to the nth degree. Speak with a health professional and they will assure you that 99.9% of the time, the cause was not your fault. Unenlightened, judgemental people, particularly those with strong moral, cultural and religious beliefs around miscarriage, often unfairly blame the woman which can add to her own feelings of guilt and is not helpful. Miscarrying women need support not criticism.

Others’ new pregnancy:
After suffering from a miscarriage, hearing about anyone’s new pregnancy and the joy it brings, especially of a close friend or relation, does not make for good feelings and often brings up thoughts most are ashamed of. It is however a natural response that many women in the same situation feel too and they need to forgive themselves. These strong reactions will eventually fade.If it is appropriate, talk to the new mother-to-be so that she understands that you are still overcome with grieving for your lost baby and cannot share her feelings just yet, however much you may wish to for her sake.

Overweight women:
Women with a BMI (Body Mass Index) higher than 35 may have an issue with miscarriage. Women whose BMI is between 24 and 30 are at less risk of a miscarriage and other health problems associated with pregnancy.
Dr Mark Hamilton, chairman of the British Fertility Society (BFS), said: 'It is recognised that women who are overweight are at a greater risk of miscarriage. It has not been defined if that risk is related to genetic problems for the embryos or the obesity itself is linked to implantation mechanisms. Our study in progress will aid our understanding of the known association with being overweight and reproductive loss.'

Poor diet:
A baby conceived to a woman whose eating habits are not viewed as very good, usually results in what is known as IUGR (intra-uterine growth restriction) or SGA (small for gestation age). Invariably, the IUGR results from a maternal disease like pre-eclampsia, gestation diabetes or cholestasis etc. whereas an SGA baby’s weight will be due the woman’s poor nutrition. This has been up-held with research relative to third world pregnancies, bulimic women who fall pregnant and women who still smoke and drink alcohol throughout their pregnancy.

Panic Attacks and PTSD:
Caused by what is experienced by the person as a ‘traumatic event’. Miscarriage can fall under this category and often does although the cause may not necessarily be identified.
For good descriptions see; www.helpguide.org and www.anxietypanic.com Please consult with your health professional.

Partners:
Research in the last 20 years has indicated that new pregnancies with new partners (when the woman has already had successful previous pregnancies) can be subjected to such outcomes as miscarriage, spontaneous early labour, HELLP syndrome and pre-eclampsia. It is all genetic and as yet unfortunately, there is no test to say when the sperm and egg are compatible.

Planned pregnancies:
No research has been done on whether the grief/disappointment of miscarriage is more profound in those couples who plan their pregnancy than those who don’t, but logic would suggest that it would be for the former. Some people prefer to plan a pregnancy meticulously including pre-pregnancy preparation like excluding alcohol, which can reduce miscarrying odds by up to 40%, others throw caution to the wind and 'let nature takes it course'. Either one is right if it is what suits a couple, but for any pregnancy, it is advisable for women to achieve a stable level of health before conceiving. For those who have miscarried, waiting for at least 12 weeks or after 3 periods before actively trying again, is the most sensible decision.

Previous terminations:
Many of these are now carried out by inducing labour using the drugs misoprostel or mifegynon but in past years, they were done under general anaesthetic with the use of instrument/vacuum extraction and in some instances, they still are. In such cases, a forced invasion of the cervix and uterus could have caused scarring and a weakness similar to a second/third time pregnancy and the cervix is then entirely different. We only know that if the cervix has had a type of operation, it can then occasionally have a problem with holding on to the fetus or when labour commences.

Problems with the father:
In some cases, the DNA of the father is incompatible to the baby’s development and therefore the continuation of the pregnancy. It helps if he is aware that his lifestyle can also affect the healthy outcome of a pregnancy.
Drugs, alcohol and smoking etc. can alter and damage cells within our bodies and it also affects the tiny foetus dependent on a healthy environment.

Relationships:
These do not always resume normality in a few weeks. People can be deeply affected by the ending of a pregnancy and grief will be as individual as the person. Many close relationships change - partners, friends and relatives.
It can take up to 6 months before the strong effects of a miscarriage fade. There is then a new normal for women and often their partner. Women and men grieve differently and the isolation of suffering a miscarriage should be gently handled by talking it through, but if both parents are grieving in depth, they can blame each other. Do not feel uncomfortable if outside support is needed by either for the situation to be dealt with. Unresolved grief does not go away; it goes deeper and has repercussions.

Sex:
There is no evidence to suggest that sex of any sort induces a miscarriage. The mechanism of sex is that penetration takes place within the entrance of the vagina not past the cervix and into the uterus. The growing baby is very well protected within the muscles of the uterus and then cushioned with the amnion and chorion that holds the fluid in which he/she breathes/swallows throughout the pregnancy. Sex will not hurt the baby at all and the baby cannot see anything. In regard to women who have suffered recurrent miscarriages and penetrative sex is an issue, then a health professional would advise abstinence until about 14 weeks gestation, when it can be gently reintroduced.

Sex of the baby:
It is well known that craving for particular foods at the beginning of a pregnancy can almost certainly denote the baby's sex – the more salty and spicy the foods craved, the more likely it is to be a boy. The more dairy and softer food desired, the more likely it is to be a girl. Current research talks about a more suitable uterine environment for a particular sex. Certain imbalances are currently being investigated like, how in a family of 6 children, the eldest was a boy followed by 5 sisters and in that same family, these six siblings went on to produce 10 females and six males and of these, 17 females and 6 males were produced. Also, there is some research being done to try and establish if, after a previous successful pregnancy, a miscarriage is being triggered by the mother’s body reacting to a new pregnancy that is of the opposite sex to her last one. There is no proved validity that bad morning sickness or no morning sickness means you are having a girl or that less means it’s a boy. 

Stress:
Although about three quarters of women believe stress could cause a bad pregnancy outcome, there is no evidence to suggest it is a cause of miscarriage. Everyone deals with stress on a day to day basis but if a woman leads a particularly stressful lifestyle it can mean amongst other things, her body will develop high blood pressure or it may lower her immunity or disturb her eating and sleeping patterns. For those couples who suffer from recurrent miscarriage it is helpful to talk to a medical professional about recent research and what their options are. The Supportive Care Programme at the National Women’s Hospital ‘Recurrent Miscarriage Clinic’ in Auckland, New Zealand resulted in a 70% success rate of all women who became pregnant. (Information from the original clinic)

Superstitious Sayings:
Sayings about early pregnancies like; ‘It is bad luck to buy baby things too soon’ or ‘tell people too early and get jinxed’ are only superstitions. If it makes you feel better why not? However, you may not get much support if you do miscarry as no-one knew you were pregnant and they could feel resentful instead of sympathetic as you didn’t trust them enough to tell them in the first place.

Teeth:
Teeth that need attention have been suggested as a possible miscarriage problem.

Toilet:
You will not miscarry straining at the toilet if you are constipated.

Travelling:
When being inoculated and/or prescribed drugs for travelling, your medical professional should know you are pregnant. If for instance you are going to tropical or sub-tropical areas of the world, especially some third world countries where Malaria is commonplace, you will need anti Malarial- drugs however these are not all safe and the incorrect ones may cause a miscarriage as does Malaria itself. (The World Health Organization state that pregnant women who are non-immune and semi-immune to the disease are at greater risk. The miscarriage rate may be as high as 60% and is one of the main causes of miscarriage in these countries.)

Underweight women:
In women who are severely underweight, the menstrual cycle can be seriously effected to the point that she has no periods and therefore, no ovulation. 72% of underweight women are more likely to miscarry in the first trimester. For women who are naturally and genetically lean, there is no evidence of increased miscarriage. A good diet for everyone is recommended including taking vitamin supplements like folic acid, iron and multivitamins during early pregnancy (before also if it is a planned one) along with eating fresh fruit and vegetables daily. Following these principals, underweight women can reduce being at risk by half. Chocolate has a low risk factor many women will be pleased to know.

Unfulfilled food cravings:
If a diet and a body’s dietary stores do not have what the growing baby needs for the development of its skeleton, brain, vital organs and a healthy blood supply etc., then there may be a desire for a particular commodity that satisfies a craving. For example, a woman low in iron and calcium could go through several packets of lollies that have a chalky taste. It would be helpful to have a discussion with a medical professional about unbalanced mineral levels and other blood results that can indicate the need for certain foods. Although it is advisable for women to increase the calorific value of their food by approximately 300 calories a day, eating for two is not really justified. The name ‘Pica’ is given to those women who desire peculiar tastes like mud or sucking on stones, which is fairly common.

Upsetting situations:
It all depends how upsetting the situation is and how it is personally handled by the mother and what the support around her is like. The baby undoubtedly feels his/her mother's sadness - we know this when listening to the fetal heart. An upset and sad mother will show a fetal heart that is steady and calm and a happy one will show a fetal heart that is active and buoyant. BUT, unlike what 25% of mother’s believe, neither has any negative effect on the unborn baby or leads to miscarriage.

Western Women:
Recent research figures suggest as many as 25% of western women may never have a family for various reasons.

Work:
Repeated exposure to either parent from anything that is not natural, may have an effect on the growing pregnancy. For example, exposure to anaesthetic gases, pesticides, dangerous chemicals (e.g. mercury and lead) and radiation - all can have a detrimental effect but it does not happen very often. It does account for the anecdotal belief about certain jobs that are perceived as leading to higher rates of miscarriage like dental nurses, air hostesses and veterinarians.

Working too hard:
This is similar to stress in that everyone is different but an excess of anything will affect everyone at some stage. Moderation and working overtime a couple of times a week is not unreasonable. For everyone who wants to have a successful pregnancy outcome, it is recommended they be more aware than usual of their choices and recognise when they are overdoing it. Recent research suggests long hours (over 60 per week) and regular night shift work is problematic.

X-rays:
‘X-rays while pregnant means your baby will miscarry or have horrible birth defects.’  Accidental exposure to a small amount of radiation (e.g. chest x-ray) is extremely unlikely to cause any damage. Health professionals should always be advised that you are pregnant if an x-ray is suggested so that you can discuss that decision.