June 22, 2019 • 24 mins
Miscarriage is one of the most common pregnancy experiences, though rarely talked about openly. This classic episode provides an overview of what miscarriage entails, what causes it, what doesn't and its psychological repercussions of pregnancy loss for women and men.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Hey, this is Annie and the Samantha and Welcome to Stuff.
I've never told your production of I Heart Radios how
stuff works. And this classic episode we wanted to to
replay one that is a part of the conversation we're
(00:28):
having nationally worldwide around abortion and it's miscarriage. Yes, because
a lot of the laws and bands being proposed here
are being passed here do you have stipulations in them
where somebody who has a miscarriage to be investigated for homicide? Right?
(00:49):
This is something I think you and I Samantha definitely
wanna return to and um find some people to to
talk to you about this because I think that, um,
it impacts more women. Um then we know, right, it
impacts a lot of women. In the statistics out there,
it's pretty high the likelihood of miscarriage, and you know
(01:10):
that's being floated around for quite some time now. And
then just having the language of what is a miscarriage
versus an abortion and on what does all that look like,
especially like with medical procedures and how that can be. Yes,
But in the meantime, here is this classic episode and
we hope you enjoy Welcome to Stuff. Mom never told
(01:35):
you from how stupp works dot com. Hello and welcome
to the podcast. I'm Caroline and I'm Kristen. Today's topic
is one that has been requested by a lot of
you listeners out there. It's a rather sensitive topic for
a lot of women and their partners. Um it's we're
(01:56):
talking about miscarriages today. It's a it's a common health
issue that a lot of people face, and we have
never done anything just kind of giving you the one
oh one on miscarriages before, so today we thought we
would talk about the whole issue. Yeah, and I think
it's also important for us to talk about miscarriage, not
just because so many women experience it, but because it's
(02:17):
something that we don't talk about very much, probably among ourselves,
especially considering how common it is. Um. So we're just gonna, yeah,
walk through what it is and why it happens, more importantly,
almost why it doesn't happen, and the psychological repercussions. So,
first off, what is a miscarriage. This is coming from
(02:40):
the National Institutes of Health, and technically speaking, it's the
spontaneous loss of a fetus before the twenty week of pregnancy,
because pregnancy loss after the twenty week is actually called
a pre term delivery, right. And another term for miscarriage
is spontaneous abortion, and spontaneous being the key word, this
(03:02):
refers to a naturally occurring event, not anything to do
with medical abortions or surgical abortions. And there are other
terms for early loss of pregnancy, including what's termed a
complete abortion, wherein all of the tissue of conception leaves
the body, and there's incomplete, inevitable, infected, and missed abortion.
(03:25):
All of those different terms relate to how much of
a tissue leaves the body, whether or not, as infected
abortion implies whether or not there was some kind of
infection in the womb. Um. Missed abortion, for instance, is
when the pregnancy is lost but the products of conception
as they're called, remain inside of the body. Right. And
(03:47):
there's also this term called threatened miscarriage. This is basically
when the symptoms of miscarriage occur, whether without vaginal bleeding,
and half of threatened miscarriages do in fact in in
pregnancy loss, and so the signs of miscarriage include things
like cramping, bleeding, and lower back pain. And there was
one column that I was reading in Slate by a
(04:08):
woman named Sarah shem Kiss, who was talking about how
miscarriage is often portrayed on television as this one time event,
like where a woman goes to the bathroom and she
sees blood and then it's over. And one thing that
a lot of people might not realize is that this
can be a process that can take at least in
(04:28):
shem Kisses case, as long as a week to happen. Um. So, yeah,
then that just is just kind of putting it out
there to clarify how the process can can vary for
different women. Right, And so we should take a look
at the causes of miscarriage because contrary to you know,
(04:49):
there's a lot of misinformation I feel like around around
things like this, having sex exercise, mild falls and most
medications do not cause miscarriage. Again, sex exercise, mild false
medications not a cause of miscarriage. And a lot of
times when it happens, there might be some guilt on
the part of the mother and her partner thinking that
(05:13):
there might be something wrong with their genes that caused
this pregnancy loss. But in fact, most miscarriages are caused
by chromosomal problems that essentially make it impossible for the
baby to develop, but those problems are usually not related
to mother's or father's genes, right, And a common chromosomal
(05:34):
issue that comes up is that the embryo or fetus
has a chromosome that causes it to develop abnormally. And
this is not usually a sign of a condition that
could cause problems in future pregnancies because it usually happens
by chance when the egg divides and grows. And this
is actually a problem that causes at least half of miscarriages.
(05:54):
And one thing that medical scholars have been looking more
closely at too in recent years is a correlation between
miscarriage and partners age, not the mother's age, um they're
the frequency. For instance, of these kinds of chromosomal anomalies
in spermatozoa appear to increase with male age, So, for instance,
(06:18):
in two thousand four, there was a study published an
American Journal of Epidemiology which found that pregnancies by fathers
fifty years or older carried twice the risk of miscarriage
compared with pregnancies with younger fathers. And some other possible
risk factors for miscarriage include things like drug and alcohol
abuse during pregnancy, exposure to environmental toxins, hormone problems, infection, obesity,
(06:44):
or on the flip side, being extremely underweight, um smoking,
and problems with the body's immune response. Yeah, an age
can also be a factor for risk of miscarriage as well,
as we talked about in our episode on why it's
harder to get pregnant after thirty five of because the
risk of miscarriages hiring women who are older, and that
(07:06):
risk starts to elevate after age thirty, but it really
escalates after forty. But no matter the age of the mother,
miscarriage is most likely to happen early. In fact, most
miscarriages occurred during the first seven weeks of pregnancy. Eight
out of ten miscarriages happened during the first three months
(07:27):
of pregnancy, and second trimester miscarriages happened in just one
to five of pregnancies. Yeah, I kind of put another way.
More than half of all pregnancies are spontaneously lost before
a woman even knows she's pregnant, before she even misses
a period. That's how common this happened. So in other words,
(07:48):
women might have miscarriages and not even know it because
they didn't even realize they were pregnant, right, And you know,
as as horrifying as the experience of miscarriage is, typically
it's to tistically, it is usually a one time occurrence.
Most women who miscarry go on to have a healthy
pregnancy after the miscarriage. However, there is a recovery period,
(08:10):
and people kind of debate how long this period should
go on, you know, do you wait a long time,
do you try again immediately? Should you take you know,
basically mental health into consideration when you're doing that. And
while it of course varies from person to person, the
physical recovery from miscarriage in most cases takes only a
few hours to a couple of days. Yeah, I mean,
(08:32):
your periods will likely return within four to six weeks,
and it is possible to become pregnant during the menstrual
cycle immediately after a miscarriage. Now, that said, the World
Health Organization recommends waiting at least six months before trying
to conceive. That six month waiting period seems to be
standard advice, although more recent studies are starting to call
(08:55):
that in a question because the w h O is
recommending that's six month wait time based largely on maternal
health in developing countries where medical care is less reliable
and where women tend to get pregnant at earlier ages. Correct. Yeah,
And the British Medical Journal actually says that women who
(09:15):
conceive within six months of a miscarriage instead of waiting
up to a year end up reducing their risk of
another miscarriage by a third, and they also increase their
chances of a healthy and successful pregnancy. But Julius Shelley,
who's an associate professor at Deacon University in Burwood, Australia,
wrote an editorial accompanying that British Medical Journal study, offering
(09:36):
a little bit of a qualification, saying, quote, we cannot
really tell whether pregnancy is conceived very soon after a
miscarriage really do have better outcomes, or whether women and
couples who conceive quickly following a miscarriage have better outcomes
in subsequent pregnancy than couples who take longer to conceive. Right.
And so, I mean it kind of depends person to person,
(09:59):
really on your own person mental health and all of
that stuff. I mean, if you're healthy and feel ready,
doctors say there might not be a need to wait. Uh,
you know, if you're if you're taking your prenatal vitamins
or your full like acid supplements. You know that that
usually starts months before you even conceive, as long as
you're maintaining a healthy weight including physical activity, uh and
(10:19):
eating a healthy diet, and of course managing stress and
avoiding alcohol smoking that sort of stuff. Yeah, and I
would imagine too that that weight time might also depend
on the type of miscarriage that occurs, like we were
referenced at the top of the podcast of the various
kinds that can happen. Um. But one thing too that
we wanted to mention is the question of whether or
(10:40):
not having a medical abortion of voluntary abortion in any
way predisposes you to miscarriage, because I think that is
a fairly common assumption. When I was just poking around
on Google looking for solid data on this, there were
a lot of uh sort of inflammatory tie A blog
posts that immediately pop up saying that if you have
(11:04):
an abortion, then you are risking you know, subsequent miscarriage
or infertility. Um. However, the Royal College of Obstetricians and
Gynecologists says, quote there are no proven associations between induced
abortion and subsequent ectopic pregnancy PULLA cent to previa or infertility.
And one reason that some people have thought that miscar
(11:26):
that abortion might lead to miscarriage is because it's based
on old data. Basically, abortion technology has improved and made
it safer for the mother and left the uterus and
the cervis more intact, So there should not be a
(11:46):
greater risk of miscarriage, right exactly. And one risk factor
that we didn't really touch on fully is the idea
that women who have had previous miscarriages are at a
greater risk of having future or miscarriages. And yes, this
is a definite risk factor, but it is it is small.
Less than five percent of women have two consecutive miscarriages
(12:08):
and only one percent have three or more consecutive miscarriages.
And this is coming from the Mayo Clinic. Uh they
write that after two consecutive miscarriages, there's a seventy chance
that the next pregnancy will be maintained. Now, somewhat counterintuitively,
after three miscarriages, in fact, that risk drops to But
when looking for the reasons why someone might be experiencing
(12:33):
recurrent miscarriages, but in cases of recurrent miscarriage, the big
question mark often is why it's happening because I believe
this was reported on in the New York Times that
in fewer than half of couples experiencing that will doctors
pinpoint a definite cause, and the causes of recurrent miscarriage
(12:57):
really tied back to miscarriage over all. UH, the overwhelming
majority of these recurrent miscarriages that happen because of chromosomal abnormalities, which,
as we already discussed, increase with the mother's age and
with the father's age. There could be genetic errors in
the egg or sperm that result in embryos with too
many or too few chromosomes, but environmental factors are rarely
(13:22):
linked to pregnancy loss and there have been no associations
between environmental factors and recurrent pregnancy loss established. There could
also be an inherited disorder that raises a woman's risk
of blood clots um also called thrombosis, that can increase
the risk of fetal death in the second half of
pregnancy as well. And if you experience multiple miscarriages, there
(13:46):
there are tests that you can have when you go
to your doctor, things like blood tests. They can evaluate
it to detect problems with hormones, your immune system, um,
there are chromosomal tests that you and your partner might
both have your IT tested to determine if chromosomes can
be a factor if there is tissue from the miscarriage
that's remaining that can be tested, and these chromosomal analyzes
(14:09):
can basically see if there's some inherited genetic cause that happens.
And that's in less than five percent of couples. But
I mean, you know, talking about the immune system problems
and the hormonal problems, like you know, we mentioned in
our thyroid episode that you know that is both when
you have something like graves or hashimotos, that's both a
hormone and an immune disorder problem. So having those tests
(14:31):
leading up to pregnancy, whether you've had miscarriages or not,
is very important. Yeah, and and again we want to
underscore that on the bright side, about six of women
with unexplained repeated miscarriages still go on to have healthy pregnancies,
So even if you've had multiple miscarriages, it's certainly likely
that you can still have a baby. So we've talked
(14:54):
about the physical repercussions of miscarriage, what what might be
going on inside the b addie, but we also need
to talk about how miscarriage can impact the mind and
your emotional well being, not just for mothers, but also
for partners as well. So we're going to get into
the psychology of pregnancy loss when we come right back
(15:16):
from a quick break. So we were talking a lot
about the physical causes and effects of miscarriages, but one
thing we have not talked about yet is the psychological effect,
the burden that the mother and her partner feel when
this tragedy has happened, and calling it a tragedy is
(15:41):
I mean, I feel like a lot of times when
miscarriages are discussed, they're kind of brushed off anyone outside
of the couple or the mother who is having the child.
It's kind of the attitude is like, oh, well, you'll
be okay, just try try again. Well, and especially if
it's lost early from the pregnancy to right there's seems
to be kind of this general misunderstanding about the emotional
(16:04):
toll that a miscarriage can take on a couple or
a mother, however early it happens, Traditionally, it's kind of
this private event, you know. I know a friend of
mine had a miscarriage before she had her children, and
I didn't even know about it. You know, it was
once she was pregnant with her now two year old
that you know, she said, oh, yeah, you know, early on,
(16:24):
I had this thing. And and it's almost as if
a lot of moms feel like they're not allowed to
be sad, or they're not allowed to be sad in public. Yeah,
but a new research suggests that some women might actually
more in for a lot longer than expected, which is,
you know, part of why we wanted to to talk
about this issue, to kind of open up these conversational
(16:44):
lines for women to feel more comfortable talking about these experiences,
because it can last even after the birth of a
healthy child, although of course the range inseverity of the
symptoms are going to vary and h Janet Jaffee, who
is a clinical psychologist at the Center for Reproductive Psychology
(17:05):
in San Diego, says that it's kind of the medical
commonality of miscarriages that lead us to kind of brushing
them off, to underestimate the impact that they can have
on a family. Um Jaffe says that it's a traumatic
loss not only of the pregnancy, but of a woman's
sense of self and her hopes and her dreams. Of
the future. She has lost her reproductive story and it
(17:25):
needs to be grieved. Yeah, and a woman who has
a miscarriage is understandably at risk for symptoms of depression
and anxiety, not just immediately following the miscarriage, but in
in the years to come and even after having a
healthy child. Women who miscarry also have a higher risk
of postpartum depression. And there is a paper published in
(17:49):
the British Journal of Psychiatry in two thousand eleven looking
at this, and the researcher followed more than thirteen thousand
women for three years post birth and of though who
had miscarriages, they were about hundred of those women who
had had a miscarriage experienced clinically significant depression and or
(18:10):
exiety anxiety during and after the pregnancies for up to
those three years. And this can really affect women as
they become mothers, as they bear healthy children. Um A
study looked at women who had delivered a child within
nineteen months after a miscarriage and found that of the
infants had disorganized attachments to their mothers that it was
(18:33):
still affecting them in the way that they viewed their
healthy children. And not only can it take a toll
on mother's relationship with her children, but understandably it can
take a toll on her relationship with her partner. Um,
there have been there's been research into how miscarriage can
impact UH sex life, for instance, and a lot of
(18:55):
times you'll see in heterosexual relationships men might be ready
to move on and wanted reignite that flame, whereas women
might not be ready to have sex for a while. Yeah, exactly.
And we should look at at partners, both both male
and female partners, when it comes to having a miscarriage
(19:16):
because traditionally, the feelings experienced by the partner tend to
be dismissed, both within the family and without. And studies
have shown that men are not satisfied with the support
they get from others. Nonetheless, research also has shown that
that men absolutely grieve these losses as well, but it
(19:36):
might not be as intense or as enduring as their partners,
which is understandable because it's not as much of a
physical experience perhaps for them. Right. And study in the
Journal of Psychosomatic Research found that UM, for both men
and women in these situations, giving up their personal expectations,
(19:58):
hopes for and fantasies about out the unborn child is
a major source of grieving. Some men, on the other hand,
feel burdened, particularly by their wives grief or depressive reactions.
I'm sure, feeling helpless, not knowing what to do or say.
They can't say anything right exactly. I mean, there's no
way to to magically fix that situation. Um. And so
(20:19):
you see sort of gender stereotypical differences emerging in these
studies of how men tend to manage their grief compared
to women. For instance, one study published in the Journal
of Reproductive and Infant Psychology found that men might display
less what they call immediate active grief, but they might
(20:40):
also be more vulnerable to feelings of despair and difficulty coping,
probably because of a sense of helplessness. Right. And while
studies have shown that no matter how advanced the pregnancy is,
the woman will likely feel the same sense of loss,
for men, the more advanced it is, the greater their
sense of loss, the more it's almost like they're getting
(21:01):
to know this little person from the ultrasound on, whereas
the woman's sense of grief is heightened either way. Yeah,
and there have been similar studies on this conducted among
lesbian couples as well, and it finds for the non
pregnant lesbian partners similar feelings that that husbands or boyfriends
might experience in heterosexual relationships. Um for instance, in one
(21:24):
study talked about how often the response is, you know,
a sense of having not only lost the baby, but
also kind of having lost emotionally speaking, the partner, not
knowing how to sort of rebuild that connection. How do
you move forward from that? Right, and researcher Denuda m
(21:44):
Wasner said that lesbian couples do face kind of a
unique situation psychologically and emotionally in that they're gonna be
a lot of people who didn't approve of this union
and this pregnancy in the first place, So there might
even be a ratear lack of support for them in
this time. Well, they might have to go to greater
(22:04):
links as well to go about getting pregnant in the
first place. Right, and and that even ties in with
other studies that have shown that women who go through
like fertility treatments or IVF or something like that their
grief tends to be extended past the point of where
other women are starting to move on. Yeah, and and
I don't want to leave gay fathers out of the
(22:27):
equation as well, because I'm sure there can be a
similar process. For instance, if you're, you know, hoping to
adopt and that falls through. I mean, anytime you're going
to experience some kind of of loss of unexpected child,
we need to be able to to talk about it
into to grieve with them and for them, and allow
(22:49):
that process to happen. So the question would be, then,
you know, if you are the friend, what can you
do if you find out that that someone you know
has experienced a miscarriage. Well grief expert Robbie Miller Kaplan
(23:11):
stresses that a miscarriage is a death in the family,
and just like any death, the bereaved must grieve for
the loved ones they have lost. And so she says,
first it's really important to acknowledge the loss that your
friend is experienced. Yeah, she says, you should treat your
friend just like you would treat a loved one who
had who has had a family member die. Send flowers,
write a note, bring a meal, or just offered to
(23:34):
visit and listen, you know, right, And she stresses that
when you're talking with your friend and listening to your
friend kind of repeat things back to him or her
so that she or he knows you're listening, you're actually
taking it all in, and that they're being heard.
Hey, this is Annie and the Samantha and Welcome to Stuff.
I've never told your production of I Heart Radios how
stuff works. And this classic episode we wanted to to
replay one that is a part of the conversation we're
(00:28):
having nationally worldwide around abortion and it's miscarriage. Yes, because
a lot of the laws and bands being proposed here
are being passed here do you have stipulations in them
where somebody who has a miscarriage to be investigated for homicide? Right?
(00:49):
This is something I think you and I Samantha definitely
wanna return to and um find some people to to
talk to you about this because I think that, um,
it impacts more women. Um then we know, right, it
impacts a lot of women. In the statistics out there,
it's pretty high the likelihood of miscarriage, and you know
(01:10):
that's being floated around for quite some time now. And
then just having the language of what is a miscarriage
versus an abortion and on what does all that look like,
especially like with medical procedures and how that can be. Yes,
But in the meantime, here is this classic episode and
we hope you enjoy Welcome to Stuff. Mom never told
(01:35):
you from how stupp works dot com. Hello and welcome
to the podcast. I'm Caroline and I'm Kristen. Today's topic
is one that has been requested by a lot of
you listeners out there. It's a rather sensitive topic for
a lot of women and their partners. Um it's we're
(01:56):
talking about miscarriages today. It's a it's a common health
issue that a lot of people face, and we have
never done anything just kind of giving you the one
oh one on miscarriages before, so today we thought we
would talk about the whole issue. Yeah, and I think
it's also important for us to talk about miscarriage, not
just because so many women experience it, but because it's
(02:17):
something that we don't talk about very much, probably among ourselves,
especially considering how common it is. Um. So we're just gonna, yeah,
walk through what it is and why it happens, more importantly,
almost why it doesn't happen, and the psychological repercussions. So,
first off, what is a miscarriage. This is coming from
(02:40):
the National Institutes of Health, and technically speaking, it's the
spontaneous loss of a fetus before the twenty week of pregnancy,
because pregnancy loss after the twenty week is actually called
a pre term delivery, right. And another term for miscarriage
is spontaneous abortion, and spontaneous being the key word, this
(03:02):
refers to a naturally occurring event, not anything to do
with medical abortions or surgical abortions. And there are other
terms for early loss of pregnancy, including what's termed a
complete abortion, wherein all of the tissue of conception leaves
the body, and there's incomplete, inevitable, infected, and missed abortion.
(03:25):
All of those different terms relate to how much of
a tissue leaves the body, whether or not, as infected
abortion implies whether or not there was some kind of
infection in the womb. Um. Missed abortion, for instance, is
when the pregnancy is lost but the products of conception
as they're called, remain inside of the body. Right. And
(03:47):
there's also this term called threatened miscarriage. This is basically
when the symptoms of miscarriage occur, whether without vaginal bleeding,
and half of threatened miscarriages do in fact in in
pregnancy loss, and so the signs of miscarriage include things
like cramping, bleeding, and lower back pain. And there was
one column that I was reading in Slate by a
(04:08):
woman named Sarah shem Kiss, who was talking about how
miscarriage is often portrayed on television as this one time event,
like where a woman goes to the bathroom and she
sees blood and then it's over. And one thing that
a lot of people might not realize is that this
can be a process that can take at least in
(04:28):
shem Kisses case, as long as a week to happen. Um. So, yeah,
then that just is just kind of putting it out
there to clarify how the process can can vary for
different women. Right, And so we should take a look
at the causes of miscarriage because contrary to you know,
(04:49):
there's a lot of misinformation I feel like around around
things like this, having sex exercise, mild falls and most
medications do not cause miscarriage. Again, sex exercise, mild false
medications not a cause of miscarriage. And a lot of
times when it happens, there might be some guilt on
the part of the mother and her partner thinking that
(05:13):
there might be something wrong with their genes that caused
this pregnancy loss. But in fact, most miscarriages are caused
by chromosomal problems that essentially make it impossible for the
baby to develop, but those problems are usually not related
to mother's or father's genes, right, And a common chromosomal
(05:34):
issue that comes up is that the embryo or fetus
has a chromosome that causes it to develop abnormally. And
this is not usually a sign of a condition that
could cause problems in future pregnancies because it usually happens
by chance when the egg divides and grows. And this
is actually a problem that causes at least half of miscarriages.
(05:54):
And one thing that medical scholars have been looking more
closely at too in recent years is a correlation between
miscarriage and partners age, not the mother's age, um they're
the frequency. For instance, of these kinds of chromosomal anomalies
in spermatozoa appear to increase with male age, So, for instance,
(06:18):
in two thousand four, there was a study published an
American Journal of Epidemiology which found that pregnancies by fathers
fifty years or older carried twice the risk of miscarriage
compared with pregnancies with younger fathers. And some other possible
risk factors for miscarriage include things like drug and alcohol
abuse during pregnancy, exposure to environmental toxins, hormone problems, infection, obesity,
(06:44):
or on the flip side, being extremely underweight, um smoking,
and problems with the body's immune response. Yeah, an age
can also be a factor for risk of miscarriage as well,
as we talked about in our episode on why it's
harder to get pregnant after thirty five of because the
risk of miscarriages hiring women who are older, and that
(07:06):
risk starts to elevate after age thirty, but it really
escalates after forty. But no matter the age of the mother,
miscarriage is most likely to happen early. In fact, most
miscarriages occurred during the first seven weeks of pregnancy. Eight
out of ten miscarriages happened during the first three months
(07:27):
of pregnancy, and second trimester miscarriages happened in just one
to five of pregnancies. Yeah, I kind of put another way.
More than half of all pregnancies are spontaneously lost before
a woman even knows she's pregnant, before she even misses
a period. That's how common this happened. So in other words,
(07:48):
women might have miscarriages and not even know it because
they didn't even realize they were pregnant, right, And you know,
as as horrifying as the experience of miscarriage is, typically
it's to tistically, it is usually a one time occurrence.
Most women who miscarry go on to have a healthy
pregnancy after the miscarriage. However, there is a recovery period,
(08:10):
and people kind of debate how long this period should
go on, you know, do you wait a long time,
do you try again immediately? Should you take you know,
basically mental health into consideration when you're doing that. And
while it of course varies from person to person, the
physical recovery from miscarriage in most cases takes only a
few hours to a couple of days. Yeah, I mean,
(08:32):
your periods will likely return within four to six weeks,
and it is possible to become pregnant during the menstrual
cycle immediately after a miscarriage. Now, that said, the World
Health Organization recommends waiting at least six months before trying
to conceive. That six month waiting period seems to be
standard advice, although more recent studies are starting to call
(08:55):
that in a question because the w h O is
recommending that's six month wait time based largely on maternal
health in developing countries where medical care is less reliable
and where women tend to get pregnant at earlier ages. Correct. Yeah,
And the British Medical Journal actually says that women who
(09:15):
conceive within six months of a miscarriage instead of waiting
up to a year end up reducing their risk of
another miscarriage by a third, and they also increase their
chances of a healthy and successful pregnancy. But Julius Shelley,
who's an associate professor at Deacon University in Burwood, Australia,
wrote an editorial accompanying that British Medical Journal study, offering
(09:36):
a little bit of a qualification, saying, quote, we cannot
really tell whether pregnancy is conceived very soon after a
miscarriage really do have better outcomes, or whether women and
couples who conceive quickly following a miscarriage have better outcomes
in subsequent pregnancy than couples who take longer to conceive. Right.
And so, I mean it kind of depends person to person,
(09:59):
really on your own person mental health and all of
that stuff. I mean, if you're healthy and feel ready,
doctors say there might not be a need to wait. Uh,
you know, if you're if you're taking your prenatal vitamins
or your full like acid supplements. You know that that
usually starts months before you even conceive, as long as
you're maintaining a healthy weight including physical activity, uh and
(10:19):
eating a healthy diet, and of course managing stress and
avoiding alcohol smoking that sort of stuff. Yeah, and I
would imagine too that that weight time might also depend
on the type of miscarriage that occurs, like we were
referenced at the top of the podcast of the various
kinds that can happen. Um. But one thing too that
we wanted to mention is the question of whether or
(10:40):
not having a medical abortion of voluntary abortion in any
way predisposes you to miscarriage, because I think that is
a fairly common assumption. When I was just poking around
on Google looking for solid data on this, there were
a lot of uh sort of inflammatory tie A blog
posts that immediately pop up saying that if you have
(11:04):
an abortion, then you are risking you know, subsequent miscarriage
or infertility. Um. However, the Royal College of Obstetricians and
Gynecologists says, quote there are no proven associations between induced
abortion and subsequent ectopic pregnancy PULLA cent to previa or infertility.
And one reason that some people have thought that miscar
(11:26):
that abortion might lead to miscarriage is because it's based
on old data. Basically, abortion technology has improved and made
it safer for the mother and left the uterus and
the cervis more intact, So there should not be a
(11:46):
greater risk of miscarriage, right exactly. And one risk factor
that we didn't really touch on fully is the idea
that women who have had previous miscarriages are at a
greater risk of having future or miscarriages. And yes, this
is a definite risk factor, but it is it is small.
Less than five percent of women have two consecutive miscarriages
(12:08):
and only one percent have three or more consecutive miscarriages.
And this is coming from the Mayo Clinic. Uh they
write that after two consecutive miscarriages, there's a seventy chance
that the next pregnancy will be maintained. Now, somewhat counterintuitively,
after three miscarriages, in fact, that risk drops to But
when looking for the reasons why someone might be experiencing
(12:33):
recurrent miscarriages, but in cases of recurrent miscarriage, the big
question mark often is why it's happening because I believe
this was reported on in the New York Times that
in fewer than half of couples experiencing that will doctors
pinpoint a definite cause, and the causes of recurrent miscarriage
(12:57):
really tied back to miscarriage over all. UH, the overwhelming
majority of these recurrent miscarriages that happen because of chromosomal abnormalities, which,
as we already discussed, increase with the mother's age and
with the father's age. There could be genetic errors in
the egg or sperm that result in embryos with too
many or too few chromosomes, but environmental factors are rarely
(13:22):
linked to pregnancy loss and there have been no associations
between environmental factors and recurrent pregnancy loss established. There could
also be an inherited disorder that raises a woman's risk
of blood clots um also called thrombosis, that can increase
the risk of fetal death in the second half of
pregnancy as well. And if you experience multiple miscarriages, there
(13:46):
there are tests that you can have when you go
to your doctor, things like blood tests. They can evaluate
it to detect problems with hormones, your immune system, um,
there are chromosomal tests that you and your partner might
both have your IT tested to determine if chromosomes can
be a factor if there is tissue from the miscarriage
that's remaining that can be tested, and these chromosomal analyzes
(14:09):
can basically see if there's some inherited genetic cause that happens.
And that's in less than five percent of couples. But
I mean, you know, talking about the immune system problems
and the hormonal problems, like you know, we mentioned in
our thyroid episode that you know that is both when
you have something like graves or hashimotos, that's both a
hormone and an immune disorder problem. So having those tests
(14:31):
leading up to pregnancy, whether you've had miscarriages or not,
is very important. Yeah, and and again we want to
underscore that on the bright side, about six of women
with unexplained repeated miscarriages still go on to have healthy pregnancies,
So even if you've had multiple miscarriages, it's certainly likely
that you can still have a baby. So we've talked
(14:54):
about the physical repercussions of miscarriage, what what might be
going on inside the b addie, but we also need
to talk about how miscarriage can impact the mind and
your emotional well being, not just for mothers, but also
for partners as well. So we're going to get into
the psychology of pregnancy loss when we come right back
(15:16):
from a quick break. So we were talking a lot
about the physical causes and effects of miscarriages, but one
thing we have not talked about yet is the psychological effect,
the burden that the mother and her partner feel when
this tragedy has happened, and calling it a tragedy is
(15:41):
I mean, I feel like a lot of times when
miscarriages are discussed, they're kind of brushed off anyone outside
of the couple or the mother who is having the child.
It's kind of the attitude is like, oh, well, you'll
be okay, just try try again. Well, and especially if
it's lost early from the pregnancy to right there's seems
to be kind of this general misunderstanding about the emotional
(16:04):
toll that a miscarriage can take on a couple or
a mother, however early it happens, Traditionally, it's kind of
this private event, you know. I know a friend of
mine had a miscarriage before she had her children, and
I didn't even know about it. You know, it was
once she was pregnant with her now two year old
that you know, she said, oh, yeah, you know, early on,
(16:24):
I had this thing. And and it's almost as if
a lot of moms feel like they're not allowed to
be sad, or they're not allowed to be sad in public. Yeah,
but a new research suggests that some women might actually
more in for a lot longer than expected, which is,
you know, part of why we wanted to to talk
about this issue, to kind of open up these conversational
(16:44):
lines for women to feel more comfortable talking about these experiences,
because it can last even after the birth of a
healthy child, although of course the range inseverity of the
symptoms are going to vary and h Janet Jaffee, who
is a clinical psychologist at the Center for Reproductive Psychology
(17:05):
in San Diego, says that it's kind of the medical
commonality of miscarriages that lead us to kind of brushing
them off, to underestimate the impact that they can have
on a family. Um Jaffe says that it's a traumatic
loss not only of the pregnancy, but of a woman's
sense of self and her hopes and her dreams. Of
the future. She has lost her reproductive story and it
(17:25):
needs to be grieved. Yeah, and a woman who has
a miscarriage is understandably at risk for symptoms of depression
and anxiety, not just immediately following the miscarriage, but in
in the years to come and even after having a
healthy child. Women who miscarry also have a higher risk
of postpartum depression. And there is a paper published in
(17:49):
the British Journal of Psychiatry in two thousand eleven looking
at this, and the researcher followed more than thirteen thousand
women for three years post birth and of though who
had miscarriages, they were about hundred of those women who
had had a miscarriage experienced clinically significant depression and or
(18:10):
exiety anxiety during and after the pregnancies for up to
those three years. And this can really affect women as
they become mothers, as they bear healthy children. Um A
study looked at women who had delivered a child within
nineteen months after a miscarriage and found that of the
infants had disorganized attachments to their mothers that it was
(18:33):
still affecting them in the way that they viewed their
healthy children. And not only can it take a toll
on mother's relationship with her children, but understandably it can
take a toll on her relationship with her partner. Um,
there have been there's been research into how miscarriage can
impact UH sex life, for instance, and a lot of
(18:55):
times you'll see in heterosexual relationships men might be ready
to move on and wanted reignite that flame, whereas women
might not be ready to have sex for a while. Yeah, exactly.
And we should look at at partners, both both male
and female partners, when it comes to having a miscarriage
(19:16):
because traditionally, the feelings experienced by the partner tend to
be dismissed, both within the family and without. And studies
have shown that men are not satisfied with the support
they get from others. Nonetheless, research also has shown that
that men absolutely grieve these losses as well, but it
(19:36):
might not be as intense or as enduring as their partners,
which is understandable because it's not as much of a
physical experience perhaps for them. Right. And study in the
Journal of Psychosomatic Research found that UM, for both men
and women in these situations, giving up their personal expectations,
(19:58):
hopes for and fantasies about out the unborn child is
a major source of grieving. Some men, on the other hand,
feel burdened, particularly by their wives grief or depressive reactions.
I'm sure, feeling helpless, not knowing what to do or say.
They can't say anything right exactly. I mean, there's no
way to to magically fix that situation. Um. And so
(20:19):
you see sort of gender stereotypical differences emerging in these
studies of how men tend to manage their grief compared
to women. For instance, one study published in the Journal
of Reproductive and Infant Psychology found that men might display
less what they call immediate active grief, but they might
(20:40):
also be more vulnerable to feelings of despair and difficulty coping,
probably because of a sense of helplessness. Right. And while
studies have shown that no matter how advanced the pregnancy is,
the woman will likely feel the same sense of loss,
for men, the more advanced it is, the greater their
sense of loss, the more it's almost like they're getting
(21:01):
to know this little person from the ultrasound on, whereas
the woman's sense of grief is heightened either way. Yeah,
and there have been similar studies on this conducted among
lesbian couples as well, and it finds for the non
pregnant lesbian partners similar feelings that that husbands or boyfriends
might experience in heterosexual relationships. Um for instance, in one
(21:24):
study talked about how often the response is, you know,
a sense of having not only lost the baby, but
also kind of having lost emotionally speaking, the partner, not
knowing how to sort of rebuild that connection. How do
you move forward from that? Right, and researcher Denuda m
(21:44):
Wasner said that lesbian couples do face kind of a
unique situation psychologically and emotionally in that they're gonna be
a lot of people who didn't approve of this union
and this pregnancy in the first place, So there might
even be a ratear lack of support for them in
this time. Well, they might have to go to greater
(22:04):
links as well to go about getting pregnant in the
first place. Right, and and that even ties in with
other studies that have shown that women who go through
like fertility treatments or IVF or something like that their
grief tends to be extended past the point of where
other women are starting to move on. Yeah, and and
I don't want to leave gay fathers out of the
(22:27):
equation as well, because I'm sure there can be a
similar process. For instance, if you're, you know, hoping to
adopt and that falls through. I mean, anytime you're going
to experience some kind of of loss of unexpected child,
we need to be able to to talk about it
into to grieve with them and for them, and allow
(22:49):
that process to happen. So the question would be, then,
you know, if you are the friend, what can you
do if you find out that that someone you know
has experienced a miscarriage. Well grief expert Robbie Miller Kaplan
(23:11):
stresses that a miscarriage is a death in the family,
and just like any death, the bereaved must grieve for
the loved ones they have lost. And so she says,
first it's really important to acknowledge the loss that your
friend is experienced. Yeah, she says, you should treat your
friend just like you would treat a loved one who
had who has had a family member die. Send flowers,
write a note, bring a meal, or just offered to
(23:34):
visit and listen, you know, right, And she stresses that
when you're talking with your friend and listening to your
friend kind of repeat things back to him or her
so that she or he knows you're listening, you're actually
taking it all in, and that they're being heard.
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