Dr Nora Aniko Kiss from Epsom and St Helier University Hospitals NHS Trust explains her latest project on the psychological impact of recurrent miscarriage and aims to explore the reasons underlying its isolating nature.
Reconnecting with my friend, I was aware of her journey to conceive, which had been marked by two early pregnancy losses. Our lunch took place outdoors, a thoughtful choice to avoid crowded spaces. She took extra precautions, refusing public transportation and carefully washing her hands. Amidst our conversation, I found myself contemplating whether it was appropriate to inquire about her anxiety or if I should delicately navigate around the topic. We discussed various aspects of her life—her work, her progress in therapy with her husband—but I refrained from broaching the subject. I understood the deep impact her last loss had on her, compounded by her physician's seemingly dismissive suggestion to "simply continue trying."
It is evident that, regardless of the stage of pregnancy or the number of losses, miscarriage can profoundly affect the mental wellbeing of couples. Many experience a range of emotions: grief, anxiety, fear, guilt, self-blame, isolation, or depression. Although these feelings are widely recognised, they are unfortunately seldom addressed.
This personal experience led me to reflect on my role as a friend and a healthcare professional. Did I provide sufficient support? Am I truly listening to my patients? Moreover, it ignited a strong desire within me to understand society's perceptions of miscarriage and, more importantly, why women are often left to face this experience alone.
Unseen
Drawing from my own experiences, one possible reason for this silence is the sheer prevalence of pregnancy loss—an estimated 23 million miscarriages occur worldwide each year. (1) Due to its natural occurrence and frequency, society tends to underestimate its significance, perceiving it as a normal event. However, each miscarriage represents the loss of a potential life and the dreams and hopes associated with it. This disparity in perception creates a formidable barrier between women and their environment.
Women may suffer in silence, feeling that their loss is not "approved or validated," a phenomenon known as disenfranchised grief. (2) They might believe that society does not view their loss as significant as losing a child, leading them to believe they are not entitled to mourn. This isolating experience can be incredibly challenging.
Additionally, women face harmful societal expectations. They may feel pressured to move on quickly, with the true magnitude of their loss going unrecognised. Often, they are compelled to carry on with their daily responsibilities without allowing themselves the time to mourn properly. (3) Unaddressed grief can potentially contribute to mental health disorders that may persist for months or even years.
Unheard
For many people, the journey to conceive can be a highly stressful period, particularly when they have experienced previous pregnancies that end in a loss. The disappointment often compounds, leading to increasing frustration with each subsequent miscarriage. In addition to medical assistance, they require compassion and support from us. (4) As healthcare professionals, we face our own challenges in such situations. We may experience personal sadness due to their loss and a sense of helplessness when the exact cause remains unknown. We may hesitate to inquire about their thoughts, fearing that our words may unintentionally cause harm or damage their trust. Some individuals simply need time with their partner, while others seek as much information as we can provide in a single session.
Failure to initiate these conversations may leave women feeling uncomfortable about asking important questions. They may perceive that the mental health consequences are not prioritised when we focus solely on physical aspects, like asking, "Has the bleeding settled?" without addressing, "Do you know how to access help?"
Let's talk
Through recent evaluations at our recurrent miscarriage clinic, we received invaluable feedback. Women emphasised the paramount importance of education—knowing what to expect physically and mentally, including the grieving process—to alleviate their anxiety significantly. They stressed the need for specialised counselling and accessible support groups like the Miscarriage Association or Tommy's. Knowing they are not alone can be immensely beneficial.
Furthermore, it has become evident that partners play a crucial role in providing support. Many women desire their partners to accompany them in the scanning room and be present during consultations. They believe active participation in decision-making is in their partners' best interest and can enhance their ability to cope with the loss.
Conclusion
No woman should ever feel disregarded or overlooked following a miscarriage. As healthcare professionals, it is our duty to promote healing by making women feel heard and fostering an environment of security and safety. Let us actively normalise the process of grieving and expressing emotions for everyone involved. Additionally, I strongly encourage couples to communicate openly, seek support from relevant groups, and reach out for assistance whenever necessary.
I would like to express my heartfelt gratitude to Professor Hassan Shehata and Miss Radhika Viswanatha for their invaluable input and feedback.
References
- Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021;397(10285):1658-67. doi:10.1016/S0140-6736(21)006826
- Doka KJ Disenfranchised grief: Recognising hidden sorrow. Lexington Books, Lexington, Mass; 1989
- Miscarriage Association. Research reveals lack of support for women returning to work after a miscarriage. Available from: https://www.miscarriageassociation.org.uk/2020/09/miscarriage-and-the-workplace/ [Accessed 26th May 2023].
- Simmons RK, Singh G, Maconochie N, Doyle P, Green J. Experience of miscarriage in the UK: qualitative findings from the National Women's Health Study. Soc Sci Med. 2006;63(7):1934-1946. doi:10.1016/j.socscimed.2006.04.024