The truths and misconceptions of miscarriage

The Society of Obstetricians and Gynaecologists of Canada estimates that one in five pregnancies ends in miscarriage. Others suggest that as many as one-third of women experience pregnancy loss. 

Dr. Sheila Wijayasinghe is one of those women and today she sat down with the hosts to have an honest discussion about the often-misunderstood subject of miscarriage. 

Signs and symptoms of miscarriage
Possible signs can include bleeding, mild to severe cramps, back pain, lower abdominal pain, and passing tissue or clots. Some women don't have any symptoms at all and will find out with a routine test, like an ultrasound.

What causes miscarriage
It's normal to want an answer to why a miscarriage has happened and question the preceding days/weeks to analyze what may have gone wrong. Miscarriages most often happen due to reasons beyond our control – the fertilized egg does not develop normally. It's not caused by stress, exercise or sex. In many cases, we don't know why it happens. However there are risk factors. People at increased risk for miscarriage include those with:
  • Advanced age (older than 35)
  • A history of recurrent miscarriages (3+)
  • Polycystic ovaries
  • Bacterial/viral infections during pregnancy
  • Blood clotting disorders
  • Structural problems with the uterus
  • Alcohol and/or cocaine use during pregnancy

Available treatments and the pros and cons of each
There are three options:

Watchful waiting (known as expectant management) which means you wait for the miscarriage to complete on its own.
  • PROS: It allows your body to complete the miscarriage naturally – no medication or surgery required.
  • CONS: It's not an option if bleeding becomes too heavy or if there are signs of infection. You may end up needing surgery to clear the uterus. For some, this process can take several weeks which may be emotionally difficult to wait out.

Medical management uses medicine to complete the miscarriage. A pill is inserted into the vagina which causes uterine contractions to empty its contents. This usually needs to happen at eight weeks or earlier.
  • PROS: It can be done at home.
  • CONS: It can cause pain, nausea, and/or diarrhea and can take days for it work. If it doesn't work with the first round of medication, you can try one more round. If it still doesn't clear the uterus, you'll need surgery to complete the miscarriage.

Surgical treatment, such a dilation and curettage (D+C), to complete the miscarriage.
  • PROS: Quickest method and less painful because of anesthetic.
  • CONS: There are risks of infection, possible puncture or scarring of the uterus, though these are all rare side effects.

Suffering in silence
Our society has been conditioned to not even talk about being pregnant until you're three months along. The chances of miscarriage go down significantly after 12 weeks so it's often chosen as the “safe time” to share. The thought behind it is that if something happens and you lose your baby, you don't want to have to go out and tell people you've had a miscarriage. But the truth is, for many people, it's important to share your news and feel that excitement. If you do share, share with those you know will be of support to you, regardless of what the outcome is. By talking about being pregnant early on, you create the network of support up front so that if something happens, you have people to talk to so you're not grieving in isolation.

Options for those experiencing emotional distress or depression
Everyone is different and will grieve in their unique way. The most important thing is to allow a grieving period. There will likely be a profound sense of sadness. There are support groups available for those who experience pregnancy loss, such as PAIL (Pregnancy and Infant Loss Network). Other options for support can include speaking to your doctor, going to counselling and getting adequate time off work (if this is available to you) to allow for grieving. 

Support for spouses
Unfortunately, the same support isn't available. Partners are often described as the silent sufferers. When women are going through a miscarriage, the attention is focused on her and her symptoms and sadness. Partners can be left out of this and it's so important that they are included, checked in on, and comforted.

Miscarriages and disability
Despite miscarriage being fairly common, it is highly stigmatized and the impact both physically and emotionally is often downplayed. After the Ontario Human Rights tribunal recognized an individuals' right to claim disability due to miscarriage, it has set a precedent in Ontario and across Canada to make it possible for women to claim the time they need to appropriately grieve and heal after this occurs. It would involve going to see your doctor and having them complete the paperwork necessary from your workplace to apply for disability support.

How to react when someone has had a miscarriage
It's hard to know what to say but sometimes sitting with someone, listening to them, and allowing them to grieve speaks volumes and can mean so much. Everyone is different in what they need for support but in general, having check-ins, a phone call, or a note are very helpful. 

People are well intentioned when they try to make someone feel better and will try to say things like, “at least you can get pregnant” or “it's better that it happened earlier than later”, but this can be hard to hear. 

Being sad is a healthy and normal response. Tears are a healthy and normal response. It may be comfortable to know what to say but just being present and holding space for someone who has had this loss can be extremely helpful.

The information provided on the show is for general information purposes only. If you have a health problem, medical emergency, or a general health question, you should contact a physician or other qualified health care provider for consultation, diagnosis and/or treatment. Under no circumstances should you attempt self-diagnosis or treatment based on anything you have seen on the show. 
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