Miscarriage: The loneliest grief of all
Kate Evans has had six miscarriages. To her, each felt like a bereavement – yet she mourned in silence. So how do you deal with the loss of someone who never lived?
Tuesday 27 January 2009
The doctor's silence tells me everything I need to know. Eventually, he clears his throat, and says in a voice deliberately gentled, "I'm very sorry". And so am I. There on the screen before us, I can make out the form of a tiny curled foetus and, where a few weeks earlier, its heart was thumping with life, it now lies still in the cavernous vacancy of my womb. This is no longer a baby. It is a miscarriage.
It surprises me how surprised I am. This is the sixth baby we will have lost; you would think that I would be used to it by now. But maybe it's not surprising that I had to believe in this baby, as though by investing in it some hope, and some love, I could will it into being.
They have run all the tests. Like the majority of women with recurrent miscarriage, they have found nothing wrong with me. They don't know why this is happening.
In my mother's generation, there were no early pregnancy tests, and you weren't officially pregnant until you had missed three periods. These days, it's different. The very first day of absent menstruation can find you racing to the chemist, and then fumbling with instructions and collection pots and testing sticks until that tell-tale blue line makes its announcement.
The next step is a visit to your GP, where you are told the day your baby is due. You are handed a free book on pregnancy containing photographs and descriptions of your developing baby. It confidently states that, by 12 weeks, the foetus is fully formed. (It doesn't warn you here that only five out of six pregnancies make it this far). The book suggests that you make an early appointment with your midwife and begin thinking about where you want your baby to be born. So you do.
And you discover the unmistakable differences that pregnancy brings – the signs that women have never needed testing kits to tell them. A visit from the tit-fairy brings you newly enlarged and extra-sensitive bosoms. You have a vastly increased need for food and for sleep. You feel more squeamish, more nauseous, more emotional and more hygienic. The hormone rushes make you feel like you're stoned. Lack of food makes you violent. You feel the glow of life inside you. You begin to plan and to dream. You probably chat to your baby. You consider its sex and its name.
And then you begin to bleed.
So you've lost your baby. And it's such a massive thing to lose. You, me, everyone reading this, we all started out as a little smudge of amniotic cells. My children would be 18 months old, or four months old, or I would be five months pregnant. I've lost a good friend because her baby was born on the day that mine was due and I have never been to see him. It hurts too much.
I have never known depression like the cloud that descends every time I lose a baby. I can compare it with the death of a close friend and I can honestly say that it's worse. When a friend of mine died suddenly, we viewed the body, we buried him and we were able to say goodbye. I had the company of others who were as grief-stricken as I was. My mind replayed moments with him – a ceaseless video stream of memories, which was part of the way that my brain processed the loss.
With a miscarriage, I'm left battling through the layers of euphemism to even recognise that I have been bereaved. What is this that has happened? "Pregnancy loss"? The word "baby" was never mentioned by the staff in the Early Pregnancy Advisory Unit. When the scan revealed that my baby was no longer viable, I was referred for an operation with the horrendous name of "Evacuation of Retained Products of Conception". My child, described as clinical waste.
If there's no body, how can I grieve? I feel as though I must be kidding myself, wallowing in a morass of grief over a person who never even lived. Every time my mind trips back to this death, this loss, it strikes on empty, because there's nothing there to miss. This jellybean, lying forlornly on some toilet tissue – how can that sum up all my hopes and dreams for this child? How can it contain all my love?
I almost welcome the pain and blood that happens when I miscarry. It seems more real to me than opting for an operation under general anaesthetic. There is pain involved. I want to feel it.
When a friend dies, you can seek solace in the company of other mourners. Miscarriage, by contrast is an entirely private grief. There's me and my partner, and he's generally so intent on protecting and comforting me that it's hard for him to make space for his emotions. "How are you?" a friend will ask, in a conversational tone, and I wonder, do they really want to know the blackness of my mood? Every time it happens, I find it harder to struggle through, and yet I fear that, for my friends, this drama has become repetitive and boring. With each miscarriage I need help more, yet I feel I can ask for it less.
I am a mother. I have a child, conceived after my third miscarriage. In an earnest attempt at consolation, I am repeatedly told "Well, at least you have got him". And it's true, and I love my son dearly: he is perfect, wonderful and amazing. I am aware that the pain of other women who never carry a child must be greater than mine. But that doesn't mean that I'm not hurting. Having had a baby, I know exactly what it is I've lost. I know what it feels like to give birth, to breast-feed and to raise a child. The stack of baby clothes that I have in the attic is slowly diminishing, pragmatically distributed to women who are actually having babies, not ghosts.
And alongside the helplessness and hopelessness there is another, even darker emotion. It could be politely described as bitterness. How it actually feels to me is hatred. I hate pregnant women. This is nuts. I have been heavily pregnant myself and I know it's no fun. What I should feel is sympathy. Envy would be understandable, but hatred? What's going on here?
There's generally no point trying to bury your emotions. It's only by feeling them and naming them that you can get through them. And if you try to run away from them, they have a habit of catching up with you. Jealousy and hatred are impolite, socially unacceptable emotions, but they could serve a purpose. Throughout the animal kingdom, there are examples of bereaved mothers attempting to steal babies. Maybe I'm just part of a bigger picture here. The survival of the species is best achieved if there is a mechanism for matching up thwarted parents with unwanted babies. And I have reached the point where I've thought, "She's got my baby. That's my baby that she's growing." Insanity, I know, but possibly evolutionarily useful insanity.
So where does this leave me now?
The stakes keep rising but we have to keep playing the game. Maybe another baby will arrive to heal the hole in my heart. Or maybe my life will continue, trapped into this loop, like a needle that lands on a record but hits a scratch and lifts off again before the song even starts playing.
On a practical level, we don't seem to have much problem conceiving, which isn't entirely a blessing. I am sincerely grateful that we haven't spent thousands of pounds on IVF to walk this difficult road. But it does mean that any time we want to step off the roller-coaster, to gather our energies for the next ride, we have to avoid trying to conceive a baby that we desperately want. Which makes our lovemaking very poignant. The only fixed point that I can see ahead is the eventual end of my child-bearing years. Either we will have had another baby, or we will have tried. I won't be so sentimental as to say that these unborn babies will stay with me, because they never really lived, but these scars will have made me part of who I am. And I am proud of that.
Our society conspires to render miscarriage invisible. There is an unwritten rule that a woman should never announce her pregnancy until she reaches three months "just in case". Just who is this helping? The first trimester is when a woman does the work of creating the baby. Every organ in the baby's body is formed, and the mother experiences worse fatigue and nausea than at any other point of gestation. Women need to be supported through this vulnerable period and, with no outward sign that they are pregnant, how are they going to access that help if they can't ask for it?
And if they miscarry, as one in six early babies will, women need even more support through their trauma. "Not telling" leaves women stranded with their grief. How can they begin to explain that they are mourning the loss of something whose existence was kept secret in the first place?
Pregnancy is a superstitious time and I can see why women don't want to tempt fate by announcing their news too soon. But fate has dealt me that blow, the one people don't talk about, and I can tell you that the fact that people don't talk about it makes it a whole lot worse.
So talk. Tell. We can be proud of our pregnancies, no matter how "successful" they are. A hurting heart is a sign of a loving heart. The only thing that has really helped me through this is knowing other women who have been through the same thing. Miscarriage is such a common trauma – there is no reason for us to be alone in our grief.
Kate Evans's book on breast-feeding, 'The Food of Love', is published by Myriad Editions (£12.99). Her email is firstname.lastname@example.org
When it all goes wrong: The facts about pregancy loss
* Miscarriage is common. Between one in five and one in eight pregnancies ends in miscarriage. Most miscarriages occur during the first 12 weeks of pregnancy.
* About half of miscarriages are thought to be due to the fact that the foetus is not developing normally because of chromosomal, genetic or other problems. The causes of the other half are not known.
* The risk of miscarriage increases with age, rising to about one in four pregnancies in women over 40.
* Following one miscarriage, a woman has the same chance of a subsequent pregnancy being successful as a woman who has not miscarried. Even after three miscarriages, there is a 70 per cent chance that the next pregnancy will be successful if no cause for the miscarriage has been identified.
* If a woman has three consecutive miscarriages, this is known as recurrent spontaneous miscarriage and doctors will want to investigate any possible causes. But often no cause can be found.
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