Understanding miscarriages

When Meghan Markle recently wrote in a Western-media publication on her miscarriage, her statements resonated with many women who’d undergone similar trauma but hadn’t opened up about facing it. That was not only because Meghan was “Royalty” speaking on this sensitive topic, but also because she was a mother, speaking about an early pregnancy loss.
In her article, Meghan had written, “I think the awareness of the mental trauma of the miscarriage is not openly addressed in the society as most of the times, particularly in early pregnancy losses where there are no obvious physical pregnancy changes seen on the mother. Often a woman tends to blame herself for the miscarriage. That guilt feeling of not being able to safeguard a new unborn life gives rise to a feeling of failure as motherhood and shame. In being invited to share our pain, together we take the first steps toward healing.”
The Duchess of Sussex addressing the matter was especially relevant because early pregnancy losses aren’t usually spoken about on public platforms, adding to the sense of loneliness and bereavement women go through after miscarriages. Other global celebs who spoke about miscarriage include Facebook founder Mark Zuckerberg and his wife Priscilla Zuckerberg. Michele Obama had also touched on the topic in her memoir, Becoming, when she wrote that her miscarriage had left her feeling physically uncomfortable.
Closer home, Bollywood actress Shilpa Shetty Kundra recently revealed she’d suffered several miscarriages before she finally decided to opt for surrogacy for her daughter, Samisha Shetty Kundra. Actress Kajol, a mother of two, also opened up about going through multiple miscarriages in the middle of her busy career. Gauri Khan and Kiran Rao also spoke about it in the past.
The sense of damage
Surprisingly, miscarriage is a very common phenomenon —one in four women across the world can suffer from one. However, and despite the staggering commonality of this pain, conversations around the topic still remain taboo, riddled with shame and solitary mourning. It may have something to do with our traditional pregnancy testing method, which doesn’t broadcast positive pregnancy tests until after the first three months.
Dr Vaishali Joshi, a senior obstetrician and gynaecologist at Kokilaben Ambani Hospital in Mumbai, shares that in medical terms miscarriage is a pregnancy loss that depends on the stages of pregnancy and the stage when the pregnancy failed to grow. “Usually, miscarriage is labelled to all pregnancy losses that happen spontaneously before five months of pregnancy,” she adds in clarification.
According to the gynaecologist, a woman can suffer miscarriage for various reasons. “The most common cause is genetics,” she explains. “As the genetic makeup of the baby shapes up, there may be defective numbers of total chromosomes, which the body realises isn’t a normal genetic makeup of a human being. Then the growth of the pregnancy stops, turning into a miscarriage.” Some other reasons for the loss include infection, immunological problems and complications in the uterus or genital organs.
The myth of permanence
As per experts, a miscarriage doesn’t necessarily mean permanent damage and it’s important to remove any stigma surrounding the issue with adequate family support during the time.
According to Dr Vaishali, a woman’s body goes back to normal after her first period four to six weeks after the miscarriage.
“Once she’s ready mentally and emotionally, she can begin planning for a baby again,” reveals the gynaecologist, though she also suggests, “But try to conceive after two to three period cycles after the miscarriage, and take periconceptional folic acid supplements.”
Driving the point, Padma-Sri Awardee Dr Manjula Anagani, MD, FICOG, who is the head of the department, chief gynaecologist, obstetrician, infertility speciality and laparoscopic surgeon at Maxcure Hospitals in Hyderabad, tells us that she had four miscarriages before she had her daughter. So also, she’s vocal about the topic, clarifying that miscarriages are quite common in the first trimester especially when the woman is exposed to viral infections. “Besides the complications of infections in the uterus through blockages in tubes, the most common cause of miscarriages is initially the genetic or chromosomal anomaly of that particular foetus and it is usually a non-repetitive cause if it mutates that particular pregnancy,” she reiterates. “Causes in repetitive miscarriages (more than thrice) must be evaluated, and for over two miscarriages, treatment must be started according to the evaluation.”
The necessary emotional support
When a woman suffers miscarriage, besides the physical changes, she undergoes mental and emotional traumas of losing an unborn child.
“Getting pregnant itself can be stressful, so pregnancy-induced complications, undergoing abortions and miscarriages can really affect a woman’s psyche and her daily life,” emphasises Dr Manjula, adding that while ensuring she gets post-pregnancy care physically, a woman must heal emotionally too. Dr Cherry Shah, another obstetrician and gynaecologist from Mumbai adds that while for physical care, women should have healthy food and do regular exercises, they need support, sensitivity and acknowledgement of their emotions. “After a miscarriage, a woman should try not to indulge in physically intimate relationships till the first monthly menstruation cycle, though her partner should support her and be emotionally available for her,” adds Dr Cherry. “Family and friends must also understand and acknowledge her pain and be emotionally empathetic to her. Importantly, women must be counselled that miscarriage is a natural phenomenon and that they shouldn’t blame themselves for it.”
Clinical psychologist Dr Monica Sharma states that it’s imperative to realise by the time miscarriage happens, there’s nothing a woman could’ve done to prevent it. She finds emotions such as grief and blame very common after a miscarriage. “Other common emotions include sadness, numbness, anger, denial, disappointment and sometimes even relief. Over time, those feelings change and the incident would become a timely memory as a woman might recall her miscarriage on the important dates such as expected due date, anniversary of the incident and that can be disturbing,” adds Dr Monica. “However, if a woman’s unsure of expressing her emotions and feels no one’s going to understand her, she must seek professional help. Just remember, there is no right or wrong way to react.”