We have spoken about miscarriage before here on Storytellhers. Not an easy topic but in many ways that makes it all the more important. Last year I shared my personal experience of baby loss, and the massive impact it had on my life, mental wellbeing and personality.
Last week I spoke to Dr. Jessica Farren, an obstetrician who has carried out PhD research into the psychological impact of early pregnancy loss, and the findings are staggering.
As an obstetrician and gynaecologist for the past 10 years, Jessica took some time out in 2014 to carry out this research (supported by Imperial College Healthcare Charity, and as part of the Tommy’s centre for Miscarriage Research). A few weeks ago her findings were published.
Jessica sent questionnaires to women 1, 3 and 9 months after pregnancy loss, and also to a group of women in healthy pregnancy. The results showed high levels of anxiety, depression and post-traumatic stress in the women who had lost babies. In fact, even 9 months after loss 1 in 6 women had symptoms consistent with PTSD.
These statistics don't really surprise me, based on my own experience, and yet they are staggering when you consider the air time that miscarriage receives, or rather doesn't receive.
When I asked Jessica why she had carried out this research she suggested that one of the main reasons was indeed to put the subject of early pregnancy loss more firmly on the agenda.
"It's absurd that miscarriage doesn’t get more bandwidth, given the impact on your sense of self, your relationship to your body and your mental health".
As we spoke I felt compelled to ask Jessica if she was talking from personal experience as well as in her professional capacity- she just seemed to have an element of insight that I had not necessarily experienced from other doctors who I had previously spoken to on this topic.
Sadly I was right. Following the birth of her first daughter, and whilst she was carrying out this study, Jessica suffered two miscarriages. Remarkable when you consider the work she was doing, and therefore had no headspace from this issue.
“I was surprised by how it affected my relationship with my body, my husband, and my self-esteem, especially as someone who should have been so well equipped to deal with it - both in terms of being prepared for it (in the knowledge of how common it is), and in terms of self-compassion! And yet I felt completely hopeless, and so disappointed in myself somehow. Even though every rational part of my brain knew it was not my fault. I lost count of the number of nights I cried myself to sleep”
"One particualry bad day came a whole 6 months later - when I was due to address a conference on the topic of the psychological impact of miscarriage when I should have been 39 weeks with the first baby I lost. The night before, I opened my presentation and for the first time in my career, I doubted that I could stand up and address 200 people on what I myself was going through. I broke down on the phone to my PhD supervisor - who was incredibly understanding - and even offered to stand in himself (for which I will be forever grateful). The following morning I was able to gather myself and did give the lecture."
Jessica is extremely professional and is keen to ensure that the clinical findings of her study are the story and not her personal experience. However, I feel that her journey allows her to speak with an openness and authenticity that she could only have from a personal perspective, which to me makes her findings all the more insightful.
And yet Jessica is simply a testament to the statistics we all know. 1 in 2 women go through baby loss and 1 in 4 pregnancies end in miscarriage. In fact, Jessica says if you try for three children you are extremely lucky if you do not experience a loss. And perhaps we can take comfort in this information. Although it is incredibly hard to go through, it is also incredibly normal.
I asked Jessica what can be done to improve the experience for women who do suffer a loss?
"It is about starting a conversation. There is incredibly little media coverage of miscarriage. So any mention of miscarriage is a positive thing I think, to make people recognise that they are not alone. All pregnancy advice, and all the behavioral restrictions that are suggested, imply responsibility for the safekeeping of the child: i.e. that you are somehow in control. When you combine this with a lack of awareness as to how common it is, I think women who go through loss feel compelled to look for reasons as to why it happened to them (was it that gym class I went to? Or that glass of wine?). We need to shift this way of thinking so we see it as an almost inevitable part of life. So any form of exposure is helpful.
“For a lot of women the physical trauma of miscarriage is something they are entirely unprepared for, and that can add to the distress. Arming women with more information and making the conversation more commonplace would help. "
Jessica and I agreed that miscarriage is one of the last workplace taboos. Naturally, women are reticent to share their story with their employer for fear of flagging that they are planning a pregnancy. We can’t hope that women will feel able to be open at work until we sort out equality. Most women just don’t want work to know - in case it does have an impact on that promotion they were aiming for - and this adds to the isolation and lack of support when it happens.
And for women who are struggling with the impact of miscarriage? Jessica doesn't have magic solitons but suggests things do improve over time, but they are unlikely to improve without some sort of treatment. And treatment should be available in just the same way as any other disorder with any other trigger.
"Anecdotally we can say that by the time your focus has shifted to a subsequent pregnancy and child then some healing is likely to take place. But waiting for that is a bad idea, as you just never know what will happen - and, even if things go well, untreated symptoms may have implications for your health and experience of any subsequent pregnancy, and your relationship with that child."
Jessica's research will now be used as the starting point for another medical team to look at how best to treat women suffering after baby loss, through CBT for example.
And in the interim, her message is simple. Psychological illness after miscarriage is not just a grief reaction that should be brushed under the carpet - women will need access to the care and support they deserve.