Lisa Evans/HuffPost UK
LIFESTYLE
11/11/2018 06:00 GMT | Updated 11/11/2018 10:29 GMT

One In Four Pregnancies End In Miscarriage – So Why Aren't We Talking About It More?

"Miscarrying was the most intense physical and emotional pain I've ever known."

Part Four In A Four Part Series About Fertility And How We Experience It

Nikki was surrounded by pregnant women when she first suspected she might be miscarrying. The 36-year-old, 10 weeks pregnant at the time, was on her way to an event for expectant mothers when she first noticed blood in the toilet. Sitting among the swollen bellies of women who were 7 to 8 months pregnant, she just “had an intuition”. On the way home, she called her husband, who started furiously googling; he reassured her that bleeding during the early stages of pregnancy can be “perfectly normal”.

But the next day the couple’s greatest fear was confirmed after they were referred for a scan. Only then did they learn that Nikki had been carrying twins – a second blow: “It was a double hit of loss, and the lost chance that maybe one of them could have survived,” Nikki explains. Over a year on, she still struggles to find the words to describe those first moments. “I couldn’t even walk I was so sad,” she recalls, tearing up during our interview. “It makes me sad now.”

Nikki was given the option of waiting for her pregnancy tissue to pass naturally (which can take a few weeks); taking medication, which causes the cervix to open, allowing the tissue to pass more quickly; or having surgery to remove it. She chose the medication. “I couldn’t bear the idea of bleeding for another month and the heartbreaking feeling would just be drawn out,” she says.

Lisa Evans/HuffPost UK

Within 24 hours, Nikki was curled up in a ball on her bathroom floor while her husband rubbed her back and held her hand. “It was the most intense physical and emotional pain I’ve ever known,” says Nikki, adding that some women have likened the pain to labour itself. The bleeding lasted for about 10 days after she took the pills and she got through a super sanitary pad every hour – a crimson reminder of her loss. This was accompanied by an intense mix of emotions, including shame, failure and guilt.

Around one in four pregnancies will end in miscarriage. Some women experience more than one miscarriage, and it is estimated one in 100 couples trying for a baby will experience three or more consecutive miscarriages.

Miscarriages are more common during the first trimester of a pregnancy – around 85 per cent take place during this time. This is why many people choose not to share their pregnancy news widely until after their 12 week scan, which marks the beginning of a “safer” period for the pregnancy.

But despite the fact that, statistically, miscarriage is commonplace, the subject is still relatively little discussed. Women can feel isolated and unable to fully grieve – particularly those who miscarry before letting people, such as employers, know they were pregnant in the first place.

Jennie Agg, 32, has had four miscarriages, three of which took place over a nine month period in 2017. Her first miscarriage happened just three days before her 12 week scan. “In my head we were almost there where we were going to tell everybody. I’d been really looking forward to that, so to have to make a very different announcement was doubly hard.”

The miscarriage happened on a Saturday and Jennie spent the day in hospital recovering. Feeling unwell on the Sunday, she realised she needed to take a few days off work to recover physically and emotionally, and so decided to tell her boss she had miscarried.

She says her employer was really supportive, insisting she take a week off to recover, but she understands why people might hesitate to tell the truth. In fact, many women who spoke to HuffPost UK about their experience asked to remain anonymous for fear their employer would find out they were trying for a baby. “Of course, by telling someone you’ve had a miscarriage, you’re announcing your intention to have a child,” Jennie reasons. “I could see that it would feel like a risk, career-wise, to do that – especially if you’re on a short-term contract or similar.”

By telling someone you've had a miscarriage, you're announcing your intention to have a child... I could see that it would feel like a risk." Jennie

While the decision to tell your employer – or not – is entirely up to you and depends on individual circumstance, midwife Kate Pinney, a spokesperson for Tommy’s, the miscarriage, stillbirth and premature birth charity, recommends telling your employer about a miscarriage if you feel able. “You are likely to need several days off work following a miscarriage at the very least. Depending on your stage of pregnancy and your individual circumstances, this may be longer,” says Pinney. “Although you won’t be entitled to any specific time off, your GP may sign you off sick for a while and you may be able to take annual leave or compassionate leave, an agreed period of unpaid leave depending on what your employment contract allows.”

Pregnancy loss before 24 weeks does not entitle women to maternity leave and pay – as is the case with pregnancy loss over 24 weeks, which is considered a stillbirth – but women are still legally protected from discrimination. “Pregnancy-related sickness absence should be recorded separately from other illnesses,” Pinney explains, adding that it should not count towards your total sickness record or be used as a reason for redundancy or disciplinary action.

It can feel a long time to wait until to the 12-week mark to tell people you’re pregnant – especially if you’re excited to share the news or think that people might start to suspect (perhaps you’re usually the first one down the pub). It’s possible your bump could already be beginning to show.

Elated with their news, when Nikki first fell pregnant, she and her husband decided to share it with their closest friends and family. This meant that in March 2017, as they came to terms with their miscarriage, they also had to let their loved ones know. “Maybe there is a bigger wisdom to wait until the 12th week to tell people,” Nikki says on reflection, “but I don’t regret anything as I had so much support.”

Nikki has recently had a baby girl, Eliza. But before giving birth she struggled with fear that something might go wrong; a second miscarriage four months after her first had left her anxious she might never have children. “So many of my friends have said the feeling that something might happen will always be there as a mother. But it’s a completely different experience – it’s not that you might lose, but you have lost,” she says. 

Maybe there is a bigger wisdom to wait until the 12th week to tell people, but I don’t regret anything as I had so much support.” Nikki
Lisa Evans/HuffPost UK

Many women I talked to agree that falling pregnant after miscarriage is a bittersweet moment. There are the mixed emotions of hopefulness and fear, but also a feeling of responsibility as you bring your loved ones on the journey with the uncertainty of what lies ahead. For Jennie, sharing pregnancy announcements with family and friends became harder each time. “You become reluctant to tell people you are pregnant. You feel like you’re putting that anxiety on them.”

For those who already have children, sharing news of the loss – or concealing the pregnancy altogether – can add another layer of pressure. Rachel*, 44, was pregnant with twins when she had a late miscarriage at 22 weeks. Her son Adam was almost three at the time and looking forward to becoming a big brother. Her husband broke the news to him in the hospital car park. “He explained that his two baby brothers had been very poorly and too small to live,” she recalls.

It was difficult, she admits, but her son’s innocence and, at times, insensitive questions that only a toddler can or would ask were refreshing compared with awkward adult responses. “He gave me lots of cuddles,” Rachel recalls. “He knew there was something wrong and so was a lot more loving.” He was also concerned whether he would still be getting the new bedroom his parents had promised him, and for that Rachel is grateful. “He was a breath of fresh air. He gave us a reason to carry on – a superstar with his bluntness.”

For Letizia, 38, who had a miscarriage in March this year, the pain is still incredibly raw. Her daughter is “itching” to be a big sister. “I am ever so glad that she knew nothing about our pregnancy but now whenever she asks when I am going to have a baby I feel such guilt,” she says.

It was also difficult for Letizia, who miscarried at just over 10 weeks, to break the news to her sister, who was five months pregnant at the time. The couple didn’t tell her for a few days, but eventually had to. “I didn’t want her to worry about miscarriage. It was hard.”

Jennie says being around friends who are pregnant is difficult, because it’s a constant reminder of what could have been. “A particular friend had a baby recently, who was a few months ahead of me [when I was pregnant]. I’d worked out that our babies would have been in the same school year.” Knowing that can never happen is tough, she says. 

Miscarriage can understandably have a lasting effect on women and their partners, with many continuing to grieve for years. Research conducted by Tommy’s found that one month after a miscarriage, more than one in four women (28 per cent) met the official criteria for probable post-traumatic stress disorder.

There is little in the way of formal or organised support for women or couples after miscarriage, says Ruth Bender Atik, national director of the Miscarriage Association, adding: “Some hospitals and some GPs may offer a follow-up appointment, but this is the exception rather than the rule.”

If you feel you need professional help, Tommy’s recommends being proactive and asking your GP to refer you for counselling, or self-referring through the NHS initiative IAPT (Improving Access to Psychological Therapies). Midwife Kate Pinney, explains: “Simply talking to someone you trust about how you feel can be really important so not to bottle up your emotions – it is important to allow yourself to grieve. Women may also need a little extra emotional support in a subsequent pregnancy as levels of anxiety are often higher.”

While professional help is scarce, many women and couples find much-needed support through family and friends. Sharing your story tends to mean other people come forward with their own experiences.

Simply talking to someone you trust about how you feel can be really important so not to bottle up your emotions – it is important to allow yourself to grieve." Midwife Kate Pinney

Letizia says she and her husband Tim don’t know where they’d be without their loved ones. Her parents, who live abroad, jumped on the first plane and came to visit, offering both emotional and practical support. “Having them with us meant I could rest and not worry about our four year old as much,” says Letizia. “It meant that I wasn’t sitting alone while Tim was at work.”

Another lifeline was speaking to friends who had been through a similar loss. When the couple broke the news, friends came forward who she didn’t know had miscarried. “It helped [us] feel less alone and it helped to be able to talk to friends who ‘got it’.”

Silence around miscarriage is deafening. Those who came forward say sharing the experience, whether anonymously, with loved ones or professionals, was a saving grace.

While Letizia’s pain is still new, her advice is simply to “be open”. She says sharing her story and hearing other’s experiences has shown her how common miscarriage is, and although this doesn’t lessen her pain, it shows a way forward. “It doesn’t help to know you’re one of many, but helps to know you’re not alone. I can see the women who have been through it and that they’re okay – they’ve coped, even though I feel like a rotten mess. It makes me feel that I’m gonna be alright.”

If you’ve been affected by pregnancy loss contact the following organisations for support:

Tommy’s - visit the website or call Tommy’s Pregnancy Line on 0800 0147 800

Miscarriage Association – visit the website or call 01924 200799

*Some surnames have been withheld to conceal identities.