Recently on The Fertility Podcast, we welcomed Jessica Zucker – a psychologist who specialises in reproductive and maternal mental health, and the founder of the ‘I had a miscarriage’ campaign, as well as discussing miscarriage policies and the causes of miscarriage. The blog post features parts of the conversation.
Why miscarriage happens?
To give a background into why a miscarriage occurs, previous podcast guest, researcher and associate professor in reproductive medicine, Dr Ingrid Granne, talked about the most common causes of miscarriage and what can increase the risk of miscarriage.
Dr Granne tells us that one of the most common causes, especially during early pregnancy, is that the pregnancy does not have the right genetics. Cells are made up of 23 pairs of chromosomes, 23 from the egg and 23 from the sperm. During conception and early stages of cell division as the egg is fertilised, you can get genetic spelling mistakes meaning pregnancies cannot continue normally. Often when you look at pregnancy tissue from these early miscarriages, at least half of the cases would show there is a chromosome issue.
There are other causes which can also lead to miscarriage or increase the risk of miscarriage. Chromosome issues is heavily related to maternal age, which is sadly something difficult to combat. If you are in your twenties, there is a 1 in 10 chance of miscarriage, but by the age of 45, this has increased to a 1 in 2 risk. Paternal age can also increase miscarriage risk, but not to the same extent as maternal age.
Other factors include whether you have any pre-existing medical conditions. For example, uncontrolled diabetes and thyroid issues. Being overweight has been shown to increase miscarriage risk, but reasons for this are not fully understood yet. Ongoing research is also showing that genetic factors can play a part in predisposing some women to miscarriage. Additional issues could also be related to the implantation in the womb, hormones, or the immune system.
Miscarriage policies around the world
Recently there have been new developments around the world regarding miscarriage policies. In New Zealand, Jacinda Ardern announced that women and their partners are entitled to three days of paid leave following a miscarriage or stillbirth. New Zealand is the second country to do this after India. Most recently organisations in the UK such as Channel 4, Monzo Bank and LadBible have launched pregnancy loss and fertility policies supporting bereaved parents and those navigating IVF treatments.
Tommy’s recently published the results of their survey with some shocking statistics including links between miscarriage and depression.
Life after loss
The podcast then delved into the conversation with Jessica Zucker, talking about life after loss and the impact of a miscarriage on mental health. Jessica talks about her experience with miscarriage, so please do be aware if this is a trigger subject for you.
Miscarriage is not just about wondering about the physical causes. It can have a devastating impact on mental health and your wider life. Jessica’s traumatic experience of miscarrying at 16 weeks while alone at home made her realise that she hadn’t given herself the time to fall apart. As humans, we have a survival instinct to keep going. It can be hard to slow down and let your mind and body rest because this can also mean getting closer to the pain.
As a psychologist specialising in reproductive mental health, the experience also impacted Jessica on a professional level. She realised that before her miscarriage, she didn’t understand the emotions that her patients were going through but having gone through miscarriage on a personal level, it was enlightening and led to her better understanding her patients trauma.
Sex and miscarriage
The impact of a miscarriage also affects relationships and intimacy with your partner. The thought of sex can be the last thing you want to focus on after a miscarriage. If a miscarriage is related to a fertility struggle, this can create even more pressure to be intimate again. She feels it is an under-discussed aspect of miscarriage and something which people feel differently about. For some women, sex after miscarriage can be freeing and inspiring. At the other end of the spectrum, it can also bring up feelings of guilt, body hatred and something you want to retreat from. The prospect of sex also brings with it the prospect of getting pregnant and the possibility of more loss.
Miscarriage and relief
Another subject discussed is relief and miscarriage. Jessica described how she spoke to people who feel relieved after miscarrying. Sometimes this could be because a person is young and wasn’t sure if they were ready to have a baby, but later, they are ready and want to try again.
Relief can be felt because there is a feeling that something was wrong with pregnancy. It is not relief in the sense that they didn’t want to be pregnant or have a baby, but their concerns are validated.
It is assumed that the main emotions when a miscarriage happens are grief and sadness, but the reality is there are a wide range of emotions and it is unfair to alienate people for feeling different emotions. Similarly, there is no time frame or rulebook for dealing with miscarriage.
It is ok to ask for help
Due to the stigma around mental health, there can be a reluctance to ask for help and emotional support following a miscarriage. Talking about the emotional impact of a miscarriage needs to be normalised because you are not alone if you are struggling to come to terms with your loss.
The support should extend beyond a miscarriage but moving forward too. If you decide to try again, there can be an overwhelming sense of fear that you will miscarry again, and Jessica describes how a woman can be ‘flipping out in her body’. It can stop you from enjoying the pregnancy, especially if you are constantly checking for bleeding, fearing the birth and your baby’s health.
Whether you stop trying for a baby or keep going after miscarriage, be gentle and compassionate with your mind and body, and never feel that you can’t ask for help.