IN THIS CHAPTER
Suffering the loss of a pregnancy
Making a decision when the baby develops an abnormality
Knowing where to turn for support
Healing — and getting ready to try again
We wish we had no reason to include this chapter. We wish every pregnant couple could end up delivering a healthy baby. Most do, but not everyone is so fortunate. Those who suffer the loss of a fetus or discover that their baby has a significant abnormality need to understand what happens and figure out how to respond when things go wrong. If you’re experiencing any of the problems covered in this chapter, we hope you find some of this information helpful.
Perhaps you’re drawn to this chapter because you’ve had an unsuccessful pregnancy in the past. If so, you may be anxious about your current pregnancy. That’s entirely normal. For many women who’ve had poor outcomes in the past, the only thing that can truly alleviate their anxiety is to hold a healthy baby.
One way to at least minimize your worry is to sit down with your doctor and discuss the situation. Ask him to map out a plan for your current pregnancy that maximizes your chances of a favorable outcome and helps you cope with your concerns. When you feel certain you’re doing everything you possibly can do to avoid a recurring problem, you may rest a little easier. Your worry probably won’t disappear, but remember that although a certain part of the process is in Mother Nature’s hands, you can take medical steps to maximize your chances of having a healthy baby.
Surviving Recurrent Miscarriages
Unfortunately, a first-trimester miscarriage is a fairly common occurrence. Doctors estimate that about 15 to 20 percent of recognized pregnancies — those that have yielded a positive pregnancy test — end up in miscarriage. Still more early embryos (also called conceptuses) are lost before they’re actually known to exist — that is, before a woman takes a pregnancy test. More than half the time, the cause of first-trimester miscarriage is the presence of some chromosomal abnormality in the embryo or fetus. Another 20 percent of early miscarriages are due to structural abnormalities in the embryo. Usually they’re spontaneous events with low chances of recurrence.
Fortunately, 80 to 90 percent of women who experience a single early miscarriage subsequently deliver a normal baby.
Recurrent miscarriage — technically, the loss of three consecutive pregnancies — is far less common. This problem occurs in only 0.5 to 1 percent of women. A variety of causes contribute to recurrent miscarriage, including the following:
· Genetic causes
· Uterine abnormalities
· Immunologic causes (though not all physicians agree that this is a factor)
· Inadequate progesterone secretion
· Certain infections (although this cause is also controversial)
· Antiphospholipid antibody syndrome (lupus anticoagulant or anticardiolipin antibodies; see Book 6, Chapter 3)
· Certain environmental toxins or drugs (such as antimalarials and some anesthetic agents)
Most doctors suggest that women undergo certain tests after having three miscarriages; some begin testing even sooner. Because chromosomal abnormalities are the most common cause of miscarriage, an important first diagnostic step is to run tests on the chromosomes of the fetal tissue, when possible.
Various strategies for treating recurrent miscarriage are available, but doctors may disagree about which one, if any, is best. Choosing a strategy is easier if you know what the problem is. For example, your doctor may be able to surgically repair an abnormally shaped uterus. If doctors can’t find a cause for recurrent miscarriage, knowing which treatment is best may be difficult. Note, however, that even if no treatment is attempted, women who have had three consecutive miscarriages still have a greater than 50 percent chance of having a normal, successful pregnancy.
Coping with Late-Pregnancy Loss
Late-pregnancy loss refers to a fetal death, a stillbirth, or the death of an infant in the immediate newborn period. Fortunately, these losses are infrequent and rarely occur more than once. Some causes of late losses include
· Chromosomal abnormalities
· Other genetic syndromes
· Structural defects
· A massive placental abruption or separation (see Book 2, Chapter 2)
· Antiphospholipid antibodies or clotting disorders (see Book 2, Chapter 3)
· Umbilical cord compression
· Unexplained reasons, which are very common
Women who suffer a loss of pregnancy often ask, “Did I do something to cause this?” The answer is almost always no, so you have no reason to add to your grief by mixing in guilt. Many patients find it helpful, after the initial hurt has begun to subside, to gather all their pregnancy records, including any pathology reports, and consult with their doctor or a specialist. Sometimes your doctor can identify a cause, and sometimes not. Either way, most patients benefit from sitting down with their doctor and mapping out a strategy for trying to prevent a loss in future pregnancies. Having a plan to focus on makes many patients feel less helpless. Support groups are also very helpful (see the “Finding Help” section later in this chapter).
In subsequent pregnancies, your doctor may recommend that you undergo blood tests to check for certain abnormalities that have been associated with fetal loss. Often, if you’ve experienced a prior late-pregnancy loss, doctors follow your progress with regular ultrasound examinations and tests of fetal well-being. Your doctor may recommend that you deliver somewhat early, before you go into labor. You’re likely to feel anxious during subsequent pregnancies, which is completely normal. But keep in mind that suffering a pregnancy loss a second time is quite unlikely.
A good online source of support and information on pregnancy loss is www.marchofdimes.org/complications/loss-and-grief.aspx.
Dealing with Fetal Abnormalities
All prospective parents wonder whether their baby will be “normal.” And for most, the answer is yes. Still, 2 to 3 percent of babies end up having a significant abnormality. Some of these abnormalities can be repaired and have very little impact on the baby’s overall quality of life. Occasionally, however, the condition can have a bigger impact, whether it’s a structural, chromosomal, or genetic abnormality.
When an abnormality occurs, the first question many women ask is “Is this my fault?” And the answer, most often, is no. From what is known about fetal abnormalities, most are what are called sporadic, meaning they occur randomly and have no identifiable cause. If your doctor can’t identify a cause, chances are low that the same kind of abnormality will recur in a subsequent pregnancy. (If the cause is genetic, there may be some chance that the abnormality could occur again.)
If your fetus is diagnosed with a birth defect or genetic disorder by ultrasound or some other test, your doctor may recommend that you have additional tests to look for other factors that have been associated with that particular problem. He may recommend that you see a genetic counselor to discuss the implications of the abnormality. If the condition is a structural defect that can be surgically repaired or treated, your doctor may recommend that you meet with a specialist who can treat the baby after she is born. These discussions help you prepare for what lies ahead during the newborn period and also later on in your child’s life.
Nobody wants to get the news that a fetus has an abnormality, but having this information is helpful for several reasons:
· If you’re aware of some disorders, such as fetal anemia or obstructions in the urinary tract, doctors may be able to treat them.
· The knowledge helps to prepare you for what happens after the baby is born.
· This information helps you manage your pregnancy and consider all possible options.
· The information can give you important insights into the management of future pregnancies.
Finding Help
If your pregnancy didn’t turn out as you had hoped, the first and most obvious place to look for support is from your partner. Family members, friends, and clergy can also be very helpful. Professional advice or treatment from a psychotherapist or social worker may be useful for many couples. Support groups also can provide understanding and expert insight into your problem — you can find hundreds of support groups on the Internet. Dozens of helpful books are also available, including the following:
· How to Go on Living after the Death of a Baby, by Larry G. Peppers and Ronald J. Knapp (Peachtree Publishers)
· Loss during Pregnancy or in the Newborn Period, by James Woods, Jr., and Jenifer Esposito Woods (Jannetti Publications, Inc.)
· Roses in December: Comfort for the Grieving Heart, by Marilyn Willett Heavilin (Harvest House Publishers)
· When Mourning Breaks: Coping with Miscarriage, by Melissa Sexson Hanson (Morehouse Publishing Co.)
Beginning to Heal
Couples naturally feel a strong emotional attachment to their unborn child, beginning as early as the first trimester. As a result, many couples experience the same grief after the loss of a fetus as they would after the loss of another family member or a close friend. The loss of a fetus is no less significant than the loss of another child. Parents who decide to terminate a pregnancy because of an abnormality also go through tremendous grief.
Both parents should acknowledge their need — and their right — to grieve after a pregnancy loss. The emotional response takes time and typically goes through a number of stages, beginning with shock and denial, progressing to anger, and eventually reaching acceptance and the ability to carry on with life. Understand that each of you will grieve in a different way.
After you go through the stages of grief and feel you’re physically and emotionally strong, you’ll probably be ready to start trying to conceive again. In some couples, one person progresses through the grieving process faster than the other. Make sure both of you are ready before you begin trying to get pregnant again. And remember that a successful pregnancy, although joyful, doesn’t replace a lost one, so the grieving process is necessary.
From a medical perspective, make sure that you finish looking into possible causes for the loss and have a plan of action for the next pregnancy. Realize that your next pregnancy will be somewhat stressful and that you’ll need extra attention and compassion from your family, friends, and healthcare professionals.