Pregnancy is an emotional journey undertaken by women of different ages, that generally ends with the beginning of the beautiful journey of motherhood. Motherhood, with all its highs and lows, can be an unforgettable and joyous time for the mother as well as the child. Each pregnancy is a new day, a new start, a new sense of normal, the feeling of your reality about to shift upon its axis. During pregnancy, the expecting mother may do many things. Select a name. Pick out a crib. Buy the clothes. Unfortunately, many names go unsaid, cribs go unused, and clothes go unworn. Millions of women are not awarded the right to enjoy those highs and lows of motherhood because of complications in the birth of their much awaited child, the most common of which are miscarriages and stillbirths. What are they? Why do they happen? What can we do to stop them?
Miscarriage is defined as “the spontaneous loss of a fetus before the 20th week or in the first trimester” (1). There are several ways to decipher if a woman is undergoing a miscarriage. The symptoms can range from vaginal bleeding/spotting to severe abdominal cramping and back pain. Many times, women undergo miscarriages very early in the pregnancy, before they even know they are pregnant. Symptoms like bleeding and cramping are also similar to periods. So, how would a woman that doesn’t even know she’s pregnant differentiate between the two? When miscarrying, abdominal pain is much more intense and painful. The pregnant woman would also pass larger clots and more fluids out when miscarrying. These symptoms last much longer than the regular duration of menstruation.
Miscarriages can be caused by many different factors. They can be caused by genetic and chromosomal disorders (a chromosome holds genes which are pieces of DNA that code for a specific protein). These disorders can contribute to intrauterine fetal demise, where the embryo forms but stops developing before the mother is able to feel symptoms of pregnancy loss. They can also result in a a blighted ovum, a scenario where a fertilised egg is successfully implanted into the uterine wall but the embryo does not form. This could be due to poor quality sperm or egg, or abnormal cell division. These disorders can also cause a molar pregnancy, where both chromosomes in a zygote (fertilised ovum) are given by the father or the zygote has 3 sets of chromosomes, 1 from the mother and 2 from the father.
Poor diet, alcohol or drug abuse, trauma, thyroid diseases, infections, and problems related to the uterus can also be forefront causes for miscarriages. A poor diet can lead to the fetus getting an insufficient amount of nutrients which can eventually lead to stunted growth and death of the fetus. Harmful chemicals and gases from drugs like marijuana and heroin can be passed onto the fetus via the umbilical cord. Gases like carbon monoxide can build up at dangerous levels and reduce the oxygen-carrying capacity of red blood cells, which can cause fetal death as the fetus gets an insufficient amount of oxygen.
If the mother goes through physical trauma such as a car crash, it can lead to a miscarriage or a stillbirth as it can harm the fetus in many ways. It can cause the fetus to develop a brain bleed, or cause the placenta to burst, which will deprive the fetus of nutrients.
As women grow older and conceive, the risk of miscarrying increases. Research by Mayo clinic states that the risk of miscarriage is up to 25% at the age of 35. This risk rises by more than 3 times to 80% at the age of 45 (1). This is due to increased chances of chromosomal abnormalities in their eggs. Genes that are imperative for fetal growth may be missing, or the egg may have more or less number of chromosomes than required.
How are women who suffered from miscarriages treated? There are 3 different methods to treat miscarriages. Many times the dead tissue is removed naturally from the body via the vagina. This is known as expectant management. The dead tissue can also be removed from the body by medicines. These medicines help open and widen the cervix of the uterus to allow the dead tissue to pass out naturally. This process is called medical management and is 85% successful. Surgical management is another method that is used to treat women who have miscarried. The surgical process is known as dilation and curettage. This surgical procedure involves opening the uterus and removing the dead pregnancy tissue. This form of treatment is successful 95-100% of the time (excluding general surgery risks, certain types of infections, and excessive blood loss).
Another form of fetal death is stillbirth. This is a condition where the fetus dies during childbirth or before childbirth. This usually occurs after the 20th week which differentiates it from miscarriages. According to the Centre for Disease Control (CDC), every year 24,000 babies are stillborn in the US (2). Obese women, African-American women and women older than 35 are statistically more likely to experience stillbirth, both due to biological causes and variations in the availability of prenatal care.
Stillbirth can be caused by many reasons, and many more are still unknown. It can be caused by preeclampsia, which is a medical condition that leads to high blood pressure and swelling in the later stages of pregnancy. This condition increases the chances of placental abruption, a condition where the placenta has detached from the uterine wall, which results in bleeding and loss of nutrients to the fetus which leads to stillbirth. Other medical conditions such as haemophilia, lupus, diabetes and thyroid disease are common causes for stillbirth. If the mother is diagnosed with Lupus it can cause kidney diseases which can lead to sepsis. Sepsis in the mother can lead to toxins being passed on to the fetus which can build up in life-threatening amounts and eventually lead to the fetus’ death. Thyroid diseases like hypothyroidism in the mother can cause placental abruption, preeclampsia and heart failure. Intrahepatic cholestasis of pregnancy (ICP) in the mother is another cause of stillbirth. ICP is a condition that affects the liver and impairs the ability of liver cells to release bile. Bile can build up in the mother’s body and can be passed onto the fetus which can lead to its death. Trauma and infections can lead to fetal sepsis which leads to stillbirth.
20% of all pregnancies end in miscarriages or stillbirths (2). To prevent going through such traumatic and painful experiences, pregnant women should take good prenatal care, consume an appropriate amount of folic acid (folic acid is the synthetic form of folate which is a naturally occurring form of vitamin B), and have a balanced diet to meet the needs of their baby. They should also immediately seek help if they experience severe itchiness or vaginal bleeding. Pregnant women should completely avoid any drugs or alcohol.
But often, despite taking all these precautions, miscarriages and stillbirths can occur. It’s extremely important that expecting mothers don’t blame themselves for these complications.
After miscarrying or having a stillbirth, women might often fall prey to depression. They may develop feelings and emotions such as pain, guilt and emptiness. I believe no woman should ever have to go through such a difficult situation like this. The sorrow felt by a mother when their baby dies is living proof that the bond between a mother and her baby exists beyond reality, energy and matter. It is a divine relationship and no woman should ever have to be deprived of that bond.
Written by Prabhleen Swaitch
1. Miscarriage - Symptoms and causes - Mayo Clinic. (2019, July 16). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pregnancy-loss-miscarriage/symptoms-causes/syc-20354298
2. What is Stillbirth? | CDC. (2020, November 16). Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/stillbirth/facts.html
3. Treatment options for miscarriage. (n.d.). HealthyWA, Western Australian Department of Health. Retrieved July 6, 2021, from https://www.healthywa.wa.gov.au/Articles/S_T/Treatment-options-for-miscarriage
4. Stillbirth: Definition, Causes & Prevention. (n.d.). Cleveland Clinic. Retrieved July 6, 2021, from https://my.clevelandclinic.org/health/diseases/9685-stillbirth
5. Miscarriages: Symptoms, Types, Causes, and Support. (2019, May 2). Healthline; Healthline Media. https://www.healthline.com/health/miscarriage#miscarriage-or-period
6. website. (12 C.E.). Stillbirth - NHS. Nhs.Uk. https://www.nhs.uk/conditions/stillbirth/
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