A recent study by researchers at Imperial College London reports women need more sensitive and specific care after a miscarriage or ectopic pregnancy.
This advice comes after as many as one in six women on the study developed long term post-traumatic stress following early pregnancy loss.
Facts about early pregnancy loss
Although in recent years much progress has been made around women’s mental health in pregnancy and postnatally. Yet, early pregnancy loss has little acknowledgement of how distressing and profound an event it is and many women still suffer in silence.
Sadly, one in four pregnancies ends in miscarriage, most often before 12 weeks. There are about 250,000 miscarriages every year in the UK and around 11,000 emergency admissions for ectopic pregnancies.
Ectopic pregnancies are when an embryo grows outside the mother’s womb and is unable to grow without causing serious harm to the mother. It always results in pregnancy loss.
Break the silence
Many women don’t tell colleagues, friends or family they are pregnant before the 12-week scan, leaving them feeling unable to discuss their emotions after losing the dream of their baby.
Their partners may also suffer psychological distress following a miscarriage or ectopic pregnancy.
In the study, researchers looked at women who had experienced a baby loss through miscarriage before 12 weeks or an ectopic pregnancy.
In the first month after pregnancy loss, nearly one-third of the women suffered post-traumatic stress, one in four experienced moderate to severe anxiety and one in ten developed moderate to severe depression.
Even though their losses are at a very early stage, women are looking for validation for them. Nine months later, most of these women still experienced poor mental health because of the event.
Impact on Perinatal Mental Health
The results of such large numbers of women experiencing post-traumatic stress suggest many more women could be suffering in silence.
Dr Jessica Farren, an author of the study said:
“Post-traumatic stress can have a toxic effect on all elements of a person’s life — affecting work, home and relationships.
Women who took part in the study said they had regular intrusive or unwanted thoughts about their miscarriage and kept reliving the feelings associated with losing their baby.
Some also reported having nightmares or flashbacks, while others changed their behaviour to avoid anything reminding them of their loss.
Professor Tom Bourne, Consultant Gynaecologist and lead researcher said:
“Pregnancy loss affects up to one in two women, and for many women, it will be the most traumatic event in their life. This research suggests the loss of a longed-for child can leave a lasting legacy, and result in a woman still suffering post-traumatic stress nearly a year after her pregnancy loss.”
“The treatment women receive following early pregnancy loss must change to reflect its psychological impact”. Recent efforts to encourage people to talk more openly about this very common issue are a step in the right direction.
Kate Rawson, an actor and playwright, experienced two miscarriages in 2014 and 2015, one at 8 weeks and one at 11 weeks. She has written a radio play about recurrent miscarriage called Little Blue Lines. Here she discusses her experience:
“After my first miscarriage, I was numb. I did not know how to react or who to approach. I did not know if it was grief that I was feeling, or if that was even a valid response to have about losing something so ‘small’. So I tried to believe reassuring words (‘it’s not your fault; you can try again; you’ve got time; it’s just one of those things.’)
The second time it happened I knew something was wrong immediately, just a faint pink patch in my pants, a slight cramping feeling. Then dread and anxiety at what was to come, and guilt at what I could have done to cause it; sadness for myself, but also my husband, my family, my friends who would have to do all those sad faces and texts and calls again. The physical miscarriage was a huge shock, one I was absolutely not prepared for and I will never forget it.
I tried to ‘move on’ as advised. ‘Trying again’ was full of anxiety that got worse when I fell pregnant for the third time. Happily, that resulted in a healthy full-term birth, but the first trimester was extremely stressful, for both myself and my husband. I struggled to keep perspective and flitted between wanting this baby more than anything else to wishing I would just bleed and get the awful thing over with and my life back.
It was only after my son was born I realized the enormity of what I had been through, and the need to process it — there are support groups at my hospital now but there was nothing available to me at the time — so I wrote about it.”
Need for Change
Miscarriage or ectopic pregnancy has a deep and long-lasting impact on a women’s mental health and this important study is being taken very seriously by healthcare professionals working in perinatal mental health.
The study recommends that women who have miscarried are screened to find out who is most at risk of psychological problems. For too long, women have not received the care they need following a miscarriage and this research shows the scale of the problem.
Whilst general support and counselling help many women, those with significant post-traumatic stress symptoms require special care to make a full recovery.
Currently, this is not widely available. Women should be screened for post-traumatic stress following an early pregnancy loss to identify those who most need help and provide ongoing support.
Using the data from this study, my professional perinatal network got together and we explored how to use new working models to provide better psychological support for patients and their families following early pregnancy loss. We discussed how we can better follow up women to assess their mental wellbeing with support being offered to those who need it. Change is coming and not a day too soon.
In support of motherminds everywhere, I have a small favour to ask you; please share this article because the more we can all talk about post-traumatic stress following pregnancy loss, the quicker we can bring down walls of silence and help those suffering.
If you have been affected by pregnancy loss please reach out for support from your GP or https://www.miscarriageassociation.org.uk/
Darcey Croft is a specialist perinatal midwife for Buckinghamshire Health Care Trust. To receive more posts about improving perinatal mental health sign up here
Original source, journal reference:
- Jessica Farren, Maria Jalmbrant, Nora Falconieri, Nicola Mitchell-Jones, Shabnam Bobdiwala, Maya AL-Memar, Sophie Tapp, Ben Van Calster, Laure Wynants, Dirk Timmerman, Tom Bourne. Post-traumatic stress, anxiety and depression following a miscarriage and ectopic pregnancy: a multi-centre, prospective, cohort study. American Journal of Obstetrics and Gynecology, 2019; DOI: 10.1016/j.ajog.2019.10.102