The silence splintered into a million shards of pain. “There is no heartbeat,” said our doctor.
The pregnancy had been an unexpected joy – we discovered it on Christmas morning. By January 2020, a box of singlets and of socks, of baby-proofing material and of baby-coddling fabric had been gathered, and the arguments that raged revolved around who should shop for more baby things – the mum or the grandma. In February, the day before we went for the three-month scan, my husband and I sat for hours talking to the baby, trying to feel the baby move, discussing names – little did we know what would happen next: it was a sudden blank.
For months afterwards there was just a void that nothing could fill. An emptiness that no amount of food or drink could fix. An upending of the emotional wicker basket – getting up was hard, sitting still was harder. Pregnancy hormones would rage for months in my system, it was as if my body wouldn’t believe what was happening.
The grief of losing a child is all consuming – but what happens when that child is still in the womb? We keep quiet about it. Miscarriages – the term used for the loss of a child before 20 weeks – is fairly common; “It happens in one out of three pregnancies,” says Dr Elias Abi Khalil, Head of Obstetrics and Gynaecology department at Clemenceau Medical Centre Dubai.
And yet, there seems to be a stigma when it comes to talking about your loss. In hushed whispers the news is shared and quietly buried. Even doctors start calling your baby – because the second you know you are pregnant it is your baby – the product of conception.
The emotional spiral is almost a given.
What causes miscarriages?
It’s difficult to pin-point a reason for the end of a pregnancy because it could be a single thing or interplay of various factors. “The most common reason is genetic abnormality in the foetus. Other reasons are maternal anatomic abnormalities in the uterus like fibroids, polyps or adhesions, increased clotting tendency and trauma,” explains Dr Khalil.
The fallout is devastating for the whole family. British expat Rhiannon Downie-Hurst says of her recent loss, “I feel like a part of me died with her. I’m still scarred.” As are her husband and son. “I think people often forget the husband and the siblings – I got hundreds of messages, my husband got just a few. There are books to help the child deal with the trauma of pregnancy loss,” she says.
I think people often forget the husband and the siblings – I got hundreds of messages, my husband got just a few. There are books to help the child deal with the trauma of pregnancy loss.
Downie-Hurst had wanted a second child, but the pregnancy was difficult. “I bled a lot from seven to weeks but when we did the scan everything was fine, the baby was healthy,” she recalls. “I was on a lot of pills – including progesterone. I was on bed rest. We found out the baby’s gender and made an announcement at 12 weeks.”
At 13 weeks, she says, they lost her.
“A lot of cultures blame the women, ask her stupid questions: what went wrong? How did it happen? Maybe you were exercising too much? You can always have another. But these are things you should never say to someone who has lost her baby. You should just say I’m sorry for your loss and I’m here for you,” she says of the wave of concern that came her way.
Red flags
A pregnancy can be complicated enough without worrying about a sudden termination, but there are some signs one should be on the lookout for:
- sudden cessation of symptoms of pregnancy like bloating, nausea, breast engorgement, pelvic cramping or pain
- vaginal bleeding or brownish discharge, or
- fever.
Age matters
One of the most influential factors of a successful pregnancy is age. Dr Shiva Harikirshnan, Senior Consultant – Obstetrics and Gynaecology, Medcare Women and Children Hospital, says: “The peak age of fertility for women is 18 to 28 years. By the age of 30, fertility starts declining in females. The decline becomes more rapid after 35. Women have a fixed number of eggs (usually around two to three million) and the repository starts declining even before birth; it declines at the rate of 10 per cent every year.”
British expat Emma Belle says, “When I was 37, we first decided to try for a family. I already knew I had fertility problems like diminished fertility reserves. So I knew I would have to go to a fertility clinic to get help to get pregnant. So that’s what we did. The first round of fertility treatment we actually got pregnant and then had a very early miscarriage at five-and-a-half weeks.”
I was told that because of the other presentations, they anticipated that she would die inside of me by the time I was 28 weeks pregnant. I was faced with a few options – carry on and wait for her to die inside of me, or carry on and hope there’s some miracle she’s born alive; they told me she may live for a couple of hours or a day at the most.
She didn’t give up, going on to have five more founds of treatment – on the fifth try, she knew success. “The pregnancy continued and we had scans. I was terrified every single time that they would say, ‘there’s no heartbeat’. But every time we went, it was fine… I had just started my second trimester of pregnancy when the scenographer said to me there were lots of things wrong with our baby and that our baby had a cystic hygroma [a sac filled with fluid] on her head, [there was a] lot of fluid over her chest and under her body. And there were a lot of indications that she had a genetic disorder. So we had a lots of tests and it turns out our baby had Edwards’ syndrome. I was told that because of the other presentations, they anticipated that she would die inside of me by the time I was 28 weeks pregnant. I was faced with a few options – carry on and wait for her to die inside of me, or carry on and hope there’s some miracle she’s born alive; they told me she may live for a couple of hours or a day at the most; or I could make the heart-breaking choice to bring the pregnancy to an end, because she was diagnosed with a foetal fatal condition. We decided not to continue,” she says.
“We actually did two rounds [of In vitro fertilization (IVF)] after Willow [the baby passed away] – in February and March, which failed – which just compounds the grief and compounds the loss. We are just preparing for what we think is our final round – which will be in November or December,” adds Belle.
Cassie Destino, an American expat, has been in the UAE for seven years. Her journey to motherhood began when she was still living in San Francisco. “I knew I was going to have trouble – I just always had irregular periods – and you can sometimes feel it in your bones; this isn’t going to be easy. It wasn’t. I finally went to a doctor and they did some tests and we discovered that we were going to have fertility treatments to get pregnant. We started with the lowest one – you take a pill, see if that works – it did not. We moved on to the IUI [Intrauterine insemination], which did not work,” says the now 46-year-old.
And so she decided on what she calls “the nuclear option”.
“I knew I was going to have trouble – I just always had irregular periods – and you can sometimes feel it in your bones; this isn’t going to be easy. It wasn’t.
“In July 2014, we did our first IVF and we were successful with twins. They put two embryos in. When I went for my first scan, the doctor said one of them isn’t going to last. So we thought, well ok. We had the next scan everything was fine. We had the next scan and everything was fine. We went for the 12th week scan, which is sort of the graduation from the fertility treatment, and we found there was no heartbeat. I was due to move to Abu Dhabi two weeks later. I didn’t have time to pass it naturally so we ended up doing a D and C [dilation and curettage procedure] – when they did that, they were able to send the material to the lab and I found out it was just a very common genetic abnormality. No one had talked to me about screening the embryos for genetic abnormalities or tests, so I just chose a bad one and it didn’t work,” she says.
“[When] we moved to Abu Dhabi, it took me a few months to find a clinic that I liked. We did another IVF that didn’t work, then we did another one and that one resulted in my almost six-year-old twins! I was very much one of the lucky ones. So for me, it was four IUIs and three IVFs to bring home my babies. There’s a lot of heartbreak and anxiety and fear in all that – you are never guaranteed anything in a fertility treatment. You can throw all the money in the world and it doesn’t mean that you’ll be successful,” she says.
What could increase your risk of miscarriage?
Dr Kassem Ahmed Mazzaz, Consultant Obstetrics and Gynaecology, explains that there are several factors that may affect your pregnancy and increase the rate of miscarriage:
- Age – Older individuals are more likely to have a miscarriage than younger persons.
- Previous miscarriage – Having a miscarriage in the past may increase the risk for a future miscarriage.
- Smoking – Smoking more than 10 cigarettes a day increases the risk of miscarriage.
- Alcohol – Drinking alcohol increases the risk of miscarriage.
- Fever – Pregnant people who develop fevers of (37.8°C) or more appear to have an increased risk of miscarriage.
- Trauma – Trauma to the uterus can increase the risk of miscarriage.
- Some medical conditions also increase the risk of miscarriage such as diabetes, cardiovascular diseases, thyroid diseases and infections.
- Some medications could also cause miscarriage; always consult your doctor before taking any medication while you are pregnant.
- Exposure to toxins and pollutants may also cause a miscarriage.
The silent killer
On this bumpy ride of grief where you are battling a swarm of emotion – including survivor’s guilt – and your body is coping with the rush and ebb of hormones that marked the period, it’s important to have support. “The truth is, to keep talking is key, to find other people, to find community that is going through something similar to you. I’ve gone on to set up support groups called TFMR Mamas to support mums who’ve been through what we’ve been through. And, there are actually support groups where the women will meet up and we can work through the grief, the traumas, the triggers that goes with this type of baby loss, because it is very traumatic and very shocking,” says Belle.
“I feel sharing really helped me – it meant I had a support system. Everyone has been so kind, so caring,” adds Downie-Hurst. “I’m just taking it easy, listening to what my body needs,” she adds.
Both Belle and Downie-Hurst had small commemorative ceremonies for their young loses. “We had a commemoration ceremony and that allowed my husband to let his tears out. My son was also grieving,” explains Downie-Hurst.
It’s important to normalise conversation so we can mourn our loses, so we can come out on the other side of the tunnel stronger.
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