Issue 29 / 3 August 2015

MISCARRIAGE is the most common complication of pregnancy, occurring in about one in five recognised pregnancies. 
However, the impact of this experience on the woman and her partner may be underestimated and, unfortunately, misperceptions related to miscarriage abound.
A recent online survey of more than 1000 men and women in the US, investigating public perceptions of miscarriage, found that more than a third of people who had experienced miscarriage felt they had lost a child, and almost half felt guilty.
This highlights the fact that although miscarriage may be common, it is not an insignificant event. People experiencing miscarriage felt they had done something wrong and therefore contributed to their loss.
This study also confirms a widespread lack of understanding of the cause of miscarriage. 
The majority of participants (76%) incorrectly believed that a stressful event could cause miscarriage, and almost two-thirds believed that lifting heavy objects could cause it. Other fears about causation included prior sexually transmitted infections and contraception.
The incidence of miscarriage was also underestimated, with 55% of respondents believing that miscarriage occurs in less than 6% of pregnancies. 
The experience of reproductive loss, including miscarriage and infertility, is culturally and socially shaped. In Australia up to the 1970s, and even into the 1980s, issues related to pregnancy and parenting remained mostly within the private domain of families. The pregnant body was often viewed as embarrassing, and pregnant women had to leave their jobs.
Many women who experienced reproductive loss during this time grieved in isolation and in silence.
Since then, women have experienced both increasing autonomy and public dialogue in relation to their reproductive lives. 
An interesting aspect of this public dialogue has been the increasing prominence of pregnancy and parenting in popular culture. This culture shift reached a tipping point in 1991 when Demi Moore posed naked during pregnancy on the cover of Vanity Fair magazine.
More than two decades later, magazine covers are dominated by references to “baby bumps”, babies and post-pregnancy bodies. This imagery mirrors public acceptance of pregnancy but also demonstrates new pressures on women to be idealised mothers who can maintain “sexiness” during and after pregnancy. 
Parenting advice once provided by extended family members is now sourced from an almost infinite number of social media forums and support groups. This has led to the evolution of phenomena such as “oversharenting” — the oversharing of information about children and their milestones. 
The boundaries of privacy in relation to raising children are now irreversibly blurred. Women experiencing reproductive loss may find it difficult to retreat from a world saturated with the “reproductive success” of others, which can compound feelings of failure.
The internet has also driven the rise of “wellness” bloggers and the growth of a new-age philosophy that promotes the idea that disease can be eradicated by commitment to specific foods or lifestyle choices. In the setting of reproductive loss, this is a particularly potent source of self-blame. 
It is disappointing in this information age that misperceptions regarding miscarriage persist. 
There is danger in believing that activities such as heavy lifting or stressful events could cause miscarriage. If these beliefs persist after pregnancy loss, it can amplify feelings of self-blame, lead to relationship difficulties and contribute to complicated grief, depression and anxiety. 
It is therefore incumbent on clinicians who care for women experiencing reproductive loss to cut through this misinformation. 
Women require validation of both the depth of their grief and the unique challenges of grieving in a world which is socially connected and in which motherhood is idealised. Incorrect beliefs about the cause of a miscarriage should be explored and explained, so that women and couples can be relieved of the burden of guilt. 
This is a world that is more connected than ever before, and conversations relating to pregnancy and birth are more public. However, if misinformation regarding pregnancy loss remains prevalent, then that interconnection cannot provide all of the support needed after miscarriage.
It is what we, as doctors, say that can change the experience of pregnancy loss.
Dr Anne Coffey is a fertility specialist with Queensland Fertility Group and a senior clinical lecturer at James Cook University.

4 thoughts on “Anne Coffey: Guilt of loss

  1. Owen McKay COLTMAN says:

    As a retired obstetrician I wholeheartedly agree that part of the follow up of the patient who has suffered a miscarriage must include anti-guilt counselling. I don’t know why women feel guilty about miscarriages but it goes back a long way, getting a mention in James Fraser’s Golden Bough. A more recent problem is that of the U/S gestational sac with nothng inside it, difficult news to break to an eager and enthusiastic young would-be primigravida and I usually indulged in some temporising or fudging. Perhaps today’s young are better at accepting what they see on the screen.

  2. Catherine Duncan says:

    As a working obstetrician I fully agree that looking after the psychosocial side of miscarriage is almost as important as the physical. A full gamut of feelings of failure, guilt, shame and anger need addressing. I have two ‘take home’ messages: first – ‘nothing you did (or didn’t do)  has caused this’ and second – ‘your chances of successful pregnancy next time are the same as anybody else’ . When someone has just been told of their pregnancy loss, emotion and shock blur messages so I repeat them several times.

  3. Ruth Bender Atik says:

    “I feel a failure as a mother, as a woman and as a wife” – the comment of one of the people contacting the UK-based Miscarriage Association after her miscarriage.  And versions of “Why can’t I do the one thing natural to all women?”, feelings of failure, shame and guilt are not at all uncommon.

    The medical team can do much to reassure, to reduce the sense of guilt and to acknowledge the real sense of loss and grief felt by many woman – and their partners too – after miscarriage.


  4. Sue Ieraci says:

    Thank you for a very important article. I feel that we, as a profession, hold some historical responsibility for this guilt, from when we used to tell women that they should “rest” in pregnancy. This made those who didn’t rest, and who suffered a miscarriage, to think they had somehow caused it.

    I see lots of women having early miscarriages, and I do two main things to assuage guit. First,  I explain that the early failure of a pregnancy means failure of the foetus to develop, and that the gestation was intrinsically not viable. Second, while performing a basic ultrasound, I show then how low down and deep in the pelvis a first trimester uterus is – well-protected from outside forces. I never tell women having threatened miscarriage to rest – I assure them that whatever they do won’t affect the eventual outcome.

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