Elizabeth Petrucelli

Author, Blogger, Educator

Category: miscarriage (page 1 of 9)

Miscarriage and the Flu Vaccine

Several mainstream news sources, to include USA Today, have recently posted articles on miscarriage and the influenza vaccination. Newly pregnant mothers want to know, is the flu vaccine safe in pregnancy? The flu vaccine is recommended for all pregnant women and women are told there is little to no risk in receiving the vaccination during their pregnancy. Yet many vaccinations haven’t been tested in pregnant women. 1 in 4 miscarriage

So let’s talk about it. This is the recently published study by the CDC that shows an increased risk of miscarriage after receiving the influenza vaccination containing pH1N1. The 2017-2018 influenza vaccination looks to have this virus in it. Here are the three viruses for this season:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus (updated)
  • an A/Hong Kong/4801/2014 (H3N2)-like virus
  • a B/Brisbane/60/2008-like (B/Victoria lineage) virus

The risk of miscarriage was only looked at for the 1 – 28 days following the vaccine and the woman had to have received a prior influenza vaccine which contained pH1N1 as well. The 2016-2017 influenza vaccine contained A/California/7/2009 (H1N1)pdm09-like virus (I am only listing H1N1).  While the study authors stated that it cannot establish a causal relationship, the association of receiving the flu vaccine during pregnancy and having a miscarriage (SAB) was significant.

What we do know is that pregnant women ARE at a higher risk of contracting illnesses during pregnancy and the flu is one of those illnesses. I used to receive the flu vaccine but as I have aged, I have become allergic to the ingredients in many vaccines. Even if I weren’t allergic, I personally would not receive the flu vaccination, or any vaccination for that matter, during pregnancy. I was pregnant this year and in February, I contracted Influenza B. Not a single person in my family was sick or became sick. I was miserable and I did what I could to protect my baby.

I am not certain where I contracted Influenza B but I do work in a hospital so maybe that’s where I picked it up. My symptoms did not present normally. I did not have a fever at all but I felt very sick, headache, muscle aches, heart palpitations, and I felt like I was struggling to breathe. I put off visiting the ER, mostly because my husband did not want to take me in the middle of the night. In addition, we knew the visit would be costly and that is always a consideration.

It was not easy waiting through the night not to be seen. I couldn’t sleep and honestly, I wanted to be put out of my misery.  Instead of going to the ER, I asked for a walk-in appointment the following morning. When I arrived at the clinic, the doctor was upset I was there and not in the ER. While my oxygenation was fine, I was clearly struggling to breathe. Their concern was that I had been breathing rapidly (over 33 respiration’s per minute) for more than 12 hours and my body would give out and I would “crash.” That was their nice way of saying, die.

I felt absolutely awful but I wanted to avoid the ER so I asked for any testing or procedures they could do in the office. They said they couldn’t test for the flu in their clinic and I would have to go to the ER for that, but they would give me a nebulizer treatment and see if that helped. I did not want to take any medication during my pregnancy but I needed some relief. I was convinced to take the treatment in hopes that it would help and I would avoid the ER.

It did nothing, so we were sent to the ER. I again received an ineffective breathing treatment and was sent home. I was told my blood labs were normal and that my influenza test hadn’t come back but they would call if it was positive. They had no explanation for my illness, other than I must have a bad cold (even though I wasn’t congested at all) and because I was “old” and pregnant, I was responding harshly to the virus. I later learned that my labs were not “normal” but the doctors didn’t believe my labs were indicative of anything.

During the 15 minute drive home, the doctor called my husband to confirm that I had Influenza B. I was surprised they didn’t admit me as my respirations were still horrible but they sent me home with Tamiflu. I hesitated to take the medication. There are no studies of the use of this drug in pregnant women but I needed relief. In addition, I had been symptomatic beyond the 48 hour window for the effectiveness of this drug.

I conducted a little research before consuming the drug. I had immense anxiety over this. I was well into my second trimester and  was passed the gestation where the defects could occur. There were three babies whose mothers had taken the drug who had defects (although some babies were aborted but according to the study, this was not statistically significant). 24 hours after taking Tamiflu, I began to feel relief. By 72 hours after Tamiflu, I was feeling well although exhausted.

I worried throughout my pregnancy that I somehow hurt my baby from the Tamiflu. Only time would tell and a future ultrasound did not show any defects with her heart. Once she was born “normal” I felt okay about taking Tamiflu although it’s still possible she could have been affected but we won’t know until later in her life. So far, all is well with her.

Despite the CDC study, women are still urged to get the flu shot in pregnancy. Why? The reasons cited are to reduce hospitalizations due to complications from the flu, morbidity and mortality, and to pass on antibodies to the unborn baby. This study shows that the influenza vaccine in pregnancy is 91.5% effective in preventing hospitalization of the infant in the first six months of their life (this does not say the infant does not contract influenza). I am sure my daughter has antibodies for Influenza B since I had it.

So what should a pregnant woman do? There is clearly a relationship between miscarriage and having received the influenza vaccination so it would be up to the woman to assume the risk. Do the research, make the decision. I don’t ever recommend just listening to a doctor. I want to be very clear in what I am saying; the doctors recommendation IS important; however, it should not be the only deciding factor. If a woman receives the vaccination and then miscarries, how would she feel knowing that ?

I know I would never forgive myself so I choose not to receive vaccinations during pregnancy and most especially during the first trimester. Only you can decide if it’s right for you. As someone who has experienced miscarriage twice, I worry so much during subsequent pregnancies about losing the baby and anything I can do to reduce that anxiety is helpful. Once the baby is born, I know there are many things I can do to help keep the baby healthy and I follow all those precautions and recommendations during such a fragile time.

Making the decision to receive or not receive the flu vaccine is difficult. There seems to be good research out there to help make an informed decision, although much of it is irrelevant if the baby does not make it to term if the flu vaccine causes miscarriage.

The D&E for Miscarriage

When a baby dies in the second trimester of pregnancy, their death is either a miscarriage or a stillbirth. Stillbirth in the U.S. is defined as when a baby dies after 20 weeks gestation. A death before 20 weeks gestation is called a miscarriage. A second trimester miscarriage is a miscarriage between 12 completed weeks and 20 weeks. How a second trimester miscarriage is managed differs greatly between care providers. This post is the information I give my clients when they are told the unfortunate news that they are experiencing a second trimester miscarriage.

There are multiple factors when it comes to options for delivering a baby who has died or will die before 20 weeks gestation. Many care providers immediately state that the patient needs a surgical procedure called a D&C; although beyond 12 weeks gestation (in the second trimester), the surgical procedure is a D&E; which is different and I will explain those differences.

First; however, let me state that if the woman is experiencing a missed miscarriage, a D&C may be performed instead of a D&E. For example, if the woman goes to her 16 week appointment only to discover her baby died at 11 weeks gestation, the doctor will likely recommend a D&C. But, if the woman goes to her 16 week appointment and the baby has recently died, then a D&E would be recommended (even if the doctor calls the procedure a D&C).

When a doctor recommends surgery for the miscarriage, a woman usually schedules the procedure either for that day or within a week but rarely is the woman given any other options.

There are other options for second trimester miscarriage.

Just like with first trimester miscarriage, a woman has three options for miscarriage.

  1. Expectant Management (wait and see approach).
  2. Medical Management (using a medication to induce the miscarriage/delivery)
  3. Surgical Management (D&C or D&E)

When it comes to second trimester miscarriage, the number one cited reason for surgical management of miscarriage is risk of infection from leaving the baby or “pregnancy tissue” in the uterus. Yet, in the several hours of research on this particular topic, I could not find any substantial data to prove that a woman was at a higher risk of infection with expectant management of miscarriage versus surgical management of miscarriage.

This Cochrane Review explained that the risk for infection with expectant management of miscarriage was similar to surgical management; although I did find information here that suggests there is a 1% risk of infection with expectant management and this site suggests 0% to 10% chance of infection with expectant management. This leads me to believe it’s not well studied, especially in the second trimester since second trimester miscarriage and pregnancy loss is less common.

Nearly ALL the websites I explored stated that the woman’s preference should be utilized. But here lies the conundrum because care providers are only presenting one option for second trimester miscarriage; the D&E.

The D&E (dilatation and evacuation) is generally performed for miscarriages over 12 weeks gestation. The difference between a D&C and D&E procedure is that during a D&E, the surgeon dilates the cervix and then uses a grasping instrument (forceps) to remove the baby (sometimes in parts) and then uses a vacuum or curettage to suction and scrape the remaining tissue in the uterus.

In essence, because the uterus is not dilated big enough to remove the entire baby all at once, the baby must be removed in pieces and once removed, a curettage procedure is performed. While this is a very effective and viable option, some women and their partners would like to see and hold their baby, possibly take pictures of and with their baby, receive handprints/footprints from their baby, wash their baby, dress their baby, provide dignified services such as baptisms or blessings, and bury or cremate their baby. Some of these options might be available with a D&E but not all of them.

If I were your bereavement doula, I would personally walk you through these options and discuss them at length so you can make the best decision for your family. Hiring a bereavement doula is highly recommended for miscarriage and stillbirth. It is nearly impossible to explain in such detail here all a bereavement doula would present and help you with in this scenario. Please reach out if you would like to know more, I can help from afar as well.

There is no definitive amount of time on when labor will begin with expectant management. I use the term labor, because it is labor. It is NOT a heavy period, especially in the second trimester. Your cervix still has to soften (efface) and dilate (open) in order for the uterus to contract and push out the baby (“contents”).

Expectant management of second trimester miscarriage could take days, weeks, or even months to complete. Waiting is not always an option for women both physically and emotionally. Preparing to deliver a baby at home would also need to be considered as many women are sent home to give birth to their deceased baby. I do not recommend having such a large baby at home on your own and always recommend to my clients that they are admitted to the hospital for induction. Too many women have gone home to either wait for the baby or utilize medical management (taking medication to induce a miscarriage) and ended up in the emergency room bleeding severely and requiring a blood transfusion.

In my blog post, How to Prepare for Your Miscarriage, I explain in depth the materials needed in order to have a miscarriage at home. If you are considering this option, please read the information and prepare accordingly. If you are uncomfortable with the risks or seeing such an early baby, a hospital induction is an option. Care providers may give some push-back on this option and of course, there may be higher medical costs associated with this option but if you want to deliver your baby in a hospital with all the medical equipment needed for the risks, you can and should have this option.

I want to end this post with the risks of D&E. I have not linked to any specific website on this procedure as it may be too traumatic because the websites that list the risks are for abortion, not second trimester miscarriage. However, should you want to confirm the risks I list, you may conduct an internet search “Risks of D&E” which will provide the information.

The risks of the D&E are very similar to the risks of a D&C.

  • Injury to the cervix and/or uterine lining.
  • Uterine perforation (the provider punctures a hole in the uterus)
  • Infection
  • Bleeding/hemorrhaging
  • Retained products of conception, fetal tissue, or other tissue (requiring a second surgery)
  • Uterine rupture (from medications frequently used before the procedure to prepare the cervix)
  • Blood clots

It is also important to note that with a second trimester miscarriage, you may go through baby blues and/or depression just like a woman who has a full term, live birth and you may lactate and/or have engorged breasts. These are more likely to occur after 16 weeks gestation although I have had a few clients with 14 week losses who lactated (breastmilk).

I highly recommend you purchase the book, It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook to help you through this process. It explains miscarriage more in depth.

Dear Self Magazine: Change on Miscarriage Starts With You

Self Magazine published an article on August 5, 2016 entitled When You’re Having a Miscarriage but Have to Work Anyway, by Zahra Barnes. This article helps bring to light many of the pressing issues women who miscarry face such has social stigmas and having to work through a miscarriage. Many women don’t realize that miscarriage can be covered under FMLA as a serious complication from pregnancy or a serious medical condition. Learn more about FMLA for miscarriage here.

There are many good things about the article which focuses on the miscarriage experiences of Ashley Frangipane (Halsey), who suffered a miscarriage while on tour in 2015 and took narcotic pain killers while wearing an adult diaper while at her work venue. No time to have her miscarriage in the comforts of home or safety of a medical facility, if she stopped working it could have been detrimental to her career. This is an issue many women face.

1 in 4 pregnancies end in miscarriage; roughly 10-25% of recognized pregnancies. The statistics are frightening because most women don’t realize how common miscarriage is until they have one. Women are typically silent about their miscarriages due to cultural taboo on talking about miscarriage. The social stigma is that miscarriage isn’t a big deal and when women do feel different than the stigma of the norm, there is shame in those feelings. Women become silent and suffer in that silence.

When famous women come out to share their experiences of miscarriage, the media reports for them. This helps women not feel so alone and that is very needed. It sheds light on the millions of women experiencing pregnancy loss around the world. Articles such as the Self article can be helpful but there is a hidden message in the article Self wrote. I will tell you what that is.

At the end of the article, the author calls for change in the beginning of her final statement when she writes: “Although it will take some time for cultural attitudes about miscarriage to shift…” But instead of helping to change that stigma, the author actually furthered a common misconception about miscarriage, that it’s “like a heavy period.” The author interviewed Dr. Sherry Ross, an OBGYN who stated that miscarriage will evolve into something like “the heaviest period you’ve ever experienced.”

I wonder if this doctor has talked with her patients or better yet, been there while her patients experience miscarriage. A majority of them would likely not describe miscarriage this way, especially if they held their very tiny baby. As a woman who experienced miscarriage twice, I can attest and confirm that miscarriage is nothing like a heavy period. In fact, I suffered through horrible periods associated with PCOS and hormonal imbalances for a majority of my life and I would take that experience over the labor pains I had with my miscarriages.

Another OBGYN, a male I might add, describes miscarriage to women as “hell.” He then explains that miscarriage can be “really heavy bleeding, really heavy cramping, and generally feeling really beaten up.” Before I discovered that Dr. Jacques Moritz was male, I made an assumption that this doctor had a personal experience with miscarriage and maybe his partner had one but he still minimizes the miscarriage experience. The statements by these OBGYN’s further trick women into believing that miscarriage is “no big deal,” “not a serious medical event,” can be experienced at home or work with little complication, and that miscarriage, “is like a heavy period.”

Doctors and Miscarriage

My book “It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook” shares with you how miscarriage is not a heavy period. It’s rarely experienced that way, yet women are told by their doctors that they will bleed like a heavy period and receive little to nothing more. Nothing to help with the pain that shocks them out of their sleep, nothing to catch their baby or remains in, and no real guidance on warning signs. Women are left to go through this experience alone and uninformed. I often wonder how doctors truly understand the miscarriage experiences of their patients when the majority of women are never seen and their pleas for help and guidance are ignored.

The article wasn’t all bad. I know I focused solely on the statements by these OBGYN’s but when Self Magazine calls for change, they should help create that change by interviewing proper professionals or women who have experienced miscarriage. One statement of particular note was when Penelope Trunk talked about how some women might prefer to go back to work immediately and that “there are basically no wrong choices here.”

This is a very true statement and women need to hear this. While some women couldn’t imagine going to work during a miscarriage, there are others who may prefer to go back to work and neither is wrong. Women who don’t feel they can go to work need to be empowered with information on how to manage that, such as through FMLA. Statements like the ones made by medical professionals, minimize the experiences of miscarriage by the majority of women. Because they are medical professionals, society places more trust in their words than in the words of the women who experience miscarriage.

So Self Magazine, if you want change for women; help make that change happen for women.

How to Prepare for Your Miscarriage

miscarriage in ultrasound roomYou’ve just been told that your baby/pregnancy isn’t viable, that there is no longer a heartbeat, or that you will be miscarrying; so what do you do now? Chances are, you were sent home with medication to induce the miscarriage or told to just go home and wait it out but do you really know all that you need to prepare for? Probably not.

Here is some practical information on how to prepare for your miscarriage. This is information you would likely never hear from your care provider.

Step 1. Before you leave the doctors office, ask for the following (if you have already left, you can call them or send someone back to their office).

  • A list of warning signs.
  • Induction medication instructions, warning signs, and how long it may take to work.
  • A miscarriage kit (strainer, gloves, saline solution, container for remains/baby).
  • Pain medication (prescription in hand or actual pills).
  • A sleep aid (if you feel you will need it).

Step 2. Prepare your home by setting up the bathroom for the delivery process. Purchase a miscarriage kit. If you don’t have time to purchase a kit, use the information below to prepare.

  • Have the strainer in the toilet (for every use)
  • A container to place the baby/remains.
  • Saline solution (for preserving and viewing the baby).
  • Gloves on hand in case you feel like you need them (it’s okay to touch the baby/remains without gloves).
  • Towels/wash clothes for cleaning up.

Step 3. Prepare emotionally.

  • Talk with others who may have miscarried.
  • Share your feelings with your partner and ask him how he is feeling/doing.
  • Books are an excellent way to learn what others have felt and they can help validate your own feelings. It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook or The Miscarriage App, can be very helpful.
  • Join an online support group and ask others about their experiences.

Step 4. Have someone with you. You should not miscarry or deliver your baby at home alone.

  • Your partner or husband should be with you. If they are not available, a friend or other family member should be with you.
  • Hire a professional such as a bereavement doula, loss doula, or perinatal loss specialist who can mentor you through this process.
  • Ask if you can be induced and deliver in the hospital. For miscarriages beyond 10 weeks, this can be a very viable option. I recommend that all my clients deliver in a hospital when they are between 14 – 20 weeks.

Step 5. Consider testing. Doctors speculate that miscarriages are caused by genetic abnormalities but with so few women testing (only 13% of stillborn babies receive an autopsy), we just don’t know for sure if there is something you can do to prevent a miscarriage.

  • Ask your doctor about the Anora Miscarriage test kit by Natera. This is a test on your baby’s remains and may give you some answers such as sex of the baby and the baby’s condition/chromosomes. For baby’s between 16-20 weeks an autopsy may also be performed.
  • Ask your doctor to run blood tests on you which may reveal conditions like MTHFR and other antibody/antigen issues which could cause miscarriage.
  • In a future pregnancy, consider progesterone testing to ensure your progesterone is at the optimal level for carrying a baby. This test should be done as soon as you become pregnant and monitored during the first trimester.

Step 6. Decide the final resting place for the baby/remains. You have many options available to you.

  • Flushing (accidental or purposeful) is one option. If you feel guilt over flushing or would like to honor your baby, you can perform a water ceremony for miscarriage which can help to release some of the guilt and/or honor your baby.
  • Burial (at home, at a cemetery, or other location). Be sure to check the local laws on home burial or burial at any other location other than a cemetery, you do not want to break local ordinances and laws. Burial at home is not usually recommended in the event that you might move. Some families choose to bury a tiny baby in a pot and plant a tree which is portable in the event of moving. Many cemetery’s offer communal burial or plots for miscarried babies and many are free. Be sure to inquire.
  • Cremation. You will need to work with a mortuary or crematory for cremation if you are not utilizing the hospital cremation process. Please note that most hospitals cremate all biohazard together and that includes the baby/remains. You will also not receive any ashes back with hospital cremation/disposal. Many mortuaries and crematories will conduct the cremation free of charge. You might even be able to include special blankets or notes during that process. Be sure to inquire. With very early babies (13 weeks and earlier), you may not receive any ashes back.

Step 7. Create memories. Yes, there are ways to create memories, even for early miscarriages.

Memory Box for Miscarriage - Erika Zane Photography

  • Pictures can be taken of your very tiny baby either professionally or with your phone.
  • Smells and scents can help you remember. Lavender is a very common scent used to help relax but it can also be used to help you remember. You may not think you will want to remember this experience but many women do.
  • Name your baby. This can be very beneficial in validating your baby’s existence. It’s not something everyone does but many women enjoy naming their baby, even if they call their baby “peanut” or Baby (insert last name).
  • Miscarriage AnnouncementMementos don’t have to be elaborate. If you have a larger baby, you can try capturing handprints/footprints but with smaller babies, you will need be a bit more creative. Examples of mementos are sympathy cards, hospital admission bracelet (from you), remembrance jewelry, breastmilk pendant (if your milk came in), cord keepsake, blanket (with or without baby’s name on it), plant a tree, plant flowers, make a donation to a charity,  etc.
  • Create a miscarriage announcement.
  • Attend annual events such as a candlelight vigil or remembrance walk. You can find local vigils and events here.

Step 8. Move forward.

  • Understand that moving forward is not moving on. It will take time for you to feel like you can move, let alone move forward. Take your time moving forward.
  • Seek a support group or one-on-one mentoring/counseling.
  • You will likely never return to “normal” but will learn a new normal.
  • There is no timeline on grief. Some people move through grief quickly and some move through grief more slowly. There is no right or wrong.
  • Purchase a recovery kit.
  • Grief is not depression.
Photo Credit: Dravas Photography

Photo Credit: Dravas Photography

Having a miscarriage is not easy, even if you might not have wanted the baby. It is emotionally and physically draining yet we are led to believe that this is an easy experience and it’s “no big deal.” Many women are confused when they are hurting yet are not treated as if this is a hurtful event. With the information above, women will understand how to prepare for your miscarriage. They will feel empowered and validated and will know they have options.

Miscarriages are NOT Heavy Periods

miscarriage in ultrasound room“Miscarriages are like heavy periods.” I don’t understand where this phrase comes from at all. After diagnosis of a miscarriage, many women hear the words, “It will be like a heavy period.” Sometimes the medical professional adds, “And you might see more clots and pass tissue.” There is rarely mention of pain or contractions. Do doctors not understand that some women do not cramp at all during their periods? So now, when a woman who wouldn’t normally cramp during her periods, experiences this crampy feeling, what are her thoughts?

Let me explain. I teach childbirth education classes and we discuss contractions, pressure waves, etc during the childbirth preparation. I prefer to relate the pain of contractions to something they have felt before, menstrual cramps, diarrhea cramps, ovulation pain, etc. It can give a general idea on where they might feel contractions. I also explain that these are functions that do not mean something is wrong.

Because nearly all the experiences of pain we have are signals that there is something wrong.

So, pain = something is wrong.

In the case of menstrual cramps, contractions, etc, pain is not a signal that something is wrong but we don’t typically think of it this way and again, a woman who doesn’t experience menstrual cramps will be confused about what is taking place in her body. So now, this woman begins the miscarriage process and she is cramping (contracting) and now, because all her prior experiences of pain signaled something was wrong, she will likely think that something is wrong. And fear sets in.

Now the woman has fear in a very emotional situation where she is already deeply hurting. When you put physical pain together with emotional pain, the combined pain is off the charts. It can be too much to manage at all.

Now imagine that the medical professional explained the process a bit more. “You will likely bleed heavily, pass clots and tissue (grey, pink, and red), you may see the baby in full form or partial form, and you will likely experience cramping or contracting. If the pain is too unbearable, you may take this medication I have prescribed to you.” Then they add some warning signs, “If you bleed through more than 1 pad an hour, please contact us, if you pass any clots larger then the size of an egg/plum call us immediately or head to the emergency room, and if you see the baby you may put the baby in a bag or box and place them in the refrigerator and then call us.” Then they add even more, “You may begin bleeding more heavily after you pass tissue and this can be a sign of retained tissue. Keep an eye on this and if you feel faint, dizzy, lightheaded, or nauseated please go to an emergency room. If you pass out, someone needs to call 911. This means that you should not miscarry alone and someone should be with you at all times.”

WOW! That is one awesome medical provider!

Knowledge is power and this woman would feel much more confident in her experience even though it is sad and emotionally difficult but at least she knows what is normal and what isn’t. This helps reduce fear and empowers her to take control.

woman-grief-3-labeled-for-reuseBut, miscarriage is treated just like a period. Women believe that “it’s no big deal.” That all the contents that emerge from her are to be flushed or discarded and when the gravity of the situation takes over, she is confused about why she is so sad and if she is worthy of grieving.

She is then silent about her experience and becomes shameful. She fears telling anyone because miscarriages are “like a heavy period” so what’s the big deal? Yet she mourns. She yearns for her baby. If she was in her second trimester, she may have held her baby (some can do this in the first trimester), she may have weeped over her baby and repeated to her baby over and over that she was sorry.

Yet miscarriage is like a heavy period. Society thinks, “Why is this woman so distraught, it was just a heavy period!” These experiences just irk me. This is not okay. Women ARE worthy of grief. Miscarriages are NOT like a heavy period. About the only time a miscarriage would be “like a heavy period” would be if it were to happen extremely early within the pregnancy, often so early the woman may not even suspect she was pregnant. This would be before 5 weeks of pregnancy. Miscarriages after 5 weeks would likely be more painful.

It's Not "Just" a Heavy Period; The Miscarriage HandbookAll of these reasons and more are why I wrote the book, “It’s Not ‘Just’ a Heavy Period; The Miscarriage Handbook.” Women should have the information they need to make the best decisions they can when they are miscarrying. They should have the knowledge needed to feel empowered with their choices which helps reduce trauma and improves their coping as they grieve.

Why are so many medical providers causing more emotional trauma and hurt by dismissing this experience as a heavy period? We MUST change this! I want to mention a recent movement in the US to help change this. It’s called Don’t Talk About the Baby. I hope you will join me in supporting them so that this movie can come to fruition. We must stop the medical community and society from telling women miscarriage is no big deal. It is a big deal.

Breaking the silence of first trimester miscarriage.

For Gus

Dear Emergency Departments Everywhere

Dear Emergency Departments everywhere…

STOP SENDING WOMEN HOME WHO ARE HAVING A MISCARRIAGE!!!!!!!!!!!!!!

I really cannot stress this enough. It’s getting very old hearing the words, “There is nothing we can do, go home.”

Is that really all you have to say? Do you really thing there is nothing you can do? Let me explain to you the things that you CAN do because what you are doing is not enough and is definitely nothing. In the end, you are hurting so many more women emotionally and physically. And many of you have no idea that these women are being put at risk and readmitted for complications or seeking care elsewhere.

Here is what an emergency department can do when a woman is miscarrying:

  1. Express condolences. Even if you think the woman is relieved or that this doesn’t matter to her (or to you), saying, “I’m sorry for your loss,” or “I’m sorry you have to go through this experience,” is perfectly appropriate.
  2. Don’t rush. Families do not understand the administrative responsibilities of an emergency department. We don’t know how many people should utilize the room per day to operate at your maximum efficiency. So when you rush a family out of the emergency department, it comes off as you don’t care and that the experience wasn’t worthy of more time, compassion, and attention. And to be honest, your survey responses will be poor.
  3. Don’t send her home. Let’s be honest here, no women should miscarry at home. She is giving birth and is at risk of hemorrhage and other complications but if a woman is going to miscarry a baby beyond 11 weeks, she should have the option of being admitted during the process. And let’s get more serious, if a woman is between 15-20 weeks, it’s insane to send her home to deliver her baby alone. Actually, it’s malpractice in my opinion.
  4. If you have to send me home, send me with information. With how common miscarriage is, of course hospitals would be overrun with women delivering their deceased babies; however, you can’t just send them home with no information. That’s irresponsible and dangerous. Women need to know what the process is going to be like, feel like, and look like. Then they need to know how to manage everything from the pain to delivering the baby, to what to do with the baby. How about you give them a book? Something like “It’s Not Just a Heavy Period; The Miscarriage Handbook” would work wonderfully.  In addition, women should be sent home with a way to capture and preserve her baby. A miscarriage kit by Heaven’s Gain would be perfect.
  5. Present options. What does a woman do with a miscarried baby? Women need guidance. Offer those options. Families can create memories such as photos, prints (even with tiny babies), and molds. Women should be offered bonding and memorial options. If you don’t know about any, learn. Cremation and burial are also options so do not forget to present them.
  6. Offer testing. Women who lose a baby have a desire to know why. Women deserve testing even if you believe nothing will be revealed. If only 13% of families choose autopsy, no one can say with any certainty that information can not be revealed. This should be offered so this is another reason not to discharge a woman to deliver her baby at home. If she has to deliver her baby at home, testing can still be an option. Send her home with a test kit, such as the Anora miscarriage kit.
  7. If you are hesitant to send her home, don’t. Do something. Admit her, run tests, monitor her and the baby (if still alive), and provide options and resources as mentioned above.
  8. If the baby is still alive, do something. Imagine how you would feel like if you were sent home after your water broke or your cervix was dilating, knowing your baby was still alive, and being told there was nothing that could be done by a medical institution. Ever heard of the Trendelenburg position? Or how about an amnioinfusion? Admit this mother! The outcome may not change but you did something to try. Can you imagine the guilt a mother feels when she can’t do anything but everything within her is telling her she should have? Do something! Because there IS something that can be done in this situation.
Photo Credit: Dravas Photography

Photo Credit: Dravas Photography

This information is not hard to present or to find. The problem is, emergency departments just don’t have the information but with how common miscarriage is, they should. This is no different than having information and resources for heart attacks or suicidal ideation. It’s time that emergency departments take miscarriage seriously.

Hospitals do not believe women should be delivering their babies at home. They believe that homebirth is dangerous and all women should deliver within the confounds of the hospital, yet they have no problem sending a women home to deliver their dead baby or their baby that is too young/early for life saving interventions. This makes no sense. The risks you are concerned about are still there but the fact that her baby is dead changes everything and that is just plain sick (and this is just another blog topic).

While the goal should be to stop sending women home to hemorrhage on their bathroom floors only to be transferred via ambulance to the hospital in a fatal condition and to deliver their dead babies at home; your policies aren’t going to change overnight. So start doing this better. It’s imperative that you do. Women’s lives depend on it!

-Breaking the silence of first trimester miscarriage.

On this day, May 11

Memory Box for Miscarriage - Erika Zane PhotographyLast year, he was born on May 11. Silent and still on the ultrasound just days before, we knew his birth was inevitable. It was devastating. Our 4th and thought-to-be last child, gone so quickly. We were so excited to be pregnant with him, naturally and at our age. It was a miracle. But he was not to be. He was not to live on this earth, just a saint in heaven.

That’s what today represents for me. It’s Augustus’s (AKA Gus) anniversary. Today doesn’t feel much different, other than I know how I was last year and all I was enduring physically and emotionally. I think today feels mostly normal because Gus is in my life every day. The entire family talks about him and shares about him.  His candle sits on our table next to Ruby’s and his memory box (which you see to the left) is in our dining room.

Facebook has a timeline memory feature that can be so very cruel when it reminds you of events such as miscarriage, stillbirth or any loss really. When you least expect it, a memory appears. On May 11, 2015, I didn’t post anything about delivering Gus. I was very quiet about that particular day. So I imagine tomorrow my memory reminder will show information about our loss.

I was specifically quiet on Facebook that day. I needed one more day of the world thinking I was pregnant. One more day of me feeling like I was pregnant even though my body had birthed already our baby. So instead of a sad memory appearing in my Facebook Memory Timeline, I saw a post from May 11, 2011.

It was a simple post:

I actually helped save a life today and the person is extremely thankful. I feel amazed to be a part of his life.

It was a chilly morning that day; cloudy and rainy. I was managing the security department at my local hospital that day when I received a call there was a “crazy man” rolling around in the grass in the front of the hospital. Me and another officer went out looking for him. I ran out without a coat, as did my partner. Neither of us could find him and if I recall, my partner returned to the building to get his coat.

I found a man inside a car near the grass. He was hanging out his door but trying to start the car. He was wet and looked disheveled. I asked him if he needed help and he said he was trying to start his car but his speech was slurred. He didn’t look like he felt alright so I asked him to get out of his car and come in to be checked out.

He complied fairly easily but he seemed confused. As he stood up, I realized he was wearing only one slipper. He was also a very large man. Most likely 280lbs and about 6’5″. This was not a man I wanted to fight with but that was what was about to happen.

As I talked with him, he kept walking away. He would stumble as he walked towards the grass. I kept asking him questions but his speech was jumbling and he wasn’t making much sense. When I placed my hand on his elbow to try to direct him, he pulled away and then turned towards me and got in my face. He became aggressive. I contacted dispatch to call 911.

As I attempted to hold him off from hurting me, my partner arrived…just in time. He himself was big and burly and could stand up to him. We both were holding him back and trying to get him to calm down and just talk to us. Finally, I yelled at him, “WHAT’S YOUR NAME?”

He looked blankly at me. He stopped fighting and just looked off in the distance as if he was scared because he could not form the words. I then called 911 and told them to send rescue. This man was having a medical issue. He was not drunk, he just couldn’t be. Something else was going on with him.

As I hung up, I could hear sirens. The police quickly arrived and helped us to get him under control and into custody. The ambulance arrived and assisted him into the truck and drove him to the emergency room. When he arrived, his blood sugar was 22 and it was dropping. Due to the cold temperature, his body was burning off more and more sugar and he was close to having a seizure or entering into a coma.

The hospital administered sugar and instantly this man came back to life. He was such a gentleman and apologized. He explained that he had just seen his doctor and was heading back to his house in the mountains but when he got into his car, he blacked out. He didn’t remember any of what had taken place. He was grateful we found him. He was admitted to the hospital for over a month and I visited him nearly every day I worked. He was such a pleasure and I wished him the best.

I hope he is still alive and well today. I know he had many medical issues that needed to be addressed. I remember that day like it was yesterday. Just like I remember Gus’s birth like it was yesterday. With Gus, the medical staff treated me kindly and were so empathetic to my situation. My husband was there and was so loving and supportive. It was a sad day but we made the best of it.

So today, I want to remember the life I helped save instead of feeling sad about Gus. I feel sad about Gus often, wishing he was here yet accepting that he is not and that I was chosen to carry him…even if for a short while.

If you have experienced a pregnancy loss and had talked about your pregnancy on Facebook, maybe even announced a pregnancy on Facebook, I recommend turning off Facebook memories. I researched “How to turn off Facebook Memories” and found the answer. Visit your newsfeed or “home page.” On the left side of the screen, scroll down to “Apps.” It will be the section under “Friends” but before “Interests,” at least that’s how it was on my screen.

You will find something called “On this day.” Click on that and you can make changes or turn off the notifications. I hope this helps and alleviates some of the cruel reminders that Facebook will notify you of.

They lost a child for goodness sake!

It isn’t called a miscarriage, it’s called a stillbirth. They lost a child for goodness sake.

Miscarriage vs. Stillbirth

This is a very interesting statement and it implies that a woman experiencing a miscarriage, did not lose a child. If she didn’t lose a child, what DID she lose?

For me, the moment I discovered I was pregnant, I believed I was pregnant with a baby. Some do not believe this and that may be the right choice for them but if anyone called my baby an embryo or fetus, that was offensive to me. Because of this, when my baby died, I felt I had lost a child. There was so much our family lost when both Ruby and Gus died.

I recently attended a workgroup in Houston, Texas where we discussed how to effectively manage miscarriage in the emergency department. This is an area I am working hard to change because many women are sent away from the emergency department with little to no support or options.

While at the workshop, important leaders within the medical community met with leaders in perinatal loss which included members of PLIDA. We talked for four hours about what we can do to best assist families through miscarriage and we came up with some great ideas, but I left sad. The reason was because one major thing needed to change or none of what was presented would change either. That was the language that was used.

Spontaneous abortion/miscarriage, products of conception, embryo/fetus, baby/child, etc. While these words were used, I watch the faces of the medical professionals when someone referred to their “products of conception” as a baby. They cringed. And one woman called her baby a fetus but when a doctor heard the gestation of the baby, she became upset that fetus was used because the term embryo should have been used instead.

Even though we discussed language was a big factor in how miscarriage should be managed within an emergency department, if the medical professionals don’t want to change their language to what the family is using, our efforts will be fruitless. This will certainly be a challenge.

So let’s talk about the comments in the thread of the picture above. This was in response to a woman whose baby had passed away near term. I remember the story and the person is a celebrity. The news reported the loss as a miscarriage; however, the term was incorrect and in fact, the baby was near full-term which is a stillbirth.

But that first comment is one of the stigma’s surrounding miscarriage and can make women confused about whether or not they have a right to grieve. If society does not accept that a miscarried embryo/fetus is not a child/baby, then what it is and is it acceptable for a woman to grieve that loss?

The thoughts and prayers are certainly wonderful but the responses above are really trying to compare miscarriage and stillbirth. Comparing loss serves no one.

 

 

 

The Water Ceremony for Miscarriage

Photo for this weeks theme message/meddelande for the group Fotosöndag (Photo Sunday). FLICKR

Image Credit: FLICKR

You may find yourself here because you have experienced a miscarriage and are looking for a particular kind of ceremony for your baby or maybe you flushed your baby and would like a way to honor your baby and find a bit of peace and closure. This post will walk you through the water ceremony for miscarriage.

I learned about the water ceremony a few months ago and have incorporated this into my practice ever since. I have had so many women carry such guilt over flushing their baby and this is a way to help them find peace.

The basis behind it is to find a large body of water. Some people have done this on vacations or have purposely gone to the ocean but you don’t have to do that. It’s up to you although it can also be healing to go on vacation and perform such a ceremony.

Preparation for the ceremony is important. Some people right a poem, a note to their baby or God, pick flowers or other items that remind them of their pregnancy or baby, pictures, etc. So finding something of importance or remembrance at the water ceremony is important.

Clothing – deciding what you will wear much like any other ceremony can be important since many people prepare for other ceremonies in this way.

Pictures – Do you want a photographer or someone else to take pictures at your ceremony?

Choose the date – The due date, other date of significance, or your next day off, etc. Some Catholics choose a feast day or a particular Saints day.

Other items of significance.

Once you feel prepared for the ceremony and have chosen a date, you would begin. It can be very simple or as elaborate as you would like. You could have candles or flowers around as well.

Thank anyone who came to the ceremony if it feels appropriate. During the ceremony, you could announce your baby’s sex or their name if it was something you have kept from others. Share about your baby or pregnancy if it feels right.

Then you can read some bible verses, religious/spiritual affirmations/sayings, talk to mother earth or sit in silence.

There are some verses that can be said. You can completely make them up or adapt them. Here is an example of one:

“Little one [or you can fill in baby’s name] you have been received by the water, ‘For as the rain and the snow come down from heaven, And do not return there without watering the earth and making it bear and sprout, and furnishing seed to the sower and bread to the eater;’ you will help this Earth bear fruit for its eternity.” Adapted from Isaiah 55:10

Once all of that has been completed, you might read the poem or note(s). Some people place them in a bottle, attach them to a balloon or flower, and release them instead or after reading them, it’s up to you.

So that’s the gist of the water ceremony for miscarriage. There is so much you could add to this and when I work with my clients on this ceremony, we design it together. Sometimes they just run with it and do it all on their own.

 

 

Caffeine Linked to Miscarriage – Study

Caffeine and MiscarriageToday.com posted an article today entitled Caffeine Linked to Miscarriage and Dad’s Habits Matter Too. The headline: “New Warning for Couples Trying to Conceive: Caffeine Linked to Miscarriage.” The headline alone will make anyone stop and take a look, especially those trying to conceive. This article can be frightening and I don’t think it has to be. Of course, it is always recommended to reduce caffeine consumption while trying to conceive as well as smoking and other habits but there seems to be some flaws in the study and the cause of alarm might not be as bad as Today.com is making it.

Noted in the the study conducted by the Longitudinal Investigation of Fertility and the Environment (LIFE), 501 couples from two states were enrolled in this study. From that group, 344 couples with singleton pregnancies were studied checking their smoking use, caffeine consumption, and multivitamin use from the weeks before they conceived (how many weeks was not listed) through the seventh week of pregnancy.

The study notes they performed a “hazard ratio;” which estimates that chances of a particular outcome during the study time frame. In this instance, caffeinated beverages were evaluated for the likelihood of pregnancy loss. The study states “a score greater than 1 indicates an increased risk for pregnancy loss each day following conception, and a score less than 1 indicates a reduced daily risk.

The results of the study? 98 of the 344 pregnancies ended in miscarriage. That’s a rate of 28%. Yet the normal miscarriage rate is 10-25%. After reading those differences, one might think that the statement “caffeine use leads to miscarriage” is actually correct but there was something else performed in the study which makes a difference.

Women were advised to take regular pregnancy tests. This indicates that women would know they were pregnant sooner than the normal population. Because the gestational ages of the embryo/baby were not listed, we have no idea of knowing if the majority were chemical pregnancies or pregnancies after seeing a heartbeat. So statistically, women and their partners who drink more than three caffeinated beverages per day are at the same risk of miscarriage as couples who don’t. 

I will be the first to say that I am not a statistician or a doctor. I am not trained to analyze studies but the statements implied within can be very damaging to couples, especially women who already tend to hold immense guilt over not being able to sustain a pregnancy. Is the media jumping onto something else to scare women?

But wait! The study found a hazard ratio of 1.98. “For the preconception period, miscarriage was associated with female age of 35 or above, for a hazard ratio of 1.96 (nearly twice the miscarriage risk of younger women).” Yet the authors of the study and the media are reporting that caffeine consumption increases miscarriage risk. Is this for the entire childbearing population or just for women over 35?

A dangerous statement lies within this study. “The study was not designed to conclusively prove cause and effect.” Wait, so more than three caffeinated beverages may NOT cause pregnancy loss after all?

YES!

UltrasoundThe study then states, “The study authors cited possible explanations for the higher risk, including advanced age of sperm and egg in older couples or cumulative exposure to substances in the environment, which could be expected to increase as people age.” The study discusses that women over 35 are at a greater risk of miscarriage.

This might bring you to wonder, what were the age groups of the study participants? Those were not listed. Were partners close in age or was one significantly older than the other? What other environmental factors could be present? The above statement sounds like the authors are referring to “advanced maternal age” which has already been studied and women in this category are at an increased risk of miscarriage.

Furthermore, the type of caffeinated beverage was not listed nor the amount of caffeine in those beverages. This can make a significant difference. Someone who drinks green tea (25mg) for instance, will not consume as much caffeine as someone who drinks Monster energy drinks (160mg); 75mg vs. 480mg respectively. A comprehensive list of caffeine content can be listed here.

Two earlier studies had different outcomes. One study in the American Journal of Obstetrics and Gynecology found that women who consumed 200mg or more daily were twice as likely to miscarry and those who didn’t and a study in Epidemiology, found there was no increase in miscarriage of women who consumed between 200-350mg of caffeine daily.

When trying to find a “causative” factor for miscarriage and actually link caffeine to miscarriage, it is important to know if any of the embryos/babies/products of conception were tested? The part of the study I was able to access did not state that. So how many of these miscarriages were due to genetic/chromosomal abnormalities?

Were these healthy babies that were spontaneously aborted because of caffeine consumption? Could caffeine have caused the genetic/chromosomal abnormality? What about the placenta? Did caffeine directly affect growth of the placenta or blood flow to the embryo/baby? These are all valid questions and there are many more that I know others would want answers to. 

So what are couples to do? It’s best to avoid caffeine…to be on the safe side. Caffeine consumption doesn’t cause miscarriage, it may increase the risk and it may not but by no means does it cause miscarriage.

My final question and concern is about the couples in the study, especially the women. Were they counseled? What kind of support did they receive during and after their miscarriage? That’s 98 women and their partners who were affected. How might they feel after the study results came out indicating that pregnancy loss may have occurred due to their and/or their partners caffeine consumption?

This is a very concerning study and the way the media is portraying this can be extremely harmful. Talk with your care providers. Estimate the risks and the benefits. Make a decision that is best for you and your family. If you are addicted to caffeine, meaning, you will have severe headaches if you stop cold turkey, there are other options. Reduce your caffeine intake every few days. The medications you take to combat the headache can be more risky than the caffeine consumption.

NOTE: The study concludes with information on how to reduce risk of miscarriage by taking a multivitamin with folic acid. The B vitamin can help reduce miscarriage. When researching multivitamins, be sure to research folic acid vs. folate. There is a difference and one may make a significant difference in your risk of miscarriage, especially if you have a blood disorder such as MTHFR.

Only those with professional medical subscriptions can access the full details of the study but with the limited information released and the media jumping on the scare-tactic bandwagon, we can only be left to believe that the study is flawed.

#caffeinemiscarriage
#caffienemiscarriage

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