*Women with experiences narrate as doctors tell what to do
By VIVIAN ONYEBUKWA and HENRY OKONKWO
Aptly put, miscarriage means an unhappy ending to a happy event. When it concerns pregnancy, it is a topic women abhor to even think about, let alone discuss.
Sadly, miscarriages are very common occurrences among Nigerian women. According to experts, more than 30 per cent of pregnancies in Nigeria end up in miscarriages. The chance of having a miscarriage is much higher in the first trimester or first three months of a pregnancy. Gynaecologists estimate that about 75 per cent of miscarriages happen during the first trimester of pregnancy. Strangely, many women miscarry before they even know they are pregnant, or before it has been confirmed by a health-care provider.
Experts define miscarriage or spontaneous abortion, as the spontaneous loss of a pregnancy in the first 20 weeks.
The experience of pregnancy loss understandably, leave the victims deeply saddened and the emotional impact can usually take longer to heal than the physical impact.
Women recount experiences:
This was the exact situation of 37- year- old Mrs. Comfort Okoronkwo when she lost her six weeks old pregnancy. She was heartbroken and shattered because it was her first pregnancy. “It started when I suddenly started seeing slight traces of blood,” she recalled. “I panicked and rushed to my doctor. He told me to calm down and gave me some drugs. But after a few days the bleeding became heavier. When I went back to my doctor, he confirmed that I have had a miscarriage. My baby was gone. And I cried for days and weeks and refused to be consoled,” she said. “Not only was the miscarriage unexpected, my doctor assured me that it was a perfect pregnancy. So when I lost the pregnancy, I blamed myself and also antagonized my husband for the loss of the child.”
Losing a baby can be tragic no matter how early in pregnancy it happens. Mrs. Ann Okwesa said she suffered six miscarriages in her eight years of marriage. “Of course, having miscarriage after miscarriage was incredibly hard on both me and my husband. We got to the point where we told no one when I was pregnant, because it somehow made it more tolerable to not have to share the grief. I actually considered not telling my husband I was pregnant once or twice, to try and spare him the pain of another miscarriage, but never could keep it from him. I found myself so jealous and hateful of friends and strangers with babies. I would even try to avoid places where I knew I would see lots of pregnant women or babies. I hated feeling bad for myself and hated the feelings of anger I had towards those who had no problem getting pregnant. I was incredibly frustrated with myself, and with my body. I had always found that with hardwork, I’d been able to achieve anything I wanted. This was the one time I wanted something, and I wanted it so badly, and couldn’t do a thing about it. It was infuriating”. However, today, Okwessa is a proud mother of three children- two boys and a girl.
For Mrs. Janet Asuquo, having miscarriage could be a very terrible experience, especially when one is in dire need of a child. “I got married at the age of 18 and could not have a child until 28. It was series upon series of miscarriages. I experience eight miscarriages before I could have a child. At a point I lost hope of having a child. Although I have two children now, those periods of miscarriages were something I can never wish even an enemy. It’s the time when you feel your worst physically, and when you really need support and care.”
“After several miscarriages, tongues started wagging from different quarters. I was labelled a witch, and that I am eating my children. How could I when I needed a child. It was traumatizing for me. I went from one church to another and from one hospital to another. But thank God I have a child now. That has shut critics up.” says Gloria Enilama.
When miscarriage strikes:
The first symptom of a miscarriage is bleeding, which may range from spotting traces of blood, to heavy bleeding (haemorrhage). “A miscarriage may result in haemorrhage, which may really be life-threatening, if prompt medical help is not given. In the long run, a woman may become anaemic due to blood loss, unless she is given adequate iron supplements. Occasionally, infection of the uterus and pelvic organs can result from an unattended miscarriage. Hence, a woman should be under the supervision of a gynaecologist after a miscarriage. Some women experience extreme pain and a sense of loss or failure. Many blame themselves or feel responsible. This may lead to anxiety and depression,” says gynaecologist, Dr. Charles Okere.
Explaining the psyche of a woman that has had a miscarriage, clinical psychologist, Dr. Helen Odife says such a woman is at risk of mental depression and anxiety symptoms in subsequent years. “Miscarriage is a traumatic loss, not only of the pregnancy, but of a woman’s sense of self and her hopes and dreams of the future. She has lost her ‘reproductive story,’ and it needs to be grieved.
According Dr. Odife, women after a miscarriage may experience a roller coaster of emotions such as numbness, disbelief, anger, guilt, sadness, depression, and difficulty concentrating. “Even if the pregnancy ended very early, the sense of bonding between a mother and her baby can be strong. Some women even experience physical symptoms from their emotional distress. These symptoms include: fatigue, trouble sleeping, difficulty concentrating, loss of appetite, and frequent episodes of crying,” he says.
Why it happens
“Many things can cause miscarriage, but the most common cause of a miscarriage especially during the first trimester is usually chromosomal abnormalities of the foetus,” gynaecologist, Dr. Charles Okere says. He explains: “The chromosomes are components of every cell in the body. They carry the genes that determine such things as the facial features, eye colour among others. In the process of embryo formation, cells divide severally. Along the way, a problem can occur. An abnormal chromosome or occurrence in the division can lead to miscarriage.”
Dr. Okere further discloses other various factors that cause miscarriage, saying by knowing the causes, one can prevent future miscarriages. These, he says include infections, uterine abnormalities, endocrine abnormalities, fever, hormonal problems like thyroid diseases, environmental pollution and contamination, and diseases such as diabetes. Also advanced age, infections, common illnesses that are left untreated and even accidents can be causative factors of miscarriage.
Another gynaecologist, Dr. Steve Oyewunmi of Springs Hospital, Lagos, says about 50 per cent of all clinically recognised early miscarriages are triggered by genetic factor. “Here, the foetus is genetically or chromosomally defective and unable to survive. This occurs as a random event and a majority of such women will have a normal pregnancy the next time. Couples who suffer repeated miscarriages can opt for genetic testing of the foetus.
He explains that there could also be immunological causes: According to him, some women carry antibodies in their blood, which may attack their own cells. Some of these antibodies may attack the placenta or promote formation of clots in the blood supply to the foetus, leading to slower foetal growth and eventual demise.
He adds that sometimes the cause may have to do with the woman’s anatomy. “ Some women may have a septum (wall) within the uterus, a ‘double’ or ‘half’ uterine cavity, or a similar defect. Miscarriage may result from that. Huge fibroids, especially those which encroach upon the uterine cavity, may also interfere with a successful pregnancy outcome, says Oyewunmi.
Miscarriage can also arise from infections, when they interfere with early pregnancy development. Many types of bacteria, viruses or parasites have been implicated in causing pregnancy loss, though this is not common.
Endocrine causes: Early pregnancy is interplay of multiple maternal hormones, which work in balance to provide an ideal environment to the developing embryo. Hence, some women with menstrual disturbances and Postcystic ovary syndrome (PCOS) may have a higher risk of early pregnancy loss, experts also say. PCOS is a problem in which a woman’s hormones are out of balance. It can cause problems with a woman’s periods and make it difficult for her to get pregnant.
Also, harmful substances such as drugs, alcohol, smoking or excessive caffeine intake and stress may harm the foetus and cause miscarriage.
However, some women do not experience symptoms of miscarriage at all. But possible signs besides bleeding, include mild to severe cramps, back pain, pregnancy symptoms, such as nausea or vomiting, white-pink mucus, passing tissue or clot-like material.
How to avoid miscarriage
According to gynaecologists, miscarriage is relatively common and difficult to prevent. Though the risk is higher in women with a history of more than one miscarriage, they can still conceive. With proper prenatal care, avoiding risk factors, smoking and drinking alcohol and understanding what causes a miscarriage. Women are further urged to plan their pregnancy under a doctor’s supervision.
“Women need to be careful during the first three months of their pregnancy, because what she consumes orally or through her lungs may reach her unborn baby who is at a crucial stage of growth. Certain drugs, alcohol, smoking, excessive caffeine intake and stress may harm the foetus. Pregnant women should not undergo X-ray or CT scan, unless recommended by the doctor”, Dr Emmanuel Igwilo admonishes.
Carrying on after a miscarriage:
Every woman’s ability to cope after a miscarriage differs. “Women need to give themselves time and space to grieve,” Dr. Odife says, adding: “She may decide to take time off from work, involve herself in prayer or spiritual practices. Her family needs to make her feel that they are with her. Most partners support each other and usually, a miscarriage brings them closer. But some women may perceive their husbands as ‘cold’. Sometimes, a man may also feel that his wife is taking too long to get over the grief. This may strain the relationship.
“In most cases, physical recovery takes only a few hours to a couple of days.
Emotional healing takes longer. Losing a baby can be heart-rending. The woman may feel angry, sad and depressed.”
After a miscarriage, doctors advise that victims wait for a certain amount of time before trying again. “If possible, a woman must take a few days off work and get adequate rest. Bleeding will reduce after a week. But if it persists, or is heavier than a normal period, visit your doctor,” counsels Dr. Okere.
In addition, sexual intercourse is highly discouraged after a miscarriage to avoid infection. “Contraception is highly recommended to prevent getting pregnant immediately,” says Dr. Igwilo, stressing: “Many women abort naturally without any medical aid, while some need to take pills to flush the womb, while others may opt for D&C (surgical evacuation of the uterus).
“It is also advised that the woman be taking iron and vitamin-rich diet and supplements to take care of nutritional deficit.”
Getting pregnant again:
Experts say it takes about six weeks for a woman’s body to come back to normal after a miscarriage. So, “a couple can plan their next pregnancy from the third month after the miscarriage. But before doing that, they must be thoroughly investigated to rule out any possible causes of repeated miscarriages. In case of repeated miscarriages, certain treatments like Active Immunotherapy can be taken before planning the next pregnancy,” Dr Igwilo says.
His words: “One should attempt to identify the cause of the present miscarriage so as to avoid a future mishap. If a cause is found, it should be treated before attempting another pregnancy. After a first miscarriage, basic testing is done to rule out obvious infection or endocrine causes. However, after a second miscarriage, more detailed testing needs to be done. A late miscarriage warrants immunological testing to look for harmful antibodies in the blood. After a third loss, detailed counselling, including genetic counselling and a search for any possible cause should be performed.”