I am no stranger to miscarriage, having suffered two consecutive miscarriages before having my first child in 2009.
My first pregnancy was a surprise – I had discovered myself pregnant at Week 7 and promptly bled the following week while working at an event. The second happened months later and as I crossed into the second trimester at Week 13, I discovered the foetus had no heartbeat while at the obstetrician-gynaecologist’s office.
Needless to say, I was devastated. The loss happened close to Christmas and we were looking forward to sharing the news with our family and friends. These losses forever changed my views on fertility, the pregnancy journey and baby loss.
WHAT IS A MISCARRIAGE?
A miscarriage is the loss of the pregnancy from the time of conception up to 24 weeks of gestation. According to SingHealth, miscarriages are fairly common, with most of them happening before Week 12 of the pregnancy or within the first three months.
Miscarriages are also called “spontaneous abortion” or a naturally occurring symptom, which cannot be controlled. Approximately 10 to 20 per cent of known pregnancies may end in miscarriage. It’s important to note that many women are unaware that they are pregnant when these miscarriages occur.
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For pregnancies lost between 12 to 24 weeks, they are called second trimester miscarriages. After 24 weeks, a late miscarriage occurs with a stillbirth or intrauterine foetal death.
The most common signs of a miscarriage are when the woman finds herself spotting or sees fluid or tissue being passed out. She may also experience some abdomen pain or cramps, or a dull pain in her lower back.
Many times, in the case of missed miscarriage, when the embryo stops developing but the body behaves as if the pregnancy is still ongoing, few or none of these symptoms occur, so even if you experience any, it may not indicate a loss at all.
WHAT CAUSES MISCARRIAGE? HOW MANY TYPES ARE THERE?
There is no exact cause for miscarriage but more than half of all miscarriages are due to chromosomal abnormalities which hamper the normal growth and development of the embryo. Many of these disorders or defects happen by chance and do not affect future pregnancies.
Other causes of miscarriage include womb abnormalities, hormonal deficiencies, an incompetent cervix, and other genetic health conditions such as autoimmune disease.
Another cause is when a blighted ovum occurs – this is when a fertilised egg is implanted in the womb but never develops.
In a missed miscarriage, some pregnancy symptoms may lessen but one often finds out during a scan with the ob-gyn as they try to locate a heartbeat. This loss is more common and more often than not, there is nothing one can do to prevent it.
A unique cause is an ectopic pregnancy. This is when a fertilised egg implants itself on the outside of the womb, or lodges in other places like the cervix, or one of the Fallopian tubes.
When this occurs, the pregnancy would not be viable and will require a medical procedure to remove the implanted egg. This reduces it from causing further harm to the woman’s reproductive organs.
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Recurring miscarriages can also happen and in such cases, doctors would assess the health of both parents.
Dr Kelly Loi, medical director at Mount Elizabeth Hospital Fertility Centre tells CNA Women: “Only 1 to 2 per cent of women experience such consecutive loss, that is, the loss of two, or more pregnancies. Further investigations will help assess the couple’s fertility, and medical history. With the appropriate care and management, many go on to have successful pregnancies.”
TREATMENTS FOR MISCARRIAGE
Depending on the type of miscarriage, treatment options will differ.
For some, after ultrasound scans and understanding the symptoms, ob-gyns may let nature take its course and let the foetal tissue be expelled from the body on its own.
However, in the case of a missed miscarriage or a late one, doctors may prescribe treatment by medication to kickstart the process. Otherwise, a medical procedure called the dilation and curettage (D&C) is done. This is classified as a medical abortion to remove the tissue from the uterus.
ROAD TO RECOVERY – PHYSICAL AND EMOTIONAL
Either one of the above treatments requires the female body to recover both physically and emotionally.
According to Singhealth, most recovery from miscarriage requires physical rest. Singhealth also says the recovery journey depends on the overall health and physical condition one was in prior to pregnancy.
Post-miscarriage, women are encouraged to refrain from any sexual activity, from using tampons or partaking in strenuous exercise for at least two weeks.
Dr Loi added: “Physical recovery can be faster than the psychological one. Every woman will react differently and have varying emotions, depending on her personal medical and fertility history.”
For early miscarriages, the woman’s normal menstrual cycle should resume after four to six weeks and this would allow the couple to try conceiving again.
For miscarriages that occur late in trimester, medical assessment is important to diagnose any underlying conditions and treat them, to reduce risks of repeat miscarriage. Late miscarriages also mean the uterus requires more time to contract back to its original size. This process could take two to three months.
Dr Adaline Ng, Senior Principal Clinical Psychologist from Better Life Psychological Medicine Clinic, told CNA Women that baby loss leads to a wide and complex range of emotions. “Each person’s measure of that loss is different. The emotions a woman (and her partner) can have range from shock, numbness, grief, despair, guilt, shame, anger and even anxiety.
“She may start to question herself if she did anything to cause the loss. Sometimes she may view herself as a failure – towards their unborn baby and to themselves or loved ones, as she views herself as less of a woman.”
It is this gamut of emotions that Dr Loi refers couples under her care to see a psychologist post-miscarriage. She reasoned: “Everyone grieves differently following a miscarriage and each person requires various forms of support. It has been well-recognised that women and their partners who have suffered pregnancy loss are at risk of prolonged severe psychological reactions, including post-traumatic stress disorder.”
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Dr Ng added: “Psychological recovery does not occur in a linear fashion. Sometimes, the shock and emotions of the loss may abate over time, with slight triggers that may bring about tinges of guilt or sadness.”
One common example is when couples come to terms with their loss. However, as they begin to feel better, they could construe the process of grieving as “forgetting” their lost baby and be consumed by guilt.
Dr Ng advised both women and their partners to seek professional help if the intensity of feelings takes over one’s normal ability to function. Another sign to seek help is when the loss creates anxiety over one’s health, leading to unhealthy and uncontrollable behaviours aimed at protecting the health of others and their own.
The process of understanding loss requires processing emotions which may be uncomfortable, as it requires one to confront those feelings, rather than suppress them. “Talking to friends or other women who have experienced baby loss will provide perspective and immeasurable support during this difficult time,” she added.
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SUPPORT IN THE WORKPLACE
It was speaking to others and her therapist that supported Marilyn*, 40, when she had her miscarriage in November 2021. She suffered a missed miscarriage at Week 9 and required medical procedures as she had also developed an autoimmune condition.
Marilyn works in the Singapore office of a US-based tech company and was given unlimited time off to recover from her loss, although she only took three weeks. She recounted: “We have a strong female leadership within the organisation who is understanding and empathetic to such situations. I felt very supported during that time.”
It took six weeks for her to recover physically from the miscarriage but after that, she required weekly sessions with her therapist to talk through her emotions from the loss.
She eventually went to a Chinese temple and performed a ceremony for the soul of her lost baby. “This gave me some closure spiritually and although it is almost a year past, every now and then I’ll remember this little one we had for a very short while and loved very much.”
In Singapore, companies are not required by law to cater for miscarriage. As such, most women who experience loss are given days off, based on their allotted medical/sick leave. If they had medical procedures which required them to stay in the hospital, those entitlements may be used for her to recover.
The Ministry of Manpower provides full maternity leave for stillbirths or babies who die shortly after birth as long as these mothers meet the eligible criteria under the Government’s Paid Maternity Leave scheme. They receive 16 weeks of paid maternity leave.
A number of companies I spoke to did not cater for miscarriage leave, although a handful do.
One Singapore tech start-up offers unlimited leave from its employees’ entitlement. The company, iSabel, is a workplace well-being app, and counts Kyndryl in its pool of clients.
Said its CEO and co-founder, Meilin Wong: “As a women-led tech company that’s focused on addressing workplace well-being, iSabel lives out its values of diversity and inclusivity. When it comes to supporting our people, regardless of gender, we want to meet their needs as and when. One way we do so is by offering our team unlimited leave.
“In the case of an unfortunate medical trauma like a miscarriage, whether it’s a female employee herself, or a male employee coping with the loss, they should be able to take time off to recover, without worrying how many days they need from what type of leave. It shouldn’t matter whether my team takes days from their medical or hospitalisation or personal days.”
HOW YOU CAN HELP
Some tips if you know someone who’s suffered a loss.
- Recognise, don’t minimise. If you are suffering from baby loss or know someone who has, don’t rush them to feel better. It minimises their loss and displaces their emotions. Instead, recognise the emotions and acknowledge them as part of the recovery process.
- Men also feel emotional loss, even without physical loss. Potential fathers may be as affected as the mothers – even if they don’t suffer the bodily changes in hormones.
- Talk about feelings – at the right time. Support by asking: “What can we do?” Or “How can I help?” and be present.
TIME HEALS – ALMOST EVERYTHING
It took me slightly over a year to get over my loss. For the first few weeks, I felt a deep sense of loss, and shame that I couldn’t do the very basic thing women do: Carry a child to full term.
I know now that there are a number of debilitating factors which cause miscarriages. Then, my head was in a constant fog of confusion, grief and a deep sadness. There were days of brilliance where I was feeling great one minute, and then utterly miserable the next, triggered by the smallest thing.
It took me almost six months to feel my “normal” self and during that time, I threw myself into work, so that I could be “good” at something.
I fell pregnant with our first child almost nine months after my second loss. However, I carried that anxiety, fearing the loss would happen a third time and was hyper vigilant about my health and activities. My husband also felt it and although he was less anxious, he went along with my paranoia till I safely delivered our daughter in 2009.
Dr Ng advises couples who suffer from baby loss to offer oneself and each other a bit of grace. “It is important to be kind and gentle to yourself during this process of recovery. Baby loss is an unexpected tragedy and a traumatic experience. Time, space and grace to heal is essential.”
Maybe it was the six months or the entire 18 months from loss to having my rainbow baby that got me through. Whatever it was, my loss and the subsequent road to recovery was made easier by accepting the loss as part of life and processing my emotions to pull back from sadness and look forward.
*Name has been changed.
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