Love with no place to go
IF YOUR PREGNANCY LASTED LESS THAN 12 WEEKS, WAS IT REAL AT ALL? JENNIE AGG EXPLAINS WHY OUR PREVAILING CULTURAL AND MEDICAL IDEAS ABOUT PREGNANCY DIMINISH THE MAGNITUDE OF EARLY MISCARRIAGE
Itried not to look at the woman sitting across the Tube carriage, the full moon of her pregnant body extending into the space in front of me. It made me ache with envy. When she’d got on the train, everyone had reacted – moving to let her pass or standing up to offer her their seat. After four miscarriages – all within the first 12 weeks of pregnancy – I wanted so badly what she had: not only to be pregnant, but for my pregnancy to be acknowledged by the world around me. While the conversation around pregnancy loss has opened up in recent years, with high-profile women such as Chrissy Teigen and Michelle Obama sharing their experiences, there is still some way to go. Misconceptions remain. In particular, if you didn’t make it out of the first trimester, others can make you feel it wasn’t a pregnancy in quite the same way; that it was less real, little more than a false start. This is often echoed in the things people say: ‘At least it was early,’ ‘At least you know you can get pregnant.’
I understand why the magnitude of losing a pregnancy early isn’t always easy for others to grasp. Often, there is no physical ‘proof’ of its existence: no visible bump, no scan photo, no ‘baby on board’ badge. Sometimes, I even started to doubt myself; my mind unpicking the reality of what my body had made, and then unmade. Did we really see that heartbeat? Was the nausea really that bad? Did I actually have those cravings? Or had I imagined it all?
For many people, the pregnancy is over before they have a chance to tell anyone about it. An estimated 85% of miscarriages occur within the first 12 weeks – when the first scan is typically performed. It’s standard to wait for this scan before announcing a pregnancy, precisely because the likelihood of miscarrying is much higher in those early weeks. But, along with making miscarriage harder to discuss, this custom plays into a hierarchy of pregnancy loss.
It can mean your pregnancy does not exist in real time for other people. While you may have known for many weeks, for them it begins and ends in the same instant (assuming you tell people about the miscarriage at all). It can be difficult,
then, for them to understand the attachment you’ve already formed; the future you had imagined for that pregnancy – that baby as the toddler, the teenager, the adult you presumed they’d become. The ‘12-week rule’ undermines the pain of early loss; the love that now has no place to go.
Any miscarriage that happens before 13 weeks, when the second trimester begins, is classified as an early miscarriage. ‘It doesn’t always feel early for the person who’s been pregnant,’ says professor of health psychology at Cardiff University Jacky Boivin, who specialises in fertility issues. ‘The biology is one thing, but the psychology is another.’
Indeed, research is beginning to show how devastating the loss of an early pregnancy can be. In 2020, researchers at Imperial College London found almost one in five women who’d had a first-trimester miscarriage or an ectopic pregnancy met the criteria for post-traumatic stress disorder (PTSD) nine months on. Many experienced intrusive thoughts, nightmares or flashbacks; anxiety and depression were common. One in 12 partners of women who’d miscarried also showed signs of PTSD.
MEDICAL MISCONCEPTIONS
Early miscarriage will remain a hidden trauma while it’s still under-researched and under-prioritised by medical bodies and governments.
Unlike other maternity statistics, we don’t collect official data on the number of miscarriages that happen each year in the UK. We’re not alone in this – it’s a data gap in most countries, according to the World Health Organization.
Meanwhile, the prevailing medical wisdom is that, for the most part, miscarriage can’t be predicted or prevented. Yet this is not based on science. In 2021, medical journal The Lancet called for worldwide reform of miscarriage care. ‘The lack of medical progress should be shocking,’ it said. ‘Instead, there is a pervasive acceptance.’ The current approach, it went on, is ‘ideological, not evidence-based’.
In fact, there is emerging evidence that what happens early in pregnancy – the unfurling of a blood vessel here, a genetic twist there – has all kinds of potential consequences, from whether the mother develops pre-eclampsia (a potentially serious condition that can occur during pregnancy) to the child’s risk of disease later in life. Understanding this phase better, therefore, has major consequences for everyone’s health, as well as potentially preventing miscarriages. And yet, the medical establishment, as a whole, doesn’t seem particularly interested.
MOVING FORWARD
There are signs of progress, such as a pledge in the recent Women’s Health Strategy that means people in England who lose a pregnancy before 24 weeks will be entitled to an official certificate to commemorate their loss, if they wish (although this will still not contribute to any official record of the total number of miscarriages).
Apart from accurate data and more research, kinder workplaces could make a difference. Specific policies entitling everyone to paid miscarriage leave (as is currently being called for in a Parliamentary Bill introduced by Scottish MP Angela Crawley) might also help to acknowledge early loss as both a traumatic physical experience and a kind of bereavement.
It could also help us to reconsider how we think about early pregnancy, shaking off semi-superstitious notions that it is an ambiguous state, and instead recognising that this time can be a distinct and profound experience in its own right.
Shortly after my son was born – in 2020, after a fraught fifth pregnancy – I stumbled across a curious series of medical studies showing that cells from a foetus are often found in a mother’s tissues and organs years after birth. This is a phenomenon known as ‘microchimerism’ and this sharing of cells has been found to happen as early as seven weeks pregnant, if not before.
It is a dizzying thought that the DNA of my first four pregnancies could be imprinted in my blood, my brain, my heart, in the same way that my son’s could be. It’s a reminder that they were every bit as real, just as much a part of my story – as is the case for countless women, however brief their pregnancies were.