For the numerous individuals who experience miscarriage, this report offers hope. The study makes encouraging recommendations for coordinated medical and physiological care following a miscarriage.
Risk Factors and Preventing Miscarriage
Researchers combed data from numerous studies to compile a list of lifestyle, demographic, and environmental risk factors. Very high or very low body mass index (BMI), being younger than 20 or older than 35, stress, smoking, alcohol use, exposure to pollutants, and Black ethnicity are some of the factors that can affect the success of a pregnancy. Often, there is no way to prevent a miscarriage from happening. However, the study found that in some cases, it is possible to stop an impending pregnancy loss. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes. Progestogens, anticoagulant therapy, and nutritional supplementation are some of the possible tools investigators evaluated that may help to keep some pregnancies viable. Medical personnel must present those options. “Couples have voiced concerns over unsympathetic routine clinical care by healthcare providers,” the report notes.
Study Recommendations
The study notes that after the first loss, the risk of miscarriage increases by 10% with each subsequent miscarriage. There is a 42% risk of loss in women who have suffered three or more miscarriages. It goes on to recommend several measures to improve treatment.
A miscarriage survivor should have an organized care management plan, including a medical professional overseeing her care.Using the same terminology for miscarriage and its phases will simplify and strengthen communication between doctors, as well as their patients.If there is a viable way to save the pregnancy, patients should have the option to pursue that care.The level of care should increase with each additional miscarriage. That care should extend to additional testing and examinations to get to the root cause of the recurrent miscarriages.The individual should receive mental health screenings after miscarriage.
If a woman suffers a miscarriage, they need to know what options are available to them. “Our recommendation is that women should be presented with available evidence and supported to choose the management approach that suits their needs and preferences,” another report in the same issue of The Lancet says.
Mental Health Matters
“I think offering a screening would be fantastic for women after a miscarriage because at least it would be saying you’re allowed to feel these things,” states Rachael Benjamin, LCSW, Director of Tribeca Maternity. She adds that OB-GYN doctors should have a list of maternal mental health providers available. “I think when we under socialize (miscarriage) within the community, then we’re putting people more at risk for strain or stress,” she continues. The study echoes these sentiments. “Our literature review identified that anxiety, depression, and suicide are strongly associated with miscarriage.” Researchers also noted that in addition to the pregnant person, many other people suffer from the grief of the miscarriage, as well. “I do think the suffering of partners is often overlooked. While the woman carrying the pregnancy has to undergo the physical burden of dealing with the loss, the physiological pain is shared. An important first step is recognizing and acknowledging this,” says Zev Williams, MD, PhD, Director of Columbia University Fertility Center.
Why Are Changes Needed?
A miscarriage is defined by the American Society of Reproductive Medicine as “the naturally occurring expulsion of a nonviable fetus and placenta from the uterus.” If the fetus doesn’t leave the woman’s body naturally, they may have to have a dilation and curettage (D&C) surgical procedure. They may also have to take medication at home to get the baby to pass, without a medical provider. “You have a miscarriage and you do it on your own and then you’re left to wonder do I need help or not,” Benjamin states. “From the women I’ve talked to, they’re suffering alone.” The problem is exacerbated when a woman experiences multiple miscarriages. Recurring pregnancy loss leaves a woman scouring for answers. “A piecemeal evaluation that only focuses on some possible causes for the losses, such as blood clotting disorders, problems with immune system, etc., may miss some of the roadblocks that result in that particular woman experiencing losses.”
This Impacts All of Us
The costs of miscarriage worldwide are staggering, mentally, emotionally, and financially. Miscarriage can predict future medical problems for someone that goes undiagnosed without the appropriate care. Monetary costs vary according to procedure, location, and even from doctor to doctor within the same area. There are also costs associated with lost work productivity. The study notes that US miscarriage treatments can soar into thousands of dollars. While there are no comprehensive figures for overall costs in the United States, annual costs in England for lost productivity and other healthcare are equivalent to more than $600 million. Moving forward, a unified database of information on miscarriage, a pipeline for continuous care, and the normalization of grief will go a long way in helping women, their partners, and their families heal and process their loss.
