Recurrent pregnancy loss

In 2021, I unwittingly and unwillingly joined this exclusive club, whose membership requires 2 or more spontaneous early pregnancy losses [ESHRE, ACOG]. Much like with endometriosis, I've become something of a lay-person expert on the topic, as well as an impatient advocate. The Guardian has published a number of personal articles describing the experience, and in 2021, The Lancet published an excellent series on the state of miscarriage research. Of note, people from low-income backgrounds and historically marginalized groups are affected at a higher rate and receive lower quality care. (This is sadly in line with a despicable trend throughout the misogynistic and racist history of gynecology.)

It is estimated that 15.3% of clinically recognized pregnancies result in miscarriage. In terms of what that means for individuals, 10.8% of all pregnancy-capable people have had one miscarriage; 1.9% have had two; and 0.7% have had three or more [Quenby et al., 2021]. The statistical fact is, RPL is more likely indicative of an underlying disease process (like impaired decidualization [Salker et al., 2010, Jing et al., 2022, Ng et al., 2020]) than to be the result of bad luck or bad habits. And yet, to quote the experts [Muter et al., 2021]:

Despite the astonishing lack of evidence, clinical practise remains grounded in a historical, and arguably patriarchal, misconception that early pregnancy represents an exceptionally precarious physiological state, easily disrupted by 'perturbations' that otherwise do not impact overtly on health and well-being outside pregnancy.

Myths abound regarding potential miscarriage causes-- jogging, picking up your two-year-old, that one glass of wine you had before you tested positive, warm showers, etc.-- which are not only provably false, but emotionally harmful, as they lead people to blame themselves unfairly.* RPL in particular contributes to psychological complications (depression, anxiety, PTSD, suicidal thoughts), and increases the risk for physiological pregnancy complications if/when an RPL patient eventually does carry to term [Quenby et al., 2021]. Psychological outcomes are worse for people with no living children, and grief often persists even after an RPL patient gives birth to a healthy child, to the point that it can affect the bond with the living child [Robertson Blackmore et al., 2011].

Timely interventions from therapists and support groups can help ameliorate many of these complications, but medical professionals regularly neglect to screen and forward patients. My personal experience demonstrates this well. From my first pregnancy through the third, I have seen a total of 12 different MDs who knew I had recently experienced at least one miscarriage. Only one screened me for depression and anxiety-- a psychiatrist I had arranged to see on my own. She refused me medication and instead offered me herbal "fertility" tea, insisting I would be happy once I had a baby. When her paltry attempts at cognitive behavioral therapy and EMDR didn't produce immediate effects (i.e., after one appointment), she said she had nothing more to offer me, and insisted I find a psychiatrist who works in a gynecology clinic. Such a specialized psychiatrist didn't exist at any such clinic in my vicinity at the time. Ironically, Reddit has been more helpful than any MD on this front, thanks to strictly regulated subreddits that actively try to reduce triggers and re-traumatization for the already emotionally flagellated.

I'm a big fan of Tommy's, a UK charity that has funded numerous ground-breaking pregnancy studies and advocates for people with high-risk pregnancies and a history of loss. I stand with them in their mission to reduce pregnancy complications and challenge healthcare professionals who think that just because miscarriage is statistically common, it should not be taken seriously.

If you are looking for ways to comfort someone after a loss, please check out these resources first. If you are going through a loss yourself, Tommy's has tons of resources for you too. Miscarriage is physically, psychologically, and emotionally traumatic. People grieve after miscarriages, just like they do for any other significant loss in life. Dismissive statements ("it's just one of those things / it wasn't a real baby yet") and well-intentioned attempts to cheer someone up ("at least you can get pregnant / at least it was early / you're young, you've still got time") can complicate the grieving process. Taking a bit of time to understand and be compassionate can help someone heal.

*That's not to say external factors never lead to abortion-- indeed, that's the whole point of targeted abortifacients. In addition, heavy drinking, certain illegal and legal medications, as well severe physical trauma can also lead to spontaneous abortions. The point is, it's not easy to do accidentally.