Jane’s Friday Thoughts are a collection of entries on the state of modern maternity from OB-GYN and Maven Medical Director, Jane van Dis.
It's a story familiar to any ObGyn. A life turned completely upside down in a matter of hours. A few weeks ago, a normal ultrasound showing excellent growth, fluid and markers – a woman who has every reason to feel excited about her pregnancy. Zero indication of the catastrophe ahead. Her water breaks, she starts to have pain, and shortly after that, a fever, and then an infection (called Chorioamnionitis) that spreads in minutes, like wildfire, in her uterus. Sometimes a Code Sepsis is called, as bacteria and their toxins invade and overwhelm her organs. Some of these women end up in the ICU. In the developing world, sepsis can cause up to 13% of pregnancy-related deaths. It's a condition we as ObGyns take very seriously. According to the CDC, between 2011 and 2013, sepsis caused 12.7% of pregnancy-related deaths in the US. But in nearly every case, the fetus dies. And that loss, no matter the trimester, is profound.
Miscarriage and why it matters
- 25-30% of all pregnancies end in miscarriage
- Nearly 50% of pregnancies end in miscarriages before implantation, 30% of pregnancies end after implantation but before a woman knows she’s pregnant, and 10-15% after clinical recognition of the pregnancy
- Most miscarriages happen before a woman even knows she’s pregnant
- In one study, 43% of parous women had experienced at least 1 miscarriage
- 80% of miscarriages happen in the 1st trimester
- Women in their 20’s have a 9-17% chance of miscarriage, at 35 it’s 20%, at 40 it’s 40% and at 45 it can be as high as 80%
- Most of the time, miscarriage is due to an embryo not having the right number of chromosomes, according to the American College of Obstetricians and Gynecologists. Eggs and sperm should have 23 chromosomes each. But too many or too few chromosomes—in egg, sperm, or both—produce an embryo that probably won’t survive.
- 50% of miscarrying women suffer some form of psychological morbidity in the weeks and months after loss
- Elevated anxiety and depressive symptoms are common, and major depressive disorder has been reported in 10–50% after miscarriage
- Psychological symptoms could persist for 6 months to 1 year after miscarriage
- Risk factors for miscarriage include advanced maternal age, previous spontaneous abortion, and maternal smoking
- Feelings of depression and anxiety following a miscarriage may last for almost 3 years after the birth of a healthy baby, which points to the long-lasting effect miscarriages have on women’s brains, psychology and spirituality
- Signs that a woman may still be recovering emotionally from miscarriage include feelings of sadness that affect everyday functioning, not sleeping, and changes in diet/weight
- History of pregnancy loss may be a risk factor for postpartum depression in a similar way as other known risk factors, such as personal or family history of depression
How Maven can help
At Maven, we recognize that pregnancy loss happens to a lot of women – and we are here to talk about it. We provide clinical support through our ObGyns, our CNMs, and our NPs. We provide psychological support through our maternal mental health specialists – our social workers, our psychologists, our counselors. And we are here to help if a woman has had a miscarriage and wants to talk about what’s next on her family planning and fertility journey.
My title for this week’s column, Hope is a Circle, is a philosophy that I often share with my patients. After a pregnancy loss, many women report experiencing a common thread of hopelessness, feelings of failure, a wall of sadness, and worries that their bodies will never be able to hold a pregnancy – not to mention mourning and dealing with death. On the one hand, I acknowledge and stand with these women in their grief, pain, and loss. But I also talk about the role of hope, and how it’s an essential element of the conversation around loss. I had 4 miscarriages before I got pregnant with my twins at age 39, and I felt really scared for years, and also very alone. One of these miscarriages was an ectopic pregnancy, and I lost an entire fallopian tube. But I turned that loss into hope when I decided in the emergency room that night to become a doctor. Hope is essential.