Monday, January 14, 2008

Losing a baby

Why miscarriages occur, and what can we do to minimise its occurrence.

AS an obstetrician, my job is to help pregnant mothers welcome their babies into this world. Therefore, I have always found that the hardest part of the job is when the pregnancy ends in a miscarriage, and my patients turn to me and ask, “Why did this happen?”

If dealing with miscarriage is difficult for me, I can’t imagine how heartbreaking it must be for the women who have this precious gift snatched right out of their hands.

In this article, I will talk about how to recognise when you’re having a miscarriage and reducing your risk factors for miscarriage.

Defining a miscarriage

A miscarriage is the loss of a baby before the 20th week of pregnancy, with most miscarriages occurring in the first trimester.

Up to 15% of all recognised pregnancies end in miscarriage – however, many more miscarriages actually occur, but women are not aware of them because they did not know that they were pregnant in the first place.

The most obvious signs of a miscarriage are vaginal bleeding or spotting, pain or cramping of the abdomen, passing of tissue from the vagina and fluids draining out from the vagina.

If you are pregnant and experience any of these signs, go to your obstetrician immediately.

When a miscarriage occurs, the first instinct is to ask, “Why did this happen? What did I do wrong?” Relatives or friends may make things worse by telling you that you should not have eaten this or done that during your pregnancy.

Some old wives’ tales may blame a miscarriage on “bad” foods, sex, too much exercise, bad feng shui or even astrological signs! However, these are unfounded beliefs. Even we doctors do not really know the cause of most miscarriages.

We do know that they are often caused by chromosomal abnormalities in the unborn baby, but we do not know what specifically causes these abnormalities.

The result is that the baby cannot develop normally, and the body spontaneously terminates the pregnancy.

There are some things that have been identified as definite risk factors for miscarriage.

Although there are no guarantees against a miscarriage, you can try to change your lifestyle or seek medical advice to reduce as many of these risk factors as possible.

Here are three things that you should definitely do during pregnancy to prevent a miscarriage: don’t smoke, don’t use illegal drugs and don’t drink too much alcohol.

You may have certain medical problems, hormonal disorders or chronic diseases that can affect your pregnancy – talk to your obstetrician before you get pregnant about your options for medical or surgical treatment to treat these conditions.

Certain infections during pregnancy, such as rubella, can also cause miscarriage, which is why it is very important that you be tested for these infections and take precautions to avoid being infected while you are pregnant.

Finally, getting pregnant at an older age, and above, puts you at higher risk of having a miscarriage.

However, I wish to stress again that these are only risk factors; just because you are an older mother-to-be does not mean you will definitely miscarry.

What if I have repeated miscarriages?

Some women have several subsequent miscarriages, which can be very distressing for them and their families.

I comfort my patients by telling them that 85% of women who miscarry go on to have a healthy next pregnancy.

Unfortunately, there are some women who have repeated miscarriages, due to medical problems that have not been treated.

For instance, if the repeated miscarriages are caused by cervical incompetence, you can undergo a procedure to keep the cervix closed throughout the pregnancy.

If you have a chronic disease like diabetes, you have to keep the condition under control (such as by maintaining healthy glucose levels) to reduce the chances of another miscarriage.

If you have several miscarriages, your doctor should conduct a complete medical check to try and determine the cause.

Often, however, your doctor will not have an answer. Do not blame him or her, as miscarriages still remain a mystery in medical science.

It may be Mother Nature’s way of ensuring that your pregnancy will not go on to harm you or your unborn baby.

This is not a time for anger and recrimination between you and your partner. You will both need time to grieve and to come to terms with the fact.

Cast out thoughts such as, “I should not have eaten that food”, “I should not have done that exercise” or even “I should not have had sex during pregnancy”.

Blaming yourself or each other will only make the pain worse.

In my next article, I will talk about the emotional impact of a miscarriage, and how women and men can cope with it.

- Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician & gynaecologist (FRCOG, UK). She is co chairman of Nur Sejahtera, Women & Family Healthcare Program, Ministry of Women, Family and Development.


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