Various celebrities have been in the news lately because they have had late - and very public - miscarriages.
The 31 year old model, Kelly Brook, lost her baby five months into her pregnancy in May 2011.
In November 2010, the 25-year-old singer Lily Allen faced a similar tragedy six months into her pregnancy having previously miscarried in 2008, when she was four months pregnant.
The actress and talent show judge, Amanda Holden aged 40, lost a baby at seven months in February 2011 having also suffered a previous miscarriage in 2010.
Jennifer Aniston too now admits that the cause of her breakup with Brad Pitt related to the loss of two pregnancies (in 2003 and 2004) which neither of them were able to recover from.
So is the number of miscarriages rising or are we simply more aware of the problem because high-profile celebrities have spoken out about their losses?
One of the explanations for the increase in the number of reported miscarriages in due to more openness about the issue and also to the early forms of home pregnancy testing that are now available which weren't available to our mother's generation.
However, it is thought that there is also likely to be an underlying actual increase in the number of miscarriages and part of this can be attributed to the increase in the number of women having babies later in life.
Miscarriage: the statistics
Losing a baby after 24 weeks of pregnancy - when it might technically have survived in an incubator - is classed as a stillbirth. Prior to 24 weeks, the loss of a pregnancy is classed as a miscarriage. Very early miscarriages that occur in the first 6 weeks of pregnancy are medically termed early pregnancy loss or chemical pregnancy and miscarriages that occur after the sixth week of pregnancy are medically termed clinical spontaneous abortions.
Sadly, miscarriages are a very common occurrence. Estimates vary, but at least 1 in 4 confirmed pregnancies are thought to end in miscarriage and if unconfirmed pregnancies are included then possibly the majority of pregnancies end in early miscarriage.
Approximately 75% of all miscarriages occur in the first trimester and then this risk decreases sharply to less than 2% for the remainder of the pregnancy - hence the advice not to make any public announcements prior to 12 weeks.
Over 100,000 British and 1 million American women are estimated to miscarry every year and 4,000 British and 26,000 American women to experience a stillbirth. In fact, a recent report in the The Lancet shows that Britain has one of the worst records for stillbirth, ranking 33 out of 35 high-income countries.
An estimated 80% of all miscarriages are single miscarriages and the vast majority of women suffering one miscarriage can expect to have a normal pregnancy next time. The vast majority (85%) of women who have had two miscarriages will also continue on to conceive and carry normally afterwards. However, recurrent miscarriage is defined as the occurrence of three consecutive miscarriages and this occurs in about 1% if women. All multiple pregnancies pose a greater risk of miscarriage.
Management of miscarriage
Sometimes an empty gestational sac can form early in the pregnancy but the embryo is either absent or stopped growing very early. Blood clots form around the embryo and placenta these are expelled over a period of hours or days often accompanied by cramping pains. Many may mistake an early miscarriage for a late, heavy period if the pregnancy has not been confirmed using a pregnancy test.
A miscarriage is said to be complete when all the products of conception have been expelled including the gestational sac, embryo or foetus, umbilical cord, placenta, amniotic fluid, amniotic membrane, etc. An incomplete abortion occurs when tissue has been passed, but some still remains in utero. If a missed or incomplete miscarriage becomes infected, there is a risk of septicaemia and death.
For women who have passed the foetus, the majority will also pass the placenta within a few weeks. However for pregnancies over 13 weeks whilst the foetus may be passed, the placenta is often fully or partially retained in the uterus, resulting in an incomplete abortion. The physical signs of bleeding, cramping and pain can be similar to an early miscarriage, but sometimes more severe and labour-like.
Alternatively, the prostaglandin drug (misoprostol) can be administered to encourage completion of the miscarriage. This is successful in about 95% of cases within a few days. Finally, some will require surgical intervention to evacuate the remains of pregnancy and conception (ERPC).
Miscarriage becomes inevitable once the cervix has dilated and there may or may not be a heartbeat at this stage. A missed abortion is when the embryo or foetus has died, but a miscarriage has not yet occurred. It is also referred to as delayed or missed miscarriage.
The most common symptom of a miscarriage is bleeding and of those women who seek clinical treatment for bleeding during pregnancy, about half will go on to have a miscarriage. Any bleeding during pregnancy should be investigated and bed rest may help to improve the chances of taking the pregnancy to term. Miscarriage may also be detected during an ultrasound exam or via two or more pregnancy tests.
The causes of miscarriage
Miscarriages can occur for a variety of reasons including:
The age of both the father and the mother is a significant factor. Pregnancies where the father is 25 or under are 40% less likely to end in miscarriage than the pregnancies fathered by men aged 25–29 years. And pregnancies from men older than 40 years are 60% more likely to end in miscarriage than the 25–29 year age group. The increased risk relating to the age of the father is mainly seen during the first trimester. For women aged 30 there is a 12% risk of miscarriage, rising to 41% by the early forties and 75% over the age of 45. Women aged 45 and over are 8 times more likely to miscarry than women in their early twenties.
Chromosomal abnormalities are found in over half of embryos miscarried in the first 13 weeks. In fact, a foetus with a genetic problem has a 95% probability of being miscarried and the higher miscarriage rates observed in older parents may be related to an increased number of genetic abnormalities.
Another cause of early miscarriage may be progesterone deficiency.
One-in-seven miscarriages in the second trimester may be due to problems with the uterus or cervix and one-in-five second trimester losses may be caused by problems relating to the umbilical cord with still more being due to problems with the placenta.
Uncontrolled diabetes can greatly increase the risk of miscarriage, whereas well controlled diabetes does not. So an important part of prenatal care is to monitor for signs of the disease.
Up to a half of all pregnancies in women with polycystic ovary syndrome (PCOS) end in miscarriage in the first trimester.
Hypothyroidism and autoimmune diseases are both associated with an increased risk of miscarriage.
The development of high blood pressure during pregnancy, known as preeclampsia, can sometimes be caused by an inappropriate immune reaction to the developing foetus and can lead to miscarriage.
Infections such as rubella, chlamydia or parasitic infestations can increase the risk of miscarriage.
Either the mother or father being a cigarette smoker increases the risk of miscarriage. In fact, where the father smokes more than 20 cigarettes a day there is an 81% increased risk of miscarriage.
The use of recreational drugs such as cocaine and pharmaceutical drugs such as the antidepressants can lead to spontaneous abortion.
Alcohol consumption during pregnancy.
The use of an IUD at the time of conception.
Exercise, and especially vigorous exercise, prior to 18 weeks has been associated with a higher risk of miscarriage. However, no association was found between higher exercise rates after the 18th week of pregnancy.
Consumption of caffeine was also found to be related to a higher miscarriage rate.
The presence of environmental toxins and particularly toxic metals within the body of the mother greatly increases the chances of miscarriage. Mercury in particular is known to induce miscarriages and the rate in female dental workers is 3.5 times that of the population average (which is probably also elevated by exposure to mercury from dental amalgams, vaccinations, fish, etc).
The presence of mineral and vitamin deficiencies in the mother.
Physical trauma during pregnancy.
Exposure to electromagnetic pollution (mobile phones, WiFi etc.)
There are concerns about the use of ultrasound particularly during the first trimester and especially the use of transvaginal Doppler ultrasound which is now starting to be used. This is frequently used on women with a history of miscarriages and creates intensities and tissue heating many times that of the normal ultrasound often before the embryo's organs have formed. Women with a history of miscarriages may willingly submit to regular scans to monitor the pregnancy not realising that the very scan itself may be part of the problem.
The psychological and spiritual impact of miscarriage
In the immediate aftermath of a miscarriage all the hormones that were readying the mother's body for birth return to normal. Although most women recover physically within a few weeks, the psychological recovery can take a long time. Some are able to move on from the trauma within a few weeks or months, but others may take more than a year. Still others may feel relief and possibly guilt for not feeling worse about their loss.
One study found that just over half of miscarrying women were distressed at the time of the miscarriage, and this fell to a quarter by 3 months, one in five by 6 months, with one in ten still grieving a year after their loss. For some there is the emotional devastation as an anticipated future is dashed and especially with advancing age and a history of previous miscarriages the dawning realisation that a longed-for child may never materialise.
Miscarriages can also be a very lonely business. With other deaths you have others to share your grief with, but the loss of a pregnancy is often borne alone especially if the pregnancy had not been publicly announced and therefore a declaration of a miscarriage is deemed inappropriate.
Men and women too tend to have different grieving styles and the mother may be more expressive about her loss, whereas her partner may fact find, problem solve or bury themselves in work.
Also whilst the mother may have bonded early on the in pregnancy with the baby, her partner may not have bonded until later on or even until the baby was born. This means that the loss may be handled differently by the parents. In order to prevent this trauma pulling you apart it is important to be respectful of each other's feelings and needs, to keep communicating and to accept your different coping styles.
Take the time you need to grieve and heal, but if you feel that you are not able to move on then consider seeking help from a counsellor, therapist or support group to help guide you through the grieving process. Take comfort from the fact that many millions of other couples have survived their grief, and in time you will too. If it feels right, then create some way of remembering your lost baby such as planting a tree or buying jewellery with their birthstone.
In addition to sadness and grief, other common emotions in response to a miscarriage or stillbirth include feelings include of uselessness, anger, rage, blame and being betrayed by your body. Some women may experience significant problems being around other pregnant women and their babies and feel resentful of their fertility and happiness. Other people's responses and lack of understanding can also fuel further upset.
The loss of a child whether through miscarriage, stillbirth, cot death or adoption can also seriously and permanently impact pancreatic function and blood sugar control causing comfort eating to assuage the grief. The pancreas is associated with feelings about life being sweet, and the loss of a child can mean that life definitely does not feel sweet.
For every miscarriage that goes recognised and overtly mourned, many more probably pass unnoticed dismissed as heavy, late periods, but these too can have profound and lifelong effects on pancreatic function.
Kirsty Alley, the former sitcom Cheers actress had a miscarriage that left her devastated, mourning - and eating. It was after this time that she struggled to gain control of her weight. Oprah Winfrey too experienced the stillbirth of a baby aged 14 - and we all know about her gargantuan struggles with her weight.
A significant proportion of pregnancies are also thought to start out as twins, triplets or even quadruplets where one or more embryos either fail to mature or are sacrificed in order to take one pregnancy to term. This is known as the vanishing twin syndrome. This too can cause the body to go into a profound grief although the couple may be completely unaware of their loss.
Using Bach and other flower remedies and Emotional Freedom Technique and/or EMDR may help to process and release the feelings associated with a miscarriage.
Suggestions for a successful pregnancy
The natural healthcare programme developed by Foresight Preconception Care to best support pregnancy and to prevent miscarriage involves:
Eating an organic diet with few refined carbohydrates, colourings, additives and junk food.
No alcohol prior to conception for father and mother, and no alcohol during pregnancy for the mother.
No use of the contraceptive pill or IUD while the body is being rebalanced prior to conception. Abstinence or condom use during fertile periods.
Eliminating food and other allergens.
A hair analysis to check for the presence of toxic metals and mineral deficiencies. If levels of toxic metals are found to be high, then a programme of metal detoxification is undertaken using vitamin C, garlic and the herb milk thistle. If mineral deficiencies are found, the appropriate minerals are supplemented.
Finally, decreasing the amount of stress in your life as much as possible.
For related information, please refer to the Foresight Preconception Care website (www.foresight-preconception.org.uk), the American Pregnancy website (www.americanpregnancy.org) or the Association for Improvements in Maternity Services (AIMS) website (http://www.aims.org.uk) for their article entitled Unsound Ultrasound.
Click the appropriate link for a listing of Bach Flower Remedies available through this site in the UK or US or to order go to the Supplements page.