‘Miscarriage can lead to post-traumatic stress,’ say the headlines.
I have the research paper on my desk top, and I’m reading through it, trying to keep focused. I’m looking for inclusion criteria, drop-out rates and confidence intervals. I’m analysing it. That’s what I do. I’m a medical writer.
But every few minutes I catch myself staring into space. I try to get a grip – I’m on a deadline. I’m a professional. I don’t have time for this.
Nine months after a pregnancy loss, 18% of women reported symptoms of post-traumatic stress. Just under one in five.
I’m sitting on the floor of the maternity outpatient department waiting room (no free chairs) surrounded by heavily-pregnant women and their children, trying not to cry. I wait for three hours, hurting and bleeding quietly, before the ultrasound operator tells me – kindly – that she can’t see a pregnancy. Back out in the waiting room, I want passionately to be somewhere else. Somewhere cold, and clean, and empty. Somewhere this hasn’t happened. Iceland.
As many as 1 in 2 women experience pregnancy loss, I read. I frown. I thought the figure was more like 1 in 6 pregnancies end in miscarriage. But of course, I realise, many women have more than one pregnancy. Some, like me, have more than one pregnancy loss.
I’m in sweatpants and teeshirt, cuddled on the sofa with my husband. The grappling hooks embedded in my pelvis are dragging lumps out of me. I’m sweating with the pain. I need the bathroom. He helps me as far as the hall, where I pass out. As I come round on the floor, I hear him on the phone, telling the 999 operator that my lips have gone white. I realise he thinks I might die. I don’t much care if I do.
After each flash of memory, I drag myself back to the paper. 29% had symptoms of post-traumatic stress after one month, based on 487 responses out of a total of 737 women with pregnancy loss recruited to the study. It’s a high drop-out rate, much higher than usual for a cohort study. Does that matter?
I wonder if I would have filled in questionnaires. Probably; I was quite obedient then.
I’m on a trolley in a cubicle in A&E. It’s happening again. I don’t know how long I’ve been here. An impatient doctor flounces in, dragged down from O&G. ‘So, what’s the problem? You’ve got your period?’ Yeah, I always pop down to the hospital when that happens, I don’t say. Then he examines me and mutters something about the evacuation having spontaneously completed. I try to find the words that will make this real.
I think about what I would have liked him to say. ‘I’m sorry, you’ve lost the baby.’ That would have done fine. Seven words, shorter than the jargon he was trying to evade me with. I don’t think I’d have filled in a questionnaire for him. I might have done for the nurse, though. The one who brought me hot chocolate and a biscuit, the first food I’d had all day. It was sweet and comforting, like she was.
The next week, I walk for hours through London streets. And suddenly feel bone tired, so exhausted I sit down on a bench in the cold February dusk, and try to work out where I am and how I got here. A little later I wake in the middle of the night, misread the clock, panic, get up and showered and ready for work. Still dark. 3am, not 9.
It’s been more than a decade. But even now, when I have to write about miscarriage, I find it that bit harder than writing about other things. It takes me longer to cut to the science, through the miasma of memory.
When I heard this study reported on the Today programme this morning, I guessed I’d have to write about it. And I knew it would be hard.
The most common sign of post-traumatic stress reported by women in the study was ‘re-experiencing symptoms’, with 91% reporting this at one month. Re-experiencing symptoms: involuntarily reliving the event, through flashbacks, nightmares, and distressing images or sensations.
I finish my report, send it off. I roll my shoulders, try to undo the knot of tension between them. Unclench my jaw.
The report authors call for recognition that pregnancy loss can have a psychological impact, and for support to be made available to those who need it. A modest call. I wonder if it would have made a difference.
Source: Farren J, Jalmbrant M, Falconieri N, et al. Post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multi-center, prospective, cohort study. American Journal of Obstetrics and Gynecology.