Speaker 1: Hey, this is Annie and the Samantha and Welcome to Stuff.
Speaker 1: I've never told your production of I Heart Radios how
Speaker 1: stuff works. And this classic episode we wanted to to
Speaker 1: replay one that is a part of the conversation we're
Speaker 1: having nationally worldwide around abortion and it's miscarriage. Yes, because
Speaker 1: a lot of the laws and bands being proposed here
Speaker 1: are being passed here do you have stipulations in them
Speaker 1: where somebody who has a miscarriage to be investigated for homicide? Right?
Speaker 1: This is something I think you and I Samantha definitely
Speaker 1: wanna return to and um find some people to to
Speaker 1: talk to you about this because I think that, um,
Speaker 1: it impacts more women. Um then we know, right, it
Speaker 1: impacts a lot of women. In the statistics out there,
Speaker 1: it's pretty high the likelihood of miscarriage, and you know
Speaker 1: that's being floated around for quite some time now. And
Speaker 1: then just having the language of what is a miscarriage
Speaker 1: versus an abortion and on what does all that look like,
Speaker 1: especially like with medical procedures and how that can be. Yes,
Speaker 1: But in the meantime, here is this classic episode and
Speaker 1: we hope you enjoy Welcome to Stuff. Mom never told
Speaker 1: you from how stupp works dot com. Hello and welcome
Speaker 1: to the podcast. I'm Caroline and I'm Kristen. Today's topic
Speaker 1: is one that has been requested by a lot of
Speaker 1: you listeners out there. It's a rather sensitive topic for
Speaker 1: a lot of women and their partners. Um it's we're
Speaker 1: talking about miscarriages today. It's a it's a common health
Speaker 1: issue that a lot of people face, and we have
Speaker 1: never done anything just kind of giving you the one
Speaker 1: oh one on miscarriages before, so today we thought we
Speaker 1: would talk about the whole issue. Yeah, and I think
Speaker 1: it's also important for us to talk about miscarriage, not
Speaker 1: just because so many women experience it, but because it's
Speaker 1: something that we don't talk about very much, probably among ourselves,
Speaker 1: especially considering how common it is. Um. So we're just gonna, yeah,
Speaker 1: walk through what it is and why it happens, more importantly,
Speaker 1: almost why it doesn't happen, and the psychological repercussions. So,
Speaker 1: first off, what is a miscarriage. This is coming from
Speaker 1: the National Institutes of Health, and technically speaking, it's the
Speaker 1: spontaneous loss of a fetus before the twenty week of pregnancy,
Speaker 1: because pregnancy loss after the twenty week is actually called
Speaker 1: a pre term delivery, right. And another term for miscarriage
Speaker 1: is spontaneous abortion, and spontaneous being the key word, this
Speaker 1: refers to a naturally occurring event, not anything to do
Speaker 1: with medical abortions or surgical abortions. And there are other
Speaker 1: terms for early loss of pregnancy, including what's termed a
Speaker 1: complete abortion, wherein all of the tissue of conception leaves
Speaker 1: the body, and there's incomplete, inevitable, infected, and missed abortion.
Speaker 1: All of those different terms relate to how much of
Speaker 1: a tissue leaves the body, whether or not, as infected
Speaker 1: abortion implies whether or not there was some kind of
Speaker 1: infection in the womb. Um. Missed abortion, for instance, is
Speaker 1: when the pregnancy is lost but the products of conception
Speaker 1: as they're called, remain inside of the body. Right. And
Speaker 1: there's also this term called threatened miscarriage. This is basically
Speaker 1: when the symptoms of miscarriage occur, whether without vaginal bleeding,
Speaker 1: and half of threatened miscarriages do in fact in in
Speaker 1: pregnancy loss, and so the signs of miscarriage include things
Speaker 1: like cramping, bleeding, and lower back pain. And there was
Speaker 1: one column that I was reading in Slate by a
Speaker 1: woman named Sarah shem Kiss, who was talking about how
Speaker 1: miscarriage is often portrayed on television as this one time event,
Speaker 1: like where a woman goes to the bathroom and she
Speaker 1: sees blood and then it's over. And one thing that
Speaker 1: a lot of people might not realize is that this
Speaker 1: can be a process that can take at least in
Speaker 1: shem Kisses case, as long as a week to happen. Um. So, yeah,
Speaker 1: then that just is just kind of putting it out
Speaker 1: there to clarify how the process can can vary for
Speaker 1: different women. Right, And so we should take a look
Speaker 1: at the causes of miscarriage because contrary to you know,
Speaker 1: there's a lot of misinformation I feel like around around
Speaker 1: things like this, having sex exercise, mild falls and most
Speaker 1: medications do not cause miscarriage. Again, sex exercise, mild false
Speaker 1: medications not a cause of miscarriage. And a lot of
Speaker 1: times when it happens, there might be some guilt on
Speaker 1: the part of the mother and her partner thinking that
Speaker 1: there might be something wrong with their genes that caused
Speaker 1: this pregnancy loss. But in fact, most miscarriages are caused
Speaker 1: by chromosomal problems that essentially make it impossible for the
Speaker 1: baby to develop, but those problems are usually not related
Speaker 1: to mother's or father's genes, right, And a common chromosomal
Speaker 1: issue that comes up is that the embryo or fetus
Speaker 1: has a chromosome that causes it to develop abnormally. And
Speaker 1: this is not usually a sign of a condition that
Speaker 1: could cause problems in future pregnancies because it usually happens
Speaker 1: by chance when the egg divides and grows. And this
Speaker 1: is actually a problem that causes at least half of miscarriages.
Speaker 1: And one thing that medical scholars have been looking more
Speaker 1: closely at too in recent years is a correlation between
Speaker 1: miscarriage and partners age, not the mother's age, um they're
Speaker 1: the frequency. For instance, of these kinds of chromosomal anomalies
Speaker 1: in spermatozoa appear to increase with male age, So, for instance,
Speaker 1: in two thousand four, there was a study published an
Speaker 1: American Journal of Epidemiology which found that pregnancies by fathers
Speaker 1: fifty years or older carried twice the risk of miscarriage
Speaker 1: compared with pregnancies with younger fathers. And some other possible
Speaker 1: risk factors for miscarriage include things like drug and alcohol
Speaker 1: abuse during pregnancy, exposure to environmental toxins, hormone problems, infection, obesity,
Speaker 1: or on the flip side, being extremely underweight, um smoking,
Speaker 1: and problems with the body's immune response. Yeah, an age
Speaker 1: can also be a factor for risk of miscarriage as well,
Speaker 1: as we talked about in our episode on why it's
Speaker 1: harder to get pregnant after thirty five of because the
Speaker 1: risk of miscarriages hiring women who are older, and that
Speaker 1: risk starts to elevate after age thirty, but it really
Speaker 1: escalates after forty. But no matter the age of the mother,
Speaker 1: miscarriage is most likely to happen early. In fact, most
Speaker 1: miscarriages occurred during the first seven weeks of pregnancy. Eight
Speaker 1: out of ten miscarriages happened during the first three months
Speaker 1: of pregnancy, and second trimester miscarriages happened in just one
Speaker 1: to five of pregnancies. Yeah, I kind of put another way.
Speaker 1: More than half of all pregnancies are spontaneously lost before
Speaker 1: a woman even knows she's pregnant, before she even misses
Speaker 1: a period. That's how common this happened. So in other words,
Speaker 1: women might have miscarriages and not even know it because
Speaker 1: they didn't even realize they were pregnant, right, And you know,
Speaker 1: as as horrifying as the experience of miscarriage is, typically
Speaker 1: it's to tistically, it is usually a one time occurrence.
Speaker 1: Most women who miscarry go on to have a healthy
Speaker 1: pregnancy after the miscarriage. However, there is a recovery period,
Speaker 1: and people kind of debate how long this period should
Speaker 1: go on, you know, do you wait a long time,
Speaker 1: do you try again immediately? Should you take you know,
Speaker 1: basically mental health into consideration when you're doing that. And
Speaker 1: while it of course varies from person to person, the
Speaker 1: physical recovery from miscarriage in most cases takes only a
Speaker 1: few hours to a couple of days. Yeah, I mean,
Speaker 1: your periods will likely return within four to six weeks,
Speaker 1: and it is possible to become pregnant during the menstrual
Speaker 1: cycle immediately after a miscarriage. Now, that said, the World
Speaker 1: Health Organization recommends waiting at least six months before trying
Speaker 1: to conceive. That six month waiting period seems to be
Speaker 1: standard advice, although more recent studies are starting to call
Speaker 1: that in a question because the w h O is
Speaker 1: recommending that's six month wait time based largely on maternal
Speaker 1: health in developing countries where medical care is less reliable
Speaker 1: and where women tend to get pregnant at earlier ages. Correct. Yeah,
Speaker 1: And the British Medical Journal actually says that women who
Speaker 1: conceive within six months of a miscarriage instead of waiting
Speaker 1: up to a year end up reducing their risk of
Speaker 1: another miscarriage by a third, and they also increase their
Speaker 1: chances of a healthy and successful pregnancy. But Julius Shelley,
Speaker 1: who's an associate professor at Deacon University in Burwood, Australia,
Speaker 1: wrote an editorial accompanying that British Medical Journal study, offering
Speaker 1: a little bit of a qualification, saying, quote, we cannot
Speaker 1: really tell whether pregnancy is conceived very soon after a
Speaker 1: miscarriage really do have better outcomes, or whether women and
Speaker 1: couples who conceive quickly following a miscarriage have better outcomes
Speaker 1: in subsequent pregnancy than couples who take longer to conceive. Right.
Speaker 1: And so, I mean it kind of depends person to person,
Speaker 1: really on your own person mental health and all of
Speaker 1: that stuff. I mean, if you're healthy and feel ready,
Speaker 1: doctors say there might not be a need to wait. Uh,
Speaker 1: you know, if you're if you're taking your prenatal vitamins
Speaker 1: or your full like acid supplements. You know that that
Speaker 1: usually starts months before you even conceive, as long as
Speaker 1: you're maintaining a healthy weight including physical activity, uh and
Speaker 1: eating a healthy diet, and of course managing stress and
Speaker 1: avoiding alcohol smoking that sort of stuff. Yeah, and I
Speaker 1: would imagine too that that weight time might also depend
Speaker 1: on the type of miscarriage that occurs, like we were
Speaker 1: referenced at the top of the podcast of the various
Speaker 1: kinds that can happen. Um. But one thing too that
Speaker 1: we wanted to mention is the question of whether or
Speaker 1: not having a medical abortion of voluntary abortion in any
Speaker 1: way predisposes you to miscarriage, because I think that is
Speaker 1: a fairly common assumption. When I was just poking around
Speaker 1: on Google looking for solid data on this, there were
Speaker 1: a lot of uh sort of inflammatory tie A blog
Speaker 1: posts that immediately pop up saying that if you have
Speaker 1: an abortion, then you are risking you know, subsequent miscarriage
Speaker 1: or infertility. Um. However, the Royal College of Obstetricians and
Speaker 1: Gynecologists says, quote there are no proven associations between induced
Speaker 1: abortion and subsequent ectopic pregnancy PULLA cent to previa or infertility.
Speaker 1: And one reason that some people have thought that miscar
Speaker 1: that abortion might lead to miscarriage is because it's based
Speaker 1: on old data. Basically, abortion technology has improved and made
Speaker 1: it safer for the mother and left the uterus and
Speaker 1: the cervis more intact, So there should not be a
Speaker 1: greater risk of miscarriage, right exactly. And one risk factor
Speaker 1: that we didn't really touch on fully is the idea
Speaker 1: that women who have had previous miscarriages are at a
Speaker 1: greater risk of having future or miscarriages. And yes, this
Speaker 1: is a definite risk factor, but it is it is small.
Speaker 1: Less than five percent of women have two consecutive miscarriages
Speaker 1: and only one percent have three or more consecutive miscarriages.
Speaker 1: And this is coming from the Mayo Clinic. Uh they
Speaker 1: write that after two consecutive miscarriages, there's a seventy chance
Speaker 1: that the next pregnancy will be maintained. Now, somewhat counterintuitively,
Speaker 1: after three miscarriages, in fact, that risk drops to But
Speaker 1: when looking for the reasons why someone might be experiencing
Speaker 1: recurrent miscarriages, but in cases of recurrent miscarriage, the big
Speaker 1: question mark often is why it's happening because I believe
Speaker 1: this was reported on in the New York Times that
Speaker 1: in fewer than half of couples experiencing that will doctors
Speaker 1: pinpoint a definite cause, and the causes of recurrent miscarriage
Speaker 1: really tied back to miscarriage over all. UH, the overwhelming
Speaker 1: majority of these recurrent miscarriages that happen because of chromosomal abnormalities, which,
Speaker 1: as we already discussed, increase with the mother's age and
Speaker 1: with the father's age. There could be genetic errors in
Speaker 1: the egg or sperm that result in embryos with too
Speaker 1: many or too few chromosomes, but environmental factors are rarely
Speaker 1: linked to pregnancy loss and there have been no associations
Speaker 1: between environmental factors and recurrent pregnancy loss established. There could
Speaker 1: also be an inherited disorder that raises a woman's risk
Speaker 1: of blood clots um also called thrombosis, that can increase
Speaker 1: the risk of fetal death in the second half of
Speaker 1: pregnancy as well. And if you experience multiple miscarriages, there
Speaker 1: there are tests that you can have when you go
Speaker 1: to your doctor, things like blood tests. They can evaluate
Speaker 1: it to detect problems with hormones, your immune system, um,
Speaker 1: there are chromosomal tests that you and your partner might
Speaker 1: both have your IT tested to determine if chromosomes can
Speaker 1: be a factor if there is tissue from the miscarriage
Speaker 1: that's remaining that can be tested, and these chromosomal analyzes
Speaker 1: can basically see if there's some inherited genetic cause that happens.
Speaker 1: And that's in less than five percent of couples. But
Speaker 1: I mean, you know, talking about the immune system problems
Speaker 1: and the hormonal problems, like you know, we mentioned in
Speaker 1: our thyroid episode that you know that is both when
Speaker 1: you have something like graves or hashimotos, that's both a
Speaker 1: hormone and an immune disorder problem. So having those tests
Speaker 1: leading up to pregnancy, whether you've had miscarriages or not,
Speaker 1: is very important. Yeah, and and again we want to
Speaker 1: underscore that on the bright side, about six of women
Speaker 1: with unexplained repeated miscarriages still go on to have healthy pregnancies,
Speaker 1: So even if you've had multiple miscarriages, it's certainly likely
Speaker 1: that you can still have a baby. So we've talked
Speaker 1: about the physical repercussions of miscarriage, what what might be
Speaker 1: going on inside the b addie, but we also need
Speaker 1: to talk about how miscarriage can impact the mind and
Speaker 1: your emotional well being, not just for mothers, but also
Speaker 1: for partners as well. So we're going to get into
Speaker 1: the psychology of pregnancy loss when we come right back
Speaker 1: from a quick break. So we were talking a lot
Speaker 1: about the physical causes and effects of miscarriages, but one
Speaker 1: thing we have not talked about yet is the psychological effect,
Speaker 1: the burden that the mother and her partner feel when
Speaker 1: this tragedy has happened, and calling it a tragedy is
Speaker 1: I mean, I feel like a lot of times when
Speaker 1: miscarriages are discussed, they're kind of brushed off anyone outside
Speaker 1: of the couple or the mother who is having the child.
Speaker 1: It's kind of the attitude is like, oh, well, you'll
Speaker 1: be okay, just try try again. Well, and especially if
Speaker 1: it's lost early from the pregnancy to right there's seems
Speaker 1: to be kind of this general misunderstanding about the emotional
Speaker 1: toll that a miscarriage can take on a couple or
Speaker 1: a mother, however early it happens, Traditionally, it's kind of
Speaker 1: this private event, you know. I know a friend of
Speaker 1: mine had a miscarriage before she had her children, and
Speaker 1: I didn't even know about it. You know, it was
Speaker 1: once she was pregnant with her now two year old
Speaker 1: that you know, she said, oh, yeah, you know, early on,
Speaker 1: I had this thing. And and it's almost as if
Speaker 1: a lot of moms feel like they're not allowed to
Speaker 1: be sad, or they're not allowed to be sad in public. Yeah,
Speaker 1: but a new research suggests that some women might actually
Speaker 1: more in for a lot longer than expected, which is,
Speaker 1: you know, part of why we wanted to to talk
Speaker 1: about this issue, to kind of open up these conversational
Speaker 1: lines for women to feel more comfortable talking about these experiences,
Speaker 1: because it can last even after the birth of a
Speaker 1: healthy child, although of course the range inseverity of the
Speaker 1: symptoms are going to vary and h Janet Jaffee, who
Speaker 1: is a clinical psychologist at the Center for Reproductive Psychology
Speaker 1: in San Diego, says that it's kind of the medical
Speaker 1: commonality of miscarriages that lead us to kind of brushing
Speaker 1: them off, to underestimate the impact that they can have
Speaker 1: on a family. Um Jaffe says that it's a traumatic
Speaker 1: loss not only of the pregnancy, but of a woman's
Speaker 1: sense of self and her hopes and her dreams. Of
Speaker 1: the future. She has lost her reproductive story and it
Speaker 1: needs to be grieved. Yeah, and a woman who has
Speaker 1: a miscarriage is understandably at risk for symptoms of depression
Speaker 1: and anxiety, not just immediately following the miscarriage, but in
Speaker 1: in the years to come and even after having a
Speaker 1: healthy child. Women who miscarry also have a higher risk
Speaker 1: of postpartum depression. And there is a paper published in
Speaker 1: the British Journal of Psychiatry in two thousand eleven looking
Speaker 1: at this, and the researcher followed more than thirteen thousand
Speaker 1: women for three years post birth and of though who
Speaker 1: had miscarriages, they were about hundred of those women who
Speaker 1: had had a miscarriage experienced clinically significant depression and or
Speaker 1: exiety anxiety during and after the pregnancies for up to
Speaker 1: those three years. And this can really affect women as
Speaker 1: they become mothers, as they bear healthy children. Um A
Speaker 1: study looked at women who had delivered a child within
Speaker 1: nineteen months after a miscarriage and found that of the
Speaker 1: infants had disorganized attachments to their mothers that it was
Speaker 1: still affecting them in the way that they viewed their
Speaker 1: healthy children. And not only can it take a toll
Speaker 1: on mother's relationship with her children, but understandably it can
Speaker 1: take a toll on her relationship with her partner. Um,
Speaker 1: there have been there's been research into how miscarriage can
Speaker 1: impact UH sex life, for instance, and a lot of
Speaker 1: times you'll see in heterosexual relationships men might be ready
Speaker 1: to move on and wanted reignite that flame, whereas women
Speaker 1: might not be ready to have sex for a while. Yeah, exactly.
Speaker 1: And we should look at at partners, both both male
Speaker 1: and female partners, when it comes to having a miscarriage
Speaker 1: because traditionally, the feelings experienced by the partner tend to
Speaker 1: be dismissed, both within the family and without. And studies
Speaker 1: have shown that men are not satisfied with the support
Speaker 1: they get from others. Nonetheless, research also has shown that
Speaker 1: that men absolutely grieve these losses as well, but it
Speaker 1: might not be as intense or as enduring as their partners,
Speaker 1: which is understandable because it's not as much of a
Speaker 1: physical experience perhaps for them. Right. And study in the
Speaker 1: Journal of Psychosomatic Research found that UM, for both men
Speaker 1: and women in these situations, giving up their personal expectations,
Speaker 1: hopes for and fantasies about out the unborn child is
Speaker 1: a major source of grieving. Some men, on the other hand,
Speaker 1: feel burdened, particularly by their wives grief or depressive reactions.
Speaker 1: I'm sure, feeling helpless, not knowing what to do or say.
Speaker 1: They can't say anything right exactly. I mean, there's no
Speaker 1: way to to magically fix that situation. Um. And so
Speaker 1: you see sort of gender stereotypical differences emerging in these
Speaker 1: studies of how men tend to manage their grief compared
Speaker 1: to women. For instance, one study published in the Journal
Speaker 1: of Reproductive and Infant Psychology found that men might display
Speaker 1: less what they call immediate active grief, but they might
Speaker 1: also be more vulnerable to feelings of despair and difficulty coping,
Speaker 1: probably because of a sense of helplessness. Right. And while
Speaker 1: studies have shown that no matter how advanced the pregnancy is,
Speaker 1: the woman will likely feel the same sense of loss,
Speaker 1: for men, the more advanced it is, the greater their
Speaker 1: sense of loss, the more it's almost like they're getting
Speaker 1: to know this little person from the ultrasound on, whereas
Speaker 1: the woman's sense of grief is heightened either way. Yeah,
Speaker 1: and there have been similar studies on this conducted among
Speaker 1: lesbian couples as well, and it finds for the non
Speaker 1: pregnant lesbian partners similar feelings that that husbands or boyfriends
Speaker 1: might experience in heterosexual relationships. Um for instance, in one
Speaker 1: study talked about how often the response is, you know,
Speaker 1: a sense of having not only lost the baby, but
Speaker 1: also kind of having lost emotionally speaking, the partner, not
Speaker 1: knowing how to sort of rebuild that connection. How do
Speaker 1: you move forward from that? Right, and researcher Denuda m
Speaker 1: Wasner said that lesbian couples do face kind of a
Speaker 1: unique situation psychologically and emotionally in that they're gonna be
Speaker 1: a lot of people who didn't approve of this union
Speaker 1: and this pregnancy in the first place, So there might
Speaker 1: even be a ratear lack of support for them in
Speaker 1: this time. Well, they might have to go to greater
Speaker 1: links as well to go about getting pregnant in the
Speaker 1: first place. Right, and and that even ties in with
Speaker 1: other studies that have shown that women who go through
Speaker 1: like fertility treatments or IVF or something like that their
Speaker 1: grief tends to be extended past the point of where
Speaker 1: other women are starting to move on. Yeah, and and
Speaker 1: I don't want to leave gay fathers out of the
Speaker 1: equation as well, because I'm sure there can be a
Speaker 1: similar process. For instance, if you're, you know, hoping to
Speaker 1: adopt and that falls through. I mean, anytime you're going
Speaker 1: to experience some kind of of loss of unexpected child,
Speaker 1: we need to be able to to talk about it
Speaker 1: into to grieve with them and for them, and allow
Speaker 1: that process to happen. So the question would be, then,
Speaker 1: you know, if you are the friend, what can you
Speaker 1: do if you find out that that someone you know
Speaker 1: has experienced a miscarriage. Well grief expert Robbie Miller Kaplan
Speaker 1: stresses that a miscarriage is a death in the family,
Speaker 1: and just like any death, the bereaved must grieve for
Speaker 1: the loved ones they have lost. And so she says,
Speaker 1: first it's really important to acknowledge the loss that your
Speaker 1: friend is experienced. Yeah, she says, you should treat your
Speaker 1: friend just like you would treat a loved one who
Speaker 1: had who has had a family member die. Send flowers,
Speaker 1: write a note, bring a meal, or just offered to
Speaker 1: visit and listen, you know, right, And she stresses that
Speaker 1: when you're talking with your friend and listening to your
Speaker 1: friend kind of repeat things back to him or her
Speaker 1: so that she or he knows you're listening, you're actually
Speaker 1: taking it all in, and that they're being heard.