I have now finished my rotation in A&E and have spent a lot of time reflecting on my time there. It is a department that receives praise and criticism, expectations and complaints from everyone: GPs, medics, surgeons, politicians and the public. You really do see all of humanity at the front door. Time and again I have been overwhelmed, shocked and surprised at what I have faced.
But of all the things I witnessed there, the one topic that continued to stay in mind was miscarriage: how common it is (15-20% of pregnancies (1)), how isolating it can be and the silence it creates around itself. Even in medical school it was never really a topic we learnt about; Obstetrics & Gynaecology was crammed into a four-week block, most of which revolved around the health of the mother and assessment of the newborn. During my clinical placements I never came across miscarriages; I was always dragged to the operating theatre to assist with a caesarian section or to witness childbirth. I am ashamed to say I had just as little knowledge as the person on the street when I first started my job in A&E.
This is not unique to me; this silence is all around us. It’s not something we chat about with our friends or discuss over the work table. We don’t see headlines in the newspapers or on our social media page. So we start to think of miscarriage as a rarity, as something that is not only sad but something to be shameful of. This self-blame is seen time and again when women such as shame, guilt and embarrassment to describe their experiences (2). Notice how these words are directed towards the self? As if the woman herself is in some way responsible. The truth is that many miscarriages are a result of the body recognising that the baby will be unlikely to survive due to chromosomal abnormalities rather than the mother having ‘done’ something (3).
Furthermore, the concept of having a successful pregnancy is still linked to femininity. To miscarry can feel to many as an attack on their womanhood – maybe even their motherhood. I came across many young women in the Emergency Department who were having a miscarriage. Most were in shock, others in tears while some lay quietly with their partners by their side. This sadness, these tears were not just directed towards the loss of their baby but towards themselves as well: I am at fault, I shouldn’t be a mother, I am a bad person. Such grief followed these young ladies long after they had left the hospital. Without someone to share their story with, they became consumed by the false belief that miscarriage was a ‘sign’ – that they shouldn’t have children or that they would be a ‘bad mother’. It is truly heartbreaking to hear such stories.
But the reason the concept of miscarriage has stayed in my mind for so long is not because of the sadness I witnessed but because of the power of knowledge and understanding. When women presented to our Emergency Department with a miscarriage, nurses would sit with them and listen to their stories. They would talk through what was going on in their body, why it was happening (that it’s not your fault) and that they were not alone. This understanding, dressed in a listening ear and a caring heart, was transformative.
This is why it is important to break the taboo. Women continue to go through this experience alone, feeling they cannot speak to anyone about something which they consider to be a personal defect, feeling that they alone are being ‘targeted’ in some way. We all deserve to be empowered by knowledge about what is going on with our bodies, as well as the opportunity to share our stories without shame or embarrassment.
Many aspects of women’s lives are now being discussed in public spheres, from conversations around menstruation to everyday sexualisation. The taboo of miscarriage is a part of this conversation and it is up to us to share our stories and fight back against this atmosphere of shame.
- Sagili, H., Divers, M. 2007. Modern management of miscarriage. The Obstetrician & Gynaecologist. 9: 102-108
- Barr, P., Cacciatore, J. 2008. Problematic Emotions and Maternal Grief. Journal of Death and Dying. 56: 331-348
- Jurkovic, D., Overton, C, Bender-Atik, R. 2013. Diagnosis and management of first trimester miscarriage. The BMJ. 346: f3676
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