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Early losses: reframing the discussion around early losses and so called “chemical pregnancies”. Why we should ban the phrase “How far along were you?”
The only evidence Lydia has of her two pregnancies are her pregnancy tests. She keeps the tests themselves under her bed and, from time to time, brings them out to look at the tiny plastic window through which she once saw her future unfolding. Nothing visible remains on the tests now – dye tests fade and digital tests run out of battery – but vibrant, virtual copies live on in Lydia’s phone in a folder entitled Babies. “Sometimes I feel like the tests themselves are my babies,” she explains. “Which makes me feel like I’m crazy. But they are the only proof I have that this has happened to me.” Lydia lost her babies at five and seven weeks respectively. She never got to see them on a scan.
According to the National Childbirth Trust, not all miscarriages are the same. And that is, nominally, true. Miscarriages occur at different stages of pregnancy, for different reasons, and are given different names as a result.
Any loss that occurs within the first 12 weeks of pregnancy is considered an “early miscarriage” and these can happen for a number of reasons.
1- A chemical pregnancy, for example, where the baby stops developing within the first five weeks, is so called because the level of the hormone human chorionic gonadotropin (hCG) is enough to produce a positive pregnancy test but reduces before a doctor can see evidence of the pregnancy on a scan. Women typically miscarry shortly afterwards and a number of them may not even know a miscarriage has taken place, perhaps mistaking the bleeding that signals the end of the pregnancy for a late period.
2- An ectopic pregnancy is when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes. This is always fatal for the foetus and can put the mother’s life at risk, too: a ruptured fallopian tube can cause life-threatening bleeding if untreated.
3- A blighted ovum, otherwise known as an anembryonic pregnancy, is when an embryo either never develops or stops developing, is reabsorbed, and leaves an empty gestational sac which can be seen on a scan.
4- And a missed miscarriage, where there is often no sign that something is wrong, is where the baby dies or stops developing but isn’t physically lost. Typically missed miscarriages are diagnosed at a routine scan.
Sadly, though, for the many women who suffer early miscarriages, the terminology used to describe their losses is often a barrier to their grief.
Lydia, for example, hates the term chemical pregnancy. “I feel like it diminishes the pregnancy you had,” she explains. “Like, it removes my right to be upset because I’m not even having a proper miscarriage, let alone a pregnancy.” Lydia also finds the expression ‘early loss’ – one she’s heard many times before, always in kindly, reassuring tones – challenging, the adjective ‘early’ caveating unnecessarily: a loss, after all, is a loss. Yes, she says, some women don’t notice a loss at this stage and, yes, some might mistake it for a late period. But she didn’t. She noticed.
Lydia isn’t alone. Kirsty fell pregnant in January and contracted Covid in February. Unable to get a scan before 14 weeks on the NHS but seeking reassurance, she paid for a private scan and was met with the news she had been dreading. She was pregnant but it wasn’t looking good: the gestational sac that surrounds an embryo during the first few weeks of development was full of blood. She was referred to hospital, where an internal scan couldn’t detect a heartbeat, and was told to prepare for a miscarriage. Sure enough, days later, she started to bleed, a small amount at first. Then, three days after the bleeding had begun, it intensified. “The clots were absolutely horrific. I couldn’t walk without feeling things falling out of me,” she says. Soaked in blood, Kirsty took herself to A&E. “I went to the loo and it was like a murder scene.” Kirsty was rushed to resus where, for 15 hours, she bled. But the foetus remained. She describes the moment the doctors gave her a tablet to end her pregnancy: “That was the worst moment of my life, knowing that I had to take it expecting to kill my child.” But it didn’t work. The following day, Kirsty had a dilation and curettage, a surgical procedure where foetal tissue is removed from the uterus. “It was absolutely horrendous. I had never felt so alone in my life,” she explains. Her anguish was compounded when the doctor who performed the surgery, upon visiting her on the ward afterwards, described the “nasty stench” of what had been removed from her womb: an embryo that had stopped developing at five weeks. Later, out of hospital, even her friends couldn’t find the right words. Kirsty says: “I was told so many times it was only an embryo.”
Small words carry great weight – whether they are uttered by friends, family, or – even – experts in the field. Charly, for example, finds the adverb “just” challenging. Just six weeks pregnant. Just a chemical pregnancy. “I feel it invalidates how sad I am,” she explains. “Even a specific counsellor who specialises in baby loss said those things to me and I never went on to get counselling as I felt embarrassed that I was upset about something an expert suggested wasn’t worth getting upset about.”
So many women have similar stories. Lucy, who lost her baby at six weeks, was asked why she was so upset if “you weren’t really pregnant”. Holly was advised – unbelievably, by a medical professional – that she hadn’t actually lost a baby, just “a collection of cells”. Ashley was told “at least you can get pregnant”. Elise was told “it’s just a period, only two weeks late”. Sophie was told, by her GP, that they don’t class chemical pregnancies as “proper pregnancies”. Chloe was reassured that “Mother Nature can be so kind if something isn’t right”. And Emma was told that her loss was “a blessing in disguise”; that “everything happens for a reason”; and, by close family members, that “you just weren’t ready to be a parent”.
So what needs to change? How can we use our language to support someone going through a miscarriage in the first trimester?
According to Amina Hatia, Midwifery Manager at pregnancy charity Tommy’s, there is no one-size-fits-all approach; everyone handles grief differently. “What is important is that being a kind, compassionate person is worth its weight in gold to someone who is feeling the sadness of baby loss – even when you don’t know what to say – sometimes the best thing to do is to just sit and listen,” she explains. “Many parents affected by loss feel alone and isolated, so your willingness to be present in some way with them really matters – more than having exactly the right thing to say.” It’s important to ask how a person wants to be supported, she explains. “If you’ve been through an early loss yourself, they might find comfort in hearing about your experience and how you coped with it, but others might not. Some people who have experienced loss might want to talk about their baby and use their name if they already had one in mind, but others’ won’t – so it’s always best to ask. Try to give them space to say everything they want to say.”
Finally, she says, it can be exhausting and overwhelming to try and answer the question ‘how are you?’ so Amina recommends asking ‘how are you doing today?’ instead, to acknowledge that every day is different and every feeling legitimate.
Lydia would like to banish the words “just”, “only”, and “at least”. Words that reduce a pregnancy, and a loss, to something lesser. She adds, too, that an acknowledgment of a person’s individual experience is important. “I’m not an expert in everyone else’s grief. I think all you can do is say: ‘This is horrible, I don’t know how you’re feeling, but I’m here.’” Charly agrees. “Make sure you tell the person going through it that it’s OK to feel all of the feelings – there’s no right or wrong way to feel.” Both women feel uncomfortable, too, about the, albeit well-meaning, advice that is too readily offered to women who experience early losses. “Sometimes success stories about people who have known people who go on to have healthy pregnancies can be helpful but they can also invalidate how you feel right now,” says Charly. Lydia agrees, explaining that people seem to think miscarriages in the first few weeks are problems to be solved, not losses to be grieved. “In those moments when you really need that support, you don’t want fixes, you want to grieve what you’ve lost.”
Because a miscarriage in the first few weeks of pregnancy is not, for many, the loss of an embryo, or a collection of cells. It’s the loss of a newborn, a toddler, and a teenager.
A decorated nursery. A name, chosen specially. A first day at school. A graduation. A wedding. An entire imagined future, gone in an instant. That is the loss that is mourned when the bleeding begins or a once positive pregnancy test begins to fade. And, say the women at the heart of this issue, it’s about time our language reflected that.
For anyone who has experienced the loss of a baby, whether through miscarriage, stillbirth, neonatal death, or termination for medical reasons. Tommy’s offer support here.