The emotional effects of a miscarriage can be long-lasting. Caroline Sylger Jones on the anxiety, guilt, isolation and depression that many women experience Miscarriage occurs in one in four pregnancies, but its commonality offers little comfort to the women who experience it. It's a loss that's hard to describe and often difficult to come to terms with. I had a miscarriage in May this year while on holiday with my husband. For 10 weeks we'd been enjoying the delicious thought that by December we would be starting a family. But over just a few days, I lost the pregnancy.
Looking back, I wish I'd waited until my first scan before I got excited, but with obvious changes happening in my body I couldn't help it. I'd been making quiet but radical plans in my head in preparation for an event that would change everything, from my career and relationship to the decor of my house and how much sleep I got. "Some women in their 50s and 60s still tell me they have two children and that they lost two," says Dr Rosalie A Sant, a consultant obstetrician and gynaecologist at Primavera Medical Centre in Dubai Healthcare City. "These are usually early miscarriages that occurred 30 to 40 years before, and they still talk about them."
The term miscarriage is normally defined as a pregnancy that ends before 22 weeks, the time just before most developing babies are able to survive outside of the womb, though the majority occur in the first 13 weeks. Some women miscarry before they even realise that they are pregnant, and after 13 weeks, Sant says, the chance of miscarrying is less than one per cent. It's usually an entirely natural process - your body's way of saying no, this one's not going to develop healthily, best let it go so we can start afresh. Intellectually I understood this, but it didn't stop me feeling a sense of loss that, four months on, continues. Though my husband is extremely supportive, he is naturally more detached from the situation.
"Hormonal changes to a woman's body in early pregnancy encourage a bond with what's inside, which is why a woman can feel such a sense of loss even if the pregnancy stops early," Sant says. Most physical effects of miscarriage tend to clear up quickly, but the emotional effects can be much greater. Depression, anxiety, grief, self-blame and anger are typical responses, though experts agree everyone reacts differently and there is no right or wrong way to feel.
The women I spoke to in Abu Dhabi and Dubai (names changed for privacy) experienced early miscarriage with a painful sense of disbelief. "I couldn't let myself accept it was actually happening when I first started bleeding," says Rose, who had a miscarriage at 10 weeks before her first child. "When the bleeding continued I knew in my heart something was seriously wrong, but I just kept hoping the baby would be OK."
Jane, who had three miscarriages over a year and a half after having her first child, says she "felt sick with disappointment". And Annabelle, a member of the Abu Dhabi Mums support group, suffered a severe dose of envy. "It is difficult to hide your emotions as you find out about yet another new pregnancy. You want to be happy for them but deep down you just feel resentment because you wish it was you."
One of the most unsettling things about experiencing a miscarriage is not knowing why it happened. While imbalances in pregnancy hormones, problems with your immune system, polycystic ovary syndrome and infections such as listeriosis and malaria are thought to increase risk, about half of all early miscarriages happen because of a problem in the way the genetic material, or chromosomes, combined during fertilisation. This is more likely to be due to chance than to any underlying problem with you or your husband.
Knowing this rarely stops women from blaming themselves for the miscarriage. I convinced myself that the body boarding I enjoyed was the reason; a friend of mine wondered if hers was due to the strong antibiotics she had been taking, while Rose thought a long-haul flight had brought hers on. Sant says there are some simple changes that women can make to reduce their chances of a miscarriage. These include giving up smoking, losing any excess weight, taking folic acid three months before you try to conceive and remaining as stress free as possible. It's especially important to eat healthily before and during pregnancy. "An unhealthy diet increases our chances of diabetes," Sant says. If you've miscarried before and feel anxious, it's also a good idea to have an early scan. In Sant's experience, if all is well on a scan at nine weeks, the risk of miscarriage will be very low.
Most women over 35 think their age may have been a factor in the case of an early miscarriage. Ruth Bender-Atik from The Miscarriage Association in the UK explains that "the risk increases the older you are because women are born with all the egg cells that they're ever going to have. Over time, some eggs pass their sell by date, so though they can be fertilised, they're not in great shape." According to the women and baby charity Tommy's, 15 per cent of mothers between 30 and 34 miscarry. The number rises to 51 per cent for women between 40 and 44. Paternal age affects the quality of a pregnancy, but less so, says Sant.
Whatever a woman's age, it is highly unlikely that anything they have done will have stopped a healthy pregnancy, which is naturally very well protected. "It's not a good idea to go parachuting while you're pregnant or to drink a bottle of wine a night, but bar a severe blow to the abdomen or a major intake of toxins, if a pregnancy is going to be OK, it will be OK," says Bender-Atik. It's best, she says, to see that nature will always take its course. "Just as it's very difficult to shift a healthy pregnancy, so you can't prevent a miscarriage if it's going to happen."
Candice, of Abu Dhabi, had a miscarriage shortly after arriving in the UAE. She reasoned it was "down to biology" and that "these things happen for the best". The worst thing for her was the pressure to get pregnant again. I too felt pressure to become pregnant again quickly - not least because I was 39 - but it's a pressure I resisted on the advice of my yoga teacher. "If you try again too early you run the risk of the same thing happening again. Give the system time to clean itself out and replenish its energy," he advised.
When a women chooses to try again will depend on her feelings and circumstances, though most doctors agree it's a good idea to wait for at least one month. What's important, says Sant, is that you have mourned however you see fit. "I always encourage my clients to express their fears, to get all their questions answered, then to get back to normal life as soon as physically possible." To do this, many women find talking to others who have experienced the same thing helps. This is not always easy, particularly for recently arrived expatriates because, as Sant says, "people have not usually known each other for a long time". It doesn't help that a lot of women keep silent about their pregnancy until their first scan, so have few people to confide in.
Focusing on the positive always helps. "I got stuck into eating prawns, Camembert and caffeine-loaded tea again and focused on the fact we already had a lovely little daughter," says Jackie, who suffered a miscarriage at 35. She is now pregnant with her second child. As for me, I am beginning to feel confident that despite my feelings of loss, I will get pregnant again.
A charity that funds scientific research, providing information on the causes and prevention of miscarriage (www.tommys.org).
Abu Dhabi Mums (www.abudhabimums.ae) and Dubai Mums Club (www.dubaimumsclub.com) are useful support networks.
The UK-based group offers advice to women from all over the globe and translates its leaflets into different languages (+ 44 1924 200799, www.miscarriageassociation.org.uk).