Pregnancy loss is the death of an unborn baby (foetus) at any time during the pregnancy, it may occur in as many as 1 in every 4 pregnancies. Most pregnancy losses occur during the first trimester, whereby sometimes it is so early even before the mother knows she is pregnant. Pregnancy loss is defined differently around the world but in general. A baby that dies before 28 weeks is called a miscarriage often referred to as spontaneous abortion, then there is stillbirth, which is when the baby dies after 28 weeks of gestation.
About half of early pregnancy losses are from problems with genes or chromosomes. However, other factors can also play a role such as hormonal imbalances, infections, autoimmune diseases like lupus, injury/trauma, exposure to toxic substances and chemicals, etc. It is however important to remember that most of these factors are usually not caused by anything the mother did as many mothers often blame themselves and feel guilty making it harder for them to cope with the pregnancy losses.
Most pregnancy losses are single events and a woman with an early pregnancy loss without a known cause has a very good chance of a normal pregnancy in future. However, when it happens 3 or more times, it is often hard to find a cause for these recurrent losses and couples may need more blood tests done to ascertain the causes. Vaginal bleeding is the most common symptom of pregnancy loss which is why bleeding is a major danger sign in pregnancy. Sometimes, a woman with a stillborn may no longer feel foetal movements and in case of these symptoms, as health care providers, we often encourage pregnant mothers to seek medical attention as soon as possible in order to address any complications that come with pregnancy loss.
Pregnancy loss is often a traumatic experience for the whole family. After losing a pregnancy, the mother and her family may experience various emotions including bitterness, helplessness, and anxiety. The mother may even go through the major stages of grief after pregnancy loss of guilt, denial, anger, depression, bargaining, and acceptance. It may take several months or sometimes years for the mother to process these difficult emotions which is why it important for doctors and midwives as first contact professionals to provide counselling and support to the mother and her family.
If this is not possible, then it is necessary for the health care provider to find resources and support groups that can help these mothers after any type of pregnancy loss. In developing countries, women have limited access to health services and hospitals due to several reasons, and sadly stigma, shame, and guilt are common themes surrounding pregnancy loss, women who lose their babies are often made to feel they should stay silent about their grief either because miscarriage is perceived to be unavoidable or so.
The most difficult part for families is the emotional stress that comes with the loss itself, families often have a grief reaction to loss that includes, shock, denial, confusion, depression, guilt, withdrawal etc. All of this takes an enormous toll on women, we have seen couples break up after pregnancy loss due to failure to properly cope with the emotions around pregnancy loss, also many women who lose a baby in pregnancy can go on to develop mental health issues that can last for months or years even after having a healthy baby.
Therefore, health care providers can show sensitivity and empathy, acknowledge how the parents feel, provide clear information and understand that parents may need specific support both in dealing with their loss and in potentially trying to have another baby. Providing human rights-based care that is socioculturally relevant, respectful, and dignified is a much-required component in maternal and newborn care. These are some positive ways that healthcare providers can help these bereaved families cope with their pregnancy loss even with our overburdened healthcare systems.
The author is Jackie Patience Obeny, Bsc Midwife working with Lira Regional Referral Hospital.
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