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Image: Tina Tiller
Image: Tina Tiller

SocietyDecember 5, 2023

The silence of miscarriage

Image: Tina Tiller
Image: Tina Tiller

In the first instalment of a two-part series on miscarriage, Zahra Shahtahmasebi speaks to two women about carrying on after tragedy.

Michele Trott is a “live life to the fullest” kind of person, a lover of the outdoors and martial arts. She’s active and energetic, but after her third miscarriage in one year, she’s struggled to get out of bed some days. While she knew a miscarriage would be disappointing, she wasn’t prepared for the full ordeal. “It’s so invisible, only you know you are going through it,” she says. “You expect that it will be pretty sad, but I didn’t realise how sad – I had some really empty moments. It was devastating.” 

The 33-year-old science communicator has had some moments “that scared the crap out of me. After my second miscarriage, I wondered: when will I feel happy again?”

Sometimes the despair doesn’t feel like it’ll end, especially as original due dates continue to roll around – November for the first pregnancy, then December and finally next year in May.

About one month on from her third miscarriage, Trott says it has been a lesson in the duality of emotions. “I’m partly moving on, partly still processing and grieving.” 

Trott has always had an understanding both of what is required to make a baby and of what miscarriage is – at university, she studied the physiology of reproduction, including how embryos develop and knows that miscarriage is the body’s defence mechanism if something goes wrong. 

But that was purely a scientific view. “Until you go through it, you don’t really have an appreciation of how awful it is. You don’t know how serious, how heavy it can be for people.”

Each one of Trott’s miscarriages has been different. She and her husband started trying for a baby at the start of the year, and by February she was pregnant. They had just under a week of excitement before she started bleeding. As the bleeding became heavier, Trott suspected she was miscarrying and a blood test confirmed it.

She fell pregnant again before she had gotten her period back. Three weeks of pregnancy symptoms followed – fatigue and food aversions. Trott and her husband were excited to attend their first ultrasound scan, only to be crushed when the technician delivered bad news – there was no heartbeat. 

“That’s when I learnt the term ‘missed miscarriage’ – which is when development has stopped without your body realising it,” says Trott. “You could believe you’re pregnant for quite a long time and not know anything is wrong, but actually things could have stopped progressing weeks ago.” 

She was given two options; pills that would cause her uterus to contract and pass the pregnancy tissue, or a surgical procedure called a D&C (dilatation and curettage) to remove it. While Trott was also informed some people wait to see if they pass the miscarriage naturally, she says she was advised against it as it comes with a risk of infection.

She opted for the pills, and spent the evening on the couch with strong painkillers to combat the intense pain and cramps. A follow-up scan found pregnancy tissue was still present in her uterus, so two days later she was booked in for a D&C.

Trott was excited when a pregnancy test came back positive for the third time in August. The food aversions and extreme fatigue were back, joined by nausea, brain fog and intense bloating. At six weeks, she had a scan and got to see a heartbeat. But 10 days later, the symptoms just disappeared.

“I know symptoms can come and go, but for me it was quite dramatic to have so many symptoms just disappear at once,” she remembers. Her gut told her she had miscarried, and a scan confirmed it. She took reassurance from the ultrasound technician whose kind words made what was a pretty awful situation better. 

“He said ‘it’s a tough road, but we can get you there and the end result can be pretty spectacular’.”

This time she wanted to pass her miscarriage naturally, and just a few days after the scan, the bleeding started. She bled for two weeks and waited as long as was safe to do so, but after a phone call from the gynaecology clinic, she realised she should see a blood clot the size of a mandarin. She hadn’t passed everything.

Another dose of pills followed, which again didn’t work, and she found herself back at the hospital for another D&C. 

She bled for two more weeks after her most recent D&C, but again it’s invisible and so life goes on, says Trott. She was bleeding while waterskiing with friends on the West Coast, while going back to work, and while at the gym. 

Trott is not alone in her experience. Having to carry on like everything was normal was one of the hardest parts of Carrie-ann Webb’s miscarriage. Webb knew something was wrong when she woke up bleeding eight weeks into her fourth pregnancy. It wasn’t brown, like the spotting she’d had with her second child, instead bright red, like the blood she’d seen during her first miscarriage, five years earlier. 

The next day, the bleeding was heavier, the cramps had started and Webb says she could feel herself dilating. 

Her midwife sent her for an internal ultrasound scan, but it proved inconclusive, with the technicians saying it might just be too early to see the pregnancy. By the time Webb got home, she was in intense pain.

“I was going to go for a beach walk to try and clear my head, but because I was in that much pain, I just physically couldn’t,” she says, “I lay in bed crying, because I knew.”

She passed her pregnancy naturally that same day. While the pain stopped immediately, the bleeding continued. Two days later, Webb had to take her children to a birthday party. While the children played, she was still bleeding heavily and trying to process what had just happened. 

“I remember not saying anything, because you’re at a kid’s birthday party,” remembers the UK expat and mother of three, “People are like ‘hello, how are you?’ and you’re like ‘yeah, I’m good’, but actually you’re not good at all.”

Auckland hairdresser Carrie-ann Webb found it took a long time to process and heal from her miscarriage, which happened shortly after lockdown in October 2020 (Image: supplied)

A couple of days later, teachers at daycare checked in on her, as one of her kids had mentioned a new baby on the way. “I told them because they asked me. They made sure I was okay, and I think I had a cry to them but not really anyone else,” says Webb.

Her first miscarriage was in 2015, 10 months after she started trying for her second baby. Webb’s period was running late, which isn’t unusual for her cycle, but when the nausea started she had an inkling she was pregnant.

A test confirmed it but the next day, she started bleeding – bright red blood. “Had I not done a test I probably would’ve just thought my period was 10 days late and not thought anything of it.” Webb didn’t see a doctor, and two months later, she conceived her second child.

The second miscarriage was in October 2020, just as Auckland came out of a Covid-19 lockdown. Life carried on, whether she was ready for it or not, with her family getting ready to move, having just sold their house. “I suppose I didn’t deal with it at all because we were moving house, then it’s Christmas, then January comes, the kids are starting a new school, we were straight into renovations,” says Webb, who, despite living in New Zealand for over 12 years, still has an unmistakable Yorkshire accent.

She was only able to start processing her miscarriage eight months later, due to another tragedy. In June 2021, the due date for what she calls her “angel baby”, she booked flights to the UK to spend time with her dad, who had been ill since March. She was told he had six months to live but instead, he made a miraculous recovery. Webb takes peace from this: “For me that was comforting, knowing I was actually meant to do that. If I had had the baby, I couldn’t have been there for my dad, and I do feel like he got better because I was there.”

Now, it’s when the memories come up on her phone’s photo gallery of her bump that she’s reminded most intensely of her angel baby: “When I see that, I wonder what would’ve been,” says Webb.

Webb’s body struggled to heal physically as well – her period and her gut haven’t been quite right since the miscarriage. She started experiencing bleeding around the time of ovulation as well as issues with her bowel.

Only now, three years later, has her body finally sorted itself out. Her last four menstrual cycles  have been normal, not heavy or painful.

Despite the trauma of a miscarriage, period disruptions following one are uncommon, as the body typically recovers quite quickly, says fertility specialist Olivia Stuart (Ngāpuhi, Ngāti Kahungunu).

Stuart, who is based at private clinic Fertility Associates in Auckland, says the menstrual cycle returns to normal within three to five weeks, once all of the pregnancy tissue and pregnancy-associated hormone hCG is gone.

She describes miscarriage as nature’s way of avoiding a pregnancy that was never going to result in a healthy baby. But, it’s complex because there is no one reason why it occurs.

There isn’t a lot of local data around miscarriages but international statistics say one in four pregnancies will end in miscarriage. Although New Zealand doesn’t collect any data on this, government website Whetūrangitia that provides information on baby loss, estimates that between 13,000 and 15,000 women experience a miscarriage every year. A miscarriage is defined as the loss of a baby before 20 weeks.

Local charity Miscarriage Matters refers to data from a Norwegian study that shows women in their teens and those aged 38 and over have a higher risk of miscarriage. In teens, the risk is 16%, but it drops between 10 and 11% in those aged between 20 and 35. Over 35, it rises to 16%, then doubles in early 40s before increasing again to 53% in those over 45. 

Lifestyle factors, including if either parent smokes, a maternal BMI under 19 or over 30, excessive alcohol or caffeine consumption as well as stress, can also contribute to miscarriage risk, says Stuart. Age, genetics, auto-immune conditions, like diabetes, anatomical issues with the uterus as well as lifestyle factors can all play a part.

Because of this, investigations by a clinic like Fertility Associates will only take place after someone has had two consecutive miscarriages. For those in the public health system, they qualify for a referral after three.

Stuart agrees with Webb that psychological recovery from a miscarriage can take a long time. It leaves an indelible mark, says Stuart: “Sometimes we never fully recover, it’s always on our minds.”

Stuart knows this partly from her patients and partly from having two miscarriages herself. It left the mother of two wondering what could’ve been, but outside of work, miscarriage is not something she ever really talks about. “We sort of bottle it in and think we’re all alone, but in actual fact, talking about it might help people cope better when they do go through it.”

Trott agrees, miscarriage is simply not talked about. “It’s a bit of a cycle,” she says, “I think people don’t want to talk about it because they find it difficult. They’re not sure how to bring it up, or they don’t want to upset you. 

“And the fact that no one does means that people aren’t really practiced in having those conversations, there’s a lack of exposure, experience, and probably a bit of fear.”

But you don’t have to know exactly what to say – just acknowledging the person’s grief goes a long way. Trott is grateful for the unwavering support of her husband, and has found comfort in opening up to friends and family, where sharing her story has seen her reconnect with old friends who have also experienced a miscarriage.

She has also appreciated the care packages she’s received from Miscarriage Matters, in particular, the hand-written notes. Knowing that other people have been through it and have got to the other side makes it feel less lonely, says Trott.

It’s starting to feel not quite as heavy now as she gets back to filling her life with good times and being proactive about looking after herself. After three consecutive miscarriages, Trott now meets the criteria for a referral to Fertility Associates and is interested to see what this will bring.

Above all, she remains hopeful her and her husband’s time will come. 

Part two: Changing how we view miscarriage, one conversation at a time

Miscarriage Matters helpline – 0800 611 116

Keep going!