By Karla Robinson, MD
Can we talk?
One of the toughest issues to deal with as African American women is infertility. It is a subject that is still somewhat taboo in our community. The inability for a woman to conceive or sustain a pregnancy is more common than most people know, simply because it just isn’t talked about. Let’s explore this subject and open the lines of communication.
While there are many different reasons that a couple might not be able to conceive and go on to have a viable pregnancy, we will focus this infertility discussion on miscarriages. Miscarriages are medically termed spontaneous abortions, or spontaneous pregnancy losses. They are characterized by an unintended loss of a pregnancy prior to 20 weeks gestation when a developing baby is not viable outside of the womb. First trimester losses are certainly the most common, occurring at 13 weeks or less.
You are not alone.
It is estimated that 50% of all pregnancies end in miscarriage. While this may seem like a startling statistic, the truth is that miscarriages commonly occur before a woman even misses her period and realizes that she is pregnant. Occasionally what a woman may think was just a slightly heavier period, or a period that came a day or two late, may have actually been an undetected pregnancy and subsequent miscarriage. Of documented pregnancies, about 15-20% of them end in spontaneous losses.
Why does this happen?
The exact cause of a miscarriage in a lot of instances is not known. We do know that African American women are at greater risk. Some other risk factors that have been identified include advanced maternal age (greater than 35 years old), alcohol use, smoking, drug use, heavy caffeine use, structural abnormalities of the uterus, and hormonal or immune system disorders. Losses in the second trimester have sometimes been associated with maternal infections or chronic health problems such as uncontrolled diabetes, hypertension, kidney or thyroid diseases, or lupus.
About half of all miscarriages are due to chromosomal abnormalities. The vast majority of these are the result of random events that occurred during the conception process. Only about 3% of these abnormalities are related to an actual genetic issue.
When is it safe to try again?
It is not uncommon to experience anxiety and fear around attempting another pregnancy after miscarriage. This is especially true when often times there is no identifiable cause for the loss. Therefore, it is first important to wait until the time is right emotionally. While there are no formal guidelines medically, it is generally accepted to wait for the menstrual cycle to return to normal prior to conceiving.
What if it happens again?
In about 2-3% of women recurrent miscarriage is a reality. Recurrent miscarriage is defined as three or more consecutive spontaneous pregnancy losses in the first trimester. Women suffering from recurrent miscarriages are generally referred to specialists to determine if there is an identifiable cause for the losses. This usually entails genetic counseling and testing for the couple, blood tests to assess for hormonal or immune system disorders, ultrasound testing, x-rays, and other methods to inspect the reproductive organs for any structural defects. The testing process can sometimes be difficult and frustrating because a cause is only identified in about 50% of recurrent pregnancy losses.
How do I cope after a miscarriage?
Suffering a pregnancy loss can be devastating emotionally and psychologically. A grieving period is normal, as a loss of this magnitude often takes time to accept. Often complicating this process is the fact that women experiencing pregnancy loss are often dealing with emotional instability due to rapid hormonal changes.
Initially, there are often overwhelming feelings of grief, self-doubt, shame and guilt. It can sometimes be difficult to discuss with loved ones as feelings of failure may surface. The reality often times is that the more we discuss it, the more we all realize just how many of our friends and family members have been affected by a pregnancy loss themselves. Grieving in isolation is hard to do. Many hospitals also offer support groups and grief counseling to aid couples in the recovery process.
It is important to seek help from your physician and counseling if these feelings linger, are excessive, or begin to interfere with your daily activities. Studies show that women who have had miscarriages are at increased risk for significant depression or anxiety for up to a year after the loss. Some women who may be more prone to developing depression are those with a previous history of depression, childless women, and those with the loss of a planned pregnancy.
There is hope.
Approximately 70% of women who have previously experienced a miscarriage ultimately go on to conceive and have a successful pregnancy. This number decreases slightly in women with advancing age and those with more recurrent losses, but the success rate in these women is still estimated at 50-60%.
If you have been having trouble dealing with a spontaneous pregnancy loss, reach out to someone. It is important to seek the comfort and advice of others you trust that may have or may currently be going through the loss of a pregnancy. If not to a friend or family member, then definitely express your questions, concerns, and fears to your healthcare provider and ensure you have all of the support and reassurance you need to move forward. Let’s not be afraid to talk about it.