As my husband Dan drives me to the hospital, the gripping pain in my abdomen intensifies. It comes in waves and instinctively I try to breathe through it — the way women in labour are supposed to.
But when I realise what I’m doing, I start to cry. Because I am not having a baby, I am having a miscarriage.
I am 12 weeks pregnant with my first child and a few days away from my first official scan. Bleeding heavily, I know, deep down, I will not be keeping that appointment. From the grim line of Dan’s mouth as he stares at the road, I know he does, too.
When the bleeding started the previous morning, I hadn’t been too concerned. Spotting — light bleeding — is common in early pregnancy as the developing embryo implants itself in the womb.
It had happened once before, around the six-week mark. That time, I’d had an early scan, the midwife found a heartbeat and the spotting stopped after a day or so.
So when it starts again almost six weeks later, I go to work as normal and try not to think about it. But with no sign of it stopping by the afternoon, I phone my GP, who suggests I come in to be referred for a scan. I hastily type a message to my boss and rush out of the office.
My GP books me in for a hospital appointment the next morning. All Dan and I can do is distract ourselves. We go for dinner, then to the cinema. By the time the film is over, I have cramps — like bad period pain — and the bleeding is getting worse.
A miscarriage can be graphic in its violence. For me, it isn’t ‘just a heavy period’, as it’s sometimes portrayed.
When I sit up in bed the next morning, the sheets flood with blood. I race to the bathroom and to my horror, feel something slide away. I scream.
When Dan asks what’s happening, I can’t find the words.
On the way to A&E, we walk through the maternity wing, past smiling women with big bumps. We wait several hours for a scan. And then, just like that, it is over.
Our first pregnancy ends, not with a cry bursting from a newborn’s lungs, but with a midwife’s whisper: ‘I’m so sorry.’
As I change out of the hospital-issue paper pants and back into my clothes to go home, I catch a glimpse of the ultrasound screen, still showing the image of my womb. Where you’d expect to see the white and greyish wriggling outline of a baby, it is just black. Empty. It is exactly how I feel.
Miscarriage, defined as a loss of a baby in the first 23 weeks of pregnancy, is incredibly common, as Dan and I have been told repeatedly since ours in January. About one in five pregnancies end this way. Most occur in the first trimester.
The majority are thought to be due to a genetic problem, meaning the baby doesn’t develop properly. Infections such as measles can sometimes trigger a miscarriage and some conditions make it more likely, such as a weak cervix (the neck of the womb) or blood-clotting disorders that can affect blood flow to the placenta.
If women have more than one miscarriage, or if the miscarriage is after the first trimester, investigative tests may be offered. But most, like me, will never know why it happened.
If you’re young and otherwise healthy (I am 30, Dan is 32, neither of us smokes or is overweight, we eat healthily and I didn’t drink while pregnant), there’s almost nothing constructive anyone can tell you. It can leave you feeling as if a miscarriage is something to shrug off, like a cold.
Sometimes it’s not even clear if a woman has miscarried.
‘There can be an assumption it’s like what you see on TV,’ says Ruth Bender Atik, director of the Miscarriage Association. ‘A woman suddenly clutching her belly and collapsing in a pool of blood. But often that’s not how it is. A woman may have some symptoms, such as spotting, but a scan may not be conclusive.
‘There might be a heartbeat, but it’s not very strong, or the baby is smaller than it should be, so they may be told to come back in a couple of weeks. There can be quite a protracted period of waiting.’
There are those who discover only at their 12-week scan that their baby has died. This is known as a missed miscarriage. Cruelly, they have no signs that anything is wrong and still feel pregnant as the hormones remain high.
My sadness is tempered only by a slight sense of shame; a worry that I’m making too much of a fuss.
After a miscarriage, women may need medication or even surgery to clear remaining pregnancy tissue. But the effects, of course, aren’t just physical. In the days after, I stay at home. I cry and watch rubbish TV. Some days I feel fine and determined — almost manically so — to get on with things: I go running, cook massive batches of dinners for the freezer. Other days I’m tearful and can barely do anything.
It’s a lonely time. Initially, we barely tell anyone what has happened. Most people didn’t know we were expecting — just my mum and a few close friends who guessed — and the idea of announcing the pregnancy and the loss seems too difficult.
My sadness is tempered only by a slight sense of shame; a worry that I’m making too much of a fuss. After all, I never got to meet this baby.
‘People don’t always appreciate how distressing early miscarriage can be,’ says Professor Jacky Boivin, a health psychologist at Cardiff University, who specialises in fertility and reproductive issues. ‘It’s almost a hidden problem.
‘As there’s a notion that you shouldn’t talk about a pregnancy before 12 weeks, in case something happens, all those cases where something does happen are never spoken about.’
Last year, research at Imperial College London, part-funded by Tommy’s, the baby charity, found that nearly four in ten women who experience a miscarriage have symptoms akin to post-traumatic stress disorder.
They experience intrusive or unwanted thoughts about their miscarriage, as well as nightmares or flashbacks, according to the study, which was published in the journal BMJ Open. ‘We have checks in place for postnatal depression, but nothing for the trauma and depression after pregnancy loss,’ said Dr Jessica Farren, who led the study.
There have been calls for more psychological support for women who miscarry.
Jane Brewin, chief executive at Tommy’s, wants all women who miscarry to be screened for mental health issues afterwards — not least because women who go into another pregnancy showing signs of depression or anxiety are more at risk from postnatal depression.
Subsequent pregnancies almost inevitably bring considerable anxiety and stress. ‘It’s almost not experienced as a pregnancy,’ says Professor Boivin.
‘What’s experienced is just waiting — waiting for the scan, waiting to pass the point they miscarried last time.
‘They’re in a constant state of fear that something bad could happen.’
Sarah Bailey, a nurse and research fellow at University Hospital Southampton, is investigating whether a self-help card could help women who have recurrent miscarriages cope with the anxiety that accompanies a new pregnancy.
The card, which she hopes can be introduced into the NHS, encourages women to see the good that accompanies a challenging situation, with statements you are asked to read and contemplate a couple of times a day, such as: ‘What could you do to make yourself feel positive?’
But it’s more than sadness. You can be left with a fear you did something wrong or that there is something ‘wrong’ with you — that you will never be a mother.
‘After a miscarriage, you’re in a significant period of uncertainty,’ says Professor Boivin. ‘You don’t know whether this will happen again and you have to wait until you have your next pregnancy.’
Most women who miscarry will go on to have a baby. Recurrent miscarriage — defined as three in a row — is much less common, affecting about one in 100 in the UK. Even in these cases, they are not considered ‘infertile’, which means they struggle to conceive.
In fact, the opposite may be true. Research, such as a study published in the journal PLOS One in 2012, suggests a possible reason why women miscarry — particularly women who have recurrent miscarriages — is that their body doesn’t interpret the biological signals an embryo gives off that suggest it’s not viable, so the uterus takes it in anyway.
They are overly generous, as it were, in their mothering. ‘Some women may find it helpful to think of it like that,’ says Professor Boivin.
Had it not been for the miscarriage, I would be 25 weeks pregnant — more than halfway there — and I dread the arrival of what would have been my due date, especially if I am not pregnant again by then.
Part of me wonders if it will always be a dark day on our calendar; the birthday we will never celebrate.
- A version of this piece first appeared in the Daily Mail