When I was about 6 weeks into my first pregnancy, I leant over the kitchen worktop really hard to close a window that was just out of reach.
When I was trying to conceive my second pregnancy, I started taking baby aspirin tablets and I carried on taking them after my positive pregnancy test.
When I was pregnant for the third time, I worried I might not be a good Mum and – just for a second – thought maybe I shouldn’t be pregnant.
During my fourth pregnancy, I ate cured meat AND blue cheese.
Did any of these things cause my miscarriages? No. But, did I blame myself for them anyway? Yes.
I’ve written about blame and miscarriages in a previous blog post, but as I’ve been discussing the concept of blame after miscarriage in my recent counselling sessions, it’s made me consider the issue again.
Womanhood, fertility and loss
Societies tend to view pregnancy and childbearing as intrinsic to womanhood. And while the importance placed on fertility varies around the world and fluctuates over time, broadly speaking having a baby is viewed as either an achievement, as a marker of a woman’s worth, or as an expectation – and sometimes all three. Conversely, the inability to carry a pregnancy to term can see a woman viewed as a failure, as having a lack of worth, or as being the cause of great disappointment to others.
In many Western countries, childless women are viewed as contributing less to society, there’s often an assumption we have less fulfilling lives and are less warm, less maternal. This portrayal can leave women like me, who are childless not by choice, feeling despondent and questioning what our life means if we don’t, or can’t, have a child.
There is no justification for these views on female worth which have been dictated by the patriarchy through many centuries. But they are difficult to challenge when they are still being perpetrated now.
I already view myself as less than those women who have successfully given birth to a child. I’m not part of the Mum club, where women are enlightened, where it’s confidently stated that you’ll never feel a love as strong as when your child is born. These women have an understanding of things that I, as a childless woman, don’t. It makes me feel isolated, excluded and dissatisfied with my own life, which – objectively – is actually really good.
Guilt, guilt and a bit more guilt…
For me, the ability to get pregnant but not stay pregnant makes me feel guilty in so many ways. I feel guilty for letting myself down, because I’ve wanted a child for so long. For letting my husband down, because I see how desperately he wants a family. For disappointing our extended family, who so want to love the child who hasn’t arrived yet. And for the children themselves, who never get to be born and live a life.
There is also guilt around experiencing the emotions that come after loss. Isn’t it normal to feel sad, lost, lacking in motivation after going through something so painful? Yes, but allowing those feelings to come can be difficult, can sometimes even feel self-indulgent. There is often a need to make sure that everyone else around you – your partner, your family – is doing ok first, before you can properly consider, or care for, yourself.
The medical establishment – at least, my experience of it – is quick to label the pregnant woman as the issue in pregnancy loss. There’s a (harmful) assumption that anything that takes place after an embryo is created is the responsibility – and therefore it if goes wrong, the fault – of the woman. It’s an easy conclusion to reach. There is far more research conducted on female factors in miscarriage. And the act of being pregnant does take place in the female body. However, it doesn’t necessarily follow that a loss is caused by something that the female body does, or doesn’t, do. To suggest that it does is unfair.
Some research also seems to place the fault at the door of pregnant women. This paper, for example, which reviews other research findings already in existence, suggests that not consuming any caffeine at all is the only safe option during pregnancy. So, for a woman who drinks her one daily cup of coffee – well within the current UK pregnancy guidelines – then loses that pregnancy, who is she going to blame? Herself, of course. It seems a convenient technique to explain away a loss that is likely to have been caused by something much more complicated – and more expensive to diagnose. Coincidence? Maybe. But research like this needs to be used carefully, otherwise it could be harmful to women whose proclivity is already to blame themselves.
Considering the male role in pregnancy loss
Countless times, when we asked if sperm could be an issue, or we requested a sperm analysis, my husband and I were told: ‘There can’t be a problem with your husband’s sperm because he’s getting you pregnant.’
When my husband’s sperm was finally analysed (when we were referred for IVF), the results showed he had less than 1% normal sperm morphology. And while nobody can tell us if this has any impact on embryo quality, the fact it took us over two years and three miscarriages to even get this diagnosis seems, to me, hard to justify.
There is an increasing need, and appetite for, further exploration of the role of male factors in the causes of miscarriage. In 2017, a James Lind Alliance involving over 3000 healthcare professionals and patients agreed the top ten miscarriage-related questions most in need of additional research. One of those questions was “What male factors contribute towards the cause of miscarriage?”
In addition, there is already growing evidence that issues with sperm may be the cause of pregnancy loss in more cases than traditionally thought.
A further study acknowledged that there is a lack of research addressing the potential effects of sperm damage on pregnancy loss. The authors recommend more studies investigating the impact of multiple factors on the levels of sperm DNA fragmentation, which has already been implicated in recurrent miscarriage.
Maybe it’s time then, for the medical establishment to catch up with science and not assume that the female body is always ‘responsible’ for pregnancy loss. And while this belief holds firm in medical circles for now, who knows the damage being done to women – already damaged by the loss itself – who now also think it’s their fault.
Mental health issues caused by pregnancy loss – and blame
The effect that pregnancy loss has on women psychologically has not, in the past, been well researched. However, with dedicated centres like Tommy’s, researching the causes of miscarriage, possible treatments and also the psychological impact, the knowledge base is growing.
One large piece of research conducted by Imperial College London, found that 29% of women showed symptoms of PTSD one month after miscarriage or ectopic pregnancy, moderate/severe anxiety was found in almost a quarter, and more than one in ten women had symptoms of moderate/severe depression.
It seems that women are fighting a losing battle when it comes to resisting feelings of guilt after a having a miscarriage. Not only do we need to quiet our own conscience, which is intent on finding something we did wrong that caused the loss. But we also have to block out the social, medical and research commentary that tells us we must be the ones to blame too.
It’s no wonder mental health often takes such a nosedive after pregnancy loss. It’s at vulnerable times like this that women really need support, and often professional help. Yet, as I’ve discussed before, this help is so often unavailable, or has such a long waiting list that by the time it becomes available, it is no longer required.
I am in the fortunate position to have been fast-tracked for counselling after my most recent miscarriage. But what of the women who aren’t so lucky? Bear in mind that somewhere between 1 and 3 out of every 10 women who lose a pregnancy will develop a diagnosable mental health condition and it feels like there needs to be some kind of safety net. A system where women are asked if they need support, rather than being left alone until they ask for it.
Guilt can be a tricky emotion, it makes you believe you don’t deserve help, continually telling you the loss was your fault. But it’s not your fault – no matter who tries to tell you that it is.