Miscarriage grief – are tests and scans the culprit?

I’ve heard it said, a number of times now, that the grief mothers commonly experience after a first trimester loss wasn’t felt by generations of women gone by.  In fact, I’ve heard it said that pregnancy tests and ultrasound scans have created first trimester miscarriage as a loss experience. That women bond earlier because of the pregnancy tests and scans.  That we make a big deal of our miscarriages.  It is important to confront this.  To explore it.  Because there’s a worrying dark underside to this assertion: the implication that the grief of women today is not valid.  That we should be more stoic, like our foremothers apparently were. So, does it really make sense?

The idea that pregnancy tests and ultrasounds have increased the grief of miscarriage isn’t entirely wrong.  There’s a grain of truth to it when it comes to very early miscarriage (miscarriage before five weeks also known as chemical pregnancy).  In the modern world, you can buy a pregnancy test over the counter and confirm that a conception has taken place, before you’ve experienced any pregnancy symptoms, before your period is even due, and without speaking to a doctor or midwife.  But we are a chromosomally unstable species and the overwhelming majority of conceptions either fail to implant, or are screened out shortly after implantation due to chromosomal abnormalities.  Following such an early positive pregnancy test, you may well go on to bleed, perhaps several days later than you expected or even on the very day that you were expecting your period.  Without that early pregnancy test you wouldn’t have known that for a brief moment you had a conceptus inside you.  It is true that previous generations of women didn’t experience very early miscarriage as miscarriage.  In fact, many women today don’t experience very early miscarriage as miscarriage, either because they aren’t actively trying to conceive at the time or because they choose to wait until their period is at least four days late before testing. 

But, although there is a grain of truth to the role of pregnancy tests when it comes to very early miscarriage, applying this logic to the whole first trimester is ridiculous.  Many women are well aware that they are pregnant, long before twelve weeks, from the signs and symptoms of pregnancy.  In fact, many women can reliably recognise pregnancy by their own symptoms at four or five weeks.  For these women, pregnancy tests don’t give a verdict, they merely give objective confirmation of what they already know to be true.  I think it is very likely that many women in previous generations recognised pregnancy by their own symptoms early in the first trimester, and hence also recognised miscarriage.  And blaming the ultrasound scan.  Really?  As any woman who has experienced miscarriage will tell you, the scan is the thing that confirmed, not pregnancy, but miscarriage.  The scan is the death-bringer.  Sure, as pregnancies progress, those incredible pictures can build and solidify bonds before birth.  But in the pregnancies that are lost during the first trimester, the scan doesn’t solidify bonds, it confirms loss. 

Further, the experience of miscarriage itself changes the longer a pregnancy progresses.  Miscarriage at four or five weeks may be a similar experience to a usual period, but as pregnancy progresses miscarriage becomes less and less period-like and more and more birth-like.  That is, the pain may be more severe and contraction-like, the blood loss may be greater, and visible pieces of tissue may be passed.  The hormonal aftermath is different too, after all, a miscarriage involves pregnancy hormones crashing.  Women may experience a low mood similar to the baby blues, exhaustion, headaches and many other symptoms.  It make take a lot longer after a miscarriage than after a period for a woman to ovulate again and the first several cycles may be very different to her usual cycles. I’m sure that many women in previous generations recognised these salient differences between a period and a first trimester miscarriage. 

So, do women today make a bigger deal about first trimester miscarriage? Within every generation, women react differently to miscarriage, with reactions from mild distress all the way to heart-tearing grief and everything in between being completely normal.  Is it possible that stronger grief reactions to miscarriage have become more common?  Maybe.  But if so, apart from very early miscarriage, I think that pregnancy tests and ultrasound scans play a very small role in this.  There are other important generational differences.  It was only a few generations ago that losing children as babies and toddlers was a common experience.  In a world in which losing a child or two during infancy is commonplace, just a normal part of motherhood, first trimester miscarriage may well have been borne more easily by comparison.  It was also only a few generations ago that families were not planned.  Contraceptive options were limited, access to contraception difficult and knowledge of natural family planning techniques patchy.  Further, birth was life-threatening, families were big, and for many resources were stretched very thinly.   Is it any wonder if women of a hundred years ago took longer to fully accept that the symptoms that they recognised as pregnancy really were yet another pregnancy?  If they took longer to bond?  If they sometimes gratefully, whispered to themselves ‘oh my period was just late, what a relief…’ knowing full well what might have been? 

So, is it possible that stronger grief reactions to miscarriage have become more common?  Maybe.  But also maybe not.  Because over the past hundred years women have gained a stronger public voice.  We, as a society, have faced many previous taboos.  We discuss in public forums subjects that, one hundred years ago, were spoken about in private homes only, in hushed tones and in euphemisms or were passed over in complete silence.  How many women in previous generations whispered of ‘late periods’, while fully knowing what it was they were experiencing and while quietly carrying a secret grief?  It is impossible to know.

If stronger grief reactions to first trimester miscarriage have become more common, I seriously doubt that pregnancy tests and scans are the culprit.  What is certain is that the reactions of women today, reactions that vary from mild distress to heart-wrenching grief, are completely normal and understandable.  Women experiencing first trimester loss deserve support and understanding. 

Apply it in your life:  Have you experienced a miscarriage?  Did you feel the grief that you experienced was normal?  Do you think pregnancy tests and scans are the culprit?