Rosina* was a special mum. I met her when she came to our maternity unit in labour. She had a fairly uneventful labour and after six hours she brought forth an adorable baby girl who weighed 3.9 kilogrammes and demonstrated a healthy pair of lungs in her loud yells. She had the perfect round eyes and a mop of black curls on her head. She was just perfect.
What was interesting is that Rosina had remained very strong throughout labour, following the instructions she had mastered from her Lamaze classes. Her husband was the perfect partner, rubbing her back, wiping her brow and helping her breathe deeply and slowly.
However, the moment the little angel made her entrance, Rosina underwent a total transformation. She wept gallons of tears and wouldn’t let go of her baby even as we stitched her episiotomy and cleaned her up. Her husband was silent, just staring at the duo.
Mother and baby were settled into bed and the little one attacked the breast like she was on a mission. For a first-time mum, Rosina seemed to settle into motherhood with amazing ease. During ward rounds, I read her file with new eyes. I had not paid too much attention to her previous obstetric history when she first came in. Rosina had suffered five miscarriages in the previous three years. The tears made sense.
I sat with Rosina for an hour, listening to her story. Rosina got married while still in university. The couple decided to wait until she had completed her studies before starting a family two years down the line. After graduation, they immediately got down to the business of conception. This was quite easy and in no time, she was celebrating missing her period. She started her ante-natal care immediately, doing her tests and taking her supplements.
At nine weeks of pregnancy, Rosina woke up in the wee hours of the night with intense lower abdominal pains hitting her in waves. She panicked and woke her husband up. By the time they got to the hospital, she was bleeding in torrents. The doctor in the emergency room informed her she was losing her pregnancy and before she could even wrap her head around what was happening, she was wheeled into theatre for uterine evacuation, effectively bringing the pregnancy to an end.
She went home numb. At the clinic review two weeks later, she was offered contraception and asked to wait for at least three months before attempting conception again. No one ever explained what a miscarriage meant. She was distraught. She blamed herself and kept looking for what she had done wrong.
After three months, she was ready to try again and similarly all went well until her eighth week when she lost her second pregnancy. She was so angry with herself, she immersed herself in her work for the next year and ignored the maternal ache. Her job restored her confidence and changed her outlook in life. She read up a lot more on early pregnancy miscarriages and slowly she made peace with herself. She was ready to try again.
With a complete change of attitude, Rosina came back with a determination that was unmatched. Failing was not an option. She lost her third pregnancy and ignored the doctor’s advice to wait. She went on a merry-go-round of conception and miscarriage two more times, bearing it stoically. None of her pregnancies ever saw the tenth week.
Then she conceived for the sixth time. She did not celebrate it, she did not go to the clinic, and she lived in silence in her soul for twelve weeks.
She could not believe she had crossed the dreaded line. She told no one of her pregnancy except her husband and each night they knelt on the bedside and prayed to see tomorrow without bleeding. Their sex life was suspended. Her husband dreaded her calls when he was away from her because he did not want to hear the dreaded words: I am headed to hospital.
At her 19th week, she began to feel the baby moving. The first night she felt it, she cried. Her husband finally convinced her to go to hospital and start her ante-natal care.
Thankfully she had an uneventful pregnancy but she was fraught with emotions. She wouldn’t even shop for the baby until she was 36 weeks. She declined a baby shower. She did not want to jinx anything.
Sitting there breastfeeding her baby, eyes glassy with tears of unexplainable joy, she took me back to all the women who have been through her journey. Women who suffer such profound loss in silence and with no support system. Women who cannot share their grief because no one even knew they were pregnant to begin with. Women who get no support because even in the medical world, doctors and midwives cannot fathom the impact of an early pregnancy loss.
For a mother who has lost a term baby, the world mourns with her. The baby has form and is respected as a person. For the early pregnancy miscarriage, the scientist’s mind fails to process that all that blood and debris was already a little person to the mother and she will mourn the loss.
Our policies are so bad that a mum who loses even a term baby is expected to resume work within a month while her counterparts get a three month leave to celebrate their baby.
Miscarriages are accorded a two-week sick leave with no consideration for the psychological state.
A small minority of mothers will be lucky to afford a uterine evacuation under anesthesia in theatre. They are spared the pain of the procedure and the awareness of it all. Majority of women will have the procedure done in a designated side room, feeling the pain and facing the finality of it all in real time. It is gut-wrenching.
It is estimated that 85 per cent of spontaneous miscarriages happening in the first trimester are a result of genetic abnormalities of the conceived embryo.
With a man generating millions of sperm daily and a woman maturing a single ova that has been dormant since before she was born, the delicate balance of gamete formation is fraught with risk of small mishaps that would result in disturbing abnormalities in the offspring.
It therefore follows that nature would do its job of cleaning up the abnormalities, allowing only the fittest to thrive, that is, a normal healthy baby. This is beyond the control of man.
But additionally, there are other causes (a minority, going by the figures) that we may or may not be able to control such as infections that are incompatible with pregnancy, chronic medical conditions in the mother that may require better control or hereditary conditions that may be inherent in the parents as carriers. It is incumbent upon all of us to make this process bearable for the couple, more so the mother. We must allow her to grieve, seek answers and access supportive care and counselling. This is her right, not a privilege!