About Aspirin and Recurrent miscarriage

As part of my MPH programme, I was able to perform a Systematic mini-review on the effectiveness of aspirin in treating women with recurrent miscarriage. I got a pretty good grade in it so I would like to share it with the more academically minded readers.

The summary is below:

Recurrent miscarriage is distressing, affecting 1% of all women and in a significant proportion no cause can be identified. Aspirin is recommended for abortion prevention and is often used empirically. The aim of this review was to determine if the empirical use of anticoagulants in women with unexplained recurrent miscarriage is justified.

Data sources included MEDLINE, DARE and the COCHRANE databases plus the reference lists of eligible studies.

Two randomised controlled trials and two prospective cohort studies of low-dose aspirin or enoxaparin compared with placebo/no treatment administered to pregnant women with history of unexplained recurrent miscarriage with a primary outcome measure of live birth rate were selected.

The results revealed 0.81 of participants on 20μg enoxaparin and 0.82 of participants on 40μg enoxaparin had live births while 0.70 of participants on 50mg aspirin, 0.68 on 75mg aspirin and 0.84 on 100mg aspirin had live births. The control groups had proportion with live births of 0.48 (questionable methodology), 0.70 and 0.64.

There is therefore a good chance of live birth with supportive care alone and the addition of anticoagulation may be unnecessary. More research in this area is needed.

I can't paste the whole study obviously, but I will be willing to answer any questions about my findings.

A Letter from Heaven

Sharon Jaynes writes in Girlfriends In God about how she struggled for three months after her miscarriage with feelings of grief. One day, she heard God speak to her heart a letter from her unborn child and that's what I want to share with you now.

Dear Mommy,

I asked Jesus if it would be all right for me to write you a letter. He said it would be OK.

First of all, I want to thank you for loving me and giving me life. I remember how happy you and daddy were when you found out that you were going to have me. I remember how you prayed that I would come to know Christ at an early age. I remember how you prayed that I would have a mission in life to help others.

Mom, I know that you and dad were sad when God decided to take me to heaven before I was born. I saw the tears that you cried. But Mom, what I wanted to tell you is this: Your prayers were answered. I am healthy. I am strong. I do know Christ, and He lets me sit on His lap every day. And mom, I do have a mission. Everyday new babies come to heaven who were never born. Many of them never knew the love of a mother or father. When they come to heaven, they always ask the same question; 'Baby Jaynes, tell me, what was it like to have the love of a mother?' And I can tell them. Oh, how I can tell them.

Thank you, mom, for loving me. I know you miss me. But one day we will be together and what a time we will have. Until then, imagine me happy and whole, playing at the feet of Jesus, and telling other babies about what it feels like to have a mommy that loves them.

See you soon,

Baby Jaynes

The uniqueness of a miscarriage

Every person is different and was created unique. And so, when a woman has a miscarriage, her experience is as unique as she is. You cannot predict what the miscarriage process will be like for her and you cannot predict what her feelings will be after the miscarriage.

Bearing this in mind, it is therefore very important to avoid projecting your expectations on the woman on how she should deal with the loss. Some women hate the idea of a D&C and would rather miscarry naturally while others will rather have the pregnancy end once and for all than endure days of bleeding and a prolonged good-bye. Some women are relieved when their pregnancies end, others feel a sense of loss that eases with time while still others deal with heightened feelings of depression, anxiety and guilt for much longer.

If we are going to offer support and encourage complete healing after a miscarriage then we should acknowledge and respect each mother's autonomy and the uniqueness of her experience; that miscarriage is common doesn't mean we should make it common.

This too shall pass

For anyone who is struggling, this poem really helped me when I struggled with grief after my miscarriage.

THIS TOO SHALL PASS

If I can endure for this minute Whatever is happening to me,No matter how heavy my heart is Or how dark the moment may be ...

If I can remain calm and quiet With all the world crashing about me,Secure in the knowledge God loves me When everyone else seems to doubt me ...

If I can but keep on believing What I know in my heart to be true,That darkness will fade with the morning And that "this will pass away, too!" ...

Then nothing in life can defeat me For as long as this knowledge remains I can suffer whatever is happening For I know God will break all the chains That are binding me tight in "the darkness"And trying to fill me with fear ...For there is "no night without dawning"And I know that "my morning" is near.
~ Helen Steiner Rice ~

MERRY CHRISTMAS!

http://www.crosscards.com/cards/holidays/christmas/christmas-tree.html

For everyone who has read my blog, for everyone who has posted comments,
For every heart that rejoices and for every heart that still hurts,
For all who have helped me and for all who I've helped,
May 2010 be an even better year than 2009.

Merry Christmas and a Happy New Year.

Dealing with the disappointment of a loss

I found this Dear Abby letter from a woman who had experienced a miscarriage: http://legacy.signonsandiego.com/uniontrib/20070312/news_1c12abby.html

DEAR ABBY: I suffered a miscarriage six weeks ago. Since then, it feels like I have suffered one disappointment after another. My sister-in-law – who was supposed to be infertile – is now expecting. The doctors thought she'd had an ectopic pregnancy, so they performed surgery on her only to find that the baby was fine and right where it should be.
I feel so bitter that I am normal and healthy, and my baby died because of random bad luck, whereas her baby is fine after all the trauma she has been through. I have become increasingly angry and unhappy and can no longer see the positive aspects of my life because I spend so much time focusing on the bad. I want to be happy for her and my brother because, surely, this is a miracle baby – but I just can't.
I think I need a dose of good common sense and a swift kick in the rear to get me out of this depression. Would you do the honors?

– Anonymous in the North

Anyone who has been through a miscarriage will immediately sympathise with her feelings of injustice and jealousy; I couldn't bear the sight of a pregnant woman, any pregnant woman for weeks after my miscarriage because i couldn't help but wonder what they did that I didn't and how unfair it all was.

Thankfully, Abby gives very good advice to this woman; she doesn't need a kick up her rear, none of us do. What we need is the opportunity and support to grieve and work through all we are feeling at the time, knowing that we are not bad persons for feeling the way we do and we will not always feel the way we do.

For anyone struggling with feelings of disappointment and resentment as a result of a miscarriage, you are not abnormal and you are not alone. You will get through this.

When you can't shake that sad feeling

After a miscarriage, no matter how painful the loss, life goes on. You probably return to work and get on the affairs of daily life. After a while, you might manage a smile when you greet people as you go about your business and even sometimes, genuine laughter.

What happens when your life seems to have returned to normal but underneath the surface you still have lingering feelings of sadness? What happens in those moments when you are suddenly confronted by the fact that you suffered a loss? What do you do then?

I don't pretend to know what can be done then; I don't pretend to know what causes the sadness to linger. I just want to say that it happens and it doesn't mean you're regressing or that you are unable to move on after the loss. There'll be sad moments and even days and all I can pray is that when those times come, we will have the grace and strength to deal with it, holding on to the hope that this too shall pass.