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.

Miscarrige in Today's World

I just finished reading an article about Celine Dion having a miscarriage and then people were free to post comments about the article.
Reading through the comments I was struck by the diversity of opinion but even more so by the ways such opinions were passionately attacked and defended.
What saddened me more was how many people were quick to judge her for longing to have a second child at 41years and by IVF; people calling for her to get over herself, to adopt, saying her eggs were to old and her body could not carry another pregnancy because of her age. I don't even feel the need to defend her but I feel the need to comment on the attitude that makes it so difficult to talk about miscarriage.

• How am I supposed to grieve the loss of a child I wanted and loved even without knowing when you make me feel that it makes me a selfish, spoiled child?
• Why should I be able to tell you about my miscarriage if, instead of saying "I'm so sorry for your loss", you say. "you can always have another/haven't you considered adoption?"
• How can I experience the catharsis of talking about what happened to me if you feel it is "yucky" and "TMI"?

I really think we need more voices to speak out and change the wrong attitude that stigmatises a legitimate loss thus hindering the ability to heal.

Sending Encouragement

I've been very busy with the Masters programme but my desire to reach out and help people dealing with miscarriage is still very strong. So if there is anyone who is struggling at this time, I would like to send you this card.

http://www.crosscards.co.uk/cards/cardform.aspx?cp=1&iNo=97&No=35

I hope you are able to read and enjoy it.

In Honour Of Pregnancy &Infant Loss Remembrance Day

October 15th is Pregnancy and Infant Loss Remembrance Day and in honour of that, I want to share a poem I wrote for the one I lost.

For my Angel.
Like a flash of lightening
You lit up my world and then you were gone
Like the morning dew fall
You came, then vanished with the rising sun

Your life was so brief
You brought me such joy, you left me in pain
It’s so hard to grasp
Why you had to go, no one can explain.

My Angel
I’ll love you forever
My Angel
I’ll forget you never
My Angel
I am a believer
That one day I’ll see you
That one day I’ll hold you
That one day, we’ll always be together.

Taking Care of Yourself when Grieving

There is a great article on msn health and fitness about this and I would like to share some of their points with you. Even though it's focus is on grieving a loved one at the end of their life, I know that the grief of a miscarriage is just as real and needs to be addressed.

This is just my summary; you can find the full article on http://health.msn.com/health-topics/caregiving/end-of-life/articlepage.aspx?cp-documentid=100245934

First, be gentle and compassionate with yourself. Grief is often described as a syndrome with intense emotional responses but it can also have cognitive, physical and spiritual effects too.
Emotional: You may need to identify and express your feelings as you experience them, be they of sadness, guilt, regret, anger, numbness, fear or even suicidal thoughts. Writing in a journal or finding someone to talk to can be really useful.
Cognitive: You may also find it difficult, in the first few days after the loss, to concentrate on work or any task and you may be more forgetful or have a short attention span.
Physical: Sleep deprivation or excess, changes in appetite, aches and pains and even the ’flu are symptoms that can be attributed to the grieving.
Spiritual: You may be attacked by a crisis of confidence in your spiritual beliefs, you may question your beliefs about the goodness of God and have difficulty making a meaning out of the loss.
Whatever symptoms you feel, be patient with yourself; they will pass with time. Take good care of yourself by ensuring you eat a balanced diet and avoid excessive alcohol (no matter how strongly you are tempted by Ben &Jerry or Johnny Walker).
Take time to meditate and reaffirm your faith and convictions and if you can afford it, pamper yourself with a manicure, a massage or even just a soothing bath. Finally, always remember to ask for help: from your doctor, your religious leader or your family.

Update

Well, I'm happy to report that I have begun a Masters in Public Health programme. I'm really grateful for the opportunity because I believe it will give me the needed skills and knowledge to improve on the work I am doing and will be doing in Nigeria as per promoting the best form of health care for women, starting first of all with women after a miscarriage.

It's been a very busy time of registration and settling in. I hope that I will still make time to update the blog and that I will continue to help those that I can.

A Word of Encouragement

"Do not let ourselves be troubled when we are sometimes beset by adversity; for we know it is meant for our spiritual welfare and carefully proportioned to our needs, and that a limit has been set to it by the wisdom of the same God who has set a bound to the ocean. Sometimes it might seem as if the sea in its fury would overflow and flood the land, but it respects the limits of its shore and its waves break upon the yielding sand. There is no tribulation or temptation whose limits God has not appointed so as to serve not for our destruction but for our salvation."

Jean Baptiste Saint-Jure

I do hope this blesses those who read it.

The Miscarraige Aftermath

An article written by Anne Nordal Broen of the University of Oslo in Norway and published by the American Psychosomatic Society in 2004 provides interesting insights following a study of two groups of women. The first group were women who had suffered a miscarriage and the second were women who had undergone an induced abortion. These women were interviewed to determine the psychological impact of their experiences.

The author questioned the assumption that a miscarriage creates a problem for the woman it happens to while an abortion solves a problem for the woman that chooses it. This assumption, of course fails to consider women who were coerced into the decision by unfavourable circumstances, uncooperative partners or by unfortunate results following genetic testing.

In this study, she excluded abortions due to genetic abnormalities and, as much as possible, late miscarriages. The women were interviewed 10days, 6months and 2years after their experience.
In a lot of the women in the miscarriage group, there were very high levels of what is called intrusion (strong feelings of grief/loss with flashbacks/nightmares/reliving the event) at the 10day interview. Part of what was credited as being responsible for the strong reaction to the experience of a miscarriage is the shock-like event that a miscarriage is; a miscarriage is unexpected and frightening and can shake the most stable of us to the core. This intrusion, however, had remarkably subsided by the 2year interview. Women who did not have the immediate grief reaction after the event were found to suffer higher levels of intrusion at the later interviews.

2years may seem like a long time but the point I want to make is that no matter how bad you feel right now, you will feel better one day. You will always remember the loss but it won’t always hurt this much.

An Important Relationship

I read something credited to John Selby and it really got me thinking. he was talking about how your relationship with yourself is one of the most important relationships in your life and how we need to decide what kind of friend we want to be to ourselves.

I felt deeply convicted as I thought about this because in the first three months or so after my miscarriage I was the worst possible friend to myself: I constantly dredged up all the things I did that may have been responsible for the loss even when I was told it wasn't my fault. I started over-eating and then berated myself for all the weight I had gained to the point that I couldn't even look at myself in the mirror. I was a judgemental and critical friend instead of being an encouraging and nurturing friend. The funny thing is, I wouldn't do that to anybody!

If you are in a dark place right now and you feel all alone, like no one understands, try to be understanding and forgiving of yourself for your own sake. Love yourself; be the kind of friend to yourself that you wish your partner, your mother, your girlfriend, your sister would be.

We owe it to ourselves to be our own best friend and not our own worst enemy.

Choosing the Appropriate Management Option

When a woman has been diagnosed with a miscarriage, there are three main methods by which the miscarriage may be managed.

The first is what we call “Expectant management”. In this method, the woman is left to bleed and miscarry naturally. This is usually recommended when a scan shows that a significant amount of tissue and blood has passed out of her womb already. The second is the “Surgical management”. Here, the woman is taken to a theatre and her womb is cleaned out and the contents sucked out with a suction device. In the third method, called the “Medical management”, the woman is given a drug (misoprostol) and this is usually given vaginally to enable the woman to miscarry completely without having to go to theatre.

I will start by saying the good points about each method. Expectant management enables you to be at home, in familiar surroundings and with people you know who love you. The advantage of the surgical intervention is that is gives a sense of finality: when you go home, you know it’s over and you are not dealing with a prolongation of the loss. Medical treatment has been shown in studies to be preferred to surgical in cases where the woman needs the miscarriage to be over quickly.

Unfortunately, no method is perfect. With Expectant management, the bleeding is very heavy with a lot of clots and cramping, much worse than a normal period. Surgical methods may cause a lot of fear in women already disposed to fear of anaesthesia and medical interventions. Also, women report feeling like they were killing their baby or the baby was being ripped out of them; this can be emotionally disturbing. Medical management is fraught with uncertainties and the women have to be monitored for up to 48hours and still may have surgical intervention. An extensive study carried out found that, based on specific criteria, Expectant and Surgical management both had similar success rates of approximately 97% with Medical management having a success rate of about 51%.

At the end of the day, whatever treatment method is chosen, it is important that the woman understands the implications of each choice and is comfortable with the decision that has been taken.

Tears

"When tears come, I breathe deeply and rest. I know I am swimming in a hallowed stream, where many have gone before. I am not alone, crazy or having a nervous breakdown. My heart is at work. My soul is awake." - Margaret Frik.



After my miscarriage, I wrote in my journal, "I finally know what a broken heart feels like." I cried all the way to the hospital and sobbed as the diagnosis was confirmed. I wept so much that I finally slept off on the hospital bed from sheer exhaustion.

Sadly, by the time I got home, I found that there was no one I felt safe enough with to lose control, let go and let the tears flow. My whole family felt so bad for me and the couple of people that saw me cry were so uncomfortable that I decided to smile and be strong. Isn't that what the song says, "Smile when your heart is breaking"? I don't agree with that song anymore.

When you cry, really cry and let the tears flow, it is the best thing you can do for your grieving heart. You're still dealing with a loss, your womb may still be empty but the tears will do you a world of good.

I like to visualise tears from a broken heart like water on a broken up soil: it makes the soil moist and ready to receive seeds and produce beauty. your heart may be broken but so much beauty can be realised if you let the tears fall. Don't be ashamed to cry; and if you're like me and can't find anyone with whom you feel free enough to soak their shirt with your tears and snot, then turn to the Divine Comforter (who, while he was on earth, wasn't ahsamed to weep in public when he lost his friend) and just cry.

Tears. They are a precious gift. Don't despise them. Don't be afraid of them. Embrace them and let them embrace you.

Good Morning

There's something special about the morning. Whether you've had a sleepless, tear-soaked night or you slept soundly only to awaken to the reality of your present situation and dreams that didn't come true, mornings still mean you have to get out of bed.

Mornings give us a fresh start, a clean slate and the promise of a new beginning. When you wake up to another sunny day, when the dawn breaks after a dark sky, you can hope that maybe, just maybe there'll be laughter today; maybe there'll be good news, an opportunity to grow or just the realisation that the pain isn't as bad as it was yesterday.

There is grace freshly prepared for you every morning like a fresh cup of coffee. All you have to do is say thanks for another morning, drink till you're satisfied and go out and conquer your world. You don't know the morning that will mark the start of the day that changes your life for good.

Have a good morning.

Trying Again After A Loss

A lot goes into the decision to try for another pregnancy after you have experienced a loss. First of all, it is important to be in the best possible state of health (physically) before you try to conceive. This means that your blood work has returned to normal and your doctor has given you a clean bill of health. The time all this will take depends on how far along the pregnancy was in the first place and all, if any, procedures that were used in the management of the loss.

More importantly though, your heart has to be in the right place before you try again. For some women, trying again can be a form of therapy helping them to move on. For others, the pain of the loss and sometimes of knowing that there was nothing that could have been done to prevent it, makes it harder to even consider trying again for another pregnancy and risking heartbreak and loss again.

Do not neglect to include your partner and his feelings because he has suffered a loss too. It helps to be open with one another and to be on the same page so that you can support each other.

No matter what you decide, it is important to stay hopeful and positive and maintain a great support network to see you through what will most likely be the scary months of pregnancy.

About "What If?" and "If Only"

After a miscarriage it is so easy to wonder "What if...?" and to wish "If only..."

• "What if I had stopped exercising?"
• "If only I didn't stress myself so much at work ".
• "What if I hadn't had sex that day?"
• "If only I didn"t drink so much coffee/wine."

Helen Jaeger, in Paths through Grief offers much-needed insight. She says, " We do not live in alternative worlds where other outcomes are possible. We live here, we live now and, when we are grieving, we live in pain."

Pause and think on that a moment. Then forgive yourself, let go and live free.