Bereavement in Obstetrics – Stigma Around Miscarriage

Miscarriage is when an unborn child dies between the first and twentieth week of pregnancy. It can take anything from a few days to months to recover physically from a miscarriage, and it’s likely to take even longer to recover from the emotional damage. They’re most likely to happen in the first trimester, but some happen later on in between weeks 13 to 19.

At least 10% of pregnancies end in miscarriage. This is a huge number – so why don’t people talk about it more? Miscarriages are a bereavement, so those who have experienced them should be given care and emotional support. Having said this, a miscarriage is often a private experience. It is a different kind of bereavement. Sometimes people might not feel they can talk to others about a miscarriage.

Unfortunately, some people who have experienced miscarriage have been met with comments like, “Oh, you’ll just have to try again”, and, “Well, that’s life, we have to deal with it”. These comments aren’t particularly helpful to somebody who is grieving. It can be a lot more helpful to acknowledge the unborn child as a life. Parents have a huge amount of emotional attachment to their unborn child, which others might struggle to empathise with.

In the past, women were expected to do housework, bear children and keep their husband happy. Even now, there is an unspoken expectation that you will have children at some point if you’re a woman. Sometimes there is a bigger reason behind a miscarriage – it can lead to discoveries of underlying conditions such as endometriosis, which can cause infertility. This can make a miscarriage even more devastating.

Women find themselves bombarded with questions as they get older, for example, “You should probably think about having children soon, you won’t have eggs forever!” Personally, I think it’s inappropriate to question people on this private topic. You never know what is going on in somebody’s life. I know a few people with long-term conditions that affect their fertility. It is very upsetting to answer questions about when they intend to have children. They often feel like a failure because, according to their doctor,  it’s unlikely they’ll be able to have any children. Some of these women have experienced multiple miscarriages as a result of their conditions, and the grieving does not become easier.

Bereavement in obstetrics can do a lot of damage to mental health. There needs to be more awareness of miscarriage, causes, and support for those who experience them. Also, partners are often overlooked when it comes to bereavement in obstetrics, and the focus ends up being on the person who carried the child. It is just as devastating to partners.

Psychopharmacology – What’s it all about?

Psychopharmacology is the study of pharmaceuticals used to treat psychological disorders. Although some mental health problems can be treated entirely with therapy or counselling, quite a lot of people do require medication to help them live their daily lives.

There is an unhelpful stigma towards mental health medication, which can lead to family members ‘sabotaging’ treatment by suggesting they can do without, “that rubbish”. Over the years, psychopharmacology has been portrayed inadequately by film and television and sensationalised. You might find that some people struggle to accept that mental health conditions are real, as they’re not ‘visible’. This can lead to very unhelpful statements such as, “It’s lazy to take anti-depressants rather than fix your problems,” or, “I heard about somebody who cured schizophrenia purely by changing their diet, you should try it,”, and of course the popular, “have you tried spending more time in nature?”. While some people may struggle to ‘fix their problems’, anti-depressants can be the key to them feeling like they can change things in their life that need changing. Diet can help with mental health to an extent, as a lot of serotonin is produced in the gut, however it is not the answer for everybody.

Medication can actually be very helpful alongside regular consultations with a psychologist or psychiatrist. There is a variety of medication available to those with schizophrenia, bipolar disorder, and many other conditions that cannot be managed with therapy alone.

There are lots of different kinds of anti-depressants. Some people discourage taking these, but the reality is that sometimes they are totally necessary. Having said this, everyone is different and can respond in different ways – just like any medication, but with medication for mental health it can be even harder to predict what might happen. This is why most people prescribed anti-depressants will be put on the lowest dose and monitored for the next 4 weeks to see if they have any unpleasant side effects. Side effects can be anything from stomach issues, to suicidal thoughts. Anyone experiencing suicidal thoughts as a side effect to their medication should tell their doctor immediately, as another anti-depressant may not affect them this way. There are gene tests available, although you have to pay for them, that may be able to give a list of medications you would respond the worst to.

Mental health problems are usually long-term, so sometimes being able to live life to the full might mean taking medication long-term. Finding the right medication for Psychopharmacology treatment  might mean having to accept certain side effects, such as weight gain or tiredness. Although accepting side effects can be hard, it’s about figuring out what is best for you.

Psychopharmacology Treatment – Some thoughts on Stigma

Medication has a stigma attached to it. There will always be somebody who skeptical of medication, and somebody spreading their concerns about ‘Big Pharma’.  However, mental health medications – psychopharmacology – definitely carry a lot more stigma than other medications, for example, diabetes or blood pressure medication. Part of this is to do with the stigma that surrounds mental health problems in general. There are ways to detect diabetes, heart problems and high blood pressure. There is equipment that can help detect exactly what’s wrong. With mental health problems, it is a lot more complicated to identify the issue. Due to this, some people genuinely believe that mental health problems don’t actually exist. Some people even claim that your mental health can be ‘fixed’ by changing your lifestyle. While changing your lifestyle can have a beneficial effect on your mental health, it isn’t the answer to a lot of mental health problems.

Let’s start with antidepressants. There are loads of different kinds of antidepressants, but regardless of the type, there are a lot of myths surrounding them. Some say that antidepressants turn you into a ‘zombie’ – incapable of feeling anything. It’s important to acknowledge that some people who take antidepressants may feel this way. That is their experience. The reason for there being so many kinds of antidepressants is that everybody is different, and everybody responds to medication differently. As there is no way of ‘measuring’ depression or anxiety, even schizophrenia or bipolar disorder, psychopharmacology treatment requires a different (but careful) approach, including a lot of observation to ensure that the patient is responding in the correct way. So, just because somebody might have had a bad experience with an antidepressant, it doesn’t mean that you definitely will too.

The above is similar for any drug used to help with a mental health condition. Just like any medication, there are side effects to most. Depending on the way your body and mind works, side effects can range from minimal to extreme. This is why mental health professionals will monitor mood and behaviour over the first few months of taking a new medication. They need to ensure that the medication is the right one for you. Side effects can be hard to deal with. Some include weight gain and fatigue, with a more extreme side effect being suicidal thoughts. Anyone experiencing suicidal thoughts as a side effect to medication should speak with their doctor as soon as possible, as it puts them at more risk. It’s all about balance and what is right for the person taking the medication – does the medication help them enough mentally to justify the other side effects?

Bereavement in Obstetrics and Social Media

Social media is the easiest way to share your life with your family and friends, and in some cases, complete strangers. It’s the perfect opportunity to make your life seem exactly how you want it to be. Pregnancy announcements are often made on social media, even more, now with the trends of ‘gender reveal’ parties and baby showers spreading across the world. It can become almost like a competition, especially for somebody who isn’t in a good mental state. Who had the cutest baby shower? Who had the most creative/funny/unique gender-reveal? When is it considered too far? You may be familiar with the story that hit the news about a gender-reveal gone wrong. A homemade device that was supposed to release a colorful powder (pink or blue) exploded, “like a pipe-bomb”, and tragically caused the death of a 56-year-old woman.

Bereavement in obstetrics is a tough topic to share on social media, therefore, there is a lack of awareness on the subject. The excitement to share pregnancy news, and the many congratulations that follow, could make it very difficult if the worst were to happen. Sadly, miscarriages are actually very common. You could argue that losing a baby in such a ‘public’ way could at least mean it’s out in the open and you have people to talk to. However, the other side of the argument is that it can emphasize any feelings of failure that come with a miscarriage. Of course, anybody experiencing a miscarriage should not feel like a failure – it’s not their fault; no matter how often it is said, this doesn’t stop those negative feelings from making their way in.

There is another side to all of this – those who are struggling to conceive. They too are bombarded with other peoples’ gender reveals and baby showers, scan photos, and newborn shoots. Some couples are trying for many years before they conceive, and depending on the reasons they had difficulty conceiving, there may be a higher risk of miscarriage. All miscarriages are heart-breaking for those involved, but the power to make it less-so is in our hands.

We have the right to share our lives and our news with the world, but do we need to share everything online? Sharing good news in person is rewarding, even more exciting, and it is also very mindful of others. The best we can do is try to be mindful of what others may be experiencing