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Miscarriage

ith two problem-free pregnancies behind me it never crossed my mind there would be a hitch the next time around. When I conceived for the third time I fully anticipated the course of the pregnancy would be, as before, trouble-free. I tried not to panic and rang my GP when I started with abdominal pain and bleeding at around six weeks.

I was not practising at the time, and prior to leaving the profession I had been a hospital physician. I therefore had little idea of what to expect in terms of management. My GP examined me and decided it was unlikely to be an ectopic and told me to 'see how things went'. She said there was nothing I, or anyone else, could do to influence the outcome.

That was really hard. I am a 'get on and sort things out' person. This time I had no control.

Had I been forgotten about?

I sat around for the next few days unsure what I was supposed to do. The doctor had said to 'take things easy' but had given no specific advice one way or the other about work. So I stayed at home awaiting further instructions. I did a lot of worrying and about six pregnancy tests to prove to myself that there was still hope.

After five days I decided I could twiddle my thumbs in the dark no longer and called my GP again to ask what to do now. She seemed a little surprised I was still bleeding and I got the feeling she had forgotten all about me. She finally made me an appointment for an ultrasound scan, which was inconclusive: a sac, they said, but maybe too early to see the contents, or perhaps the contents had gone.

They took blood for a ? HCG and I was sent home to wait again. I did a few more pregnancy tests, and hoped with less conviction that the next scan and blood test would be good news.

They were not. I was given the choice between more waiting around to see if the miscarriage would complete, and an evacuation. I chose the latter and spent the days before worrying that there would be a freak accident `and that I would die under the anaesthetic.

My husband, a sanguine anaesthetist who lacks sentimentality, thought that was ridiculous, and did not seem to be sharing my feelings of loss. I felt a bit abandoned.

Pressure to 'perform'

I have to admit I felt a little silly about being so upset ­ after all, I already had two healthy children, I knew that first trimester miscarriage was common and not usually sinister, and the 'baby' had never really existed except in my imaginings and aspirations. Nevertheless, I could not help worrying over the potential causes for my miscarriage, and I feared I would never have another baby.

With reluctance, we waited the advised two cycles before trying again. We both now felt quite under pressure to 'perform', and a copy of The Joy of Sex would not have gone amiss. We were both very relieved when I quite quickly became pregnant again.

I have never been one for counting my chickens before they have hatched, but this time, when the eighth week had come and gone, I really thought I was home and dry.

Then, at about nine weeks' gestation, it all started again. I recognised the signs immediately and my heart sank. I had avoided imagining a baby this time around and felt almost hardened against the pain of another loss. All I could think of was what a complete waste of time the last nine weeks had been, and I felt cheated and angry. I called my GP to ask for a scan immediately, and went through the inevitable process again. I was told no one would be interested in investigating until I had had three miscarriages in succession.

Fortunately the third miscarriage never happened, and I now have four children, the second and third being a little more widely spaced than we would have wished as a constant reminder of those unhappy and frustrating times.

I now regularly draw on and share my personal experiences when patients present with threatened miscarriage, and I know that many take comfort from the knowledge that, for once, the doctor really does know what they are going through.

Tips to pass on

 · Do not leave the patient without a formal plan following presentation. She needs structure to the highly stressful waiting time before the scan.

 · Patients frequently fear they will never carry a pregnancy to term, and need reassurance about the likelihood of a positive outcome of their next conception, which can be as high as 60-70 per cent.

 · The partner may be grieving too, but he may not (or may not show it), leaving the woman feeling isolated and unsupported.

 · Pressure to try again can put a strain on a couple's relationship. Remind them to have sex for fun as well as for procreation.

 · Doctors make lousy patients and probably need even more reassurance and explanation to get things in perspective.

 · Do not be afraid to share your personal experiences

with patients.

Has the way you practise been affected by a condition that you or a close relative has had?

Pulse wants to hear from GPs with a story to tell and advice to offer.

For details contact

Amanda Elliot, Pulse,

CMP Information Ltd,

Ludgate House

245 Blackfriars Road,

London SE1 9UY

aelliot@cmpinformation.com

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