Life, Almost: Miscarriage, Misconceptions and a Search for Answers from the Brink of Motherhood

"For one thing this book is beautifully written, and she raises some really important points both as a woman who has experienced recurrent pregnancy loss and as a really rigorous journalist. We’re talking about miscarriage and pregnancy loss more now than we were maybe ten years ago, but people still don’t really understand how prevalent it is. What Agg argues is that because it’s so prevalent, and so devastating, we need to get better at understanding the causes. And we need to get better at managing and treating pregnancy loss. This includes everything from clinical management to actual situational management—like the fact that if you’re having an active miscarriage, which can be incredibly painful and involve a lot of heavy bleeding, your first port of call is most likely your nearest hospital’s emergency department, which is probably the worst place to try to sit and wait while you’re having a miscarriage. She also talks about the environment in early pregnancy units, and how when you have a subsequent pregnancy your history of loss often isn’t adequately explored or addressed. So I think she makes a lot of considered arguments for advancing the conversation in those ways. Yes, and it’s a problem of infrastructure, because most maternity hospitals were not built recently and were not built with this kind of compassionate care in mind. And just in terms of practicalities, the same staff who are looking after women delivering healthy live babies are going to also be required to look after women undergoing loss. The logistics of having totally separate units for these two populations are quite challenging. We know that even if there’s a special room in a labour unit for losses, it’s not always as private or as quiet as women would like. The way forward from this isn’t clear. Here in Scotland, there was a campaign last year from a bereaved woman about having separate units for loss away from the labour unit and it had some government support, but it didn’t really go anywhere because, again, our system is very industrialised, it’s about ‘production of child’ on this efficient conveyor built moving from A to B. It’s not really designed for nuance or compassion, really. What I heard from researchers time and again, and what Jennie Agg would agree with, is that while we’re good at diagnosing pregnancy loss after the fact when we can say: this was pre-eclampsia, or: this was uncontrolled gestational diabetes, but we’re not very good at being able to predict or prevent things. And as you’ve flagged, that goes right back to this process of placentation and implantation which is really poorly understood and under-researched. And that in turn goes back even further to, as I write in my book, our poor understanding of menstruation and what that process actually involves and what it can tell us. And all of these things have a root cause in a sort of ignorance and lack of understanding around what the uterus is even doing and what it’s likely to do."