Miscarriage Articles: Medically Informative and Personal Stories

Kelly Preston was 48 when she and John Travolta had their new baby last year. Fellow celebrities Madonna, Lisa Marie Presley, Gillian Anderson, Nicola Kidman, Helena Bonham Carter and Sarah Jessica Parker also had children at 40 or older. Does the number of high-profile older mums give the misleading impression that women can indefinitely postpone motherhood?
For Dr Tony Falconer, new president of the UK’s Royal College of Obstetricians and Gynaecologists, it’s time to stop mincing words about when people should have children. The best age to become a mother, he says, is between 20 and 35.

In an interview with the Guardian newspaper shortly after taking up his role, Falconer said school students should be taught the optimum age to have a baby at the same time they are given advice on teenage pregnancy and contraception.

“There’s no doubt that between 20 and 35 is the time to have your children. We are building up a difficulty for ourselves as a society by people’s expectations that they will wait until they are older. That’s a very complex issue, but it is a problem,” he said.

Education

Specialist Dr Richard Fisher of Fertility Associates agrees that education about the best time to have a baby should start in school. He says a third of the women having IVF through Fertility Associates are over 40, which takes a toll on their chances of success, and many celebrities in the news for having babies over the age of 40 will have used donor eggs.
In 1974, the average age at which a Kiwi woman had her first baby was 23. Now it’s 30, which puts us at the top of the international table for age at first pregnancy.

New Zealand also has the highest vasectomy rate in the world. This is usually heralded as a good thing, but Fisher says a significant number of couples seek IVF treatment because the man had a vasectomy in a previous relationship.

After 35, eggs may decline in quality and be harder to fertilise. Women may also ovulate less frequently even if they’re having normal periods. Older women face an increased risk of miscarriage, stillbirth and gestational diabetes and of having multiple births or a baby with Down syndrome.
On average, 25-year-old women with normal fertility will take three or four months to conceive. By the age of 35, it takes twice as long. At 39, the average time to conception is 15 months.

Ten per cent of women lose their fertility earlier despite continuing to have normal periods; they need to aim to fall pregnant in their twenties or early thirties for the best chance of having children.

IVF

Just over one in a hundred babies born in New Zealand are the result of IVF, which involves removing mature eggs from a woman, fertilising them with a man’s sperm in a lab and implanting the embryos back in the uterus.
More than 60% of IVF cycles in New Zealand are publicly funded, but the criteria for public funding include being under the age of 40. Private funding costs about $10,000 per cycle depending on the provider and the patient’s circumstances.

Surveys have found that the main reason New Zealand women delay childbearing is not, as is popularly thought, because of the cost, but because they can’t find a man with whom they want to have a baby.
The advantage of raising the issue of women’s biological clock to teenagers is it encourages them to plan parenthood in the same way they plan the rest of the lives, says Fisher.
“At that age, teenagers are more concerned with not getting pregnant. Even for people in their twenties, parenthood can seem a long way away.”

Delaying Parenthood

Delaying parenthood has other social impacts. If a woman has her babies in her mid-thirties and those children have their babies in their mid-thirties, women become grandparents in their seventies.

Older grandparents may not be able to help with their grandchildren as much as they’d like and couples may find themselves looking after elderly parents at the same time as they’re caring for dependent children.
Fisher says he has spent the past 20 years advocating that women plan to have their babies at a time they’re most likely to get pregnant.
“The group we’re most trying to influence now is people in stable relationships who are in their mid to late thirties and saying, ‘I’m thinking of waiting five years – is that okay?’ The answer is ‘almost certainly not’.”

Warriors star tells of stillbirth tragedy

NZ Herald May 20, 2011 by Steve Deane

Warriors star Aaron Heremaia has spoken for the first time about the tragedy that resulted in his pulling out of the club’s recent two-match trip to Australia. Heremaia’s wife, Enrica, suffered a miscarriage of their identical twins shortly before the hooker was due to fly to Australia for a match against the Gold Coast Titans 12 days ago.

“It was a shock,” Heremaia said. “I came to training Thursday night and we were leaving on the Friday. I found out that Thursday. “It was definitely a shock but I just have to move on. Me and [Enrica] speak about it all the time. It is good to remember but we have to move on with our life now, just carry on.”

The miscarriage, a result of a condition called twin transfusion, occurred 19 weeks into the pregnancy. The condition means the twins share a placenta, causing a disproportionate blood supply. “It is quite common but it doesn’t usually happen that early,” Heremaia said. “It normally happens after 26 weeks and was probably a good thing it happened earlier rather than later.”
Heremaia said his wife was doing well after the trauma of a full labour to deliver the stillborn babies. “She has her moments, which is expected, but she has been awesome through the whole ordeal. “It is quite hard to lose twins but to actually deliver them too is another thing.” The couple, who have a 2-year-old son, had received a huge amount of support from the club and his teammates, Heremaia said.

“For the Gold Coast game the boys wore the black armbands and again for the Newcastle game. I’ve been flooded with texts and that from the boys.” A globetrotting former chef who played his way through league’s lower grades to earn a contract with the Warriors and later an international call-up for the Kiwis, Heremaia was looking forward to returning to action on Sunday against the South Sydney Rabbitohs at Mt Smart Stadium.

“That’s the type of person I am. I like to get back [to work]. The day I found out, the next day I was training anyway. I like to keep getting on with my routines, not sit around and mope. “It is an escape for me to get back to my football. It is what I know and what I love,” Heremaia said. “While it has been hard the last couple of weeks it is refreshing being back amongst the boys, that camaraderie and closeness that we have got here.”

Sylvia Barnes Story

Eastern Courier

Edition 2/7/10
Sylvia Barnes is extra special to her mum. The Auckland resident was born shortly after her mother gave birth to stillborn twins. Her family’s experience has become an inspiration for her studies at university. The Auckland University student is looking at the long-term effects of grief after miscarriage in mothers as part of her master’s of science in health psychology. “It is a relatively common event with about one in five pregnancies ending in miscarriage,” says Ms Barnes. So far her research shows that many mums experience profound grief but she says there are also long-term effects that have had little research. She says those she has spoken to are willing to talk about their experiences when asked but often feel they should not bring it up with friends and family.

For most mothers it is their first opportunity to talk about the experience, she says. “Many people who have not experienced it don’t think of it as a death and feel they can just have another one.” Ms Barnes hopes to recruit 130 mothers to answer a brief online questionnaire about their miscarriages. To take part in the study email Sylvia at sbar182@aucklanduni.ac.nz or call 021 296 8463.

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Safer Down syndrome tests now available

NZ Herald Feb 9, 2010 by Martin Johnston

Health services are this week starting an expanded, safer screening programme to detect Down syndrome during pregnancy, after serious flaws were detected in the old system. All women who see a midwife or doctor in early pregnancy will now be offered a blood test in addition to the existing ultrasound scan. The blood test is free, but the scan usually costs about $30 to $40. Those who present later will, as now, be offered a blood test, but a new kind. Those considered at higher risk of carrying a fetus with Down syndrome, other chromosomal disorders or spina bifida, because of the screening tests results and maternal age and weight, are offered diagnostic testing.

Analysis commissioned by the Health Ministry since 2004 found the screening system was ad hoc and that women were putting their babies’ lives at unnecessary risk. It is expected the new programme will reduce referrals for amniocentesis, an invasive test that has a 0.5 to 1 per cent chance of causing a miscarriage. This is the main diagnostic test for Down syndrome and is done on 5 per cent of all pregnant women. It involves inserting a needle into the uterus and taking a sample of the fluid surrounding the fetus for laboratory testing. The analysis found the test was being done on some women who might not have an increased chance of having a child with Down syndrome and who had not had the miscarriage risk explained to them.

Peter Stone, the professor of maternal fetal medicine at Auckland University and the author of a report on the screening system, concluded in 2006 that “more normal pregnancies may be adversely affected by amniocentesis than the numbers of Down syndrome fetuses detected”. Down syndrome is caused by the presence of an extra chromosome. It results in intellectual disability and an increased risk of some physical problems, including heart disease. It is linked to increasing maternal age and the risk rises steeply after 35. New Zealand’s incidence of Down syndrome rose from 0.87 per 1000 lives births in 1996, to 1.48 (80 Down babies) in 2002.

Jane McEntee, the manager of antenatal and newborn screening at the ministry’s National Screening Unit, said last night that New Zealand had been screening for Down syndrome for 30 years, but the system had fallen behind international practices.
“It’s quality improvement measures that have been introduced.
“This is about making sure the screening is safe and reliable and that women are fully informed around what screening means and what may follow screening and any decisions that they may need to make.
“So with the screening they can be informed and make decisions around what support is available if there was going to be a child with a disability or the decisions they make that are appropriate for them. Health professionals need to respect women on those decisions.”

The ministry has said its review of the screening is not about reducing the number of babies born with Down syndrome. It is estimated that up to 10 per cent of women who know they are carrying a baby with the condition choose not to have an abortion. The Down Syndrome Association, whose national officials could not be reached yesterday, has previously expressed its support for making the screening safer and more effective, but warned against pressuring people into having the tests.

Professor Stone said yesterday that the changes to the screening were a “significant improvement in the antenatal care for all pregnant women in New Zealand”. He urged the ministry to publicise the screening changes, as “antenatal care works best when it is commenced early in pregnancy”. The ministry said it was planning an advertising campaign to publicise the antenatal and newborn screening programmes.

The tests:
ROUND ONE
* Available to all women who go to doctor or midwife in early pregnancy.
* Blood test, week 9-13 of pregnancy.
* Ultrasound scan, week 11-13.
ROUND TWO
* For all who present later or who did not complete round one.
* Blood test, week 14-20.

Genetic testing first with birth of healthy twins

NZ Herald Aug 19, 2006 by Martin Johnston

The first woman to use a controversial form of genetic testing during fertility treatment in New Zealand has produced healthy twins. The 39-year-old Central North Island woman, who requested anonymity, had her babies last month. “She has delivered twins and they are both doing very well,” said fertility specialist Dr Richard Fisher. She sought help from his clinic, Fertility Associates, after suffering repeated miscarriages for five years.

Her condition which greatly increases the risk of her embryos having an abnormal arrangement of chromosomes, increasing the chance of miscarriage in early pregnancy. She used a procedure called pre-implantation genetic diagnosis (PGD). It starts with in-vitro fertilisation (IVF), in which her eggs are fertilised with sperm in a laboratory. One or two cells are extracted from each of the developing embryos and tested; only normal embryos are implanted in the uterus. Four other Fertility Associates patients are pregnant following PGD, which was permitted by the Government last year, with strict conditions.

Overseas, PGD has been used to choose the sex of babies. Some New Zealanders have travelled to foreign clinics for this, which in the United States can cost US$20,000 ($31,195).

Dealing with the unspoken grief of miscarriage

NZ Herald Nov 27, 2002 by Rebecca Walsh

At first Sandra van Eden thought she was going mad. She would cry when she didn’t want to and started acting completely out of character. After her second miscarriage, she leaped on to the bonnet of the car whose driver had pinched her parking space, screaming and cursing at the young men inside.
“This wasn’t me at all. I was a teacher, I was used to being in control,” she says.
“They just laughed at me and walked off … If someone had told me I was grieving, I would have just been more gentle with myself.”

One in five pregnancies in New Zealand end in miscarriage and about 80 per cent happen before 12 weeks’ gestation. Dr Hilary Liddell, founder of the Recurrent Miscarriage Clinic at National Women’s Hospital, says that after the age of 40 the chances of a miscarriage double. Ms van Eden, now the mother of three, after an operation to fix a deformed uterus, had three miscarriages in the first three years of the 1980s. At the time there were no support groups (she set up Miscarriage Support Auckland in 1985) and like most women then, she was told by doctors, “Never mind dear, go home and try again”.

Friends and family tried to be helpful, but often their comments – “it was only 10 weeks, it wasn’t a real baby” – minimised the loss. Her husband didn’t know how to cope with her grief when it lasted longer than the week the doctor told him to expect. “You don’t know who you are grieving for and society doesn’t legitimise your grief. There is no funeral, no cards, no flowers.”

How attitudes have changed

Lois Tonkin, a Christchurch-based grief counsellor, who works with women who have had miscarriages or suffered a stillbirth, says 20 years ago the attitude was that people got over a stillbirth more easily if they did not see, touch or hold their baby. Sometimes women did not even know if it was a boy or girl. Ms Tonkin remembers one woman meeting her at the front door with a ragged funeral director’s bill, saying it was all she had to prove there must have been a baby.

While attitudes have changed – people now often take their dead baby home, take photos and hold funeral services – many women who have experienced a stillbirth or miscarriage, in particular, believe their loss and grief is not always acknowledged. Ms Tonkin, who has written a book, Still Life, says women often question what’s wrong with them if they haven’t been able to carry a baby fullterm.

They can feel singled out and question if they are being punished in some way. They may feel a sense of failure, or anger and blame towards the medical profession.

Vonney Allan, co-ordinator of Miscarriage Support Auckland, says younger people often don’t realise they are grieving and can feel as if they are going mad. Talking to someone who has had a similar experience is often the best support. Some women who have had a miscarriage or stillbirth feel a desperate urge to become pregnant again, but others find it difficult.
Women who have had three or more miscarriages or two miscarriages late in their pregnancy can be referred to National Women’s Recurrent Miscarriage Clinic, which monitors up to 150 pregnancies a year.

Grieving process important
Advice for women and their families coming to terms with a miscarriage or stillbirth.

Acknowledge your loss and accept you will need time to grieve.
Talk to other people who have had a similar experience – support groups may be helpful.
Get information about grieving from your doctor, hospital or library. Some books have been targeted especially at children.
Make use of strategies to remember the baby, such as visiting their grave, planting a tree or having their name as a password on your computer.
Tell other children honestly what has happened, don’t make it mysterious or they may start thinking it’s their fault. Encourage them to express their feelings and tell them how you feel but reassure them you will be okay. Include children in the rituals of remembering.
Useful contacts: SANDS (Stillbirth and Newborn Death Support) ph (0508) 72 63 72. http://www.nzherald.co.nz

Fertility hope in embryo testing

NZ Herald Jan 23, 2001 by MONIQUE DEVEREUX

An embryo testing scheme that scientists believe may “almost certainly guarantee” to increase pregnancy rates for older women has cleared its first ethical hurdle. Auckland-based Fertility Associates wants to introduce a screening process that will separate healthy embryos from those unlikely to develop into viable pregnancies for its in-vitro fertilisation (IVF) programme. Yesterday, the Ministry of Health’s national ethics committee gave interim approval for a feasibility study to find how successful the screening programme would be.

Fertility Associates’ scientific director, Dr Bert Stewart, said yesterday that the company did not want to “promise the earth” to infertile or older women – who often have more trouble conceiving. But based on similar programmes in other Western countries, screening the embryos “almost always results in an increased number of pregnancies.” A similar programme in the United States had doubled the chances of pregnancy for women in their late 30s to early 40s. Once the feasibility study has been completed, Fertility Associates will have to reapply to the national ethics committee for approval to use the process clinically.

Screening

Dr Stewart hopes to be able to apply within six months, although that will depend on the number of available cells that are donated for study. The screening process, which Dr Stewart says is already used “in almost every other country you can think of,” is called Fish – fluorescent in-situ hybridisation. It identifies which embryos, fertilised during the IVF process, have the correct number of chromosomes to survive through the pregnancy. The screening process would be particularly helpful to older women.

Each woman has a finite number of eggs and by her late 30s most of her eggs have already gone, and those left are not always of high quality. They may still be easily fertilised, either naturally or by IVF, but the resulting embryo is more likely to have the incorrect number of chromosomes to continue as a viable pregnancy.
That can mean a miscarriage.

The Fish process would not only prevent the heartache of a miscarriage, but it could also save money by reducing the number of IVF treatment cycles – costing $4500 each – that some women would have to go through. Dr Stewart said he understood public nervousness about such procedures, but stressed that the screening programme looked only at viable embryos and was not able to detect individual genes.

“This is not a process that allows parents to find out if their child will have blond hair, blue eyes and super-intelligence.
“What we are aiming for is a higher success rate for pregnancy in people who may have otherwise faced a number of failures.”

The Fish technique could be modified to detect genetic disorders, but Fertility Associates would not be applying to test for those. Green Party health spokeswoman Sue Kedgley, who last year pushed for the development of the national ethics committee, said she understood the attraction for women wanting to become pregnant easier, but was wary of what the process could be developed into.
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Little miracles proof of life-saving clinic’s success

NZ Herald Feb 22, 1999 by Martin Johnson

Glenis Croft has a long history of miscarriages, but in the latest her precious baby boy Gage made it through. Mrs Croft was 10 weeks pregnant with twins when she suffered her ninth miscarriage in 19 years, losing one of the foetuses. Medical staff expected the other also to die. But Mrs Croft said she was stunned when an ultrasound scan a week later showed the foetus – now 14-week-old Gage – was alive.

“I prayed. I believed God had everything in control,” said the Papakura woman, who has three other children.
Gage was among seven “miracle babies” aged 5 to 14 weeks at Cornwall Park in Auckland yesterday when their parents held a reunion. The mothers had all come through a National Women’s Hospital clinic that helps pregnant women with a history of miscarriage to avoid having another.
“You go numb to get through,” Mrs Croft said. “There’s so much emotion involved in having a miscarriage.

“People say, `Never mind; you can have another one.’ You don’t want another one. You want that baby.
“I wouldn’t go through this again. It’s way too emotional. It’s a strain on every member of the family.”

Recurrent Pregnancy Loss Clinic

Mrs Croft said the clinic staff linked her miscarriages to a particular anti-body, which they treated with half an aspirin a day. She also had to stop work and have lots of rest. The clinic, which helps women during the critical first 13 weeks of their pregnancies, is unique in New Zealand.

Each year it treats around 100 women who have suffered four or more miscarriages. It has a success rate of about 80 per cent. One per cent of women lose their babies at or before 12 weeks’ gestation. Money worries last year threatened the 12-year-old clinic and although National Women’s gynaecologist Dr Hilary Liddell said yesterday that there was funding until the middle of this year, there is uncertainty beyond that. Another mother at the gathering, Ruth Scott, said: “We don’t want the unit to close. It’s been such a positive part of our lives.”
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Age Matters – Celebrities’ late motherhood sends all the wrong messages about women’s fertility

NZ Listener by Linley Boniface In Health | Published: January 29, 2011 | Issue 3690

Education

IVF

Delaying Parenthood

Warriors star tells of stillbirth tragedy

NZ Herald May 20, 2011 by Steve Deane

Sylvia Barnes Story

Eastern Courier

Safer Down syndrome tests now available

NZ Herald Feb 9, 2010 by Martin Johnston

Genetic testing first with birth of healthy twins

NZ Herald Aug 19, 2006 by Martin Johnston

Dealing with the unspoken grief of miscarriage

NZ Herald Nov 27, 2002 by Rebecca Walsh

How attitudes have changed

Fertility hope in embryo testing

NZ Herald Jan 23, 2001 by MONIQUE DEVEREUX

Screening

Little miracles proof of life-saving clinic’s success

NZ Herald Feb 22, 1999 by Martin Johnson

Recurrent Pregnancy Loss Clinic

When Trying Stops

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