Centre for Reproductive Immunology and Pregnancy
I filmed my miscarriages – for women like me
Lisa Francesca Nand got drunk the night of her 12-week scan. She had expected to call friends and family to share the thrilling secret she and her husband, David Kirk, had been savouring for the past three months. But at the ultrasound earlier that day, instead of listening to the heartbeat of the tiny form they had already nicknamed Lentil, their unborn child lay lifeless on the screen. Nand was told her baby had died and was sent home, where she passed the foetal sac a few days later.
“It was gruesome and physically very painful — I was in the bathroom for two hours trying to pass the sac and bled for six weeks afterwards,” recalls the 40-year-old broadcaster. “But more than that, it was emotionally painful. Suddenly, you’re not pregnant any more, yet everything in your life has changed. I’d stopped drinking, I went out less, I’d altered my diet — I was in mother mode.”
Lentil was Nand’s third miscarriage. She had two in her early twenties, both before 12 weeks, but being young and career-focused, she was able to move forward, confident that motherhood would come in time. The couple married in 2010 and Nand found out she was pregnant a year later while filming a travel programme in Australia. “We were up at 4am the next day for a hot air balloon ride and we were so excited about life,” says Kirk. “It was a magical time.”
Two days before Nand’s first ultrasound, she began to experience mild cramps that intensified over the weekend. Kirk took her to A&E on the Sunday evening, but unable to determine what was wrong without a scan, the doctor on duty sent her home with a couple of paracetamol. “On the journey back, I was writhing around the floor of the car, screaming with the pain of the contractions,” says Nand.
The following day, the sonogram confirmed their worst fears. In shock, the couple returned home via the waiting room they had sat in moments before, still clinging to the hope that all would be well. Around them expectant parents were taking beaming selfies to document this milestone in their pregnancies.
It was at this point Nand decided to make a documentary about their struggle to have a baby. First Heartbeat is an unapologetically honest look at the perennial disappointment of multiple miscarriages, and is powerful viewing. We’re with the couple as they celebrate conceiving again, only for Nand to miscarry eight weeks later. It’s an incredibly intimate process and in a society where vajazzling and threesomes are now acceptable dinner party chat, going on the record with such an intensely personal pain feels almost pioneering, simply because no one talks about miscarriage.
“After my third loss, I became obsessed with finding women who had gone through the same thing,” explains Nand. “The filming helped me distance myself from what was happening to me, but my hope is that other women who have miscarried will be comforted by this, but also informed — treatment, for example, is difficult to find and not a lot of people know that there’s help out there. Also, if more people spoke about miscarriage, it wouldn’t be as much of a shock when it happens to you.”
One in five women will have a miscarriage at some stage in their lives, yet it remains a taboo subject. The reason, explains Ruth Bender Atik, director of the Miscarriage Association, is that “people aren’t really comfortable talking about death and grieving. Because miscarriages tend to happen in the first 12 weeks before women typically announce they’re pregnant, people will try to minimise it by saying, ‘Well at least it wasn’t a baby; it was really just a bunch of cells.’ This not only makes the woman who has miscarried feel like she shouldn’t be talking about it, it also suggests she’s not entitled to feel what she’s feeling.”
The 12-week rule might spare a couple the heartache of having to relive their pain by telling those around them they are no longer expecting, but it can also isolate them from crucial support. “A friend of mine recently had an evacuation of retained products of conception [ERPC] after miscarrying,” says Nand. “She had the operation in the morning then went straight into work, saying she’d had a tooth out. How can you work after that? There are hormones running through your body from being pregnant, not to mention the emotional fallout.”
In 2011, Mumsnet launched a campaign to push for faster access to scanning for women who suspect they have miscarried and for better training for healthcare professionals. In the website’s survey of more than 1,000 users, 58 per cent of women said they wanted counselling after miscarrying, yet just 12 per cent were offered it. “If you’re having a loss before 15 weeks, it’s seen as quite common,” says Bender Atik. “The trouble is it’s not common for you. So there can be a mismatch between your needs and the caregiver’s response.”
In the documentary, Nand goes into hospital for an ERPC after her fourth miscarriage — her second that year. It’s a routine operation for the doctors, but for those who have found themselves in Nand and Kirk’s situation, its implications can be life-altering. On a handheld camera, a besuited Kirk films himself in the car while his wife is in surgery. Wiping away tears, he confesses, “It’s all so bloody sad. These are some of the strongest emotions I’ve ever had. It’s so important to us . . . and now I’ve got to go to work.” It’s a viscerally charged scene that offers a rare glimpse into the father’s experience of losing an unborn child.
Kirk acknowledges the miscarriages affected the couple’s relationship. “At one point Lisa wanted to know if it was me. She had changed all these things about her lifestyle and was taking steroids and after every miscarriage we’d have a little blip. We didn’t crack, but it was very tough.”
While Kirk would have considered adoption, Nand felt compelled to continue. “I didn’t want to be that person in my friendship group: the one couldn’t have kids. I felt like a failure.”
I find this admission refreshing and such a typically female response. We’re hardwired to want to excel — in our jobs, in our relationships, in parenthood . . . And when we’re told we can’t do what we’re biologically designed to do, it chips away at that superwoman exterior many of us spend a lifetime cultivating. My husband I are still debating having children. I’m not sure I’m very maternal, but I don’t want that choice taken away from me. Like Nand, I don’t want to be the friend who’s been “trying for years, poor thing”.
A woman needs to have three or more consecutive miscarriages (defined as “recurrent miscarriage”) in her first trimester or one in her second before she is eligible for a series of investigations to determine the cause. Guidelines issued by the Royal College of Obstetricians & Gynaecologists recommend GP referral to a recurrent miscarriage clinic and “clearly written patient leaflets”.
Those who do get a referral for further investigation will usually end up with one of the country’s top specialists: Professor Lesley Regan at St Mary’s Hospital in London or Dr Hassan Shehata, who runs NHS clinics at Epsom and St Helier University Hospitals. Both have impressive success rates at helping women who miscarry go on to have healthy pregnancies. But with a three-month waiting list and disillusioned with the NHS after a perceived lack of support and information, Nand and Kirk opted to see Shehata privately at the Centre for Reproductive Immunology and Pregnancy in London.
In many cases, the cause of miscarriage is unknown and the loss unpreventable. “If you consider the percentage of pregnancies that end in miscarriage, in some unfortunate cases a woman is going to miscarry more than once without an apparent cause. We tend to put this down to “bad luck”, says Dr Stuart Sanders of The London General Practice. NHS guidelines suggest that obesity and smoking and drinking during pregnancy can increase the risk. Age is also a contributing factor: in women under 30, 1 in 10 pregnancies will end in miscarriage compared with 2 in 10 among women aged 35-39.
With recurrent miscarriage, however, an underlying pathology is usually at play. “When presented with a third miscarriage, I would want to see that the patient is properly investigated,” says Sanders. “One would look towards the father and the mother to see if they have chromosome abnormalities, if the man has a sperm issue or if the woman has a physical or hormonal abnormality.”
Antiphospholipid or “sticky blood” syndrome is another known cause. The immune system makes abnormal antibodies that attack fats called phospholipids in your blood, making it sticky and more likely to clot. Anticoagulant (blood-thinning) medicines such as Warfarin, or a low-dose aspirin, is one form of treatment for recurrent miscarriage but, adds Sanders, “there are numerous treatment options. It depends on the cause — there is no silver bullet.”
Shehata is working on a new area of investigation that explores the immune system as a contributing factor to multiple miscarriages. “We’re examining whether there is anything wrong with a woman’s body that wrongly identifies the pregnancy as foreign and attacks it,” he says. “This theory erodes a big percentage of what we used to call ‘unexplained miscarriage’.”
In the documentary, he explains to Nand that she has natural killer cells that make her womb incompatible with foetal growth and suggests a treatment of steroids and intralipids, an intravenous fat emulsion that helps stabilise the immune system. Both the argument and the treatment are controversial — not all experts agree about the use of steroids — but Nand was undeterred and after 14 weeks of steroid use, started seeing Shehata as an NHS patient at Epsom hospital. “His staff knew all about NK cells and were so lovely — it was a really positive experience compared to what we went through before.”
It wasn’t an easy ride. The physical side effects of the medication include weight gain and moon face, and Nand admits to a feeling of constant anxiety. “Life got serious for us when Lisa started her treatment,” says Kirk. “Our fun-loving, pre-trying-for-a-baby days were jettisoned a little bit. The drugs and the heartache took all the romance out of pregnancy.”
After her fourth miscarriage, however, the treatment paid off and in July 2012, Sebastian Kirk was born, delivered by Shehata. Kirk took a month off work so the couple could soak up the bliss of new parenthood. “The Olympics were on at the time and fireworks were going off everywhere — it felt very symbolic.”
Nand admits to being overly anxious when it comes to Sebastian and has only recently stopped regular contact with her online miscarriage support group — loss is too old a companion for it to be any other way. “Before I had him I’d seen my life from scan to scan, so it was difficult to start imagining the future,” she tells me.
And while that future is significantly brighter, it has not been without dark days — the documentary reveals that she subsequently suffered a further miscarriage. Undeterred, she says to camera, “I think I could go through it again to have another child.”
Available on Times News : http://www.thetimes.co.uk/tto/life/families/article4477216.ece