Aborto espontâneo: por que é importante quebrar o tabu

Aborto espontâneo is a very common experience shared by millions of women every year: despite this, it remains one of the hardest topics to open up and talk about. In society, much emphasis is placed on privacy, such as not announcing pregnancy until the second trimester when the risk of pregnancy loss is reduced.

Unfortunately, these hidden miscarriages - and the resultant hidden grief - serve to keep miscarriage a taboo topic, not often discussed openly in society. As a result, many grieving parents feel isolated and unable to seek the support they may need.

Breaking the taboo and talking about miscarriage helps to normalise the experience, combat misconceptions and validate people's emotions.

Miscarriage: a common experience

A miscarriage is defined as the loss of a pregnancy during the first 23 weeks. As these losses are very often kept private, many people underestimate just how common they are. It's important to 'normalise' the experience of miscarriage by understanding how many people it affects.

Risk factors and why miscarriage is not your fault

Miscarriage can happen to anyone - the vast majority occur as a result of a random issue in the genetic make-up of your baby. That being said, there are some factors that could make miscarriage more likely. They include:

• Age (the risk of miscarriage is around 20% at 35 years, 40% at 40 years and 75% at 45 years).

• Previous miscarriages.

• Taking a long time to conceive.

• Low or high pre-pregnancy weight (BMI).

• Regular or high alcohol consumption.

• Fumar.

• Having any abnormalities of your womb (uterus) or a weakness of the neck of your womb (the cervix).

• Having certain medical conditions (for example, lúpus eritematoso sistêmico, síndrome do anticorpo antifosfolipídeo).

• Tendo diabetes mellitus that is not well controlled.

• Having certain infections such as listeria e rubéola.

In almost all cases, there is nothing that you could have done - or have failed to do - to avoid miscarriage. Talking about miscarriage can help to debunk some of the myths surrounding causes, including lifting, straining, working too hard, or normal exercise.

Such myths are not only incorrect, but the guilt they cause can be very harmful to a person's mental health and hinder recovery through the grieving process.

How does miscarriage affect parents?

"Miscarriage can affect people in very different ways, and it will be a unique experience for those involved," says Frankie Aitchison, psychotherapist and spokesperson for the Conselho de Psicoterapia do Reino Unido (UKCP).

"Whether you have gone through multiple losses or this is the first time, whether it is early on in the pregnancy or as late as 23 weeks, all are difficult and can come with a collection of complicated feelings such as shock and disbelief, sadness, anger, guilt, fear and hopelessness."

When miscarriage is treated as culturally taboo, the lack of public recognition can make women and their partners feel like they should be coping differently with their situation. In fact, all forms of pregnancy loss result in varying experiences of o luto. Aitchison explains how this is particularly difficult for parents who have started to plan for their child's arrival:

"You may have formed connections with your baby that are very real, or even have started to buy clothes, and nursery furniture, and prepare for their arrival. This preparation means that not only will you be feeling the grief of losing your baby but also the grief of a life with them, an imagined future that is now no longer possible."

No one way to grieve

Grief is normal, but there is no one way to grieve. Every person needs time to process what has happened and there is no right way or standard set of time over which this happens.

"Your journey is very much your own. You may experience emotions that are very close to the surface, you may cry a lot, feel the need to sleep, isolate yourself from people, and you may also feel like you want to avoid certain social situations, especially if you have been around others who are pregnant," says Aitchison.

"Grief is a complex thing: it can come in waves, some days may feel easier, but then you can be swept away by an overwhelming sense of the loss. Grief takes time, there is no number of weeks, months or even years where you should be past this or have gotten over it. The process of coming to terms with what has happened to you means that you will find ways to live alongside the loss."

Shame and guilt

Unfortunately, a lot of women experience a huge knock to their confidence and self-esteem. "It is not unusual to feel you have let people down or failed, feeling that your body didn't do what it was supposed to do," adds Aitchison.

"This can lead to feelings of guilt and shame, and you can question your ability to trust your body and instincts. Many people come away from pregnancy loss with no answers as to why this has happened, and this can add an additional layer of difficulty."

Why is it important to talk about miscarriage?

The cultural taboo against the public recognition of miscarriages and the expression of grief can make the healing process much harder and lonelier for a number of reasons.

Breaking the taboo by talking about miscarriage is arguably needed in all parts of society. One 2021 estudo highlights the prevalence of this taboo in the workplace, and how it affects relationships with colleagues and creates difficulties for people returning to work after their loss. Other experts believe that the taboo of pregnancy loss grief impacts therapy treatment, with parents and even some therapists minimising the experienced feelings of grief.

Normalising the experience

Through talking about miscarriage more openly, we can help parents to understand that it is relatively common. Currently, there is a huge disconnect between the actual and perceived number of miscarriages, because so many are kept hidden.

According to one US pesquisa, most people believe miscarriage to be a rare complication that happens in 5% or less of all pregnancies. In contrast, 15% reported that they or their partners had experienced at least one miscarriage.

A estudo carried out on 746 university students in Ireland also found that 30% incorrectly thought that miscarriages occurred in fewer than 10% of pregnancies. Unsurprisingly, the students who didn't know someone who had a miscarriage underestimated this rate the most.

Talking in order to 'normalise' the experience may help people to understand that miscarriages are an unfortunate but natural occurrence. This can help prevent women suffering from guilt and shame, and open discourse can also help to validate people's experiences.

While dealing with miscarriages privately isn't wrong, it's also important to treat discussions of miscarriage as normal and acceptable. This is because for many, talking and sharing this significant event with others is a source of coping.

"As pregnancy loss is something that feels very private, it can be very difficult to talk about and the loss can feel acute and painful," explains Aitchison. “The physical experience of miscarriage as well as the emotional toll can often feel like a very lonely place and the silence around it can seem very loud."

Combating misconceptions

The same US survey also suggests that there are widespread misconceptions about what causes miscarriage. A large percentage incorrectly believed miscarriage could be caused by:

• A stressful event - 76%.

• Lifting a heavy object - 64%.

• Previous use of an intrauterine contraceptive device (IUCD) - 28%.

• Contraceptivos orais - 22%.

Likewise, in the Irish study estresse was identified as a risk factor more frequently than advanced maternal age and smoking. Although some believe stress to be a factor, the clinical evidence for this is limited.

Sadly, these misconceptions can have a detrimental effect on mental health because they pass blame on to those who have miscarriages.

Talking about miscarriage can help to spread the facts and debunk the myth that miscarriage can usually be prevented, a primary cause of shame and guilt during the grieving process.

Talking as therapy

Talking to someone is one of the best ways to help you cope with grief. "It's important to know that you can reach out at any time, whether it's soon after or much further down the road. Alongside your GP, A Associação de Aborto Espontâneo offers a wealth of information and support, including a helpline with people who understand," advises Aitchison.

As Aitchison stresses, everyone has the right to be heard, to share their story and to be supported.