If there is a single phrase I associate most with having a miscarriage it’s: ‘We don’t know’.
I can still hear those words now, echoing around the otherwise too-still, too-silent scanning room after my husband and I were told our first pregnancy had ended, just shy of the 12-week mark.
Why did this happen?
‘We don’t know.’
Will it happen again?
‘We don’t know.’
It was the same answer two more miscarriages later, after a round of investigations at a specialist clinic. Was there something wrong with me? Why did this keep happening? They didn’t know. As far as they could tell from the raft of blood tests and internal scans, there was no known reason. Which is not the same as there being no reason.
Likewise, whenever I’ve started bleeding in early pregnancy – once at six weeks and once at eight weeks – and sought medical attention. Was it another miscarriage? It was ‘hard to say’. No one could tell me.
Even in my fifth pregnancy – the only one so far that has resulted in a living baby – when I was prescribed pessaries of the hormone progesterone, after I found a study that suggested it might help, those same words followed us from consultant’s room to consultant’s room. Would it work in our case? We don’t know. How exactly does it help prevent miscarriage? We don’t know.
As for whether progesterone will ‘work’ for me in another pregnancy, or whether it was just lucky coincidence, again: We just don’t know. (The glimmer of good news is that the UK’s official guidance to the NHS has since been updated to recommend progesterone be offered more widely to those who’ve had a previous miscarriage. Progesterone isn’t a panacea, but it’s worth talking to your doctor about.)
The breadth and depth of what we don’t know about miscarriage should be shocking, but instead it’s still seen as ‘just’ one of those things that we can’t do anything about.
When I had my first miscarriage, back in 2017, I had no idea how common it was. I’d naively assumed that if I followed the standard pregnancy advice, ate and drank the ‘right’ things and avoided the ‘wrong’ ones, it was unlikely to happen. This did not reflect particularly well on either me, as a health journalist, or the information I’d been given by the NHS and various pregnancy apps.
Since then, awareness of pregnancy loss has increased thanks to growing ranks of high-profile people sharing their experiences, including Michelle Obama, Meghan and Harry, Chrissy Teigen and John Legend, the MP Stella Creasy, Carrie Johnson, Stacey Solomon, Britney Spears, Jessie J, Gemma Collins, and more besides.
Slowly but surely, this subject feels a little less taboo. And now that we’re finally talking about miscarriage more, it’s time we asked why we don’t know more.
We need the science – and society – to catch up. To start with, we need to do basic things like record an official miscarriage rate. Because, currently, unlike with other maternity statistics, no such data is collected. This means what we know about the number of miscarriages that happen every year is really just a guesstimate.
We need the Government to pass the Miscarriage Leave Bill, currently making its way through parliament, which would guarantee everybody – including partners – a minimum of three days off work if a pregnancy ends before 24 weeks.
Above all, we need to start to fill in the many blanks in our knowledge of pregnancy and how it works – and sometimes doesn’t work.
We need more research so that we have better answers for those who lose pregnancy after pregnancy, or for whom IVF treatment repeatedly does not work. We need more options and a lot more understanding as to what might actually help prevent miscarriages and why. Because, as it stands, there is no treatment for recurrent miscarriage with the highest quality of evidence to show that it works, according to a 2021 review published in the medical journal The Lancet.
We need medicine to seriously consider how a man’s health might impact pregnancy, as well as a woman’s. For example, precious little is known about how sperm quality contributes to miscarriage. Sperm is not even routinely tested for people who have recurrent pregnancy losses.
Talking about miscarriage is often presented as a self-contained solution, rather than being one small part in bringing about actual improvements to medical care or any deeper scientific understanding of this aspect of human life.
There are many things I still don’t know about miscarriage, despite all of my own experience and also interviewing more than 20 leading experts and researchers for my book.
But of this I am completely certain: We shouldn’t settle for ‘we don’t know’ any more.
READ MORE: I had PTSD symptoms after five miscarriages