Close-ups

A Patient's Perspective

Letting Go



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Am Fam Physician. 2007 Jul 15;76(2):233.

I've had five miscarriages since the birth of my son. When I was 19, I found out that everyone in my family—my mother, brother, and sister—carried a translocation. I was a biology major at the time and I knew what this meant for me and my future. I was really feeling kind of defective. I was feeling, “Great, I'm broken, I have something really wrong with me.” It makes you question the naturalness of reproduction.

After so many miscarriages, it's difficult to tell people. I feel like I'm hurting them because they have so much empathy for me and my husband. It's a burden to have to tell people bad news. I have in mind a picture of a family where there are two children. Every time I get pregnant one of my friends is pregnant and they go on to have a child and I don't. But I can look at my friends and be happy for them. People ask us, “Are you going to have more children?” We say, “Oh, we're thinking about it.” People don't realize the weight of the questions that are asked about pregnancy. So many people have problems getting pregnant, you'd think everyone would be more careful of their questions. The assumption still is that when you want children, you can have them.

After my fifth dilation and curettage, I am finally letting go of the idea that my reproductive identity is the essential component of who I am. I've been so focused on trying to have another child that I've been having a really hard time concentrating on my job and my life outside of being a mother. Now I'm realizing that I can't give up so much of myself to have another child. I can't spend my whole life thinking, “Oh God, where's my other child?” I have so much to be thankful for as it is. My son is the first child born into our family who does not carry the translocation. It's miraculous, if you believe in miracles, that I have a child at all.—k.k., 35

COMMENTARY

Up to 1 percent of couples experience recurrent pregnancy loss. Causes are identified in only one half of cases and are thought to be multifactorial. Genetic abnormalities account for less than 5 percent of cases; other causes include insufficient progesterone production, uterine abnormalities, antiphospholipid syndrome, and inherited thrombophilias. Studies of treatments have been of poor methodologic quality. One review found a small but significant benefit in preventing miscarriage with progesterone, and possible benefit with human choriogonadotropin and immunotherapy.1

A study examining the relationship between grief and pregnancy status in 63 couples found that women who wanted to conceive again, had not conceived, and had no live children still had active grief 13 months after miscarriage. Women such as these may benefit from additional support and follow-up.2

REFERENCES

1. Price M, Kelsberg G, Safranek S, Damitz B. What treatments prevent miscarriage after recurrent pregnancy loss? J Fam Pract. 2005;54:892,894.

2. Barr P. Relation between grief and subsequent pregnancy status 13 months after perinatal bereavement. J Perinat Med. 2006;34:207–11.

RESOURCES

International Council on Infertility Information Dissemination

Web site: http://www.inciid.org

Close-ups is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD, Tony Miksanek, MD, and Jo-Marie Reilly, MD. Questions about this department may be sent to Dr. Wellbery at well-berc@georgetown.edu.

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.



Copyright © 2007 by the American Academy of Family Physicians.
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