Chemical Pregnancies: The Silent Loss

Home pregnancy tests have come a long way since they became available to the public in the 1970's.  Some brands are now so sensitive that they are able to detect hCG levels as low as 5-10mIU, meaning you may only be one to two days past implantation when you get a positive result.  For women who are trying to conceive or who have been struggling with infertility, these highly sensitive home tests provide answers faster and shortens the dreaded "Two Week Wait" in between ovulation and awaiting their cycle in hopes for a pregnancy.  Unfortunately this also can cause a lot of confusion and heartbreak for women.  Imagine seeing a faint positive line form on your test - your long awaited pregnancy is now a reality! - only to have your cycle start a few days later.  Or worse, having a negative result at the doctor's office when you go in to confirm the pregnancy.  This is what is known as a chemical pregnancy and is the earliest type of miscarriage that can occur. 

Approximately 50% of all pregnancies end in a miscarriage, with 80% of those occurring in the first trimester.  It is speculated that these numbers may be even higher but prior to the high sensitivity levels available with home pregnancy tests on the market today, most of these losses went undetected.  

Chemical pregnancies are defined as a miscarriage that occurs within the first 5 weeks of pregnancy.   With a chemical pregnancy, a woman may have no or very few pregnancy symptoms.  Often times with a chemical pregnancy, any pregnancy symptoms are attributed to PMS.  Her menstrual cycle may be on time but unusually heavy, or perhaps a day or two late with more intense cramping than usual, or she may have no noticeable difference than any other menstrual cycle.  Unless she was purposefully testing early, as is the case for many women who are trying to conceive, she may never have even suspected that she was pregnant for that brief time. 

Chemical pregnancies can be a very isolating and profoundly life-altering experience for women, especially those who have been trying to conceive for many cycles or who are struggling with infertility.  Since this type of loss occurs before many women even have a chance to announce their pregnancies to friends and family, it can be very difficult to find the support one would usually receive during a miscarriage.  This means that the majority of women who experience a chemical pregnancy often suffer alone and in silence.  

All known pregnancy losses take an emotional, physical, and mental toll on the mother and the length of the pregnancy does not correlate with the amount of grief they mother may experience.  As mentioned before, one of the biggest issues for mothers experiencing a chemical pregnancy is lack of support and understanding from friends and family.  Most people do not understand what exactly happened, are misinformed about early losses and either assume that the mother couldn't possibly be attached to the pregnancy that quickly, or feel that a chemical pregnancy doesn't "count" as a miscarriage.  Partners may also struggle with supporting the mother, or may not understand why she may be experiencing such profound grief and confusion.  

Care providers and well-meaning friends and family members my try to downplay the depth of grief and the sense of loss that can accompany this type of pregnancy loss.  You may hear that things are "better this way" as it is speculated that these types of miscarriages are due to chromosomal anomalies, like Down Syndrome or Trisomy, and that by miscarrying you are being "spared" a child with severe learning or physical disabilities.  These statements, however, do not lessen the pain or provide any sort of relief for a woman navigating the emotions and thoughts of a miscarriage. 

Women who experience a chemical pregnancy may worry that it means there is something wrong with her and that she may not be able to carry a pregnancy to term.  Most chemical pregnancies, however, do not indicate any underlying fertility issue with the mother or the father and many women who have had a chemical pregnancy go on to have healthy, full-term pregnancies within the next year.  If you have had multiple chemical pregnancies or first trimester losses, it is important to be seen by a provider who can assess if there are any health or hormonal issues that are preventing you from carrying a pregnancy past this point of development.  Usually in these cases it is discovered that the mother has a hormonal imbalance that prevents her from producing enough progesterone to sustain the pregnancy in the early weeks of gestation.  This issue can sometimes be resolved by using a progesterone cream for the first few weeks of pregnancy, or through dietary and life-style changes if the mother has a form of insulin-resistance known as Polycystic Ovarian Syndrome (PCOS).

It is important to remember that everyone handles loss and grief differently and there is no right or wrong way when dealing with a pregnancy loss.  It is normal for a mother to feel anger, confusion, and sorrow with this type of loss just as it can be normal for her to feel nothing more than a mild sense of disappointment before moving on.  There is no time-line for grief, just as there is no measurement for the depth of pain she may or may not experience.  Acceptance, empathy, and support are the best ways to help a mother as she deals with her loss in her own way.  It is appropriate and should be encouraged for a mother to seek counseling or therapy if she is really struggling with her emotions after a chemical pregnancy. 

All About: Birth Doulas

The term "doula" refers to a birth or life-stage professional who provides four key things to their clients: physical support, emotional support, informational support, and advocacy support.  There are many types of doulas.  Over the next several weeks, I will be talking about the types of doulas specific to pregnancy, labor & delivery, postpartum, and pregnancy loss.  Each week I will focus on a specific type of doula, her role, and the benefits she provides to her clients.

Birth & Labor Doulas: What They Are

A birth or labor doula is a person, generally a woman who has given birth before herself, who has specialized training and experience with supporting women during their birth process.  Birth doulas typically meet with their clients a few times before delivery so that they may get to know the mother and her partner better and to understand what their ideal birth experience would be, however studies have shown that simply having a birth doula present in the delivery room improves outcomes - whether or not the doula and the client have met before.  Birth doulas provide their clients with the three major tiers of doula support during labor: emotional, physical, and informational.  Some even provide advocacy support, depending on their personal views and/or certifying organization.  

What They Do:

Emotional Support

Pregnancy can be a stressful time in a woman's life.  There are so many differing opinions on what is "safe" and "healthy" while growing a person in your womb.  Add hormones, routine tests, conflicting medical advice, and sifting through all of your birth options and its enough to give anyone heartburn.  Birth doulas provide a safe, empathetic space for expecting mothers to vent all of their anxieties and concerns with.  They also give mothers reassurance, letting them know that their feelings are valid and their choices are supported.  During labor, women need a LOT of emotional support - especially if an unmedicated vaginal birth is the goal.  Birth doulas soothe and comfort the mother, letting her know that what she is going through and feeling is normal and that she is doing an amazing job with her labor.  They also support the partner!  Partners need the steady reassurance and guidance of someone who knows that what is happening to the mother, that she is not dying or in imminent danger, and who can calm them so that they are better able to offer their own unique (and much needed!) support to the mother.  Lastly, a woman remembers the emotional experience of every birth she has for the entirety of her life.  A woman who feels supported in her choices and nurtured through her birth experience will likely have positive emotions and memories, regardless of outcome.  A woman who has the "perfect" birth but who felt unsupported will probably have negative thoughts and feelings about her delivery.  Having a doula present increases the likelihood of having an emotionally satisfying birth.  

Physical Support

Mothers need a great deal of physical support during birth, regardless of the method of delivery.  Undisturbed birth, or birth that has no medical interventions whatsoever, requires a great deal of physical support by the use of comfort measures and positional changes.  Women who choose to have pain medication, such as a narcotic or an epidural, need positional changes and support to help gravity continue to play it's role in the delivery process.  Inductions can be extremely physically challenging as the synthetic hormone, Pitocin, can cause intense and unrelenting contractions - the skilled hands of a doula can help provide much needed pain relief!  Lastly, women who deliver via cesarean section are often over-looked when it comes to delivery support and yet they too are giving birth and have all the same needs as any other mother!  Doulas can be with a mother in the OR if the partner is unable to be there for some reason, and then can provide a huge amount of physical support as the mother recovers in the hospital after delivery.  

Informational Support 

Informed consent is the name of the game when it comes to having an empowering birth experience.  Yet how can you possibly be expected to make an informed choice without knowing all of your options?  Doulas bridge the gap between the medical providers and the clients by providing non-biased information about all of the options available to expecting and new parents in the delivery room and immediately postpartum.  During the delivery, if an intervention is suggested the mother and her partner can ask for a minute to talk it over.  In that time, they can ask the doula about the benefits and the risks of the intervention and provide alternative options that could be discussed with the care provider.  A doula will never choose an option for a client or suggest one option is "better" than another.  Their role is to provide the information the client needs to make their own informed choice.  

Advocacy 

The birth doula's role in advocacy can vary greatly based on a doula's certifying organization, training, and business practices so it is important when interviewing doulas to discuss their role and what they can or cannot do for you in terms of advocacy.  Generally speaking a doula cannot speak to a care provider on behalf of their client, especially in a hospital or medicalized setting.  What she can do is remind you of your choices and support you in your decisions, regardless of hospital policies or care giver preferences.  

How To Find A Birth Doula

There are several ways to go about finding the perfect doula for you.  Doulamatch.net is a free searchable database for doulas that allows women to browse doulas serving their zip code.  Doulas post profile information such as number of births attended, specialty trainings, certifications, and client testimonials.  The doulas are also able to update their availability for Estimated Due Dates on their Doulamatch profiles, allowing mothers to narrow down their searches a little faster.  

Most certifying organizations also have online databases available with listings of their doulas by state or zip code.  DONA.org is a great place to start your search!  

Lastly, word of mouth is a fantastic way to find wonderful doulas and other birthworkers in your area.  Natural birth groups, yoga studios, midwives, lactation consultants, and mom groups usually all have a list of doulas that they know and love.  

It is highly recommended that you interview several doulas before making your decision on who you would like to support your labor.  You want a doula that you feel is a good fit for you and that you have a connection with.  Doulas do not take it personally knowing that you are "shopping around".  Great doulas really want their potential clients to interview with other doulas in the area to ensure that the mother is getting the best person for them and their birth.  

Here is a list of questions you may want to ask during your interviews:

1.  How many births have you attended?  
2.  Have you supported a cesarean section delivery?  Were these planned or unplanned?
3.  What trainings and/or certifications do you hold?  
4.  Do you have a back-up doula?  Is it possible to get their website and business information so that we can familiarize ourselves with them prior to my due date?  
5.  How many prenatal appointments will we have together before my delivery?  How many postpartum visits after the baby arrives?  
6.  What is your on-call window for my birth?  
7.  Are you available by text, phone, or e-mail to answer questions prior to my delivery and during my postpartum period?  
8.  What is included with your services?  Are there limits on hours for labor support?  Do you charge an hourly fee after a certain amount of support hours are provided?  
9.  Do you support women who wish to use epidural or narcotic pain relief?