After 25 years of practising women’s health, I am continually taken aback by ongoing erroneous beliefs surrounding miscarriage. Despite improved access to information via the internet, many women continue to be under the false impression that the loss is self-generated.
In a survey of more than 1 000 men and women, respondents most commonly cited a stressful event (76%), longstanding stress (74%) and lifting a heavy object (64%) as causes of pregnancy loss. In addition, respondents inaccurately thought that miscarriage could be caused by sexually transmitted disease (41%), a previous abortion (31%) or use of implanted long-term birth control (28%). Nearly 23% of respondents erroneously believed a miscarriage could be caused solely by the woman not wanting the pregnancy.
Could the very word we choose to use — miscarriage — be partly to blame for these false impressions? Perhaps we unintentionally validate these false beliefs through our ongoing use of this term?
Medical sources generally define miscarriage as the spontaneous loss of a fetus before the 20th week of pregnancy. This definition seems benign enough; however, a more complete understanding of the negative emotional state following a miscarriage is needed. The term miscarriage is comprised of two parts: the prefix mis-, meaning “mistakenly, wrongly or badly,” and –carriage, a “means of conveyance”.
Although the –carriage portion of the term is reasonably accurate, the mis- portion is not, and is potentially harmful. Most miscarriages do not represent a mistaken, wrong or bad action on the part of a woman’s body; most are caused by spontaneous chromosomal anomalies that render human development impossible and do not relate to inherited genetic problems. In reality, there is nothing within this normal physiological event that would justify the prefix mis-. Rather, miscarriage is more often a healthy body recognizing a pregnancy that is incompatible with life and discontinuing further investment in a nonviable pregnancy.
Miscarriage is an exceedingly common and potentially life-altering event. About half of all fertilized eggs die and are spontaneously aborted, often before the woman even knows she is pregnant; among women who do know they are pregnant, the rate of miscarriage is 15%–20%. Yet a survey of more than 1 000 women and men found that 65% of respondents believe miscarriage is rare. Although knowledge of miscarriage rates was low, respondents accurately assessed that it is traumatic, with 66% believing the emotional impact is severe and potentially equivalent to the loss of a child.
The very term miscarriage implies conscious control because other words that use this prefix are quite willful by implication. Terms such as mismanage, mistake, misuse and misguide are examples of words that may play a not-so-subliminal role when coming to terms with miscarriage. These words may validate feelings of failure, depression, guilt and shame following such an event.
Current terminology in modern medicine falls short in offering more enlightened alternatives to the term miscarriage. The term spontaneous abortion is not acceptable because the common use of abortion refers to a willful act. A well-meaning healthcare worker’s intentions can backfire because the term abortion may imply that the loss of a woman’s pregnancy has been somehow the result of a desire on her part, which may worsen the feelings of shame, guilt, self blame and depression associated with pregnancy loss.
A term that more accurately conveys the reality of the loss is needed. The term natural pregnancy loss or NPL is a good alternative that does not have the negative connotations of miscarriage. NPL reflects a basic understanding of what pregnancy loss truly represents. Using the term NPL could reduce the blame implicit in the term miscarriage and help to engender a sense of empowerment and well being.
Words are important. Broad acceptance of the term natural pregnancy loss in place of the term miscarriage is of value to the health practitioner when providing psychological support to the grieving mother. The term NPL helps remind women that this loss reflects what a healthy body should do with an embryo incompatible with life.
Explanation of the inaccuracy inherent in the term miscarriage to the patient serves to highlight the generally positive prognosis for future pregnancies. Most importantly, it lessens the very palpable sense of loss.