Welcome back Chaise Lounge readers and an especially warm welcome to our newest subscribers! The topic of miscarriage is difficult to write about because of the silence and stigma surrounding it. But CL is hoping to be a part of a movement that help to open discussions. Today’s article is the second in a three-part series and is based on an interview I conducted with OB/GYN Dr. Rachel Leland. We explore the physical side of miscarriage. If you missed last week’s installment, you can read it here. Next week we will look at the psychological ramifications of having a miscarriage.
Founder and CEO Joanna Griffiths of Toronto-based Knix Wear, Inc. recently raised $53 million for her e-commerce company that sells women’s underwear and apparel. What makes this newsworthy is that Ms. Griffiths was visibly pregnant with twins during the time and set a rule that any investor who raised her pregnancy as a concern, regardless of the valuation, would be immediately disqualified from bidding. Quoted in the Globe and Mail, Ms. Griffiths says, “If that’s how they felt about me as an entrepreneur and as a female founder, they sure as hell were not going to understand the mission of Knix and what it is that we’re trying to accomplish.”
Auditors concluded that the European Union (EU) is not using its budgeting tools to advance gender equality. "Gender-responsive budgeting is not just about funding explicit gender-equality initiatives," the report said. ”It is about understanding the impact of budgetary and policy decisions on gender-equality goals, and using this information to adjust for inequalities by introducing changes to public expenditure and revenue." The report went on to point out that economic factors are an important consideration as well claiming that GDP per capita in the EU would grow by 6-9.5% by 2050 if gender equality improved. Poland and Hungary, however, are blocking the use of the term “gender equality” in the EU Social Summit.
Britta Torgrimson-Ojerio, a nurse researcher at the Kaiser Permanente Center for Health Research in Portland, Oregon conducted a study to see if exposure to tear gas affects a woman’s menstrual cycle. After hearing anecdotally from several women about the menstrual changes, she designed a study that looked at over 2,200 women. The study found that 54% of the women experienced menstrual changes. While the study cannot prove a causal relationship between the tear gas and menstrual changes, Dr. Torgrimson-Ojerio said in a New York Times interview, “we can definitively say that in our study most people who had menstrual cycles or a uterus reported menstrual irregularities after reporting exposure to tear gas.”
At Bartram Trail High School in Florida, at least 80 female students were surprised to see that their photos had been altered in the school yearbook. Apparently, the teacher in charge of the yearbook made the changes to bring the photos in line with the school’s dress code. But the dress code is open to interpretation and the girls at the school felt sexualized by the move. According to the dress code, shirts “must be modest and not revealing or distracting.” Take a look at the photos in the NY Times article and see what you think.
Finally, Vice shares the delightful story of Mary Beatrice Davidson Kenner, the inventor of the sanitary belt for menstrual pads. Ms. Kenner was a Black girl growing up in Charlotte, NC when she started inventing from a young age. Her inventions were always practical, and while they did not make her rich, she persisted.
What Actually Happens Inside Your Body When You Have a Miscarriage?
In 2019, there were over 1 million miscarriages in the United States. Yet, you have most likely not heard this statistic because the subject is typically considered taboo to discuss. That such a pervasive health issue goes unmentioned tells us that there is much work to do to demystify miscarriage.
Some women are willing to share their stories and as they do so help to bring some normalcy to the idea of talking about their experiences. Last year both Meghan Markle and Chrissy Teigen shared their stories of having miscarriages publicly by writing about them. We know that talking about traumatic events can help to heal psychic wounds, but our cultural discomfort with both death and female body parts leads us to silence when it comes to miscarriage.
When dealing with difficult issues like miscarriage, it is important to start at the beginning and understand what exactly is happening in the body. I spoke with Dr. Rachel Leland, an OB/GYN in Indianapolis, to find out more about what is going on from a physical standpoint in a woman’s body when she has a miscarriage.
Chaise Lounge (CL): Can you explain what happens inside a woman’s body when she has a miscarriage?
Dr. Leland: When a woman miscarries, usually, there's a separation of the pregnancy sack from the lining of the uterus. Bleeding starts in the space where there were tiny little connections between the sac and the uterine wall and that stimulates uterine cramping. The two most common signs of miscarriage are painful cramping and bleeding, regardless of why the miscarriage happens. Usually, this will happen within two weeks of the pregnancy discontinuing to form. But sometimes it doesn't. And then it will happen either with the assistance of medication or the surgical approach like a D & C.
CL: Sometimes, though, a woman might have a partial miscarriage that takes weeks to resolve, correct?
Dr. Leland: Absolutely. By design, the pregnancy sack is sticky, and sometimes those pieces don't come out completely. And then, unfortunately, that process that could go on technically for months, but that's not typical. Sometimes when that process doesn't naturally complete by itself, that's where a medication or surgery has to be used as a backup.
CL: Is it important for people to understand that sometimes a miscarriage can take time and people may need medical leave around this issue? I don't think that that's common knowledge.
Dr. Leland: I agree with that. When a woman loses a term pregnancy or a baby after delivery, employers are more open to that maternal leave. But if it's an early loss, it's still a loss, but they don't always have the same maternity benefits.
CL: What about the hormonal shifts that happen after a miscarriage?
Dr. Leland: The pregnancy hormone (hCG) declines and that can be a rapid process. But as we spoke about, the tissue sometimes will take longer periods to come out. And as long as there's pregnancy tissue in the uterus, there's going to be some sort of beta hCG, typically in the bloodstream. And the other thing that happens is progesterone will usually slowly decline as the corpus luteum (the system within the ovary that helps support pregnancy) starts to dissolve.
CL: I have a friend who told me that after her miscarriages, she just felt like her hormones were raging leading to disagreements and unhappiness. What was causing this?
Dr. Leland: I think that progesterone, in particular, is a cause for that. And then anytime you're grieving, they are also neurochemical changes that we can expect that can affect mood.
CL: What information do you think is most helpful to share with couples who have just experienced a miscarriage?
Dr. Leland: I think that knowing the cause for the miscarriage, ee want to know the whys. Knowing that the cause often is chromosomal and is always, with rare exceptions, completely out of your control. I guess the rare exception would be excessive cocaine or alcohol use, for example. Women in a follow-up appointment, they'll often say, “Well, I got in an argument”, or “I was dieting, or I was exercising, or something was happening.” There's always that incidental thing that was happening that they blame themselves for and think this didn't have to happen.
The truth is that 50 to 60% of miscarriages are caused by chromosomal abnormalities. And others can be caused by infection, thyroid issues and PCOS can increase that risk. There are also some clotting disorders and other kinds of unusual conditions of the uterus.
CL: What resources can you point our readers to learn more about miscarriage and support for those who have had one?
Dr. Leland: I think it's important for women to know that while we don't talk about it while we're having coffee with our friends, there is no silence around miscarriage in the OB/GYN office. This is something that I talk about every single day, multiple times a day, whether it's at a wellness checkup or an actual visit for a pregnancy loss. It means that it's something that your OB/GYN or midwife, doula, and possibly even your family physician would be comfortable discussing if you feel that you have more questions. I also recommend National Share, a website that lists resources by state as well as hosting an online community.
CL: Thank you so much for all of the information that you have shared. I know that I learned quite a bit, and I am sure our readers have too.