I give up…

The universe is determined to give me opportunities to discover social faux pas. The events of the last weeks have revealed to me a host of new things that lots of people say when one talks about miscarriage. The vast majority of these comments are very well meant, but nonetheless, have considerably missed the mark.

Being open about having had multiple miscarriages seems to unfurl two main threads of conversation. The most prolific being enquiries as to why it keeps happening and what I have done about it. I think I know why people ask these questions. Partly fear, no one wants this to happen to them. I suppose people think if they know the whys they can avoid it or fix the problem. The other side being an assumption that everything can be fixed. I understand that, we are so used to living in a world where things can be cured or treated. I know from having chronic conditions that people are often confused to learn that some things can not be corrected. In the case or recurrent miscarriage this enquiry is unhelpful for variety of reasons. Firstly miscarriage, recurrent miscarriage and infertility often fall into the category of ‘don’t know’. About half of those who suffer recurrent miscarriage are unable to find a reason after testing. I am one of those people. I have had all the standard tests and investigations to little avail. I did have some adhesions that were successfully removed and I have PCOS, but no Dr I have consulted believes that to be the cause. The short answer is, no one knows. Asking this question isn’t helpful. If a person doesn’t know, you’re just underling that difficult fact by making them explain it again. If they do, they may not want to discuss such private and sensitive information with you or anyone else.

Offshoots of this such as, Have you seen a Dr about this? You should get another opinion, My friend did such & such or surely there must be something they can do, are unwelcome. I have had four miscarriages. I have lost four children that I desperately wanted. Of course I have done everything within my power to find out why and prevent it from happening again. The suggestion that I haven’t offends me. It indicates that you think I am either stupid or careless. I understand that wasn’t the intention, but please, think before you speak. It’s also important to be aware that the NHS usually won’t begin these investigations until after a third miscarriage. Not everyone has the resources to seek private medical treatment. Anyone in that situation doesn’t need nosey salt in their wounds.

The other comments this loss has garnered are of the don’t give up variety. A lot of people have reached out to tell me there’s always hope. The have shared their own experiences of loss or struggles to conceive and assured me that miracles happens. That they eventually had their baby and it was all worth it. I know you think you are helping. I know you are trying to be kind. Let me just say this, not everyone gets a miracle. We are not all able to try again. There are limits to what the body can do, physically & emotionally. There are time constraints. Relationship constraints. Financial constraints. At this moment I don’t feel like I have another try in me. Losing another baby would destroy me. Maybe I will feel differently in the future (it would have to be the fairly near future), but I don’t think so. Facing the reality of my limitations is not weak. Recognising that I can not square this circle is not giving up.

I don’t intend this as an attack. I realise these aren’t purposeful attempts to hurt. I just want to have an open discourse. I think these confusions arise because we don’t talk about this topic enough. If you want to offer support to someone who has suffered this kind of loss it will be appreciated. Simply offering your condolences and assurances that you are available is enough. Respect that everyone grieves differently and your kindness will cherished.

 

Advertisements

On the plus side…

Fatigue is getting the best of me this week. I am out of spoons, but I don’t want to be out of words on this blog. Hence, I wil be sharing some short pieces I have written for other publications. I hope you find them as absorbing as my usual content.
First up a piece on how body shaming & fat stigma makes plus size infertility an even bigger challenge.
Infertility is  heart breaking affair for anyone who wants to have a child. With the NHS now reporting that 1 in 7 couples have difficulty conceiving, infertility is more common that we realise. Thankfully most people in UK will be able to access fertility treatment via the NHS. However, some people are not deemed suitable for treatment. One of the groups who may be denied access are those categorised as clinically obese.
Women with a BMI over 30 are routinely refused fertility treatment. Drs advise them lose weight before they can be referred to a specialist. There are a number of issues with this policy and some  are tied in with the way society as a whole views fat people. Let’s begin with index used to measure if a person is obese. Body Mass Index (BMI) has been widely discredited. The index has a number of problems including the fact that BMI does not differentiate between muscle & fat. Hence, people who are fit & have healthy body fat can be classified as obese. Another issue is that BMI does not recognise difference in body shape. It is well established that those who carry their weight around the middle (sometimes known as apple shaped) are at much higher risk of health complications than those who carry excess fat around their hips (pear shaped) [1].Thus women with very different shapes & risk factors can be labelled with the same BMI. Perhaps the biggest failing is that BMI  does not always change with lifestyle alterations. A person may make significant changes to their health without necessarily losing large amounts of weight. Partaking in regular exercise and switching to a healthy (but not calorie focused) diet will have a huge impact of a person’s wellbeing. Sadly, BMI would not recognise these positive changes unless there is also weight loss. This can put women in the position of focusing on how much they weigh rather than how healthy their lifestyle is.
Of course, there are also questions to be asked outside the clinical failings of BMI. It is important to note that there is no official policy on women who are under weight. Despite the fact that being too thin can have a bigger impact on a woman’s fertility than being too big. The medical community appear to jump to the conclusion that fat is always bad. A notion that is reflected in society & that causes plus sized women to face wide spread discrimination. It is estimated that half of pregnancies in the UK have obese mothers. Yet studies show that only 5% of admissions to neonatal units and 4% of preterm births could be avoided if all pregnant women had a ‘normal’ BMI at the start of pregnancy [2].The implications is clear, overweight woman are regularly having healthy pregnancies & deliveries. Still the overwhelming message from the medical community is that obese women automatically have  high risk pregnancies.
The most worrying part of this protocol is that women are often not even referred to a fertility specialist until the capitulate on the weight loss issue. This means that women who have specific medical problems interfering with conception are forced to delay interventions that could solve their problems. The bottom line is that women who are classified as obese get a raw deal. Underlying prejudices seem to be making an already distressing issue much harder of plus size women. Infertility can make women feel powerless and incompetent. When you are fat, those feelings are increased by the prevailing impression that your weight is to blame.
1 Mayo Clinic
2 Public Health England, Maternity obesity and pregnancy outcomes.