Research Alert: Recurrent miscarriage

When you see Professor Siobhan Quenby’s name on miscarriage research, you know it’s going to be good and today’s release is just that! An absolute superstar in this field and even though she’s not the lead author, I was excited all the same.

Today’s paper released in the British Medical Journal and titled “Quantitative assessment of pregnancy outcome following recurrent miscarriage clinic care: a prospective cohort study” has shed some new light on recurrent miscarriage.

The study followed 639 women attending a recurrent pregnancy clinic to try to establish factors that influence their pregnancy outcomes. The data is in a new database called ‘Tommy’s Net‘.

The mean age of the participants was 34 years old for women and 37 years old for partners. Rates of obesity, smoking and alcohol consumption within the group were reasonably high and more than half of the participants were not taking folic acid.

Of the cohort, 83.4 per cent got pregnant, 16.6 per cent did not, at least six months after they joined the research. Of those that conceived, 72.8 per cent had a viable pregnancy, which means (based on my own calculations that 27.2 per cent either terminated or miscarried their pregnancies. Researchers report that ‘maternal smoking and body mass index (BMI) over 30 were significantly higher in those who did not conceive’.

‘The study identified that subfertility [any form of reduced fertility with prolonged time of unwanted non-conception] as well as repeated miscarriage, maternal BMI and smoking status, contributed to failure to achieve live birth,’ reads the paper.

‘Study findings may enable comparison of clinic outcomes and inform the development of a personalised holistic care package.’

I think the most interesting aspect of this is at the end. ‘Personalised holistic care package’. Sounds suspiciously like ‘patient-centred care’… which in my experience (and that of many of the patients I speak to) is somewhat of an ideal that never quite makes into reality. But if anyone can do it, Tommy’s can!

I’m hoping to speak with Professor Siobhan Quenby soon for Hard To Bear and I’ll be asking her how this can be applied in practice in a clinical setting.

what to do and say when someone has a MISCARRIAGE

I get a lot of messages from people seeking support when they experience pregnancy loss, but I also get a lot of messages from concerned family, friends and partners. Someone they love has experienced pregnancy loss and they want to know what to do, what to say and how to help.

To mark Pregnancy Loss Awareness Month 2021, I’ve written up some ideas that may come in useful.

Before I give you some ideas of exactly what to do in this circumstance, the first thing I have to warn you is that there is no one-size-fits-all solution. Everyone is different. Some people might feel their loss acutely and be in a state of severe shock and trauma.

Other people are more pragmatic about loss and are able to accept it more readily and move on more easily. There is no correct reaction, no correct way to behave. So you need to get a sense of where they’re at before you dive in.

You should never ever show any reaction or judgement if they’re dealing with it differently to how you expect or how you think you would deal with it if it was happening to you.

The first thing to do is reach out. How you do this is really dependent on your relationship with the person in question. But whether you call, text, email or send a fax, the first thing you should do is say “I’m sorry for your loss”. The medical system and society oftentimes seems very confused as to whether an early pregnancy loss is a loss. It is.

The second thing you need to do is listen. Offer an ear and then just listen to them speak. Don’t interrupt. Don’t offer any minimisations statements (for instance, at least you can get pregnant, at least you’re young, at least you’ve got a living child) None of these help. Not one. In fact, they have the likely outcome of causing more grief or compounding existing trauma. I dedicated a whole series to it on Instagram entitled #fuckthisshit.

If the person you are speaking to refers to their loss as a baby, that’s the word you use too. Equally, if they refer to a foetus, an embryo or just a pregnancy, that is also the language you should use, irrespective of how you viewed your own loss, if you’ve ever had one. Follow their lead.

If the person you are speaking to is obviously in a state of grief, I usually recommend two things once you have offered them an ear and told them you are sorry for your loss.

The first is meal drops. Grief can be overwhelming and overpowering. Dropping meals off on the porch can help them check out of responsibilities for a while. If they have a living child, consider asking if you could take their little one to the park for an hour or two and give them some time to themselves to cry. Or just sit in silence.

The second suggestion I make is a gift to memorialise their little love. Not everyone wants to take this approach, so it may be worth gently asking if they’d like to do anything to memorialise their loss. And get a sense of whether this is something that would fit the situation. If this is something you decide to do, here are two ideas.

For my gifts I usually use a Melbourne company (I have no affiliation, just a fan of her work) called Made With Love Monkeys. She makes beautiful soft toys, embroidered with a personalised message. Some parents find it very comforting to have something to cuddle as they remember their lost bub.

Another beautiful thing to do is a simple, handmade piece of jewellery, maybe with the baby’s name or birthdate on it. There are some lovely jewellery designers on Etsy – I always try to buy from local artisans where possible.

Back in the middle of 2020 I wrote a piece for ABC entitled What (not) to say to someone who’s experienced miscarriage. This may also be useful.

The final note is please don’t forget the partner, if there is one. They may also be in a state of distress and could benefit from some support. Sometimes even grandparents need a hug and an ear.

Review: Yatdjuligin

Title: Yatdjuligin, Aboriginal and Torres Strait Islander Nursing and Midwifery Care
Publisher: Cambridge University Press
Editors: Odette Best & Bronwyn Fredericks
Release date: October 2021

Yatdjuligin (which in English means ‘talking in a good way’) first came to my attention on Twitter, when I read that its third edition was complete and primed for release. I got in touch with the publisher who kindly agreed to send me a copy to use in my research for Hard To Bear, but also to review.

Yatdjuligin is a text book, complete with exercises and thought provoking case studies, aimed at nursing and midwifery students. But really, this should be essential reading for anyone working with Aboriginal or Torres Strait Islander Peoples in any medical, therapeutic or even community service role.

You can probably tell how engaged I was with the book from the number of page notations visible in the image in this post!

I think the aspect of the book that has most resonated with me and keeps playing over and over in my head is the idea that whether or not a service is culturally safe must be defined by the client/patient. In Chapter 3, Professor Odette Best describes herself as a “cultural safety purist as defined by Māori Registered Nurse Irihapeti Ramsden”, which of course led me to Ramsden’s PhD thesis “Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu“, which should also be compulsory reading for anyone operating in the medical/care provision space.

While it would seem that clients/patients/staff define whether or not they feel culturally safe, I have worked for a number of organisations that repeatedly present themselves as culturally safe, but don’t ask for any input or rating or feedback from Aboriginal and Torres Strait Islander Peoples before making this declaration.

This is how you end up with situations like the one I observed at Australian Red Cross, with Indigenous staff and other people of colour being subjected to discriminatory and violent behaviour and forced to work in an unsafe and culturally violent environment, despite the organisation itself declaring itself to be culturally safe.

There is discussion and advice in Yatdjuligin around why white practitioners (or you might argue any white person living on stolen land) must be analysing themselves, their own contexts and colonial history before they can even hope to grasp how their behaviour or even presence can affect Aboriginal clients or patients.

Yatdjuligin includes important background and history regarding colonisation, its effect on Aboriginal people and the medical system and the development of community controlled health organisations. This is the crucial context that provides the backdrop for self-determination in care provision for Indigenous communities, irrespective of geographic location.

There are case studies throughout, giving real-world examples of the sorts of issues detailed in the book. The thing that’s amazing about this book is that it’s simple, clear and easy to understand for someone like me, who has no academic background or indeed students that are early on in their studies or careers.

The list of contributors feels like a who’s who of Aboriginal nursing and midwifery excellence, supplementing the extraordinary expertise of Odette Best, a Professor of Nursing at University of Southern Queensland, and Professor Bronwyn Fredericks, Pro-Vice-Chancellor of Indigenous Engagement at University of Queensland.

While I will be led in my writing about care provision in miscarriage for Aboriginal and Torres Strait Islander Peoples by the brilliant Cherisse Buzzacott, it’s really important that I do my homework and Yatdjuligin was an incredibly valuable first step in that ongoing and critical journey.

Book on sale now, sydney launch incoming

The Melbourne launch of Hard to Bear was absolutely fantastic and we’ll have photos up on the website soon. But in the meantime, it’s time to get ready Sydney!

The Sydney launch is will be held by the Sydney Jewish Writer’s Festival on May 17 at Woolhara Library in Double Bay. You can book here.

In the meantime, don’t forget to pick up your copy of the book, which is on sale now!