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Mental Illness After Miscarriage Is Common, But Women Aren't Getting Support

Women in Canada aren't properly screened, assessed or treated, researchers say.
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Janice Lamont* was recently diagnosed with post-traumatic stress disorder (PTSD) following two miscarriages in the past year.

"It was two pregnancies," said Lamont, who lives in London, Ont. and asked for her real name not to be used. "The first was twins. I saw their heartbeats at the six-week ultrasound. Then when I went for my 12-week ultrasound, there were no heartbeats."

Lamont decided to try again and became pregnant seven months later, but suffered another miscarriage 12 weeks into her pregnancy.

"I hemorrhaged from taking the abortion pill, which was prescribed for the miscarriage, and nearly bled to death, unconscious on my bathroom floor," Lamont told HuffPost Canada. "I was back at work two days later and wasn't given adequate time to heal or to process the traumatic event."

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Following her second miscarriage, Lamont said she wasn't feeling like herself. She struggled to focus on tasks, isolated herself from friends and no longer participated in activities she normally enjoyed.

"I developed anxiety particularly around my periods," Lamont explained. "The blood and cramping were triggering each month and would cause flashbacks. Simple medical appointments like going to the dentist and enduring the suction noise were triggering. I felt like my heart was always pounding, like I couldn't escape from something even though I was perfectly safe. I startled easily from loud noises or unexpected touch. I couldn't get past it."

Lamont made an appointment to see a therapist, and that's when she was diagnosed with PTSD, a mental illness that causes intrusive symptoms such as re-experiencing a traumatic event, can make someone feel "on edge" or numb and detached all the time, and causes changes in thoughts or mood, according to the Canadian Mental Health Association.

"It's no wonder serious mental health issues emerged," Lamont said.

"There is the initial shock of finding out your child has passed, alone in an ultrasound room because partners are not allowed in with you, then there is the trauma of the abortion pill which is essentially going into labour at home without any medical professional present, and then you are expected to live your life normally for weeks, going to work, smiling, all the while knowing your dead pregnancy is inside you and could come out at any moment. I don't think any woman finds herself on the other side of that mentally intact."

Canadian women don't receive proper mental health care after a miscarriage

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Miscarriage in Canada is defined as a spontaneous loss of pregnancy prior to 20 weeks. The Public Health Agency of Canada's Perinatal Health Indicators 2013 report defines stillbirth as any fetal death of 20 weeks or greater. Some European benchmarks consider miscarriage to be a loss at 12 weeks or less.

According to Lynn Rempel and Joyce Engel of Brock University, co-authors of the study "Health Professionals' Practices and Attitudes About Miscarriage" published in the American Journal of Maternal Child Nursing in 2016, though healthcare professionals are generally concerned about the care of women following a miscarriage, attitudes, beliefs, behaviours, and system barriers limit access to care.

Rempel told HuffPost Canada that emergency room nurses in particular lack appropriate training to support women experiencing a miscarriage.

"Women can experience complicated grief and depression following a miscarriage," Rempel said. "Women in Canada are not properly screened, assessed and treated for mental health issues following a miscarriage."

Compassionate education training is being developed

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Following their study, Rempel and Engel developed a brief grief screening tool for emergency department nurses to quickly identify women who might be at risk for complicated grieving, with suggestions on how to refer these women for follow-up.

In collaboration with the Sunnybrook Health Sciences Centre's Pregnancy and Infant Loss Network (PAIL), they've developed a compassionate miscarriage education session for nurses and are currently piloting it in an emergency department (they can't say where until their study is completed in the fall).

"But it has been challenging for nurses to add this to their current practices," Rempel said.

"Our current study will explore the barriers or using our screening tool. Some hospitals now have early pregnancy loss clinics to which they can refer women experiencing miscarriages. This is a very new development and we hope that use of these clinics will result in better screening and follow-up for women who may have mental health issues following their miscarriage."

There may be a link between PTSD and miscarriage

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Engel says that the consideration of post-traumatic stress disorder has been brought up incidentally in some studies, with a few studies suggesting that a small number of women who experience miscarriage show evidence of PTSD.

"Certainly, this number is less than that suggested for depression or anxiety," Engel said. "However, I would suggest that this may also be related to whether or not studies have been specifically assessing PTSD (as opposed to depression or anxiety)."

Engel says there are very limited long-term studies related to mental health and miscarriage and that most studies tend to have been conducted in the first year post miscarriage or even within the first six weeks.

"One study suggested that as high as two-thirds of women met the criteria for depression at one month post miscarriage and another suggested that women who miscarried were 1.66 times more likely (than the general population) to experience depression at one month post miscarriage. A number of studies suggested that the prevalence of depression tends to give way to anxiety, with higher scores noted on anxiety, if present, in the first year post miscarriage."

Engel says findings of the studies are contradictory, with some suggesting that life circumstances or social support have no bearing on the experience of either depression or anxiety. Others suggest that women who have limited social support, prior losses, longer gestation, and/or existing mental health concerns are more likely to experience greater severity in depression and/or anxiety and to experience symptoms of either up to a year.

"Why isn't this being taken seriously?"

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Though Lamont has been given the green light to try again, she says she's not sure she can put herself or her partner through the trauma again.

"I'm terrified," Lamont said.

"Right now my focus is on getting better and keep up appearances of being a normal human doing all the things instead of how I feel like being, which is in a ball, in a blanket, in a cave, on an island. The more I am open about it, the more women confide in me with miscarriage stories even more horrid than my own. Why aren't we talking about this? Why isn't it being taken seriously? Myself, and others like me would very much like to be a part of the conversation."

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