I sometimes ask myself whether miscarriage & baby loss are the last taboos. Certainly there is a great deal of denial about the suffering that it causes and many women go through miscarriage and are back in work the next day, grieving and isolated with little support or compassion. Men too suffer the loss and I suspect that there is even less support and empathy for them. Recurrent, spontaneous miscarriage is one of the most common medical complications of pregnancy and it appears to be on the increase, likely due to the later age that women are conceiving at, and the higher number of pregnancies following IVF etc. The feed back from patients is that they want answers. For those who lose a baby full term the suffering is immense and it is impossible for others to know how to meet their grief – only serving to isolate them further. Of course the reality is that there are not always answers; statistically the most likely cause is chromosome abnormalities. But just because the patient is not ill it does not mean there is not suffering. Miscarriage can also be poorly supported because physicians lack the diagnostic tests and skills to help patients find an appropriate way forward. All too often the history of the patient is over looked and they are fast tracked to IVF when the actual issue is miscarriage and not conception. This can be deeply frustrating for patients who instinctively feel that something is being missed. The reasons for miscarriage & baby loss are many and varied and beyond the scope of this article. What I wish to highlight here is the need for more support and understanding about the immense loss and emotional turmoil miscarriage can cause. Many women tell me they feel a very intense emotions ranging from anger, guilt, grief, desperation and isolation. Feeling a loss of trust in their body and a sense of failure, even shame, are common. Well meaning friends and relatives often get the support wrong; ‘it’s just one of those things’, ‘nature’s way’, ‘not meant to be’ and other such clichés; the sentiment of which only serves to isolate them more. It’s worth mentioning that many women and couples DO take comfort in these sentiments and are able to cope and move on quite easily. This fact further demonstrates the complexities of dealing with miscarriage. The expectation often brought about by early pregnancy detection has, ironically, added to the suffering. Like so much in life that can be of benefit, these tools can also be the cause of more pain. Women often know within days that they are pregnant, with that comes a heavy weight of expectation. I am always reminded of my mother’s wise words; “modern women expect so much more, in my day you didn’t really consider yourself pregnant until you had missed 3 periods”. There is of course a great deal of truth in this; but this does not help ease the suffering of those who poured their heart and soul into the hope of creating a new life Why is it that it is so hard for people to have empathy? In medicine I have observed that unless there is a solution; drug or surgery (generally) then the medical profession tend to underplay the problem. But this just makes women feel that they are wrong to feel the huge sense of loss that they feel and the myriad of other ensuing emotions. Patients constantly complain to me about the lack of support and current medical strategy to manage miscarriage Of course, delaying pregnancy until later in life is a trend likely to continue so it stands to reason that we will see an increase in miscarriage. At 40 1 in 3 pregnancies will result in miscarriage and it is thought that only 1 in 20 eggs are likely to be ‘normal’ (at this age). It’s about time we had an open conversation about this subject. Not everyone will feel the same and that’s ok. For some miscarriage will remain a taboo, full of self-blame and a deep sense of loss, for others it will be ‘just nature’s way’. Baby loss has and always will be one of the hardest things for an individual to cope with. The important thing is that however you feel about it your feelings are validated and not dismissed and appropriate support is provided. Thank you to Anna Lewis or Sketchy Muma for the lovely image.