Reviewed by: Winifred Mak, MD and PhD
Written by: Abbi Havens
Pregnancy loss can be absolutely devastating for women and couples. A widespread misunderstanding of pregnancy loss and myth surrounding its causes confuses and shames those struggling to maintain a healthy pregnancy. Caring for patients through such an emotional life event requires a care provider with the perfect balance of compassion, emotional intelligence and scientific expertise to deliver the best care possible under difficult circumstances.
UT Health Austin is lucky to have Winifred Mak, M.D. and Ph.D. in Genetics on our team of passionate care providers. Dr. Mak joined us from Yale over a year ago where she fully realized her interest in women with recurrent miscarriages while serving as the Director of the Yale Recurrent Pregnancy Loss Program. Dr. Mak’s interest in providing care to women and couples experiencing pregnancy loss is two-fold.
“Taking care of this population is highly rewarding, as many lose hope after experiencing one miscarriage after another,” says Dr. Mak. “Secondly, I am a physician and a scientist and being able to help patients through research is a passion of mine. Roughly 50 percent of couples experiencing recurrent miscarriage do not have an answer as to why they lost their pregnancy, and this is devastating. For me, this provides an opportunity for research to be done.”
Dr. Mak’s research focuses on infertility, recurrent pregnancy loss, and premature ovarian insufficiency. We sat down with Dr. Mak to discuss pregnancy loss and recurrent pregnancy loss.
Causes of Pregnancy Loss
Although more research is necessary to fully understand all possible causes of miscarriage, according to Dr. Mak there are several known causes of pregnancy loss and most involve chromosomal abnormalities.
“Most commonly there is a genetic cause for a miscarriage, such as too few chromosomes or too many,” says Dr. Mak. “Other causes of pregnancy loss are hormonal, such as underactive thyroid, diabetes, a blood clotting disorder called antiphospholipid syndrome, or an anatomical issue with the uterus such as a septum inside the uterine cavity.”
Before attempting to conceive, certain lifestyle changes should be made to optimize conditions for a healthy pregnancy. Women should stop smoking, minimize alcohol intake to no more than three beverages per week (and once pregnant, stop drinking immediately), take prenatal vitamins with folic acid two to three months before planning to become pregnant, drink no more than three cups of coffee per day, and cease any and all drug use including marijuana. Dr. Mak also emphasizes the importance of consulting your care provider before taking any prescribed medications while pregnant or trying to become pregnant.
Myth Surrounding Pregnancy Loss
Many old wives’ tales surround pregnancy and miscarriage. This comes as no surprise, given the lack of legitimate scientific research and study devoted to women’s reproductive health care until relatively recently. Unfortunately, many of these tales continue to pervade modern society and are not founded in truth. Perhaps the most widely circulated pregnancy loss myth? If you experience one miscarriage, you are likely to experience many more.
According to Dr. Mak, 15 to 25 percent of couples trying to conceive will experience one miscarriage, five percent will experience two consecutive miscarriages (which constitutes recurrent pregnancy loss), and less than one percent will experience three or more miscarriages. Therefore, one miscarriage is not an indication of a lifetime of struggling to carry a pregnancy to term.
Many believe they must wait three full menstrual cycles following a pregnancy loss to try to conceive again. However, Dr. Mak says that if a couple is emotionally ready, they may begin to try to conceive the following cycle. Stress is another common false cause of miscarriage.
“With roughly 50 percent women unable to identify a cause of pregnancy loss, they often blame themselves to have some sort of explanation, and this can be incredibly damaging,” says Dr. Mak. “Many of my patients believe stress caused their miscarriage, but this is most likely not the case.”
Dr. Mak also debunks the myth that sex while pregnant causes miscarriage. “Of course, if you experience bleeding during sex, you should cease that activity and visit your care provider. Otherwise, intimate time with your partner while pregnant is not a risk factor.”
The Emotional Impact of Pregnancy Loss
Although every woman and couple grieve differently, many view a miscarriage as the death of a child and research shows that grief after miscarriage can be profound. A recent study conducted at Imperial College in London (where Dr. Mak obtained her Ph.D.) determined that women who suffer from a miscarriage are at risk of developing PTSD (2018, Farren, Mitchell-Jones, Verbakel, Timmerman, Jalmbrant, and Bourne). Within this study, PTSD symptoms affected four in ten women within three months after a pregnancy loss. Symptoms reported by participants included nightmares, flashbacks and re-experiencing the feeling of the loss.
Dr. Mak came to fully understand the emotional impact of pregnancy loss as a board member of a charity called Hope after Loss that provides peer-to-peer support for families experiencing pregnancy loss in New Haven.
“I sent out a survey to understand their [women and couple’s] needs after a pregnancy loss. Individual comments were that empathy from doctors is so important. Many had received harsh words such as, ‘You are young and you can get pregnant again,’ or, ‘You can try again next month.”
This inspired Dr. Mak to develop her compassionate approach to helping couples through miscarriage.
“First and foremost, I am there for my patients as a human being, and that’s what many of them need directly after a miscarriage. I never lead with what comes next. I never begin by explaining what must be done now. I just listen, and I provide the emotional support the patient(s) needs.”
Other comments on the survey brought up an important issue: ‘Dads’ are often excluded from the emotional conversation. Dr. Mak takes an intentional approach to involve both the mother and her partner in the conversation and aftermath of a pregnancy loss.
Moving forward, Dr. Mak is excited to bring her expertise in recurrent pregnancy loss to Central Texas and UT Health Austin. She is carrying out a research study to discover new causes of miscarriages by investigating the placenta. She hopes to create a comprehensive pregnancy loss center, where she can assist couples in identifying the reason for their loss and give them hope for the future.