ISUOG's President Prof Tom Bourne speaks to BBC Global Health Correspondent Tulip Mazumdar about the psychological effects in the UK and worldwide.
With 23 million miscarriages taking place every year worldwide, ISUOG is asking our community to recognise the psychological impact and extend their care beyond “diagnosis and treatment” for couples experiencing baby loss. ISUOG's President Prof Tom Bourne speaks to BBC Global Health Correspondent Tulip Mazumdar about the psycological effects in the UK and worldwide.
Prof Tom Bourne states: "For many women pregnancy loss will be the most traumatic event in their life. Our research suggests the loss of a longed-for child can leave a lasting legacy, and result in a woman still suffering post-traumatic stress nearly a year after her pregnancy loss."
TM: What is the UK burden psychologically?
TB: It is reasonable to say that according to our data – 18% of women in our study had symptoms consistent with PTSD 9 months after their miscarriage. A reasonable estimate (probably an under-estimate) for the number of miscarriages in the UK is 250,000 per year. So, this means it is possible that 45,000 women each year are developing symptoms consistent with PTSD that will not resolve within 9 months. It is well documented and evidenced that PTSD is a chronic condition and general population data tells us that if left untreated it can persist for decades beyond the trauma, so left untreated the number of women with significant post-traumatic stress symptoms accumulating in the population will increase annually. There is also a significant burden of anxiety and depression.
TM: What is the global burden likely to be based on an estimate of 23 million miscarriages each year?
TB: The position is very difficult to extrapolate from our UK data. However, can we say: the experience of miscarriage may differ around the world, and we do not fully understand how cultural effects impact on the psychological impact of miscarriage. However stigma, shame, and guilt (WHO) continue to be common themes reported globally in response to pregnancy loss and we know that these are associated with increased levels of isolation and psychopathology. Therefore, given that globally a reasonable estimate is that there are 23 million miscarriages a year it is likely that millions of women are suffering each year with the mental health consequences -the full scale of which needs to be further investigated. We are planning to carry out a study to look at this starting this year.
TM: What needs to be done?
TB: What we are saying should be done at the International Society for Ultrasound in Obstetrics and Gynecology (ISUOG) – a charitable organisation and the leading international society of experts in ultrasound for obstetrics and gynecology – is:
- We believe that we must Identify people at risk of post-traumatic stress and other psychological distress following early pregnancy loss -either based on risk factors or on screening at an appropriate time – probably 3 months after the event. Research is needed to demonstrate the efficacy of screening in this context.
- Appropriate treatment should be made available to all women and their partners following an early pregnancy loss. Currently this is most likely to be trauma focussed Cognitive Behavioural Therapy (CBT) that may be delivered virtually. Trials are being carried out for other scalable interventions to reduce the likelihood of developing trauma related symptoms and data from these should be available within a year
- Research should be carried out to understand the main factors that make the experience of miscarriage worse so we can reduce the traumatic impact, examples of this would include the type of treatment, reducing diagnostic delay, the language used about miscarriage, the empathy of staff and the environment used to see people with early pregnancy problems
- ISUOG exists to provide education and its view is that all clinicians taking care of women and their partners with early pregnancy loss must be appropriately trained following a clear syllabus not only in ultrasonography but also in the appropriate communication and care required to deliver appropriate care.
- More generally ISUOG takes the view that early pregnancy loss should be acknowledged and discussed more widely in society. An example of this is the “12-week rule” whereby couples often do not talk about their pregnancy until 12 weeks gestation for fear that something might go wrong”.
- ISUOG supports the view that grief following early pregnancy loss is not gestation dependant. Accordingly, we support the view that paid bereavement leave should be made available and would suggest this should be two weeks.