Monday, April 21, 2014

Pregnancy Loss Resources: A book about the science behind miscarriage

Coming to Term: Uncovering the Truth about Miscarriage by Jon Cohen

Coming to Term is a different type of miscarriage book - it's purpose is not to comfort women or share personal narratives and coping strategies; instead it explores the scientific research behind miscarriage which, in it's own way, can be a comfort to those who have experienced pregnancy loss.  The author, Jon Cohen, is a journalist who, after having gone through his wife's multiple losses, noticed that doctors seemed to have very few concrete facts about miscarriage and set out to discover the scientific truth behind miscarriage himself by piecing together the scant medical research on the topic.

I read Coming to Term after my first miscarriage and was a bit ambivalent about it; after having a second miscarriage soon after, I'm grateful to have read it.  Knowing some concrete facts about the causes of miscarriage and some of the potential treatments kept me from losing hope after my second loss.  I still often repeat to myself the statistic that Cohen shares: a woman who has a history of repeat miscarriages - three or more - still has a 70% chance of carrying a pregnancy to term without medical intervention.

Perhaps the biggest lessons to be learned from this book is that miscarriage is more common than it was once thought, is largely still a mystery, and most miscarriages cannot be prevented.  Those are some tough facts to face for women that want answers and treatments, but can also be a comfort to know the truth, especially for the many men and women who are told conflicting, outdated, and non-evidence-based information from various medical professionals.

In additional to the hopeful statistics for future pregnancies, the two additional pieces of information that I have felt most useful to me are: 1) Research shows that approximately 50% of miscarriages are due to chromosomal abnormalities, which couples have no control over.  These losses are, essentially, just "bad luck" and do not raise the risk for future miscarriages. 2) Blood clotting disorders cause a significant number of miscarriages and the use of heparin and aspirin during pregnancy has been shown to raise the chances of successfully carrying a baby to term.  Because I read this book, I was able to ask my doctor about testing for blood clotting disorders.

I would caution women from reading this book right after a miscarriage.  Give yourself a few months to heal and read some of the more compassionate experience-sharing books first.  (I recommend After Miscarriage and Angels in my Heart.)  I found Coming to Term at times to be very difficult to read because it approached miscarriage in a clinical way.  In addition, there is frequent reference to abortion (there are some very strong links between abortion and miscarriage research), fertility treatments that do not respect the dignity of life, and surrogacy, all of which bring up ethical/moral issues and may be difficult to handle soon after a loss.

A consumer-focused view of parenthood runs throughout the book, though it certainly isn't the author's focus or even his intention; he simply includes stories of real couples, many which unfortunately include elements of this.  It is worth reading this book for the valuable medical information it contains; however, make sure you have healed enough and are prepared to be confronted by these issues.


    1. I felt like an oddball because I found comfort in this type of clinical/statistical stuff after my miscarriage (especially learning how common it was). My doctor did say thing thing about chromosomal abnormality, and it was nice knowing that it was not myself to blame. This may be a book I will pick up in the future, so thank you for your review.

    2. I am curious as to whether there was any mention of using Nfp to find out if there are other problems or the use of progesterone soon after conception. Both of these were factors in us conceiving and ultimately carrying a pregnancy after long stretches of infertility and three miscarriages.

      1. There was not. There is actually very little scientific research on using NFP/progesterone now and there was even less when this book was written. Doctors/couples who have used it swear by it, but there is very little scientific "proof" that it works at this point, mainly because proof requires double blind studies and many doctors feel that it is unethical to withhold treatment from someone that may potentially save their pregnancy in the name of research. The book talks quite a bit about the lack of reliable studies done on miscarriage treatments for this reason.

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    4. Sounds like a good one Mandi. I too found a lot of solace in the medical side of things because ours were Blighted Ovums and there for 100% chromosomal. It's hard to lay blame in that case.

      I will recommend to everyone on finding a doctor who also knows about MTHFR testing. I feel lucky that my first OB knew about this and tested be, because it turns out I have one of the severe versions of this. MTHFR can affect clotting too, though my doesn't seem to affect it currently.

    5. So helpful about converting PDF files, Mandi. Thank you :) You've def sold me on the book bundle. Now... to convince the huzz... ;)


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