Every year worldwide, there are almost two million miscarriages – a tragedy now referred to as “silent births” as opposed to the births of healthy live babies who cry. In Israel, there are about 1,500 annually.
According to the US Centers of Disease Control and Prevention, miscarriages are more common among women with specific characteristics, such as those aged 35 and over, and those who smoke during pregnancy or suffer from high blood pressure, diabetes, thyroid problems and obesity, as well as drug or alcohol use. Ingesting food that has been contaminated with listeriosis, toxoplasmosis or salmonella is also associated with an increased risk of miscarriage.
About 80% of miscarriages occur in the first 12 weeks of pregnancy (the first trimester). The underlying cause in about half of the cases involves chromosomal abnormalities; other causes include the mother having a multiple pregnancy such as twins, triplets or quadruplets and her having had a previous pregnancy loss.
Thanks to the advancement of medical technology and improvements in prenatal care, the number of cases has decreased in Israel and around the world. But they still do occur, creating a sad reality for many families.
Miscarriage Awareness Month
The Israel Midwives Association, which has 1,400 members, has marked October as Miscarriage Awareness Month, which was first established in the US by then-president Ronald Reagan and then became international. From the mother’s point of view, a “silent birth” is a regular birth to all intents and purposes, which includes all the physical symptoms and pains that accompany it. All these become more dramatic because of the psychological suffering of the parents due to the tragic outcome.
A child was born to these parents, but he/she died, and the need to address this fact underlies the accompaniment of the midwives, who bring the news to the parents and are there from the moment of discovery, during and after the birth.
COPING WITH and mourning the loss of a child continues for months and even years, even when additional healthy babies are born.
It is an event that the parents do not expect, said the midwives, and they are required to deal with it without prior preparation.
“This is one of the reasons why the continuous support and accompaniment by a midwife is so significant. She knows the stages of the process, is in practice with the mother during the birth, and has training for physical and emotional support for the mother and family members,” the association said.
“From the medical side, the woman giving birth needs follow-up and monitoring to avoid possible complications – according to known circumstances surrounding the event of the loss – of infection or maternal diseases,” it said. “The event of a quiet birth also requires coordination between various therapeutic factors.”
The Israel Midwives Association has developed different research-based models to help and support the different stages of grief. Most of the models stress the importance of performing parting processes and rituals in a miscarriage.
In addition to the processes of saying goodbye to the newborn and holding the babies, at Hadera’s Hillel Yaffe Medical Center and Rehovot’s Kaplan Medical Center, photographs are taken of the baby and given to the parents who want it. At Sheba Medical Center at Tel Hashomer, they prepare a footprint of the baby on paper for the parents, and in the Galilee Medical Center in Nahariya, they prepare a “memory box” containing various items.
After the birth, the couple receives information and guidance from the midwife regarding the options available to them regarding burial arrangements. According to the Health Ministry’s guidelines, when the silent birth occurs after the 22nd week of pregnancy, the couple has the right to choose whether to be involved in burial arrangements or to leave it to the hospital and, subsequently, to the burial societies. Sometimes, according to the need and with the consent of the parents, an autopsy will also be performed after death.
Israeli women who miscarry are released from the hospital 36 hours later and are entitled to maternity leave just like those who have a live baby. A miscarriage after the 22nd week of gestation entitles the mother to a hospitalization grant, a birth grant and maternity benefits.
After studying nursing for four years, one must study for two more years to receive a certified midwife’s license.