For Rosette Mukamwezi, the prospect of motherhood was crushed by the horrendous episodes of miscarriage. Having been married for over 20 years now, Mukamwezi has been trying to get pregnant, but every time she managed to conceive, it ended in miscarriage. This one time she managed to carry her pregnancy to full term, unfortunately, it resulted in stillbirth. Now in her late 40’s, Mukamwezi has abandoned her dream of motherhood, and to term her experience as painful would be an understatement. “That was the last time I ever tried to get pregnant, I couldn’t handle the pain anymore,” she says. She says a miscarriage is one of the most painful experiences any woman can encounter. “I would never wish for anyone to experience this, the grief and hopelessness that comes with such a loss is unbearable. It is too much for one person to handle,” she says. The loss of a baby can be a very traumatic experience for a woman; however experiencing it more than once can be daunting to no end. A woman who has had a miscarriage needs someone to take care of them, instead of being alone, as that could lead to other health complications, like depression. It is termed as a recurrent miscarriage when a woman miscarries more than twice in a row. Dr Iba Mayele, a gynaecologist at Clinic Galien, explains that the causes of this may include genetic defects. This could be due to a chromosome abnormality in the foetus. A chromosome is a thread-like structure of nucleic acids and protein found in the nucleus of most living cells, carrying genetic information in the form of genes. A baby has two copies of every chromosome — one inherited from the mother in the egg, and the other inherited from the father in the sperm. An extra chromosome or a missing chromosome can cause a miscarriage, usually in the first or second trimester of pregnancy. Dr Mayele also says that an abnormally shaped uterus can be cause for multiple miscarriages. Yet on the other hand, uterine fibroids can also be a cause, especially if they cause scar tissues in the uterus. He also mentions that issues of hormonal imbalance of prolactin, thyroid hormone, progesterone and illnesses, such as diabetes mellitus or immune system abnormality, may increase the chance of miscarriage. Emmanuel Mugabarigira, a pharmacy student and the president of Rwanda Pharmaceutical Students’ Association (RPSA), explains that the characteristic of any pregnancy is that it lasts for 40 weeks from the first day of a woman’s last normal menstrual period to the birth of the baby. From this point of view, he says, a miscarriage happens if an embryo or foetus dies earlier than the 20th week of pregnancy, noting that it always happens almost in the first trimester of a pregnancy. In terms of causes, Mugabarigira says though these vary, some are related to one’s personal lifestyle before and during pregnancy. These can include smoking and over consumption of alcohol. He also says women who have aborted many times are at risk in this case. He, on the other hand, notes that major injuries or grave infectious disease can be sound factors. Can a miscarriage be prevented? Dr Mayele says one has to be sure to take at least 400 micrograms (mcg) of folic acid every day, exercise regularly, eat healthy by having well-balanced meals. “Expectant mothers need to manage stress, keep their weight within normal limit; they shouldn’t drink alcohol or have more than one to two cups of caffeine,” he says. Dr Mayele also advises against smoking, and cautions to stay away from second-hand smoking too. Mugabarigira confirms that with some instances, a miscarriage can be avoidable, especially if it is about the lifestyle of the woman. In this case, he says, it can be easy to limit harmful consumption of substances such as cocaine and cigarettes. He also advises expectant mothers to ensure visiting the doctor for regular antenatal check-ups. Dealing with the emotional and physical trauma Having a miscarriage can be a very difficult moment for women, and with this, medics observe that the emotional effects can at times take longer to heal than the physical effects. A woman who has had a miscarriage needs someone to take care of her, Mugabarigira says. “They need their husbands and psychologists or any other healthcare providers to attend to them because such an experience can cause grief,” he says. He, therefore, highlights the relevance of consulting a health institution and seeking proper treatments. The treatment offered is given according to one’s situation, he explains. “There is a time when a foetus leaves the uterus but the tissue remains, one can, hence, continue bleeding. This is why consulting a clinic or health facility is obligatory.” When offering treatment, Dr Mayele explains that the doctor must carry out some tests to determine the cause of the miscarriage. These can include karyotype, hysterosalpingography, hysteroscopy, vaginal ultrasound, blood hormone level, endometrial biopsy, and antibody test. Mugabarigira notes that doctors can suggest surgery to fix some complications in the womb, for instance, extra tissue that divides the septum, some benign tumours, or scar tissue. Rectifying the shape of the inside of the uterus can often lower the causes for miscarriage, he says. Spontaneous miscarriages may be connected to some medical problems. These include abnormal blood sugar levels, an over or underactive thyroid gland, or elevated levels of the hormone prolactin. Treating medical conditions such as diabetes, thyroid dysfunction, or elevated prolactin levels may improve the probabilities of having a healthy, full-term pregnancy, he adds. “Doctors can also suggest blood-thinning medicines for women with autoimmune or thrombophilia problems to be treated with low-dose aspirin and heparin. All can be taken during pregnancy to lower the risk of miscarriage. However, women must talk to the healthcare providers before taking these medications since they are associated with elevated risks of serious bleeding problems.” Views Hellen Karungi is a mother of two and recently lost a baby in the second trimester of her pregnancy. She says that the loss of a child is probably the most painful thing any woman can ever experience. Karungi, who is still in the process of healing, says it is very important for one to surround themselves with family and friends for a sound recovery. Claudine Uwera says though she hasn’t experienced a miscarriage herself, she can’t imagine going through the loss of a child. “Because I am a mother, I can understand the pain of someone who has lost a child. This can be a very distressing experience. It is important to seek counselling services because it can turn out to be a very traumatic experience,” she says.
