17th February 2025
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Breaking silence to heal trauma and dispel stigma around miscarriage

Author: Yar Ajak | Published: August 12, 2024

A grieving woman. (Courtesy).

Emmanuela Pita’s voice trembles as she recounts the complicated mix of emotions and sorrowful experience of losing her three-month pregnancy in a miscarriage at the Munuki area of Juba.

Her ordeal reflects the silent agony and sorrow experienced by hundreds of women after miscarriage and without proper psychological support across the country.

At a hospital in April 2024, Ms. Pita eagerly waited to attend to her routine antennal care – when she faced her worst fear as the doctor’s expression changed, indicating that there was an issue.

“He started asking me like Emmanuela; are you feeling any pain or any bleeding? I told him I’ve not seen any blood and there’s no pain,” she narrated.

“What is it, doctor? the aggrieved mother remembers asking the doctor as she was overwhelmed with disbelief, numbness, and a profound sense of loss.

The gynecologist informed Emmanuela and her husband of their fetus’ cardiac failure after a comprehensive examination when they arrived at the hospital for their routine appointment.

“I was struggling between understanding what the doctor was trying to say and translating it to my husband, and he told me that he was not feeling the heartbeat.”

“That was the first thing he said—that he was not feeling the heartbeat of the fetus. He checked over and over, and then he told me he could see in the ultrasound that there was a miscarriage within the uterus.”

Emmanulla was not able to process the shocking news, and in disbelief, the couple decided to find a new doctor, who confirmed that her unborn child had died from heart failure.

Heartbroken and with no other choice, Emmanuela and her husband were forced to accept their fate. The next day, she would undergo the fetal expulsion.

“I started feeling numbness on my legs. My whole feet, both. So, I could not move. I was feeling sharp pain, like in my abdomen. So, I told my husband, and we immediately went back to the hospital.”

“We called the doctor to explain to him what was happening. So, I was taken into the theater. And the next thing, we lost the pregnancy.”

In Emmanuela’s search for answers on the cause of her miscarriage, the doctor suggested several potential causes including COVID-19 vaccine’s side effects, use of family planning, and the recent heatwaves.

But she said some of the explanations didn’t add up because she hadn’t received any vaccinations. Furthermore, Emmanuella argues that if it were the side effect of family planning, she would never have had her firstborn child.

“Until today, there’s been no clear explanation. There’s no cause, and there’s no reason. I’m not satisfied as the person carrying that pregnancy.”

With an estimated 789 maternal deaths per 100,000 live births, South Sudan has one of the worst rates of maternal mortality worldwide, according to study by Frontiers Global Women Health.

This is due to long-term socio-political instability, which has further exacerbated the problems facing the health sector.

Dr. Anthony Lupai Simon is the Juba Teaching Hospital’s Director General, and also a senior Obstetrician and Gynecologist.

He said the main public health facility in the country records at least 10 cases of miscarriages each day and about 25 deliveries per day.

This, the gynecologist said amounts to around 15-20% of children lost before the age of viability.

“Some years back, we used to have three to four or five women coming, and then the miscarriage in Juba Teaching Hospital, but in recent years, the number has risen to at least 10 per day,” Lupai explained in an interview with Eye Radio.

“At the same time, we have deliveries, let me say, between 15 and 25 per day. So, if we are going to get a figure of 10 miscarriages to 25 deliveries, I think that is a very big figure.”

“In general, it is found that 15 to 20 percent of pregnancies are lost before they reach a certain age of 10 or four weeks. This is in the general population.”

In addition, according to Dr. Lupai, women face a number of challenges, some of which could be fatal, either during the pregnancy itself, the postpartum period, or even following a miscarriage or abortion. Some of the conditions include hemorrhage, obstetric labor difficulties, infections, malaria, obstetric labor.

He explained what miscarriage is and how it occurs.

“As pregnancy grows for nine months, we usually count them in weeks, and the total week for pregnancy is 40 weeks from conception until delivery. So, when a woman loses that pregnancy before reaching 24 weeks of pregnancy duration, we call it gestation; we call it a miscarriage.”

“That is, the pregnancy is lost before viability. The likelihood of that outcome of pregnancy surviving depends on how much it has grown for how many weeks.”

“So, until it reaches a time when it’s delivered, it’s going to survive; this way, it is called viability gestation age, and it’s not going to be included under miscarriage.”

According to Dr. Anthony, there are several causes of miscarriage among women, including infections from the plasmodium parasite that causes malaria and congenital uterine anomalies, commonly known as lamia.

Other conditions that could lead to miscarriage include diabetes, hypertension, TB, and cervical weakness, which could cause trouble during pregnancy.

“Chromosomal anomalies is the most common cause. And this is usually rarely diagnosed in other settings because it needs some technical testing to be done so that you come to know that all this expulsion is due to chromosomal anomalies.”

Emmanuela’s husband Sambro Lupai, said watching his wife go through physical and emotional pain was unbearable.

“The biggest pain that comes is from society, and society could be immediate family; it could be extended family. Some people do not understand what is happening in our family,” he said.

“You go out, and they’re like, what are you waiting for? Lupita is already a big girl. You know, you need to have another baby. I may be able to take it, but how will my wife take it knowing that she has gone through this process?”

“I had to put myself in her shoes. So, I think this is the pain that, personally, I understand women go through. And for me, now I approach life differently.”

He appealed to fellow men to maintain open communication in their marriages and support their wives during such hardships.

According to him, communication is essential whether a couple is preparing to create a family or are already expecting, and that everyone should check in on their partners on a regular basis.

“Ensure that you have those conversations; at least have you asked how she’s feeling on a daily basis about the baby? And then two, sometimes just being there, just staying home when she’s there.”

“There are some families where it’s just the woman and the child. And with the setting that the woman does, every house chore already gives her a disadvantage when she’s in that space. So, mention whether to speak out.”

“If you cannot do it, maybe spend some extra money to bring somebody to support you in doing the house chores as well. But just be there. That’s all. Just be there. And the definition of being there is different from house to house.”

Dr. Anthony Lupai echoed the need for support, adding that women who have had any kind of miscarriage, require emotional and psychological care.

About 12–15% of confirmed pregnancies terminate in miscarriage, according to the International Federation of Gynecologists and Obstetricians.

Anxiety affects 30–50% of women and despair affects 10-15% of women following a miscarriage; these symptoms can continue anywhere from a few weeks to four months, according to the research.

The UK’s National Institute of Health and Care Excellence (NICE) noted that those experiencing various forms of significant loss have grieving reactions that are “comparable in nature, intensity, and duration” to those following a miscarriage.

In this context, Dr. Lupai said the trauma of child loss can lead to women losing their families, and in the worst-case scenario, their husbands divorce them.

To help alleviate the emotional toll that miscarriages may have on women, the medical specialist urges families to provide unwavering support at all levels.

“Women may have some psychological stress, and a lot of these have even lost their families. Marriage, divorce—they cannot keep this woman who is all losing fetuses and not having a pregnancy.”

“Unfortunately, this has happened, and this is the trauma that some women are going through, which we also try to help by showing our husbands that nobody wants to do bad things for herself.”

“No woman would like to harm herself, apart from those who do abortions. For pregnancy, they don’t want, for some social reasons, the spontaneous miscarriage happening to your wife or to our mothers.”

“We must give them comfort. Once they are troubled psychologically, the third pregnancy that could otherwise go normal in a patient or in a woman who is already traumatized psychologically may also have a bad outcome.”

“For the women who undergo miscarriage, they need some support at the family level. If they are supported psychologically, they are going to be relieved from the psychological stress, which is also one of the factors in early fetal loss.”

“We are going to significantly reduce the losses that are going to happen after the first loss if we support them psychologically at home. The support is needed, and we support them at home.”

Emmanuela urges her fellow women to speak out in order to liberate themselves from the silent trauma, asserting that women should not endure the agony in isolation.

“I don’t know if people are pretending, but miscarriage causes a lot of trauma, and the pain is something you cannot just keep quiet about; you cannot swallow it.”

“So I will advise that you speak up. If you have a circle of friends that you share, it’s good to talk. I had a lot of people come in to comfort me; they came and talked to me; others shared the experience; and we learned from each other. So if you cannot speak up in bigger forums, it’s okay; you can just do it in your small circle.”

In addition, Dr. Lupai stressed the need for prenatal care for couples to address any health issues that may contribute to miscarriage.

He suggests that couples who have experienced a miscarriage take a three to six-month gap from becoming pregnant in order to help women avoid future miscarriages.

“Delayed pregnancy can be advantageous after a bad pregnancy result. Some spouses may argue that since they lost one pregnancy, they should start another right away.”

“The result will be exceedingly unfavorable. It is imperative that you allow her to develop her body for a minimum of three to six months following the initial miscarriage in order to ensure that you will have a positive outcome if she conceives again.”

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