August 15, 2008 at 4:51 pm · Filed under Book Reviews, Miscarriage
Miscarriage, Medicine & Miracles: Everything You Need to Know about Miscarriage by Bruce Young, MD, and Amy Zavatto is the newest medical-based book on pregnancy loss. Other types of books focus on psychology, grieving, or anecdotes of women’s stories, but this is a very traditional doctor-to-patient manual.
I am always glad to find a book that is up to date and comprehensive, the best sort of resource for a woman who is ready to sit down and read, hoping to find a stronghold in what has felt like a freefall so that she can begin the search for answers.
Overall, this book delivered. The section on myths (and why luncheon meat does not cause miscarriage) made me want to leap up and shout, “Finally!” So many women, with their pregnancy manuals in hand, will apply the warnings about tuna and hair dye and hot tubs retroactively, certain that they caused their losses. Young clearly defines the line between a theoretical health risk and a serious miscarriage cause.
The book contains all the classic elements: signs of an impending loss, common causes, treatments, and thoughts on prevention. It has a nicely expanded section on the impact of health conditions that can complicate a pregnancy. Some of the stories were out-and-out riveting, including patient histories where one twin was failing and they had to make a careful decision on when to deliver for the safety of both, and the harrowing case of a woman with kidney disease trying to delay the birth so her baby would survive, even though she was risking death herself.
I would recommend this book, but I have some very sharp criticisms. I almost flung the book across the room in horror the moment I opened the Table of Contents.
I’m not sure who thought glib chapter titles such as “scarred and scared” for scar tissue or “misplaced trust” for ectopic was a good idea, but let me be clear: miscarriage is not and will never be funny. Do not try to be clever or use flip word play to women who are in real pain.
This happened again in the myths section. Young calmly talks about how working out, having sex, and caring for your other children are perfectly safe activities. Then, inexplicably, he gets cute, saying that because of the association between night work and an increased risk of miscarriage, “…You can work very hard, only not at night!”
Is that supposed to be funny? Are all the women who have evening shifts, nurses and factory workers and 911 operators, supposed to read that and think—I killed my baby? Once again I sat the book down and reflected on whether or not I could recommend it.
I am not a fan of the “I’m the doctor know-all” style, nor the way Dr.Young starts off each chapter by describing the physical characteristics (overweight, blonde, tall) of the woman whose case he is about to explain, but this is the most recent book that covers what many of you want to know—the how, the why, and the what next.
Since it does its job efficiently most of the time, I will, with some reservation, say, yes, I can recommend it to you. But don’t read it when you’re upset. Take up this book when you are ready to plod through some of the insensitive writing to get at the heart of the research and information.
More about Miscarriage, Medicine & Miracles
August 8, 2008 at 11:05 am · Filed under About Deanna's Book, Early Pregnancy Detection, Miscarriage
During research for my book Facing Miscarriage, I stumbled across an article in the British news source, The Telegraph, talking about a “panic” that spread across the UK when early detection home pregnant tests first became available a few years ago.
I didn’t find any similar articles in US papers, but it’s easy to see why the new home pregnancy tests could cause a flurry of concern.
Old-style tests, manufactured prior to 2004, typically looked for a pregnancy hormone level of 50-100 mIU/ml and were not effective until the day a woman missed her period, on average, about 14 days post fertilization. This is when the baby is well implanted and the miscarriage rate is expected to be between 8 and 20 percent.
The new tests, however, detect the hormone at 20 mIU/ml. This is within a day or two of implantation, more like 9-10 days after fertilization.
Since the advent of early sonography, we’ve known that a huge number of fertilized eggs either never implant at all, or attempt implantation and fail. This number varies depending on who you ask, but is always frighteningly high — between 50 and 75 percent.
For many moms, working so hard to achieve pregnancy and the family of their dreams, this is a terrible and sad loss. The emotional pain in getting their period after seeing a positive pregnancy test is often strong and frightening.
These early losses, however, almost never indicate a problem that needs treatment. The fusing of the egg and sperm’s genetic material is tricky and often goes awry, either misaligning or dividing improperly in early cell growth. When the egg with chromosomal errors bumps against the uterus, the body will start the implantation process. This sets off the manufacture of pregnancy hormone, but often, the lining rejects the egg. In this case, the woman’s body will register a fleeting rise in pregnancy hormone even though the baby could not implant and grow. The new tests are so sensitive as to catch the temporary rise.
This early chromosomal rejection has no bearing on the health of the mother or her ability to carry children to term. The rush of hospital visits by distressed moms causes extra upset and frustration. They often find they are simply turned away. Others might be subjected to invasive and unnecessary tests. The problem amplifies — moms want their babies to be recognized from conception, and health care providers want to maintain a simplicity in diagnosis and treatment of clinically recognized pregnancy and miscarriage.
As I write what I hope to be the newest book about miscarriage and how to get through it, I will address the issue of the new definition of miscarriage. Do we adjust our statistics and scare women with the real figure — that over half of their pregnancies will be lost before week 5? And how do we decide when a woman actually needs intervention for recurring miscarriages? Do early losses simply “not count” anymore? I do wish sites like this one that advocate super-early testing also include a reminder of how common an early loss can be.
Perhaps we will rewrite the rules based on our early detection of pregnancies, creating a hierarchy of risk based on gestational age. But the rules will be for treatment and clinical relevance only. Our babies are our babies, whether at 16 cells or fully formed in our waiting arms.
Empty
Cradle, Broken Heart
