Miscarriage | The Nonstop Women's Podcast - Season 3, Episode 4 (2023)

Women Uninterrupted is an intergenerational podcast that brings you the difficult, different and ongoing conversations about being a woman.

In this episode, we ask a gynecologist and a clinical psychologist about the physical and psychological consequences of terminating a pregnancy.

host:anna thomasGuests:Shefali Tyagi 博士和 Sunanda Kolhe

Titelmuziek - Carpet Beats:maya dewarka

Production:anna thomas

e-mail:redacteur@thehindu.co.in

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Teens and Abortion

Shuchi Bhatt, Therapist

Pro-choice does not mean you support abortion.

Freedom of movement for the purpose of terminating a pregnancy should be considered a mental health condition with significant social and psychological implications.

The psychological impact of teenage abortion can vary depending on personal beliefs, cultural background, and social support. Young people go through many hormonal changes during puberty. These hormones affect their mood, mood, and impulsivity, which in turn affects how they think about dating, sex, and other decisions.

For some teens, the decision to have an abortion can lead to guilt, shame, and regret. I may struggle with self-blame and depression.

It is worth noting that the psychological impact of abortion on adolescents is not only negative. For some young people, the experience can be empowering and give them a sense of control over their reproductive choices.

From a psychological perspective, it is important to consider an individual's unique situation and how this might affect decision making. Overall, the psychological effects of teenage abortion are complex and vary from individual to individual. It is important to approach this issue with sensitivity and provide young people with the resources they need to make informed decisions and deal with the emotional consequences.

In everything we do, we choose a particular direction. Our lives are a product of these choices. If abortion, like any other decision we make, is a conscious and self-aware decision, then it can be empowering.

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Hi, I'm Anna Thomas, host of Women Uninterrupted. With me, I have Dr. Shefali Tyagi, Obstetrician with over 19 years experience. Welcome, Dr. Shefali. In this episode, we discuss what happens when a pregnancy is terminated, both medically and psychologically. So I asked clinical psychologist Sunanda Kolhe to join us. In her private practice, Sunanda specializes in women's mental health issues during childbearing. Welcome Sunanda. I want to start by asking, what is the best way for family and friends to react and respond when a couple is going through a miscarriage?

arrive:Well, that's a great question. When someone has a miscarriage, it can be difficult to know how to react or react, what to say or not to say. It's hard because everyone is different, and what's okay for one may upset another. Sometimes friends and family are hesitant to say something, or afraid to say it. But I would say it's like sadness. This is a time of mourning. The way to do this is to simply say, “I’m sorry” or “I know this is hard for you; Important, and friends and family often agree that it's best to leave this person alone, as it's a very personal matter. Give her some space but actually sometimes this leads to isolation, it's better to keep in touch, send a message here or there, drop by them, be there for them, if someone is still confused or still not sure what to say and how to respond, Whatever you need to do is sit down and listen to the person expressing his feelings or thoughts. I think it's been a really valuable experience for them and has given them a lot of support.

anna:There is a study to back this up - certainly in the US - about public perception of abortion. Research shows that approximately 41 percent of respondents feel lonely after a miscarriage.

Dr. Shefali, I have a question from the audience. Older relatives often advised us not to announce the pregnancy, they wrote. The unspoken background is that you may lose your baby early on. Then there are many questions from relatives and friends, partly guilt, especially the behavior of the woman: she goes to work, always drinks, is always under stress, and even - she is lazy. What could be the real cause of early pregnancy miscarriage?

Dr. Shefali:Most first trimester miscarriages are linked to the baby's chromosomes and DNA. If chromosome 46 in the sperm—chromosome 23 in the egg—doesn't pair up well, parts of the chromosome are lost: deleted, added. Then nature mostly threw him away. This is the most common cause of miscarriage. Also, it could be some infection in the first trimester: if you have a fever, etc; if you have antibodies in your blood that can starve the pregnancy, or maybe genetic factors like uterine shape, uterine malformation: they can all play a role, But not so obvious. In general, your diet/travel has nothing to do with miscarriage. Unfortunately, it was the woman who was to blame and they continued to confront each other. I see in practice: "What did I do wrong for this to happen?" But the first thing we can assure you is that you have no control over it. There is some wisdom in what the elders say: don't announce it anytime soon because abortion is widespread. That is, every third pregnancy ends in miscarriage. If you test positive, you can tell your parents. Very close family members can be told after seeing the first heartbeat at about six to seven weeks. when you were 12^electronic/13. It becomes relatively safe when you get into the second trimester because most babies will go into the second trimester if the baby is genetically healthy. Losses may occur afterwards, but this is very rare.

anna:Common reasons people criticize a woman: She exercises too much; sometimes it can be "I saw her swim" or "I saw her ride a horse" and be stressed. Is stress the cause?

Dr. Shefali:I wouldn't say that. Stress can manifest itself indirectly. But we can't calculate how much stress caused the miscarriage. Some people are really stressed out. Now I have a patient whose husband went into cardiac arrest at 24 weeks. The baby is fine; no miscarriages resulted. What could be more stressful than that? We have office stress, or housewives who don't have much stress and still have miscarriages. I don't think pressure has much of an effect. But of course, we recommend that you keep your pregnancy as stress-free as possible,

anna:What are the signs of miscarriage?

Dr. Shefali:When you test positive, we will ask you to do a blood test called beta HCG. When beta-hCG levels are extremely low, our antennae go up and we want to more or less monitor the rise in beta-HCG. That's usually not appropriate: since it's supposed to double in 48 hours - that's already a bit excessive. That in itself suggests that this pregnancy may not be going well. Later, when we had an early pregnancy scan around week six to seven, we found that the dates were quite different from how the baby was growing. Sometimes the baby can't see or is very small; can't see the heart rate or the gap is large or the heart rate is very low; there is a lot of blood in it. These are all warning signs. Physically, women themselves may bleed, which can be threatening. Any bleeding during pregnancy should be checked right away.

anna:What non-surgical methods are available to treat first trimester miscarriage? What happens if you have a miscarriage?

Dr. Shefali:There used to be a treatment called threatened abortion treatment, and we didn't do anything. Nature went with the flow and after a few weeks it started bleeding and things came out. Now this happens occasionally, but it's a very unpredictable form of treatment. Working women and those with a fast pace of life can't wait weeks for the bleeding to start. Whether there will be a complete miscarriage is another question. Today, wait-list treatments are often not offered. Today we have drugs that can treat miscarriage, the drugs just start to stimulate the uterus and push the product out. Then we look at an ultrasound to see if it's a complete miscarriage. It is important to complete the abortion. No part of the pregnancy should remain in the uterus; complications may result later.

anna:What's the recovery process like; how soon can you return to work? How many days does recovery take?

Dr. Shefali:In medical and surgical procedures, recovery is very fast. Medicine is kind of hard because it's painful. After a week, we usually know if there is a complete miscarriage. So the program is a bit long. You can take two days off during a medical break and one day off during a surgical break where recovery is fairly quick.

anna:How soon after a miscarriage can a woman get pregnant again?

Dr. Shefali:I think they should wait at least two periods before rescheduling. It takes two to three months from miscarriage to planning your next pregnancy.

anna:Sunanda, I want to ask you: How has your partner helped you cope with a miscarriage or miscarriage?

arrive:I think there are two ways here, two very important ways. A partner can actually help in many ways, but the main thing is to be supportive, you know, if the partner wants to vent and talk about her feelings, it's really important for the partner to validate those feelings and comfort her. Another point is communication. I think this is very important: an open communication between two people where a woman naturally feels safe, a space where she understands that she can share her feelings with her partner without having to. Judgment or comment. That would make her a little unhappy. I think that's great support. Open communication and offering support, comfort and listening; be there for her. I think it's very important.

anna:Could anger be one of the answers?

arrive:Angry at a woman?

anna:I,

arrive:That. The most common feelings are guilt, loneliness, anger, helplessness, hopelessness, loss of control, loss of trust in your body, anxiety, and possibly depression.

anna:So it's a natural cycle.

arrive:Yes, it is very common to feel these emotions, but only if they do not start to interfere with daily functioning in some way significantly and clinically, and if the intensity is high, they will be more frequent than usual and last longer, such as over six After a few months, you should consult a psychologist or specialist.

anna:How would you advise a minor who comes to you with an unwanted pregnancy? What process did you go through there?

arrive:Yes, this is a very important and very sensitive issue. A minor usually comes with his parents, right? So it's going to be a family. First, we have individual therapy with the minor, then an educational therapy, psychoeducation of the parents, therapy with the parents. We'll bring them all together and talk later. When it comes to counseling girls one-on-one, I think some of the most important things are the counselor's empathetic attitude as opposed to hostility, non-judgmental attitude, and honesty. I think that's also really important: to be able to really understand what she's saying and where she's coming from. And, as Dr. Shefali and you also mentioned before, self-blame often takes over. It's very important for the therapist to address this self-blame and regret: "It's okay, you know, it's okay that it happened." But, of course, steps can be taken to prevent this from happening in the future. When we talk to parents, it's more about educating them about the natural flow of emotions and behaviors that a minor may exhibit and may feel. Educate them on how to deal with these behaviors and feelings, no matter what stage of pregnancy the girl is in; what happened during that time, and how it all combined to cause her to exhibit any emotions, behaviors or character traits. Ultimately, when we put them together, the two sides are actually talking to each other and trying to come to an agreement. That's the goal: both must be on the same page.

anna:Dr. Shefali here is a medical law graduate from NLSIU and I want to ask her: In 1997 I found out I was pregnant with my second child. At my first gynecologist visit, she asked if I wanted a gender test. She called it amniocentesis. Confused, asked why. She said: Your first child is a daughter; do you have a girlfriend. Many of our patients ask for tests because they no longer want girls, she said. Dr. Shefali, I have never been to that clinic again. I have no reason not to report. How should an ordinary citizen react when she learns that a sex test is being done somewhere with the intention of aborting female fetuses? Should I file a FIR? Do I have to report to the medical board on their website?

Dr. Shefali:These days, it's absolutely illegal to even ask for a gender test. Well, maybe people will ask a week before delivery because the curiosity is clearly there. A nine-month pregnant woman will ask: Doctor, I can't do anything now, can't you tell me now? But that's a big no. Under Indian law, doctors can be jailed and have their licenses revoked if the gender identification is discovered. There is a very strict PCPNDT Act. Everyone who owns an ultrasound machine must have this registration, a license, and must show everywhere that no gender identification is done. In smaller places, maybe small towns in India, it's still done, but definitely illegal. And that's actually a crime. You can file an FIR and report it to MCI later. This practice must absolutely stop in India. On the subway, no one will even tell...not even our fellow doctors...we won't tell you what gender you are; it's always a surprise to all of us.

anna:Our country does not give married and unmarried women equal abortion rights up to 24 weeks until 2022. What legal changes do you expect to give women the absolute right to bodily integrity during childbearing?

Dr. Shefali:Of course, India is way ahead when it comes to abortion laws compared to the rest of the world. They won't even do the scan in Europe - as with any deformed baby you have, be patient with her. They won't even talk about firing. We are very enlightened and unmarried women have the same abortion rights as married women; it has been around since the Medical Termination Act of 1971, but the change from 20 weeks to 24 weeks is very recent, which is actually a great advantage, Because there are a lot of anomalies over time. At 19 weeks, they are in the developmental stage, we doubt it. Then suddenly the 20-week deadline hits: there's nothing you can do after that. You know, you wash your hands and say, I can't be fired illegally. Fortunately, the Supreme Court has now extended that guideline to 24 weeks. Now we have time to see, confirm, get a second opinion and be pretty sure the baby is abnormal and needs to be terminated. In this regard, I think India is doing very well. And cancel after 24 weeks: Most people know and are educated by now; at 24 weeks it is reasonable to think you are pregnant. After that, I thought they were a one-off and they wanted to quit - but they really shouldn't. It's not that safe for both mom and baby: the baby isn't fully alive yet, but the baby will still be born alive at that moment. If you don't come back to life, it's heartbreaking, fighting for your life, crying for hours. It's inhumane and unfair. I think 24 weeks is a good time.

anna:Thank you Dr. Shefari and Sunanda. If you have any questions about this episode, please write to us at the following email address: editor@thehindu.co.in with subject line: Women Without Interruptions. For anxiety and other mental health concerns call Kiran's 24/7 free national mental health helpline on 18005990019. Unsubscribe from this episode of The Women Don't Stop podcast, brought to you by The Hindu.