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Sunday, June 26th 2011, 12:19pm

Loss - one woman's story

From today's Daily Mail

A miscarriage is a harrowing experience for any woman, and for those – like actress Amanda Holden – who have had one child but then suffer
multiple failed pregnancies, the bewilderment is immense. But at what point do you take the difficult decision to stop trying? Anna Moore reports

Amanda Holden is wowing West End audiences every night as Princess Fiona in Shrek The Musical, but behind her professional on-stage smiles lies the private agony of her attempts to have a second child. Last year, the actress and presenter, 40, miscarried at four months – heralding what was ‘without doubt the blackest period’ of her life. Because of that, she kept her subsequent pregnancy secret for six months, after which she joyfully revealed her growing bump to the cameras, telling journalists about her excitement – and of her young daughter’s too. (Lexi, now five, and Amanda had already enjoyed secret shopping trips to buy baby clothes.) Tragically, weeks later, following concern that her baby hadn’t been moving, a scan revealed that her son was stillborn (the official term for a baby that dies in utero after 24 weeks). A statement described Amanda and her husband Chris Hughes as ‘utterly devastated’. It seems that no medical reason has yet been found.

No one could fail to be moved by Amanda’s painful journey, but for some women her story will be particularly poignant. Though most of us associate secondary infertility with the inability to conceive following the successful birth of one or more children, in many cases, conceiving isn’t the problem. It’s carrying a baby to term that proves difficult.

‘Being unable to become pregnant a second time or suffering recurrent miscarriages are both extremely difficult situations,’ says Ruth Bender Atik, director of the Miscarriage Association. ‘Sometimes women in the latter group are told, “Well, at least you can get pregnant.” Whereas their own feeling is, “What’s the point?” They’d rather not have the ups followed by the terrible downs.’

Amy Scrimshaw endured the sorrow of six miscarriages in a row after the birth of her daughter Matilda. ‘The first time, I became pregnant at the same time as my sister,’ says Amy. ‘But at 12 weeks I started bleeding, and a scan showed that the baby must have died at eight or nine weeks. It’s actually painful to think of yourself walking around believing you’re pregnant when you’re not any more. You almost feel stupid.’

Knowing that this was probably a one-off and that miscarriages are common, Amy became pregnant again, towards the end of her sister’s pregnancy. ‘That was good because it took away the awkwardness, the poignancy of her having a baby and me without one,’ she says. However, an early scan – given because of her history – revealed that, despite a heartbeat, the baby was behind in development and unviable. ‘I was told that the baby would miscarry very soon. I had to carry on as normal, taking Tilly to playgroup, while this was happening inside me,’ she says. She miscarried a week later.

Miscarriage is surprisingly common: about one pregnancy in four will end this way. Recurrent miscarriage – more than three in a row – is rarer, affecting one per cent of women. In general terms, the further along the pregnancy gets, the safer it is, but stillbirth, as experienced by Amanda Holden, is not as rare as you might think: there are about 11 a day in the UK.

‘Many women expect everything to go right, especially after an easy pregnancy first time round,’ says Ruth Bender Atik. ‘And when it goes wrong, we also expect to be able to go to hospital and have it fixed. But science isn’t as advanced as we might like. I think we have to accept that there will always be miscarriages.

Any woman who has experienced more than three miscarriages in a row should be referred for further investigations. At least half will leave hospital with no obvious answers, yet many will go on to achieve a normal, healthy pregnancy without treatment. Up to five per cent of those who experience recurrent miscarriages may find that one or both of the couple carries a chromosomal abnormality. More common causes include diseases of the immune system, hormonal imbalances and problems with blood clotting – known as ‘sticky blood syndrome’, which is easily treated by low-dose aspirin.

Age is another major factor. Most of us are well aware that a woman’s supply of eggs is finite, but they also decline in quality too. Up to 75 per cent of the eggs in a woman over 39 are chromosomally abnormal – which means, among other things, that they are more likely to result in miscarriage.

Recent research has also shown that older men are more likely to produce poorer-quality sperm (the risk of miscarriage where fathers are aged 30 to 34 is 16.7 per cent; this rises to 33 per cent in men aged over 40). So a couple who start their family in their mid-30s and find pregnancy easy first time round are more likely to experience miscarriages when they try for number two.

Amy, now 39, was well aware of time pressures when it came to planning her family. ‘My wish – if I’d been able to do it – was to have three girls close together,’ she says. ‘I’m from a family of three sisters and saw myself as the mother of lots of children. All my life, that was the most important thing to me. At one point, my husband said he couldn’t even think about having children until he was 35 – he’s the same age as me. I told him that he’d have to do it without me as I wasn’t going to wait that long!’ So Matilda was born when Amy was 33. But then came the miscarriages.

‘I really feel for Amanda Holden,’ she says. ‘Of course, it must have been worse for her. None of my miscarriages were later than 12 weeks.’ But each failed pregnancy left Amy more determined to have a second child. ‘I had every test possible to try to find and fix the problem,’ she says. ‘I didn’t want any regrets about a stone left unturned. I read up, researched, trawled the internet. With miscarriage, you feel so out of control – I needed to make sense of it as much as I could.’

In addition to standard tests at a miscarriage unit – which found no obvious cause – Amy consulted specialists in Chinese medicine and naturopathy. ‘People would say, “At least you have one child,” and of course I was grateful for Tilly. But sometimes, these people had three or four children themselves. It got to the stage where I was always either trying to get pregnant, already pregnant and hoping I wouldn’t miscarry, or miscarrying. I didn’t want it to cast a shadow over Tilly’s young life – but I had a work in progress. My project was a job in itself.’

But in some ways, this project was not shared by her husband. ‘Jason’s a wonderful father, but he’s never been driven to have children, whereas for me it’s been an obsession,’ she says.

In fact, this is often the case. Patricia McCreary created a blog about her own multiple miscarriages and desperate attempts to have a second child while in her late 30s. It is a searing, bittersweet, emotional roller-coaster that she finally signed off when her husband gave her an ultimatum: they either stop trying for a baby or face the end of their marriage.

‘Multiple miscarriages polarise men and women,’ says Patricia, who owns a production company in Seattle, USA. ‘Most men feel that if it’s going to be that painful, they don’t want to continue.’

Patricia identifies easily with Amy’s ‘obsession’. ‘All my life, I’d made things happen,’ she says. ‘I thought that if I just kept trying and set my mind to it, I’d achieve this perfect family. All the time, I’d have the ever-changing due dates and age gaps running through my head. My husband felt I was totally absent from our family and I think he was right. He felt like nothing more than the sperm donor.

‘My friends were sick of me and it’s a very lonely road,’ she continues. ‘You’re the one who’s spent every waking hour for the past few weeks or months thinking about this person growing inside you. You may have seen this little heartbeat. It’s not real to anyone but you. And after each miscarriage, you’re even more desperate to replace the person you’ve just lost. I started the blog because I had all these thoughts and feelings and nowhere to put them. Very soon I was getting 150 emails a day from people going through the same thing.’

With recurrent miscarriages, the decision to ‘stop trying’ is extremely difficult. If you are unable to conceive, you may decide to discontinue IVF treatment. But if you can conceive, your only choice is to use contraception – which is counterintuitive when you yearn for a baby. ‘At some point, couples may decide they can’t put themselves through it any more, that they’re not living their lives or paying attention to the child they have,’ says Ruth Bender Atik. ‘But it’s often a decision that is made and unmade quite a few times.’

In Patricia’s case, it took a year to accept her husband’s refusal to keep trying, another year to come to terms with the fact that he did not want to adopt instead, and another to truly move on. Their son is now 11. ‘If I could choose, then I’d have loved another child,’ she says. ‘But I do appreciate how much simpler my life is with only one. Paying for a college education seems a lot less daunting than it does for my friends with several children. We travel a lot, and it’s easy to take one child with you. There’s so much that’s great about it.’

There is, Patricia says, no residual resentment about the decision to stop trying for another child.
‘I realised this was not something my husband was equipped to go through any more,’ she says. ‘He wasn’t saying “no” to be mean.’ In some ways, their relationship has strengthened because of it. ‘You truly get to understand what marriage is about,’ she says. ‘You can’t always come to a solution that both parties agree on.’

Neither Patricia nor Amy will ever know for sure what caused them to miscarry. However, Amy went on to become pregnant and gave birth to a healthy boy, Rufus, last October. ‘When we passed the 12-week watershed, I gained confidence,’ she says. ‘None of my other pregnancies – apart from Tilly’s – had gone past that. I had scan after scan, and when Rufus was born I just couldn’t believe it was real. I feel so lucky – it’s my personal heaven.’

Rufus’s birth has put the previous miscarriages into softer focus. And Tilly is as delighted as her parents. ‘For years, she’s been asking for a brother or a sister. Now he’s her favourite toy! As for the family I’d always wanted, I think I’d have struggled with three girls under four,’ says Amy.

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