The first time Sarah* got pregnant, “nothing went wrong”.
“Naively, we just thought that the second time round would be the same,” she tells the Herald.
When she and her husband found out they were expecting another child, “obviously we were quite happy”, she recalls.
“I’ve been a very fit and healthy person, I took all the right supplements. I got all the normal symptoms, they checked my blood work, and everything was basically tracking as it should be ... and we were really, really happy.”
Sarah had experienced a missed miscarriage, also known as a silent or delayed miscarriage.
“This can actually take a really long time to resolve, but it comes with risks,” she explains.
“You’ve got options of straight away getting a D&C [dilation and curettage] but I felt like that was the nuclear option – or taking some medication for your own body to expel the pregnancy. In hindsight, maybe it would have been better to [opt for the D&C] first.
“I was like, if I can just do this in the privacy of my own home [by taking medication], that would be ideal.”
Sarah opted for medical management of her miscarriage and was prescribed the drug misoprostol. The use of this drug is now typically followed by a dose of mifepristone but, at the time of Sarah’s miscarriage, that wasn’t protocol at Hutt Hospital for the treatment of first-term miscarriage.
After pushing back and enlisting the help of her GP, she was eventually prescribed both medications, but they weren’t completely effective, meaning she would still need an operation.
“Mentally, I wasn’t in a good place.”
She was given a date for surgery and told not to eat or drink beforehand, but the procedure was repeatedly postponed over the next several weeks.
“Then they would call and they would have to cancel. I think it happened about two or three times. The last time, the nurse got really upset because she could hear how upset I was,” she recalls.
“And she cried, and she said, ‘I’m trying to get you into the afternoon one, but it’s out of my hands. So many women go through this, and I’ve been through this myself, and I feel for you’.
“What I realised when I went through a miscarriage is one in four women lose a pregnancy, but we don’t talk about it.”
A Wellington woman waited more than a month for surgery after experiencing an early missed miscarriage. Photo / 123rf
There are risks that come with waiting for a miscarriage to complete on its own – blood vessels can burst and cause internal bleeding.
“I got told not to exercise, to just take it easy – and that they didn’t operate on weekends either. So you’re sort of left in limbo, knowing that you’ve got this potential ticking time bomb in your body. Psychologically, I don’t think that’s good for anybody.”
Eventually, Sarah called the hospital obstetrician and explained her situation. “He said, ‘I will get the surgeon to call you’.”
The surgeon explained that she wasn’t the only one waiting for this operation – there were not enough theatres and there were six or seven other women waiting for the procedure.
“[He said], ‘We’re going to book a theatre for all of you in one morning or afternoon, we’re going to cancel the other surgeries that are due to happen in that theatre, and we’ll do you back-to-back to get you done.”
When the day of her operation came – 35 days after she first found out she’d had a miscarriage – she recalls seeing two other women in the waiting room.
“We were shuffled through into the room one after the other, and then we were in recovery as well, next to each other.
“And we didn’t talk. It was like being shell-shocked.
“They send you away with a brief pamphlet, with a little candle and crystals and stuff. I think there were services, but at that point, I didn’t want to talk about it, other than maybe with those close to me.
“I ended up fixating on just getting on and trying again.”
Sarah had had no issues conceiving her first child, who is now at primary school. But following her ordeal and subsequent attempts to conceive, she found that she had lost her fertility due to primary ovarian insufficiency – when ovaries stop working normally before the age of 40.
She’d experienced symptoms like migraines and bad cramps for years – and more recently, the loss of her period, night sweats and trouble sleeping; blood tests showed she was in full menopause.
“All these symptoms that I’ve been having going back 10 years were probably linked to actually being in perimenopause starting in my late twenties.”
Looking back at her ordeal, Sarah says: “It [wasn’t] fair that I had to fight for mifepristone, the medication that other hospitals used. It’s not fair that other people’s surgeries were cancelled for us when maybe they had been waiting for a really long time too, and it’s not fair that the doctors are so overworked and stressed out and they don’t have staff.
“It’s not fair that a nurse is so overworked that she bursts into tears. I didn’t blame them, but I could see how the system was held together with duct tape. They’re expected to pick up the slack in a system that doesn’t work, a system that’s underfunded.”
Sarah acknowledges that at the time, hospitals were struggling with a backlog of operations following the Covid-19 pandemic. But she’s concerned that other women will go through a similarly traumatic experience, which is why she’s sharing her story.
“I just don’t want other women to go through this,” Sarah says. “The more women tell their stories, the more awareness there is around pregnancy loss and what type of health care they deserve.
“For years I’ve carried the trauma around and although some might argue that it was just some cells, or nature taking its course ... I actually feel deeply sad and angry that we haven’t come far enough in women’s health yet.”
Health New Zealand Te Whatu Ora told the Herald it did not hold national or regional wait-time data for D&C procedures, which are not counted on elective surgery waitlists.
Health NZ clinical head of the obstetrics and gynaecology department Dr Ausha De Silva said: “Typically, in the case of a missed miscarriage, options include a conservative approach (waiting for nature to take its course), medical approach (tablets) or surgical approach (D&C). These are appropriate management options and are offered to every patient.
“In the case of conservative management, patients are clearly informed in advance that it may take several weeks for the process to complete and conservative management may not be successful, thus requiring medical or surgical management.
“In response to an acute event, surgery is booked as a planned acute procedure. Typically, we offer surgery within a week however during busy times or holidays, it could be marginally longer. Clinicians always prioritise patient safety and triage acute patients accordingly.”
A review found the delay was the “root cause” of her death of a stroke and pulmonary embolism during surgery at Dunedin Hospital, according to an Open Justice report.
Health NZ Southern accepted the findings, apologised to the woman’s family, and said it had trained staff to double the hospital’s operating theatre capacity on weekends and would continue to update the commissioner.
In March, 1News reported that Nelson Hospital’s obstetrics and gynaecology department had more than 1000 people on their waiting list – 483 of those having waited longer than four months for treatment. One senior doctor told the broadcaster: “I’ve never seen that number of patients waiting to be seen”. Another revealed that doctors were performing emergency hysterectomies on women waiting for appointments.
There are three types of miscarriage: a complete miscarriage, in which a pregnancy passes from the womb naturally; an incomplete miscarriage, in which some tissue is left behind; and a missed miscarriage, when a pregnancy ends but stays in the womb.
This type of miscarriage can be symptomless, with no pain or bleeding to signal that something is wrong and is typically diagnosed during a routine scan showing you are no longer pregnant.
The complications of miscarriage include infection, which occurs in around one in 20 women, or heavy bleeding, with around one in 100 women needing a blood transfusion as a result, according to Health NZ.
One in four women will experience a miscarriage, with 95% of those taking place in the first 12-14 weeks of pregnancy, according to the New Zealand College of Midwives.
*Name changed for privacy
Need support?
If you think you may be having a miscarriage, contact your lead maternity carer – this may be a midwife or your GP. Alternatively, call Healthline free on 0800 611 116, or visit your local Urgent Medical Centre or hospital
