Recurrent pregnancy loss (RPL) has become a silent struggle for many couples. It is defined as having 2 or more miscarriages in a row. Despite its prevalence, the stigma around this often leads to personal shame and solitude. The emotional burden makes the couples difficult to navigate their grief and some become a trauma left for years causing couples feeling helplessness to embark on the pregnancy journey.

 

They often start ruminating on questions such as “What went wrong”, “What did I do to deserve this?”, “Did I eat or do something I shouldn’t have”, etc. This could be a taxing period after the miscarriage.

 

 

 

 

 

What are the causes of RPL?

While the exact causes of RPL remain unknown and many modern medicine research efforts are still ongoing, there are several risks that can increase the likelihood of RPL, such as advanced maternal or paternal age, chromosomal anomalies (parental or foetal), hormonal imbalances (diabetes, thyroid disease), uterine or cervical anomalies, blood clotting disorders (increased tendency to form clots in veins or arteries), lifestyle & environmental factors, infections (vaginal or endometrium infection), obesity, etc. From Traditional Chinese Medicine (TCM) point of view, there are 2 aspects discovered to be causing a miscarriage:

 

 

• Weakness in the Chong and Ren Vessels in the mother

The Chong vessel (penetrating vessel) is known as the “Sea of Blood” and “Sea of all 12 meridians”, while the Ren vessel (contraception vessel) is known as the “Sea of all Yin (essential substances, such as body fluids)”. Both vessels are correlated with the menstrual cycle, originated and are based on the foundation of the Kidney system. They function as the pathways to nourish the uterus, ensuring a regular menstrual cycle and smooth pregnancy with positive outcome when the Kidney system is strong. Hence, the strong foundation of the Kidney system in the parents will affect the development of the foetus.

 

• Defect in the embryo or foetus

Although fertilisation may occur, the foetus might not be strong enough to develop or grow healthily, often due to inherited factors from the parents, which can lead to miscarriage.

 

In TCM, the Kidney system encompasses the organs and functions of the reproductive system, including the quality of sperm and eggs (genes), female and male hormones . The Liver system regulates menstrual flow and cycle, influencing emotions, and affecting the function of the digestive system. The Spleen and Stomach system are responsible for digesting food, transforming and absorbing nutrients, transporting nutrients, and removing metabolic waste.

 

TCM emphasises differential patterns by identifying imbalances in body constitution that contribute to RPL. Common patterns include deficiencies in the Spleen and Kidney systems, Qi and Blood deficiencies, blood stagnation and blood-heat patterns.

 

 

What to do after a miscarriage?

1. Get confinement care.

You may want to consider having a short period of confinement care. The duration of the confinement period depends on the weeks at which the miscarriage occurred. Women who have miscarriage within 12 weeks of pregnancy should practise confinement care for 2 weeks, while 1-month confinement period is recommended for women who miscarriage after 12 weeks of pregnancy. Vaginal bleeding after a miscarriage or dilation and curettage (D&C) can last for 2 weeks, and it is essential to ensure that any residual tissues are expelled from the body. Therefore, nourishing herbs should not be consumed too early, especially for those undergoing expectant management (waiting for the body to expel the pregnancy tissue naturally).

 

2. Seek consultation from fertility specialists.

Consult your primary Obstetrician & Gynaecology doctor to get tested. By consulting a registered TCM Practitioner who specialises in gynaecology and fertility, ensuring the body is well prepared for subsequent pregnancy and achieving full-term pregnancy is the main goal. Seek a counsellor or psychologist if necessary. With proper guidance and a stress management system in place, you can help to ensure the next pregnancy proceeds smoothly.

 

3. Take the time to unwind and start to conceive when you are ready.

Take time to grieve and heal. There is no set time for healing, nor is it something that can be rushed. However, if the grief has affected your appetite, sleep quality, or daily activities, you might need to seek a TCM practitioner for herbal therapy or dietary suggestions such as herbal tea or soups to ease the symptoms.

 

Women who have a history of RPL should not think it is their fault. It’s important to stop limiting yourself and learn to be yourself again before becoming a mother. Why not use this period of time to rediscover who you are rather than getting trapped by the mindset of conceiving?

 

 

How TCM helps in RPL?

 

TCM has long records on RPL, dating back as early as the 5th century during the NanBei Dynasty of China (420 A.D.-589 A.D.). The understanding of RPL gradually deepened, covering from the causes, mechanisms of body constitution to its prevention and treatment.

 

1. Preconception care

Various aspects from lifestyle and diet to mental health, play a role in preconception care.
Before embarking on the next step, couples may seek a TCM Practitioner to consult on their body constitution and to get prepared. Preconception care is essential for couples who have been experiencing RPL as the goal is to optimise the health of both partners to improve the chances of a healthy pregnancy and a healthy baby.

 

Practising a healthy diet should start at least 3 months before conceiving by having regular meals on time, increasing the intake of whole vegetables and fruits, get sufficient food which is rich in Omega 3 (walnuts, pecan, pistachios, etc) and stop taking any amount of alcohol. Besides, stay away from chemical substances such as pesticides, nail polish, reducing the usage of plastic, etc.

 

Healing, both physically and emotionally, takes time. Building your own stress management system by practising mindfulness, keeping a journal, engaging in regular exercise, and practising deep belly breathing techniques can help to navigate the fertility journey and support your overall well-being.

 

2. Strengthening the Kidney System

TCM has a main principle for treating RPL: “Preventing by cultivating the weakness” (”预培其损”), which means nourishing the deficiencies as a preventive measure to prepare for the next pregnancy. In other words, it emphasises strengthening the Kidney system, which is the foundation of reproductive health.

 

Focus is placed on prevention. Before pregnancy, nourishing the Kidney and Spleen to strengthen the Qi and Blood, and smoothen the pathways of Chong & Ren can help in fertilisation. After pregnancy is confirmed, the treatment goals shift to supporting the continuation of a healthy pregnancy and sustain it for at least 2 gestation weeks beyond the duration of previous miscarriages.

 

Although strengthening the Kidney is crucial in treating RPL, nourishing Spleen, qi and Blood, and enhancing blood circulation to remove the stasis are essential components to achieve a positive pregnancy outcome. Additionally, soothing Liver Qi flow is crucial, as stress following the pregnancy loss and during the conception process can make pregnancy more challenging.

 

3. Personalised treatment plan

A personalised treatment plan with specific guidelines is often needed. This plan may include TCM treatments such as acupuncture and moxibustion, Chinese herbal therapy, and integrative approaches with IVF treatments.

 

Have you ever wondered how long you should wait before trying for the next pregnancy?

 

 

From TCM perspective, women who underwent D&C are generally advised to wait at least 3 months with a regular menstrual cycle to allow reproductive hormones and organs to return to optimal levels. With the history of RPL, your fertility doctor may need to run some tests to find the underlying issues. If menstruation is absent for more than 3 months, seek medical attention to determine the root cause before trying to conceive again. Besides, intercourse should only occur after vaginal bleeding has stopped to avoid infection.

 

In conclusion, time is the essence when it comes to conceiving. Couples who have been through RPL can be stuck in a vicious cycle due to the emotional burden, causing them to lose the courage in seeking for medical help or escaping reality by not searching for underlying causes which hinder the pregnancy progress, especially for couples who are entering forties. “Bad things at times do happen to good people”, quoted from the Korean drama “Hospital Playlist”. Just remember, experiences of pregnancy loss are not to punish you. It’s to remind you of practising courage, love and resilience. With the help of proper fertility treatments, there’s still a chance to get a healthy pregnancy immediately after.