'Nobody gives you a manual for this kind of stuff': Humza Yousaf and Nadia El-Nakla on their experience of multiple miscarriages

As Scotland went into lockdown and we all became more fearful for what the future might hold, Justice Secretary Humza Yousaf and his wife, Nadia El-Nakla, were grieving for a future that had already disappeared.

El-Nakla was 11 weeks pregnant in early March when she felt that something wasn’t quite right. Symptoms had simply vanished overnight, and she knew instinctively from painful experience that her pregnancy was over.

In less than three years, Nadia and Humza have experienced five pregnancies, with just one of those resulting in a baby, when Amal was born safely at 36 weeks in May 2019. And when they discovered they were expecting again at the start of this year, there was no disguising their fears.

“I had been scared about being pregnant, not just because of what had happened in the past but also because Amal was so young and I was actually quite scared about having two children under two, but the fact is, I was even more scared that it just wouldn’t last and that this pregnancy would end like all the others before it.

“I had a couple of early scans though and had heard the heartbeat and so we quickly became really excited and I was just trying to stay really positive, but I knew when the pregnancy had ended.

“I then got pregnant again during lockdown and I felt very anxious. Humza kept saying that it was good news, but I felt conflicted about whether it was good news or not. I really didn’t want to face having another miscarriage and I needed to try everything possible to keep this baby, but unfortunately my plans didn’t work and I miscarried very early on. That was just a month ago, so still very raw.

“And now I feel it is enough. My body has been through too much and I couldn’t bear the pain of this both physically and emotionally all over again. So, enough.

“With all my miscarriages I just wanted to be at home and allow myself time to process my grief, but because this last miscarriage happened during lockdown, it was even harder for my family and friends who wanted to comfort me but couldn’t. That was probably hardest on my mum, who just wanted to give me a hug, but thankfully at that point in lockdown we could meet in gardens and I remember my best friend sitting in the rain just so she could be there for me.

“I know I am lucky to have Amal and I have an 11-year-old daughter, Maya, from my previous marriage. So, when people say you are blessed, you know that already, but it doesn’t take away the pain of what you have lost.

“You start planning as soon as you know you are pregnant. You can’t help but think about what the future might hold and even silly things like whether the car will be big enough and how will you get both baby seats in. You can’t stop those thoughts, but then when you miscarry, you’re expected to just forget, instantly move on, and that’s hard.

“I got pregnant at 24 very easily, when I was first married, and had a fine pregnancy. It wasn’t until after my pregnancy that I found out that I had a bicornuate uterus and there’s some complications with that, but because I’d had a relatively normal pregnancy, I never thought there would be any problems for the future. But after Maya, I had one miscarriage and then I had five years of infertility which was just unexplained.

“So, when I met Humza, after my divorce, and I knew how much he wanted children, I did say to him that I wasn’t sure if I could have kids. I knew he really wanted them, so I wanted him to understand my history in case that was a life he couldn’t imagine living. But we got pregnant relatively quickly. We got married, and we had our Islamic wedding in the July, the end of July, and we got pregnant in October 2017.

“I knew there was a possibility that I couldn’t get pregnant, so when the first time I got pregnant in that October, I was just so excited to see a line on the test, I couldn’t believe it, that it happened so quickly. We were both so excited.

“But then I started bleeding. I was scanned and there was a heartbeat, but when I got scanned again, the heartbeat had gone. I think we miscarried at about seven or eight weeks, but I’d thought because there had been a heartbeat, it would all be ok, but when we got scanned again, the heartbeat was gone. They said, what do you want to do. You don’t really know what to say because you are just processing that you are no longer pregnant and you’re having to make decisions about whether you wait for everything to happen naturally or for the hospital to intervene. Your emotions are a mess because you don’t stop feeling like a pregnant person the instant you are told there is no heartbeat anymore, but then everything gets very clinical. “I got given a pessary, but that didn’t work, so we went back after a few days after I had had a massive bleed, like I mean, I passed out, I was sick, it was just…it was horrendous. I’m anaemic anyway, so the blood loss was huge and so I got a D&C [dilation and curettage]. That was very much the trajectory for the second pregnancy as well. And the same thing, seeing the baby, or the foetus, growing on the scan, we almost had this false hope because the heartbeat was there, so you just hang on to that hope… and I remember I asked them if they could just check like one more time, just because you know, I didn’t want to make a decision to have a D&C if there was a chance, but there was no chance and that was that...”

At this point, tears are slowly rolling down Yousaf’s face. “It’s the most helpless I’ve ever felt, I think, ever in my life, to be honest, and I know this is really outdated sounding, but you know, you want to be really strong for your, in my case for my wife, and I wanted to make sure that I knew what she was going to go through, but I could see because I mean, again, perhaps going into too much graphic detail here, but I mean, Nadia was having clots of blood coming away and passing out as I was trying to help her to get from the bed to the bathroom. You know, trying to get her to get a little bit of water to keep hydrating. Nobody gives you a manual for this kind of stuff.

“Nobody tells you, by the way, see if a miscarriage happens, this is what happens actually. You watch Hollywood movies or TV programmes and dramas and the women will go into the toilet cubicle, there will be a bit of blood on the tissue, she will be upset, and that’ll be the end, and they will move on to the next scene in the movie. Nobody tells you, in some cases, in our case, in almost all of them, just how horrifically traumatising they’ve been for the women who’s suffering the miscarriage or going through the physical and emotional elements of it.

“For me, I just felt utterly helpless, not knowing what to do. So, you know, I was calling my sister who’s a pharmacist, my older sister, asking what I could do and she said, keep her hydrated, and I was saying, I can give her water but I can’t stop the bleeding. Just helpless watching this happen. You know, all I could do is just hold her hand and tell her that I was there. But at the same time, I’m trying to process a loss too. So, I’m trying to process a loss that’s happening to both of us but feeling like I’ve got to be the strong one. You’ve got to, because if I ended up in total despair thinking about all she’s going through, it’s going to be worse for both of us.

 “I think the first miscarriage, I kind of put it down to bad luck and it can happen to anybody, and I knew it had happened to Nadia before, but I knew at least that we could get pregnant. It was really the second one I found probably the most difficult for me, because although I was really happy being a stepdad, I had obviously got my expectations up around being a father of my own child and all that can mean, and just all the process of birth and baby arriving and just how chuffed my parents would be as well. And look, people have pressure from their parents all the time about this, but if you’re from the subcontinent like my parents, the pressures intensifies tenfold. So we were really excited about it and when we miscarried the second time, I remember how upset, understandably, obviously, Nadia was, and I was really, really trying to hold it together, not to show any emotion. Just again, because I thought my role was to be as strong as I possibly could be for Nadia. I remember making her a cup of tea in our kitchen and because I had my back turned towards her, I remember saying to myself, don’t let your shoulders shudder too much because I don’t want Nadia to see that I’m crying.

“I think with the second miscarriage, I started to reconcile myself to maybe thinking it’s just not my fate, my kismet, as we call it, to have children. Maybe I am never actually made to be a dad of my own child. And for me that second one was tough.

“Nobody, nobody, talks to you about this stuff. Nobody tells you about everything that miscarriage can entail, not just the physical elements, but the emotional elements, and I suppose for me part of talking about it, and it’s taken me years to get to this point, I just hope that other men don’t actually have to buckle up and keep this all to themselves.  I really regret the fact that, certainly after the first couple of miscarriages, I really didn’t share this with anyone, and while the focus is rightly on the woman who is physically going through this, men should really talk about it too.”

Yousaf says there have been times when he has blamed himself and felt that they should just stop trying for another baby, but as a couple, they decided to carry on. He says he has learnt a huge amount about himself and that they have grown as a couple through the pain.

“There’s no barriers or secrets now between Nadia and I. I mean, as I say, I literally saw the graphic detail of our miscarriage and held Nadia’s hand while she was going through it. And, going through that hardship together on an emotional level, but actually even the physical nature of it, for me, definitely brought us even closer.”

In September 2018 the couple discovered El-Nakla was pregnant for the third time. There was no real expectation this time around and when she started bleeding at six weeks, they both believed this pregnancy would end the same way as the others. However, because this was potentially their third miscarriage, the couple were seen by a consultant and put on the hormone progesterone, which stopped the bleeding and the pregnancy continued normally until Amal’s birth at 36 weeks.

El-Nakla says that she can’t help wondering whether that simple treatment could have saved any of her other pregnancies. “I remember bleeding the second time saying, please, is there just anything you can give me, anything you can try to stop the bleeding, because on the scan I could see the heartbeat and that the baby was growing. I felt like I was begging, desperate, that there must be something they could try, but they said not. I now know that’s not entirely true. I’m not meaning that the doctor or the nurse knew there was something and refused to give me it, but evidence-based research is now coming to light that shows progesterone can only have no effect or a positive effect. There is no negative effect. So, once a heartbeat is detected there’s a big case for saying that a woman should be getting progesterone if they are bleeding in pregnancy. I’d like to see that option given routinely. For me, it did feel a little bit like I hadn’t had enough miscarriages yet to make it a choice. And that’s painful.

“When I was pregnant earlier this year, we weren’t consultant led even though we were consultant led before, and we kind of felt like we were left unsure about what to do because we knew about progesterone but when we got the scan and there was a heartbeat, the midwife said it was now up to us whether to take progesterone or not, she wouldn’t advise us.

“That was really difficult because I really wanted someone to tell me what to do, take some control, because I knew whatever happened either way, I would blame myself. So we took progesterone, and we got scanned two or three times, but they kept saying ‘oh, it’s quite small’ and then one day I said to my mum that I’d normally been eating every hour and a half, but I’d not felt hungry that day at all. I knew something wasn’t right. I phoned the early pregnancy unit and I said I just feel like something’s wrong. They’re like, ‘No, you’re booked in on Wednesday so just wait’. This was the Thursday. I couldn’t wait and I went to a place that does private scans. I just went by myself with Amal in her buggy, and they were just kind of like, ‘There’s nothing there’. I started to cry, and I had Amal with me, and they were just like, ‘Sorry, that’s £45, bye’.

“On the Monday I went to the early pregnancy unit, where they confirmed there was no longer a heartbeat and they booked us in straight away to do a medically induced evacuation because I hadn’t passed anything. That was horrible. You have to look in the toilet to see what you’re passing, and we saw it this time very clearly.

“People refer to things differently, but for me, I don’t feel like I lost a child. I don’t feel like I lost a baby, I felt like I lost what could have been our baby and yeah, we saw a foetus and for a while I just didn’t want to flush it away.

“A lot of people wouldn’t be prepared for what you go through. We minimise the actual experience of miscarriage all the time. I’m very vocal and strong. I know clearly what I want when I’m talking about my health, but what happens if a woman isn’t so confident or has language barriers, they’re not aware of what’s going to happen. I’ve been through this before and it’s just a very scary, traumatic experience and then you’re supposed to just go to work the next day or just get on with it as if nothing has happened.

“Miscarriage will mean different things to different women and I don’t like this blanket approach to it. At the beginning you’re made to feel as if it’s nothing because one in three, or one in four women, whatever the statistics say, will suffer a miscarriage so it’s just ‘normal’, but then when it happens, you are having to tick a box and be asked whether you want a cremation, a memorial service, a prayer said, and you’re talking about it in the same respect as death, so the treatment, the language, the surroundings, the emotions, they don’t all match up.

“It seems to be assumed that as a woman, this is what happens and your body will deal with it in the way that your body deems fit, but that’s not correct, because there’s a medical aspect to it as well as an emotional. Each women’s health is different.

“So, for me, I was anaemic, which made me really really ill to lose so much blood. My sister had to have a blood transfusion because she lost so much blood during a miscarriage. Humza’s sister, during her first pregnancy, and at this point, his parents didn’t have any grandchildren, and we were both pregnant at the same time, we both miscarried that same weekend and I remember thinking, you know, this isn’t just a loss for us, it was a loss for the wider family because the parents were so desperate for grandchildren. But yeah, you know, his sister suffered, my sister suffered. There’s a medical aspect to it and sending women home to deal with it at home is not always the best way, they may need an operation or medicine or support that only a hospital can offer, and it is really important that women understand that that option is there. And they should know, it’s painful. It’s really painful, even if you’re five weeks, it’s painful. Women need to know that.

“Emotionally too, you are hurting. Your dream of your baby is gone. And every time you go to the toilet and you are still bleeding, there’s a stark physical reminder of what could have been. And with all of this going on, you are meant to act as if nothing has happened.

“I would phone in sick to work. I would tell people I was off sick rather than I had miscarried. And then I would tell, like, my boss and my friends, and then maybe later I would tell other people, but you can tell it makes people uncomfortable.

“Even yesterday, we were at dinner and I said we were doing this interview and that we’d had five losses and there was some compassion there, but it was a little bit like the conversation didn’t go further.

 “I think we live in a world where you’re always supposed to be happy and that’s maybe what makes people feel so uncomfortable, the fact that I say I’m just feeling so sad about it.

“I don’t need for people to tell me I’m lucky to have kids or say anything about why it didn’t work when they don’t know either. But I do just need to have a space to process my sadness, my grief, and our loss.”