Miscarriage and Loss
About one in four known pregnancies in New Zealand end in miscarriage (that is, they are lost before 20 weeks gestation); and around one in every 200 babies are stillborn (lost after 20 weeks).
By far the majority of miscarriages occur in the first 12 weeks of pregnancy and the actual rate is probably much higher, with around half of all pregnancies thought to end in miscarriage, usually shortly after conception.
Between 2% and 5% of couples experience ‘recurrent pregnancy loss,’ which means they have been through three or more miscarriages consecutively.
It’s a heartbreaking statistic, made more difficult when a treatable cause can be identified in only around 30% of recurrent pregnancy losses.
How will I know if I have had a miscarriage?
The experience of miscarriage will vary for each person, but characteristically, there will be bleeding (which may be light but is often very heavy) and strong cramps.
Symptoms of early miscarriage include:
- Disappearance of typical ‘pregnancy’ signs, like swollen breasts and morning sickness
- Vaginal discharge (such as a thick blob of mucus which may be blood-streaked)
- Spotting or light bleeding
If you know or suspect you are pregnant and you are experiencing any of these symptoms, you should talk to your doctor, caregiver or hospital straight away.
What happens at the hospital?
If you suspect you may be experiencing a miscarriage, an ultrasound scan will be arranged.
In around 50% of miscarriages, the contents of the uterus are surgically removed through a short operation called a ‘dilatation and curettage’, or ‘D and C,’ usually performed under general anaesthetic.
If the foetus has died but a miscarriage has not started naturally, you have the option to return home to wait for the miscarriage to begin.
If there is no medical reason for a D&C, this may be an option you choose; make sure that you understand all of the options available to you and, provided there is no overriding medical reason, that you are able to choose what you feel is best for you.
In a more advanced pregnancy (after 13-15 weeks), a D & C is not possible and the mother may need to go through labour to deliver the baby.
Most hospitals are now very sympathetic to the trauma that couples experience at this time and will recommend appropriate pain relief options and support.
What happens during a miscarriage?
Many women report that miscarriage is made more difficult by not knowing what to expect. If you are likely to miscarry, ask for as much information as possible.
During a miscarriage, you will lose blood, clots and tissue (called ‘the products of conception’) and if the pregnancy is further advanced, you may lose a foetus – usually much smaller than a living embryo of the same age.
A miscarriage may occur over a few hours or may go on for a number of days and the bleeding may continue for several weeks.
You should avoid using tampons (you can use super/maternity sanitary pads). Your caregiver may ask you to record how much blood you have lost. If possible, try to save anything you pass in a container that you can take to the hospital.
If you’re worried about very heavy bleeding or intense pain, call an ambulance.
When the bleeding has stopped, it’s important to see your doctor to make sure that all the contents of the uterus have been expelled. Your doctor may recommend a scan to see if a ‘D and C’ needs to be done. This is particularly important if you want to try to fall pregnant again soon.
Reasons for miscarriage
Miscarriage is often due to a number of different factors.
In some cases, it is possible to run tests to identify a cause, but more often, it is not possible to find out why the miscarriage occurred.
However, we do know that there are many common reasons for miscarriage – and in most cases, these are beyond the control of the parents.
- A chromosomal abnormality in the baby (thought to cause half of all miscarriages)
- The fertilised egg not attaching properly to the wall of the uterus
- A problem with hormone levels or with the placenta
- Mother’s health – infection, high fever or underlying medical problems like diabetes or thyroid condition
- Cervical ‘incompetence’ or uterine problems
- Exposure to chemical toxins, including cigarette smoke and alcohol consumption
- Daily exposure to at least 200mg of caffeine
- Increased age of the mother
Some of the causes of miscarriage can be successfully treated, and some lifestyle changes can be made, but in the majority of cases, a cause is not known.
Trying again after miscarriage
While some couples feel they need to take time to grieve before they can even think about trying to fall pregnant again, others feel that another pregnancy will help them to deal with their loss.
Medically, a woman can start trying to fall pregnant after her first period following a miscarriage (in 4 to 6 weeks).
In most cases, a miscarriage is unlikely to happen in a future pregnancy. However, if you have experienced three miscarriages consecutively it is wise to get medical attention before falling pregnant again.
Reducing the risk of miscarriage
Some lifestyle factors are known to contribute to fertility and a healthy pregnancy; these include:
- Avoiding alcohol, caffeine and nicotine
- Exercising regularly and eating a balanced diet which includes folic acid and sufficient vitamins and minerals, ideally from natural sources
- Maintaining a healthy weight
- Reducing stress and getting enough sleep
Dealing with Grief and Loss
Researchers have shown that many couples who have had a miscarriage experience grief responses similar in duration and intensity to those parents who have lost a new baby.
It is quite normal for one or both partners to suffer “temporary depressive feelings,” like sadness and lethargy, and it is also typical for normal eating and sleeping patterns to be disrupted for a period of time.
It is very common for mothers to blame themselves and feel guilty about the loss of their baby, even though most miscarriages are not preventable. It can be very difficult for fathers to express their own grief when they are trying to comfort their partner and men often feel that they should be showing strength rather than emotion.
Often, women will take longer to recover from their grief and because this is not commonly recognised, they can sometimes feel that their partner is unsupportive if he needs to try to move forward before she is ready to do so.
Bereavement counselling can help couples to understand the very different ways in which men and women grieve and prevent some of the relationship problems which many couples experience following miscarriage.
Early pregnancy loss leaves little for the grieving parent but if a miscarriage during the second trimester, it may be possible to see and hold the baby. You may also wish to name the baby.
Some hospitals have “Memory Folders” for keepsakes like photographs and other mementos, and you may want to keep certain things like ultrasound pictures.
Formal burial is usually a legal requirement for babies born after twenty weeks gestation but is also possible to arrange a burial service prior to twenty weeks if you wish. Any decision depends very much on individual feelings and beliefs.
Dealing with the reactions of others
For most people who have experienced miscarriage, there is nothing tangible for their grief; there is usually no baby, no funeral, no photographs.
This can make mourning more complicated and, because there are no clear and prominent memories, can make it more difficult for resolution of this grief.
Those who have not experienced miscarriage themselves often do not recognise the extent of grief that a couple may experience and the length of time that it may take for them to recover.
Many people do not know what to say, and are awkward or uncomfortable. It can be hurtful when friends and family avoid the subject, become distant or awkward and indicate that they expect you to ‘get over it.’
Couples who don’t receive recognition or acknowledgement of the extent of their loss can feel they need to disregard their own feelings of loss and grief, but this can make it more difficult for their emotional recovery long-term.
If the reactions of others are not supportive, it can be very helpful to see a counsellor, who can also help you come to terms with your loss and to help you acknowledge and experience the many emotions that you are likely to go through at this time.