Miscarriage
Some experts estimate that as many as one in four pregnancies ends in
miscarriage. In legal terms in the UK, a miscarriage is defined as a pregnancy
which ends in the loss of a baby before 24 weeks. After 24 weeks, if the
baby is born and doesn't survive, it's known as a stillbirth
and not a miscarriage. The great majority of miscarriages happen in
the first three months.
The main sign of miscarriage is vaginal bleeding, so if at any time you
notice any bleeding, contact your doctor. If the bleeding is slight, and
there's no, or little, pain, the baby is very likely to be fine and the
pregnancy will continue normally. This is known as a threatened miscarriage.
The bleeding will stop in due course, although it can take days, or even
weeks, for it to do so.
A stronger sign of miscarriage is if you have bleeding accompanied by
cramp-like pains, it's less likely that the pregnancy will continue because
the pains are a sign that your womb is contracting. If this happens, your
doctor will probably examine you internally to see whether your cervix
is beginning to open up. If it is, there isn't anything that can be done
to stop the baby being born. This is known as an inevitable miscarriage.
For some women, the first sign of miscarriage isn't bleeding, but a
sense that something is wrong, or that they do not feel pregnant any more.
.
If you have slight bleeding without any, or with minimal pain, see your doctor. If he
or she suspects a threatened miscarriage, you'll probably be told to rest, possibly in bed
(although there's no proof that bedrest helps prevent a miscarriage), and to avoid any
exercise (including housework). Your doctor will probably tell you not to have sex for a
while too. You might be offered an ultrasound
scan to check that all's well with the baby.
If you have heavy bleeding with pain, call your doctor immediately. If you pass any
clots or mucus before the doctor arrives, keep them if you can, so that the doctor can
examine them. Your doctor may be able to tell whether a miscarriage is inevitable by
examining you internally to see whether your cervix is still closed. If it isn't, a
miscarriage is unavoidable. You may choose to wait at home for it to happen, or you may
prefer to go to hospital.
If you go to hospital, it's likely that you'll be recommended to have a minor operation
(a D & C - dilation and curettage) after the miscarriage to ensure that your womb has
been completely emptied. It's possible that some parts of the foetus or the placenta will
be left behind and this can cause further bleeding or infection. If you miscarry at home,
your doctor may recommend that you go into hospital to have this operation. It isn't
always necessary, though, so if you feel that you'd rather not have it, discuss with your
doctor whether it's really essential in your case.
Sometimes it can happen that the baby dies early on in the pregnancy, but remains in
the womb. There are no outward signs of anything being wrong and no bleeding, although
some of the physical feelings of early pregnancy, such as feeling sick and having tender
breasts, may go away. If this happens, the woman will eventually miscarry, although
possibly not for several weeks. Sometimes a routine check such as a scan will pick up that
the baby is not alive. When this happens, a D & C may be suggested as an alternative
to waiting for the miscarriage.
If you have a miscarriage after the first three or four months, the process is more
like giving birth, and you're likely to feel as if you've been through labour. If you go
into hospital, you may be offered pain-killing drugs to help with the delivery.
If your blood is Rhesus negative, you'll be given an injection of Anti-D after the
miscarriage (see Rhesus factor problems).
An inevitable miscarriage occurs when the cervix opens. Impending symptoms
are heavy bleeding, often with clots, and cramping pain.
Sometimes the baby dies in early pregnancy and the only signs are a sudden
cessation of pregnancy symptoms, or just an uneasy feeling. If an ultrasound
shows the baby has died you can either wait for miscarriage to occur or
have a D&C.
An incomplete miscarriage is where clots or 'products of conception' are left behind in the womb.
After a miscarriage, you may go through the classic stages of bereavement:
shock and emptiness, anger, sadness, depression and finally acceptance.
Sadly, it can sometimes suit family or friends more if you pretend everything's
ok, but that won't help you recover emotionally. What does help is for
you to feel that your loss is acknowledged and to be able to talk about
it for as long as it takes. But. recovery can be a slow process - you
might feel that you're taking two steps forward and three steps back until
you come to terms with your miscarriage.
Genetic abnormality
Around half of early miscarriages (before 13 weeks) are caused by a chromosomal
abnormality in the baby. Chromosomes carry the genetic information donated
by both parents and sometimes information just gets lost, meaning the
baby can't develop.
For the majority of women a chromosomal abnormality is normally responsible
for a one off miscarriage, so your next pregnancy is likely to be fine.
What can be done?
Tommy's have funded a study into genetic causes of miscarriage. The project
aims to detect which embryos have difficulty with chromosomal division.
Hormonal imbalance
Some miscarriages are related to an imbalance of pregnancy hormones such
as too high levels of lutenizing hormone, or low levels of follicle stimulating
hormone (FSH).
What can be done?
Injections of the pregnancy hormones progesterone and/or hcG can help in
some cases.
Blood clotting
Rare disorders such as Lupus or Antiphospholipid Syndrome (APS) can cause blood clots interfering with normal blood flow to the placenta, one possible cause of recurrent miscarriage.
What can be done?
Blood clotting disorders are treated with baby aspirin or heparin therapy (anti-coagulants which help to thin the blood). Tommy's have found evidence that placental failure may be linked to abnormal blood vessels in the womb.M
Structural problems
A weak cervix which dilates too soon (incompetent cervix).
What can be done?
A cervical stitch can prevent early dilation.
Infection
A recent UK study found vaginal infection to be associated with increased risk of later miscarriage. These include bacterial vaginoisis or BV which is twice as common in smokers, and chlamydia.
What can be done?
Both BV and chlamydia can be treated with antibiotics.
Lifestyle Causes
The Miscarriage Association has commissioned a major research project
on behavioural and lifestyle factors in miscarriage. The results will
be available till autumn 2003 and Ruth Bender Atik is confident the findings
will make a real difference. 'Women will know that behaviour x is linked
to miscarriage and is to be avoided (not that they will know for sure
if it's caused the miscarriage they had) OR they'll know that there's
no link so there's no need to feel guilty or anxious about it'.
Charlotte Davies, Information Manager of Tommy's adds that 'Tommy's prefer
to provide evidence-based information rather than generate unnecessary
hysteria & confusion'. The known lifestyle links so far are:
Smoking
Smokers have more complications in pregnancy including greater risk of
placental detachment and low birth weight babies.
Alcohol
The current DOH guidelines are to limit alcohol to one or two units per
week.
Caffeine
Caffeine intake above 300mg per day is linked to low birthweight and in
some cases, miscarriage. 300mg is roughly equivalent to 4 average cups
of coffee, 6 cups of tea, 8 cans of cola, 4 cans of 'energy' drinks, 8
bars of chocolate.
Having a miscarriage comes as a tremendous shock. Although it isn't always recognised
as such, miscarriage is a bereavement and produces the same sort of feelings as other
kinds of bereavement. These include initial shock, numbness and disbelief, anger, sadness
and grief, depression and, finally, coming to terms with what's happened. These are all
normal reactions, and anyone who's suffered a miscarriage needs to be able to work through
them in their own time. Sadly, the effect of the loss can often be underestimated by other
people, including medical professionals.
The process of grieving for a miscarried baby can be helped by seeing the foetus or, if
it's a late miscarriage, by holding the baby. This can be very hard to do at the time, but
it does help in the longer term, even when the miscarriage happens very early and there
may not be much to see.
You will also find that it helps to talk about what's happened, and to have the loss
acknowledged. In addition to talking to family and friends, or medical or religious
advisers, you may find it helpful to contact a miscarriage support group. These are run by
people who've had miscarriages themselves and can offer a sympathetic ear to others who
are going through the experience. If you'd like to be put in touch with a group, your GP
or hospital should be able to give you a local contact number.
The Miscarriage
Association also offers support and information: visit their website,
or try their telephone helpline on 01924 200799.
"This may be the first tragedy you go through as a couple, so you may
see a side to your partner that you've never seen before," says Sarah
Ewing, author of Losing a Baby (Sheldon, £7.99). "Just
because your partner might not be showing the same symptoms of grief as
you doesn't mean he's not hurting. Men and women cope with grief differently
- men often retreat and become withdrawn, whereas women want to talk about
what they're feeling. But don't stop talking to each other - only you
and your partner know what you're going through, so it can deepen your
bond, albeit over a tragedy. It's a myth that the majority of marriages
break up after the loss of a baby. As long as you keep talking, but also
allow each other to grieve in your own way, you can pull through this
together."
Sarah Ewing advises "If you have other children, recognise that they
will be sad too. Depending on their age, they will be feeling hurt and
confused and might not understand why mummy didn't bring a baby home from
the hospital. Explain things to them as simply and clearly as possible
- avoid ambiguity. Don't say "Mummy lost her baby" because your child
might wonder why you're not trying to find it. Tell them that it's OK
to be sad and give them a cuddle. You might find that they draw pictures
that are gloomy and dark and might act up in the days and weeks following
your loss. Try not to get too angry at them if they misbehave - small
children often don't have the maturity to deal with their feelings other
than in a destructive way, but it will pass."
As soon as you feel emotionally and physically ready, as long as you're
no longer bleeding. Some doctors recommend waiting until you have had
two or three periods, to ensure that everything is back to normal. If
your miscarriage was due to an obvious cause, which could recur, or you've
had more than one, talk to your doctor first.
Getting passed the point of your last pregnancy can be very stressful
and worrying, but try to focus on the positive aspect of your current
pregnancy, as the health and wellbeing can be affected by the levels of
stress hormones in your system. Try to take it easy and get as much help
as possible. Let your partner do more around the house and take up gentle
exercise like walking and yoga.Take care of yourself and make sure you're
in the best possible mental and physical condition during your pregnancy
- and try and enjoy it!
Having one miscarriage doesn't make it any more likely that you'll have another. If
you've had two, then the possibility of having another is slightly increased.
Sadly, sometimes the father's feelings are ignored. Your grieving partner might bury himself in work, or in trying to be strong for you, which you might interpret as not caring. You should be honest with one another and share your feelings, so that you can each reach a greater understanding of what the other is going through.
Read one dad's experience of coping with miscarriage.
Where to next?
Return to pregnancy
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