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.
What are the signs of miscarriage?
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.
What happens if I have a miscarriage?
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)
The different types of miscarriage
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.
Coping emotionally
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.
What is the cause of 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.
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
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.
How might I feel?
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.
Coping as a couple
“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.”
What to tell your children
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.”
When can I get pregnant again?
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.
What about the father?
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.
