Miscarriage

Miscarriage can be a painful, even traumatic experience and it is very sad. Unfortunately miscarriage is a fairly common pregnancy outcome, 20% of all pregnancies are said to result in miscarriage, with 80% occurring in the first trimester. Over half of all spontaneously miscarried babies are chromosomally abnormal.

It is not possible for someone else to understand the significance of a pregnancy to another person, because making a baby carries with it a huge range of immensely deep feelings, which include unspoken hopes and expectations about the meaning of the pregnancy and of the baby’s potential.

Miscarriage has been found to be significantly connected to stressful life events, though we do not know whether stressful events are actually the cause of the miscarriage. It may be the stressful event in combination with some other factor which is the trigger. 

What are the signs of miscarriage?

The most common sign of a miscarriage is heavy, bright red bleeding which may or may not include blood clots. You might also experience cramping or strong period type pains. 

Some blood spotting can be normal during early pregnancy particularly around the time you would have had your period. Sometimes even heavy bleeding can settle down and the pregnancy will continue, this is a threatened miscarriage. 

You will not stop a miscarriage by going to bed (Aleman 2010), though it might make you feel better. Unfortunately, if your pregnancy is miscarrying it will take its course and it is up to you to decide how you wish to handle it. 

Your options if you are having a miscarriage

The physical experience of a miscarriage can be frightening and painful. Our first instinct tends to be to call a known caregiver for help e.g. our midwife, GP or obstetrician. Your local hospital will have an Early Pregnancy Assessment Service (EPAS) and they may be able to offer you an appointment to assess what is going on, or they may suggest that you stay at home and see what happens.

You will need maternity-type sanitary towels to absorb the bleeding. Using tampons could increase the risk of infection. 

If you choose to attend the EPAS, the staff will talk with you about your pregnancy to date and your current symptoms. You may also be offered a transvaginal ultrasound to detect whether or not the baby has died, how far the miscarriage has progressed and also rule out the possibility of an ectopic pregnancy. The staff will be able to explain what is going on with your body and what to expect. They will also be able to give you some options for what to do next.  

Once the miscarriage has been confirmed you may be encouraged to go home and wait and see what happens for 7 – 14 days (NICE 2012), You will be offered an appointment for a check-up later on or given a number to call if you need further advice. 

Loving support and care is the most powerful help at this time, make sure that there is someone who can be with you. You may need painkillers and a heat pack/hot water bottle for the cramp pains.

If you are at increased risk of significant bleeding (in your late first trimester) or the effects of significant bleeding (have blood clotting issues or you are unable to have a blood transfusion), you may be offered options for surgical management of the miscarriage. This may also be an option for you if you have had previous difficult experiences associated with pregnancy like a stillbirth, previous miscarriage or serious bleeding. 

Options for surgical management of a miscarriage include:

• manual vacuum removal under local anaesthetic in an outpatient or clinic setting or;
• a dialation and curettage in a hospital theatre under general anaesthetic.

What To Expect After Surgery

You may have some symptoms related to the effects of the general anaesthesia such as nausea, vomiting and a sore throat which might last for a few days. It is common to continue to experience mild cramping after the procedure, as well as spotting or slight bleeding for up to a week. These procedures can sometimes impact the timing of your next period which may be early or late. 

Make sure that someone can be with you at home for a few hours after the procedure. People respond differently to the affects of anaesthesia and recover at varying rates. You should be able to drive and return to normal activities within a few days. 

Coping with a miscarriage

When you are in the middle of a miscarriage, the physical experience is the immediate concern, however once this is over the depth of feeling tends to hit. 

We know from research that there are no significant differences in the grief response when a woman loses a baby by miscarriage or stillbirth. However the frequency with which women experience miscarriage has led our communities to believe that this is not significant experience. Women go through a grieving process which can include anger at their bodies or blame of themselves and a loss in confidence regarding their fertility. These are all normal feelings associated with the experience. Talking about your feelings can help, you may find that friends and colleagues have shared the same experience and can be a comfort to you. Time will help you to learn how to live with the loss of your baby.

Creating memories around the baby who has died can be a positive and productive way of processing feelings of grief and loss for both parents, particularly in the early stages. Seeing and touching keepsakes or momentos can provide you with a focus for your feelings and allow their expression

There are also resources in our communities which can provide you and your partner with support if you have experienced a miscarriage:

SANDS promotes awareness, parent support and understanding following miscarriage 

Helpline 1300 0 SANDS

There are many parents out there who have experienced the loss of a child, you are not alone. 

References

• National Institute of Health and Clinical Excellence (NICE) (2012). CG 154 Ectopic pregnancy and miscarriage: Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage. Dec 2012. Available online at http://publications.nice.org.uk/ectopic-pregnancy-and-miscarriage-cg154 [Accessed online on 13 March 2014]