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Miscarriage – What Is A Miscarriage And Why Do They Occur?
The loss of a baby has a profound affect on the parents. The impact is not necessarily lessened when the baby is tiny and technically called a miscarriage. The journey through grief is still needed.
Miscarriage is a widely used term for early pregnancy loss, which can also be experienced through an ectopic pregnancy or a termination or pregnancy. Miscarriage is common; it is estimated that 20-25% of all pregnancies end with the loss of the baby, mostly through miscarriage (some miscarriages can occur very early, even before we find out we were pregnant).
The information below is written from the collective experiences of many women and their families who have experienced miscarriage. Those who have experienced a miscarriage often feel that the subject is taboo, and that there are very few people to whom they can talk comfortably about their loss.
While you may have had the best medical care possible, you may not realise that when you go home you could grieve the death of your baby for weeks or months or even longer. You will probably wonder why this had to happen to you, worry about future pregnancies, and wonder if your fears are unfounded.
For some, the information contained below may be upsetting. However, for others who are looking for answers to their questions, the facts may be of great comfort. Many find knowledge, however unpleasant, is easier to cope with than not knowing.
As parents who have recently experienced a miscarriage, or fear that your pregnancy may be about to end, you may be quite overwhelmed by the feelings you are experiencing. To miscarry early in pregnancy means not only the loss of that potential child, but also dreams of parenting and hopes for the future. You may be feeling quite alone, and that no one else understands what you are going through.
Every miscarriage is a private loss, and everyone is different. Reactions may range from an experience of little significance to a devastating life event. It is important to realise that there is no right or wrong way of ‘coping’ after a miscarriage, but we hope the following information will enable you to better understand the emotions you may experience.
Often, parents describe an expectation, bonding or attachment to their baby very early in pregnancy, or even prior to conception. When their baby dies, many parents feel the loss of the hopes, plans and dreams they had for their future.
To feel sad, empty and bewildered at this time is normal and understandable. You may feel that others do not acknowledge your loss and that you are alone in your grief. Our society still does not encourage women to grieve the death of their baby in early pregnancy, and often does not recognise that a miscarriage means the loss of dreams and hopes for that child. Because of this, many women feel that they must hide their grief, or that their feeling are abnormal.
What Is Miscarriage?
For the purposes of this article, we have chosen to use the word miscarriage, which is also known in medical terms as spontaneous abortion. A miscarriage occurs when the uterus expels the ‘products of conception’ before the twentieth week of pregnancy. In simple terms, this means that a miscarriage is the unplanned end of a pregnancy before the baby can live on its own. In Australia, this is regarded as before 20 weeks gestation. Figures quoted in the Australian And New Zealand Journal of Obstetrics And Gynaecology 1986 give the incidence of miscarriage as one in every seven pregnancies, but this figure is probably much higher because many miscarriages go unrecognised or unreported. Some references estimate that one in every four women who become pregnant will have one or more miscarriages. About 75% of miscarriages happen within the first 12 weeks.
An induced abortion, is a planned a voluntary termination of a pregnancy. Sometimes an induced abortion is necessary due to medical conditions of the mother or the baby.
A missed miscarriage is the medical term used when the foetus dies and is retained in the uterus.
An incomplete miscarriage is when some tissue remains in the uterus.
Stillbirth is defined as the loss of a fetus who shows no signs of life at birth and is at least 20 weeks in gestation or 400 grams in birthweight if gestation unknown.
Neonatal death is the death of a child that has lived from birth to 28 days after birth.
A threatened miscarriage is where vaginal bleeding occurs over several days or weeks. The amount of blood loss can vary greatly. If any bleeding occurs it is important to consult a doctor or clinic. As the pregnancy progresses the mother’s body produces an increased blood supply to nourish the baby. The sudden loss of quantities of this blood and the onset of sometimes severe pain can be very distressing and frightening to women and their partners. A threatened miscarriage may result in a miscarriage, although if the symptoms cease the pregnancy may continue.
If a miscarriage occurs before the seventh week of pregnancy, a curette may not be needed. On the other hand, if a woman has a missed abortion or an incomplete miscarriage, a curette is performed to remove any tissue that remains in the uterus.
Dilation and Curettage (D&C) After Miscarriage
A dilation and curettage, or D&C, as it is commonly known, is an operation performed under general anaesthetic to remove tissue from the uterus vaginally.
While you are in hospital, you may have worries and questions about what has happened to you. Ask the staff who are caring for you to answer any questions that you may have. It is better for you to know as much as possible about your miscarriage, rather than to go home with unanswered concerns.
When A Miscarriage Occurs
When a pregnancy threatens to miscarry there is often very little the mother, father or health professionals can do to alter the outcome. This can be a time of considerable uncertainty and anxiety for many women and their partners as they wait, hoping the symptoms will go away and that their baby is still alive and growing. Feelings such as fear, guilt and sadness may be intense as parents search for explanations for the onset of symptoms.
Sometimes, abdominal or vaginal ultrasound examinations are carried out to determine whether the cervix has opened or remained closed and if the baby’s heartbeat is present. If the examination shows there is no heartbeat and the cervix is open, then a miscarriage is inevitable or has already occurred.
Waiting for a miscarriage that is inevitable can be lonely and confusing. It can be difficult knowing that you are carrying your baby who has died while trying to anticipate and prepare yourself for the completion of your miscarriage.
A miscarriage may follow a threatened miscarriage, or there may be no warning. When a miscarriage occurs it may be either complete, incomplete, missed or unnoticed.
Why Does A Miscarriage Happen?
There are many suggested causes for miscarriage such as infection, hormone imbalance, problems with implantation or the placenta. Most often, something went wrong at or soon after conception, and the foetus did not develop properly. It is very rare for miscarriage to occur because of something you have, or have not done.
For the majority of women the cause of the miscarriage will never be known, even after extensive testing. Many parents have expressed feelings of frustration and helplessness when a cause for their miscarriage cannot be found.
Some of the known causes of miscarriage are listed below. Further information may be obtained from health professionals or your local library.
While uncommon prior to twenty weeks gestation, abdominal surgery may increase uterine irritability.
Anembryonic pregnancy (previously known as blighted ovum)
Sometimes an egg is fertilised but does not continue to divide. A pregnancy test will be positive and a sac is formed, although there is no baby. Miscarriage usually occurs between seven and twelve weeks.
Any Severe Or Poorly Controlled Illness
Illnesses such as hypothyroidism and diabetes, if not well controlled, may cause miscarriage, although only rarely.
Cervical incompetence is where the cervix is unable to hold the contents of the uterus in place and painlessly dilates too early, usually after the fourteenth week of pregnancy.
Chromosomal Defect Or Abnormality
The majority of chromosomal defects or abnormalities happen by chance, and in most cases, will remain unknown.
An extremely severe, direct blow to the lower abdomen may damage the uterus and placenta.
Hydatidiform Mole Or Molar Pregnancy
In rare instances, the placenta develops abnormally into a mass of fluid-filled sacs. The symptoms of pregnancy exist although there is no baby. In very rare cases, a form of cancer can develop after such a pregnancy.
Sometimes the mother’s immune system does not produce the antibodies necessary to prevent rejection of the baby.
Examples of indirect trauma are cardiac arrest, severe blood loss and shock.
Infection Or Virus
Infections or viruses such as listeria, toxoplasmosis and others may lead to miscarriage.
Uterine Abnormalities And Miscarriage
Some women are born with an unusually shaped uterus, which can increase the chance of miscarriage.
An ectopic pregnancy develops outside the uterus, usually in the fallopian tube and occasionally at other pelvic sites. This often causes bleeding, severe abdominal pain and discomfort to the mother. Some women will not be aware they are pregnant until the ectopic pregnancy is diagnosed. Symptoms are usually present by about the eighth week of pregnancy. Should symptoms be present seek medical advice, as untreated ectopic pregnancies can be life threatening.
An operation is necessary to remove the pregnancy and often the fallopian tube, as the tube may burst and cause internal bleeding. Discuss with your doctor the time needed to physically recover following this operation.
Many women wonder whether they will be able to become pregnant again if their fallopian tube has been removed or damaged. Usually, as every woman has two tubes, it is possible to become pregnant again if there are no other complications. However, discuss with you doctor the results of your ectopic pregnancy and any related concerns you may have.
See also BellyBelly’s article on Ectopic Pregnancy.
Most doctors tend not to investigate to find reasons after the first miscarriage, but after two miscarriages, chromosomal tests are usually performed on the miscarried baby. If you have three or more miscarriages in a row, medical staff will sometimes refer to them as recurrent or habitual miscarriages. After three miscarriages the chance of again miscarrying rises significantly. The cause of recurrent miscarriages often cannot be identified, however, it may be beneficial to consult with a geneticist for discussion about previous miscarriages and future fertility.
Treatment for some problems may be available. This includes surgery to correct uterine abnormalities, hormone supplements, a cervical stitch for cervical incompetence and immunological treatment (which is still in the research stage). In most cases, no cause is found, and no treatment is available.
For women who have had repeated miscarriages, each successive pregnancy will mean cautious hope, accompanied by the fear of yet another loss. Often the fear will not pass until the pregnancy progresses past the stage of the previous miscarriage, and even then, it may be difficult to relax and be confident about the successful completion of the pregnancy.
After A Miscarriage
There a number of procedures and choices that may follow either an early or late miscarriage.
Dilation and Curettage (D&C) After Miscarriage
Following an early or late miscarriage it may be necessary to have D&C or suction curettage. This is because there is a risk of infection developing from tissue remaining in the uterus.
These short operations are usually conducted under general anaesthetic but can be performed under a local anaesthetic. During a D&C the cervix is dilated and the lining of the uterus is gently scraped. A suction curettage is where the contents of the uterus are removed by suction.
Any tissue passed vaginally or recovered through a D & C, is usually sent for pathological examination to try to determine the cause of the miscarriage.
Seeing The Collected Tissue
Following a miscarriage some parents wish to see the remains of their baby. Discuss this with the medical staff before any operation occurs if you think this may be an option for you.
Size And Appearance Of The Baby
The baby’s size will depend on the length of time the baby continued to grow and any medical condition of the baby. The appearance of the baby may depend on any time lapse between death and when the baby miscarried, a particular medical condition and/or the manner of delivery. However, a fully developed, normal baby that miscarries at twelve weeks is approximately 7-9 cms in length while at sixteen weeks would be approximately 16-18 cm long (or about the size of an adult’s hand). Talk with medical staff about what to expect if you are choosing to see your baby.
A late miscarriage occurs between the twelfth and twentieth week of pregnancy. As with early miscarriage, a D & C or suction curettage will be required from an incomplete or missed miscarriage.
Where the gestational age of the baby is more than fifteen weeks and miscarriage is inevitable, medical staff may recommend that labour be induced. An intravenous infusion or vaginal pessaries are usually used to stimulate uterine contractions. Consideration will need to be given to such issues as pain relief and your choice of support persons.
Sometimes the placenta is retained in the uterus following the miscarriage. If this occurs, your doctor may recommend a D & C. Before and during labour, medical staff can provide support and information. They can describe how your baby will look and the expected size of the baby. Most miscarried babies will die before, or during birth.
What Will Happen To The Baby After Miscarriage?
Unless the parents request otherwise, babies routinely go to pathology/histology for tests to try to discover the cause of the miscarriage. Individual hospitals have their own policy which covers the cremation or burial or babies born before 20 weeks gestation. Be reassured that the staff will deal humanely with your baby.
In some hospitals, the babies are cremated. Some parents may choose to cremate or bury their baby. This can be arranged through a funeral director.
It is possible to have a memorial service for your baby, and this can be discussed with the hospital chaplain or your own minister. It may help to discuss your options with the hospital social worker.
You may find that you need to make your decision and arrangements but in the meantime it is important to tell the hospital before the baby goes to pathology, that you are considering a burial or cremation.
Spending Time With Your Baby After Miscarriage
Seeing and spending time with your baby can be a positive way to express your feelings for this baby and can help you to understand the reality of the miscarriage. However, this may only be possible if you experience a late miscarriage.
Depending on the gestational age and the condition of the baby at birth, some parents are able to hold and bathe their baby. They may be able to take photographs and have ink prints made of the baby’s hands and feet. Some parents may choose to bless or baptise their baby at this time. With the support of caring staff to assist them, many families find that this opportunity helps them create lasting memories of their baby.
Choosing to see a baby after miscarriage is a very personal, individual decision that has to take many factors into account. Whatever your choice, it is important only to do what is right for you in your particular circumstances.
Will I be in a ward where there will be babies?
Many women find it distressing after miscarriage to be close to newborn babies. Most country hospitals and small private hospitals usually have a combined maternity/gynaecology section and this may make it difficult to be separated from newborns. If you find this closeness too distressing, discuss your feelings with the staff caring for you, as this will help them to understand how you are feeling, and enable them to provide you with the best possible care.
Lactation After Miscarriage
Following late miscarriage your breasts may produce milk. Breast milk will usually not be produced if your pregnancy was less than fourteen weeks duration.
Women cannot control the hormones that stimulate the breasts to fill with milk. Full breasts may leak following an embrace, hearing the cry of a baby or even after thinking of the miscarried baby. The breasts can be very sensitive to touch and may be painful and uncomfortable. Production of milk is distressing for some mothers and comforting for others. Some women feel that their milk is the last link they have to their baby.
Breast milk can be suppressed by avoiding stimulation of the breasts and wearing a firm bra both day and night. Painful breasts are often relieved by taking warm showers, the application of chilled cabbage leaves and cold compresses and using pillows for support. Small expressions of milk may be necessary to relieve discomfort and can gradually be reduced over time.
Breast milk can also be suppressed through the use of prescription drugs. Your doctor can explain the use of these medications. Tender lumps or red areas on your breasts may indicate a blocked duct; if this occurs seek medical advice through your doctor or clinic.
Have a look at BellyBelly’s article on lactation after loss for more information.
Women’s Health After Miscarriage
Medical follow-up is important to ensure that your general state of health is good and your uterus has returned to normal. This follow-up should be carried out within six weeks of the miscarriage by your doctor, early discharge nurse or community nurse.
Anaemia or Infections After Miscarriage
Some women who experience great blood loss during miscarriage become anaemic and may require medications or dietary supplements. Antibiotics may also be prescribed following miscarriage to treat or prevent infection.
Bleeding After Miscarriage
Vaginal bleeding usually continues for seven to twenty-one days, gradually becoming lighter. It is advisable to use sanitary napkins (pads) at this time rather than tampons. If heavy bleeding occurs or if you experience strong pain, medical advice should be sought.
Sex After Miscarriage
Your doctor or medical staff may suggest the period of time before you body will be physically ready to resume sexual intercourse. However, when you will be emotionally ready is an individual experience. Discuss your feelings with your partner so that the timing is appropriate for both of you. Concern and love for each other may be expressed in other ways until you feel you are ready for sexual intercourse.
Miscarriage And Future Pregnancies
For most women, a miscarriage is a chance occurrence. The next pregnancy is very likely to proceed to the full term. Within a month or two of a miscarriage occurring, your reproductive system will have returned to normal, and unless there has been some pelvic infection, your fertility will be unaltered.
However, you may need time to get over your grief for the pregnancy that you have lost before you feel emotionally equipped to handle another pregnancy. It is normal to feel anxious about any subsequent pregnancy, especially up to the time of your earlier miscarriage. Expressing these feelings and fears to others may help.
This article was reprinted from the SIDS Foundation of Western Austraila
Below are some links to member miscarriage stories:
Take a look at the BellyBelly forum for miscarriage and loss if you would like to chat with others who have experienced miscarriage, or to read their stories.
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