The loss of a baby at any stage during pregnancy can be an extremely difficult and emotional time for parents.
When miscarriage happens early in pregnancy, the experience can be traumatic, and you may feel a huge sense of loss and grief.
So, what is an early miscarriage, exactly?
Firstly, a miscarriage is classed as the spontaneous loss of a pregnancy before 20 weeks gestation.
The embryo (baby) would not be able to survive outside the uterus.
The medical term for miscarriage is ‘spontaneous abortion’ and the baby may be referred to as ‘the products of conception’ – medical terms that can be difficult to hear for grieving parents.
If a miscarriage occurs in the first 12-14 weeks of pregnancy, it's referred to as an early miscarriage.
If pregnancy loss occurs after this time, up to 20 weeks of pregnancy, it's referred to as a late miscarriage.
How Common Is Miscarriage?
It's estimated that 10-25% of all pregnancies end in miscarriage. Of those, around 80% occur in the first trimester, however, often the miscarriages are so early, the woman doesn't realise she's pregnant. While it isn’t any consolation, if you are experiencing pregnancy loss, you're not alone.
A healthy woman who miscarries once is unlikely to miscarry the next time she becomes pregnant. It's uncommon to miscarry three times consecutively, and if it does occur, your care provider can refer you for tests to check if there is a cause.
Early Miscarriage Causes
If you've experienced an early miscarriage, you probably want to know why it happened. For most women, the cause of their miscarriage will never be known and this can cause a sense of helplessness and frustration.
For a pregnancy to continue, your body must provide the right nutrients and hormones to the baby and the baby must develop correctly. If these conditions aren’t met, the pregnancy may be lost.
It can be difficult to discover the cause of miscarriage, however some of the more common reasons pregnancies end are listed below:
- Chromosomal problems: The baby would not develop normally or would not be able to survive life outside the uterus. This is can happen by chance, and isn’t necessarily a sign of a condition that will reoccur. Chromosomal problems cause at least half of all miscarriages.
- Maternal age: As a woman ages, there is an increase of eggs with chromosomal abnormalities being released.
- Maternal health: Miscarriages can be caused by conditions such as uncontrolled diabetes, infections, hormone issues, endometriosis, thyroid disease, severe trauma, and abnormalities in the uterus (fibroids or scar tissue).
- Smoking, drugs and moderate to high use of alcohol: Use of these substances have been linked to increased risk of miscarriage.
- Caffeine: High daily doses of caffeine (more than 200mg) have an increased risk of miscarriage.
- Maternal weight extremes: Underweight or overweight women have a greater risk of miscarriage.
- Consecutive miscarriages: Women who have had 2 or more miscarriages in a row are at a greater risk of having miscarriages in the future.
- Factor V Leiden: This blood clotting genetic mutation has been found in studies to result in a lower live birth rate.
An important test for women to ask their doctors for (ideally before pregnancy, but any time is helpful) is a test for the MTHFR gene mutation. The MTHFR gene mutation is a common genetic mutation, which affects one in four people seriously and one in two mildly. If you have this mutation, you should stop taking folic acid and take folinic acid and methylfolate instead.
Diagnosis Of A Miscarriage
You may find out your pregnancy has ended if you experience any of the signs of miscarriage and see your doctor. Other women discover they have miscarried before they realise they were pregnant. You may find out that your pregnancy has ended at an early ultrasound.
To confirm if a miscarriage has happened, your care provider can do the following:
- Blood tests to check pregnancy hormone levels
- Symptoms (bleeding, pregnancy signs disappearing)
- Ultrasound (depending on gestation)
Your care provider will be able to tell you if your miscarriage is complete, incomplete or missed:
- A complete miscarriage occurs when the pregnancy tissue has been passed
- An incomplete miscarriage occurs when not all the pregnancy tissue has been passed, some has been retained in the uterus
- A missed miscarriage has occurred when the embryo has died and has not been passed.
Early Miscarriage Symptoms
The signs of a miscarriage will depend on the gestation of your pregnancy. Most women will experience miscarriage similar to a heavy period, with slightly more cramping and bleeding than usual. Others can experience labour-like cramping.
The following symptoms may be related to other conditions less serious than miscarriage. It is best to see your care provider if any of these occur:
It is important remember to use sanitary pads not tampons during a miscarriage, as these can lead to infection.
The duration of bleeding can depend on how quickly the pregnancy tissue is expelled but the usual amount of time is 1-3 weeks. If the bleeding is severe or prolonged it can mean medical intervention is needed.
Early Miscarriage Treatment
Unfortunately once a pregnancy has ended there is nothing that be done to prevent miscarriage occurring. It is best to talk to your care provider about the best way to proceed for your situation.
Natural: Many women prefer to wait for a miscarriage to occur naturally. This may help with your grieving process and may give you more of a sense of control. An incomplete miscarriage should happen within a week. A missed miscarriage can take longer to begin naturally (3-4 weeks) and you may need to discuss further treatment options with your care provider if the pregnancy tissue doesn’t pass after this time.
Medication: Some women prefer to take medication to ensure the miscarriage happens sooner rather than later. An incomplete miscarriage will usually be passed within 6-8 hours of the medication and a missed miscarriage can happen quickly or may not happen for a few weeks. There are side effects that can occur with the medication, such as nausea and vomiting, chills, fever and diarrhea. These effects usually only last for a few hours but can be distressing.
Surgery: In some cases women need surgery to remove the pregnancy tissue (called a dilatation and curette or D&C). This may happen in the case of a missed miscarriage, if there is severe bleeding and pain, or if your preference is to avoid medication and you don’t wish to wait for a miscarriage to begin naturally. A D&C happens under general anaesthesia and the surgery happens through the vagina, so there is no incision. Like all surgical procedures there are some risks involved, such as infection, heavy bleeding (retained pregnancy tissue), damage to the cervix and risks associate with the anaesthetic.
What To Expect During A Miscarriage
Experiencing a miscarriage is both a physical and emotional experience. It can be difficult to know how you will feel and what you will feel like doing during this time.
You may notice that you are passing clots, tissue or a recognisable embryo. This can be shocking and upsetting. If you are experiencing discomfort or mild pain, you can take paracetamol. If you prefer not to take pain medication you can use heat packs to relieve cramping.
If you experience any of the following you should go to the nearest hospital emergency department as soon as possible:
- Heavy bleeding (soaking two pads every hour and/or passing golf ball sized clots)
- Severe abdominal pain or shoulder pain
- Fever or chills
- Dizziness or fainting
- Vaginal discharge that smells unpleasant
- Diarrhoea or pain when you open your bowels.
Resting during this time can provide you with an opportunity to grieve your pregnancy loss. You may prefer distraction and want to go to work or do your usual activities. Make sure you are not doing anything too strenuous physically that may cause you harm or increase bleeding.
The Emotional Impact Of Miscarriage
People respond very differently to pregnancy loss. Reactions may range from an experience of little significance to a devastating life event.
It's important to know that there is no right or wrong way of ‘coping’ after a miscarriage.
You may not have told anyone about your experience and feel alone and isolated. Many women have experienced pregnancy loss, so talking about it with others who've been in the same situation can help you to cope with your loss and grief. Your partner may also be feeling his own sense of loss, while trying to hold it together to support you. Taking notice of each other’s needs to grieve can help you feel supported.
You may find those around you (including your partner) may expect you to ‘move on’ before you are ready to. There is no right way or length of time to grieve the loss of a pregnancy. You may find over time that you feel less sad, but anniversary days such as the possible due date of your baby can be difficult. Grief does not happen in a set way. Take the time you need to move forward.
Some women want to fall pregnant again as soon as possible after miscarriage, and others are afraid to. If you are particularly worried about coping with another possible miscarriage it can be helpful to discuss this. You might feel more comfortable talking to your care provider or a support group about your feelings.
Recommended Resources For Miscarriage
- Miscarriage Support New Zealand
- The Miscarriage Association UK
- How To Support Someone After A Miscarriage Or Loss (BellyBelly article for family and friends)
- What Not To Say To Those Who've Had A Miscarriage (BellyBelly article for family and friends)