A miscarriage is a traumatic experience for parents to go through at any stage of pregnancy.
It can be particularly hard to come to terms with losing a baby in late pregnancy.
Pregnancy loss occurring after 12-14 weeks gestation, and before 20 weeks, is known as late miscarriage.
Late Miscarriage – Signs and Treatment
For those experiencing late pregnancy loss, the word ‘miscarriage’ doesn’t really describe the impact and depth of their grief.
Parents who go through late miscarriage more often identify with those who have had a stillborn baby (a baby lost at or after 20 weeks gestation).
What Causes Miscarriage?
Late miscarriage is less common than early miscarriage. Of all miscarriages, about 1 in 100 happen in late pregnancy.
Usually, late pregnancy losses happen because of medical problems, most of which are very rare. Some of these are:
- Anatomical problems, such fibroids, cervical problems, or an unusually shaped uterus
- An uncontrolled condition that affects hormones, such as diabetes, or a thyroid disorder
- Infections involving the baby, such as parvovirus, cytomegalovirus (CMV), and toxoplasmosis. These are all rare, and do not affect future pregnancies
- Illnesses involving the liver and kidneys
- Sickle cell anaemia, Antiphospholipid Syndrome, or other blood conditions
- Viral infections, such as rubella
- Infections of the amniotic fluid, such as bacterial vaginosis, or group B streptococcus
- Amniocentesis, which is a test to check for fetal abnormalities; this has a miscarriage risk of between 1 in 200 and 1 in 500.
What Are the Signs of a Late Miscarriage?
Spontaneous or natural late miscarriage begins naturally, without medication. You might have labour-like cramping, a pinkish vaginal discharge or bleeding, and your waters might break.
When a silent late miscarriage happens, there might be no signs that anything is wrong, or you might have noticed your baby is not moving. You might only discover the miscarriage has occurred during an antenatal check up.
Usually labour is induced by medication, given orally or as pessaries. You might prefer to wait for a few days to see if labour will start naturally, or delay the induction while you take some time to prepare.
What To Expect During A Late Miscarriage?
Many people are not aware that when a late miscarriage happens the mother goes into labour and births her baby. For most women, this experience is bittersweet and very emotional.
The physical experience is similar to full term labour. You might have painful contractions and you will have the option of pain relief, if you want it. You will also have the support of a midwife, your partner, and any other support team, if you choose.
You will be able to see and hold your baby if you wish. Many parents are concerned what their baby will look like and are not sure whether they will want to see their baby.
Your baby’s size will depend on the length of gestation, and any medical condition present. The appearance of your baby might also depend on the time lapse between death and when the baby miscarried, or the manner of birth.
A fully developed, normal baby that miscarries at sixteen weeks will be approximately 16-18 cm long (or about the size of an adult’s hand).
Talk with hospital staff about what to expect if you choose to see your baby. You might decide to see your baby straight after birth, or wait until staff have cleaned and dressed your baby.
There is no right or wrong thing to do. You and your partner might feel differently about seeing your baby. Hospital staff will be there to support both of you during this time.
Seeing Your Baby After Birth
If you decide to see your baby, you might want to spend time touching and holding him. Many parents find holding their baby provides comfort, and a sense of reality, as up to this point they have been in too much shock and disbelief to take in the situation.
This time can help you to create memories that you will cherish forever. Staff will leave you with your baby for as long as you need, or be on hand to support you if that’s what you need.
Depending on the situation, you might also be able to bathe your baby and dress him or her in a special outfit. Sometimes babies who are born very early are too fragile to wash or dress. The hospital staff can provide a special wrap or blanket.
Many hospitals can organise a professional photographer to come to the hospital and take photos of your baby; these can be precious keepsakes. Otherwise, hospital staff might ask whether they can take photos, and keep them with your records, in case you prefer to see them later.
You might also be able to take your baby's hand or foot prints. Creating memories that you will have in the time ahead can be a great comfort. You might want other family members, such as siblings or grandparents, to meet and hold your baby too.
Be sure to read BellyBelly’s article 7 Ways To Create Memories After Losing A Baby.
What Happens To My Baby?
The hospital will ask you for permission to carry out tests that might help find out what happened. These can include taking your blood to see if you had an infection or blood clotting problem. The placenta can also be checked to see if there was any infection.
You might also decide to have a post mortem examination (autopsy) of your baby. The decision to do this is a very personal one, and the chances of finding a cause for the miscarriage are small. The hospital staff will discuss with you what will happen, and give you time to decide what is best for you.
When babies are born before 20 weeks there is no legal requirement to register their birth or burial. Most hospitals can organise a funeral service or will have your baby cremated or buried on your behalf.
Many parents wish to organise a private burial or cremation. Some organisations will provide you with a ‘recognition of loss’ certificate. Birth certificates are not given unless your baby was born after 20 weeks.
The Physical Impact of Late Miscarriage
You are likely to have pain and bleeding for a few weeks after your pregnancy loss. If you have any increase in pain or bleeding, vaginal discharge that looks or smells bad, or any other symptoms that concern you, it is best to contact your care provider immediately.
Depending on how many weeks pregnant you were, after your baby’s birth your breasts might begin to produce milk. Many women find this reminder of their baby very hard to cope with, but it can also be a tangible way of remembering that you are a mother.
Your milk will dry up after about a week, but if you find it too distressing or uncomfortable you can ask your caregiver about medication that will stop milk production. Wearing a supportive bra, using pain relief medication and heat packs can all be of help.
For more information, be sure to read Lactation After Loss.
During this time, on top of your emotions, it can be hard to deal with the physical effects of your loss. Resting and eating well can be the furthest things from your mind.
Your body is recovering from pregnancy and birth and you will probably feel very tired. If family and friends want to offer help and support, providing you with some ready-to-heat meals, and taking care of your other children or chores are often ideal ways to give you some time to recuperate physically.
How To Support Someone After A Miscarriage Or Loss has suggestions for people who want to help you.
The Emotional Impact Of Late Miscarriage
There is no right way to deal with the grief of losing a baby. Emotional distress can be very intense and overwhelming. It is hard to imagine you will ever get over losing your baby.
The first few weeks and months can be very surreal, and an emotional rollercoaster. You might feel the need to talk to others who have been through late pregnancy loss; this can be a great comfort to you.
It might be a struggle to see the nursery, or the items you were preparing in readiness for your baby’s arrival. Some women find a great deal of comfort in having those tangible proofs of their baby’s existence. Others find it too painful, and prefer to have them packed away. Whatever feels right for you is ok. You should let those around you know, so they can follow your lead.
You might also find that those around you really don’t understand the depth and extent of your grief. Well meaning family and friends sometimes say things like “It was meant to be” or “You will have another baby soon” – things that are painful and hard to hear. They might not understand that the loss of your child is the loss of future hopes and dreams that you cannot replace with another baby.
You might prefer to wait for some time before trying to conceive another baby, or you might feel you need to become pregnant again straight away. This is a personal choice that only you can make, but it is worth discussing with your caregiver. There could be reasons why is important to wait and prepare for your next pregnancy.
There are many support organisations that provide phone support to parents who have experienced late pregnancy loss. Grief counsellors, especially those who specialise in pregnancy loss and stillbirth, can support you as you deal with your grief, and learn to live with a new ‘normal’.
If you feel you need support, or you want those around you to understand how best to support you, visit the sites listed at the end of this article. If you are in a country other than Australia, you can search for ‘pregnancy loss support’ and find a support organisation in your area.
What Not To Say To Those Who've Had A Miscarriage (BellyBelly article for family and friends)