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Miscarriage

miscarriage; abortion; spontaneous; embryo; foetus; fetus; pregnancy; SANDS; death; incomplete; complete; vaginal; bleeding; grief; loss; chromosome; Rh; immunoglobulin;

Contents

A miscarriage is the unintended ending of a pregnancy. Many pregnanies end in a miscarriage - about 15 to 20 percent (about 1 in 5) of recognised pregnancies - most often in the early weeks of pregnancy, but sometimes later in the pregnancy.

A miscarriage comes as a surprise and a shock to most women and their partners. You may feel confused and frightened, and be overwhelmed by feelings of grief and sadness. Reactions and responses are individual and may range from an experience of little significance to a major life event.

For some women the miscarriage is very abrupt and over in a few hours. For others, the miscarriage begins with bleeding and may run a very uncertain course for days, or even weeks.

Most women and their partners express fear and surprise at the amount of bleeding, the amount of discomfort, and the experience of losing the pregnancy. Even when physical symptoms were not great, most women say that the event was vastly different from what they would have imagined.

(A miscarriage is sometimes called a spontaneous abortion.)

Why does a miscarriage happen?

It is very difficult in an individual case to know why, but it is normal in nature for at least 1 in 5 conceptions not to proceed past early pregnancy, possibly because of a chance problem in the early development of the fertilised egg.

Couples cannot prevent miscarriage from happening. The cause is often unknown or cannot be found.

It is common for women who experience miscarriage to question whether they may have done something to cause it. You did not cause it – emotional shock, nervousness and stress don't cause miscarriage. Even major trauma such as serious car accidents, strokes and falling from heights will usually have no effect at all on the wellbeing of the fetus.

Having had one miscarriage does not significantly increase the risk of having another miscarriage. The risk remains at 1 in 5 pregnancies.

Management of miscarriage

Complete miscarriage

This is the loss of your pregnancy and all the tissue occurring naturally. You may or may not have been aware of passing the pregnancy. You may have had pain or been bleeding or spotting for a while.

You may have had a series of blood tests that show your pregnancy hormone Beta Human Chorionic Gonadotropin (BHCG) levels are decreasing and a complete miscarriage has been diagnosed. Sometimes it is too early in the pregnancy to use an ultrasound to see if you have passed all the pregnancy tissue, so we can only use your blood hormone tests as a means to find out what is happening.

You generally will not need an operation called a dilatation and curettage (also called a D&C) with both you and your doctor deciding on a natural course of events.

Your doctor may ask you to have a repeat blood test - this will be to make sure that your pregnancy hormones are decreasing following your miscarriage.

Incomplete miscarriage

Sometimes not all the pregnancy tissue is passed. Usually an ultrasound scan will be done to check the contents of the uterus. If the baby has died, the remains of the pregnancy need to be removed from the uterus to prevent further bleeding or infection.

  • Sometimes treatment with medication might be advised. This medication helps the uterus expel the pregnancy tissue through the vagina – and hopefully there will be no need for surgical treatment.
  • Some women need an operation called a dilatation and curette (D&C) to remove the remaining tissue. This is done under a general anaesthetic. Any tissue passed vaginally or removed by D&C is sent to the laboratory for testing to try to work out the cause of the miscarriage.
  • If you have a late miscarriage (between about 12 and 20 weeks) you may be advised to have a D&C or it may be necessary to induce labour.

Rh negative women

If your blood group is Rh negative (Rhesus negative) you will probably be offered an injection of immunoglobulin. For more information have a look at this section in the topic 'Routine antenatal tests'

The changes your body can go through

Your stay in hospital will probably be very short. Talk to the hospital staff so you understand what changes may happen to your body at this time.

Once you are home, you will need to allow yourself time to recover both physically and emotionally.

  • You may find that bleeding continues for a few weeks gradually getting lighter.
  • This bleeding may be bright red, but should not be too heavy. If at any time you have heavy bleeding (soaking through one or two pads in an hour) or pass any large clots – see your doctor at once.
  • It is quite normal to have slight cramping for some days after a miscarriage. So long as your temperature is normal, this cramping, while unpleasant, is not dangerous. You could try some paracetamol or other mild pain reliever, put a heat pack on your tummy or back, and rest.

If your temperature goes up it is often the first sign that your body is working overtime to combat an infection. A smelly discharge can also be a sign that you might have an infection, as can a feeling of being generally unwell. If you have noticed any of these, check with your doctor as soon as possible.

Your body has been changing due to the pregnancy: you may have experienced nausea, changes in breast size and tenderness. These fade in the next few days.

  • If you have had a late miscarriage your breasts may produce milk.
  • Your next normal period should come in four to six weeks.

If you require contraception discuss this with you doctor.

Follow up

Your doctor will ask you to return for a check-up in 2 to 4 weeks regardless of how well and healthy you feel. Sometimes the only sign of an infection will be tenderness when your doctor does an internal examination.

Things to avoid

  • It is a good idea to avoid heavy work or strenuous exercise, sports or dancing for the next week.
  • To reduce the risk of infection it is best not to put anything in your vagina for the next 2 weeks. For example
    • use sanitary pads, not tampons;
    • have showers instead of baths, do not go swimming;
    • not have sexual intercourse or use any other objects to stimulate the vagina.

Emotions after early pregnancy loss

The loss of your pregnancy at any stage can have a big impact on you and your partner. One day you are pregnant and planning your future life with your child, and then within a short time, your pregnancy ends, and your dreams and plans are gone.

Your grief may be hard to bear with a loss in early pregnancy as you have nothing to show for the pregnancy and have no memories to grieve over. There may be no acknowledgment that you were even pregnant as your friends and family may not have been aware you were pregnant. You may feel as though your baby did not exist. It is very normal to feel a range of emotions at this time.

These feelings can be very intense and may include the feelings that people have after a significant loss:

  • Sadness
  • Anger
  • Irritability
  • Crying
  • Difficulty sleeping
  • Dreams/nightmares
  • Disbelief
  • Guilt
  • Confusion
  • Isolation
  • Not wanting to be alone
  • Not wanting to see anyone
  • Wanting to talk.

These feelings can be very intense, but they will reduce with time.

It is important to remember that your own particular experience is unique and you have the right to recover in your own way and in your own time. Your partner will also experience loss in a unique way.

You will need recuperation time, especially to recover emotionally. Try to reduce challenges as much as possible and allow yourself time to be with the people with whom you are comfortable. Give yourself as much time as you need to recover from this major event.

Whatever your feelings, allow yourself time to grieve, to cry, and to talk about the emotions you feel.

  • It can be a big help to find someone you can talk to who will listen and understand.
  • You may benefit from contacting a support group (such as SANDS) and talking to other parents who have had a similar experience.

While you are recovering, do not expect too much of yourself, and try to be with the people you feel most comfortable around.

Your partner can also experience a wide range of feelings and may be unsure how to comfort and help you.

  • His feelings about the pregnancy are different from yours.
  • You may each grieve in different ways and it is important to talk to each other and to be aware of each other’s feelings.

Looking ahead

Anyone who has experienced a miscarriage is likely to be fearful that it will happen again. Statistics tell us that it probably won't, but one in 5 women will have a miscarriage in their next pregnancy. It is normal to feel anxious. It may help to talk about these feelings with your partner and your doctor.

Generally it is recommended that you wait for at least one period before you 'try again'. If you decide to wait for a while you will need to think about contraception.

Remember, you will start to feel better and there are people you can talk to about this loss. These people include hospital social workers, chaplains, SANDS members and your doctor.

For friends and relatives

It is always hard seeing someone you care about going through a difficult experience.

Saying the following things is not helpful:
"You can always have another baby"
"It's all for the best"
"It's nature's way of sparing you from having an imperfect baby"

Do be there to listen to your friend or relative just to listen. Be patient if it does take a while for her to feel OK.

Resources

  • The hospital that you attended may have a women's social work department.

South Australia

SANDS SA (Inc)
SANDS (SA) is a support group in South Australia for parents and their family whose baby has died through stillbirth, neonatal death, miscarriage, ectopic pregnancy and medically advised termination.
Phone 1300 072 637 (24 hours)

The SANDS website has information for bereaved parents and also for their relatives and friends. There is a book list and some stories written by bereaved parents.
SANDS SA

There are SANDS groups in some other Australian states and information can be obtained from the SANDS Australia website 
http://www.sands.org.au  

Information in languages other than English

NSW Multicultural Health Communication Service 
http://www.mhcs.health.nsw.gov.au/ 

More information

Pregnancy, birth and baby Pregnancy, Birth and Baby is a national Australian Government service providing support and information for expecting parents and parents of children, from birth to 5 years of age.
http://www.pregnancybirthbaby.org.au 

Raising Children Network Raising Children website is produced with the help of an extensive Australian network including the Australian Government.
http://raisingchildren.net.au/ 

Source

Women's and Children's Health Network (South Australia) pamphlets about 'Miscarriage'.

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see your doctor or midwife.

 

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