Pregnancy and Miscarriage

Miscarriage

A miscarriage is the loss of a baby from the date of a missed period up to 24 weeks of pregnancy.

You may hear miscarriages described as either ‘early’ or ‘late’.

An ‘early miscarriage’ may happen until 12 weeks of pregnancy. A ‘late miscarriage’ may occur between weeks 12 to 24 of pregnancy.

For many people, their first emotion is shock when either they or someone close to them has a miscarriage, as it is not something you hear much about. As most miscarriages happen in the early few weeks of pregnancy, many women will not yet have told their friends or family that they were pregnant.

Unless someone close to you has had a miscarriage and told you about it, you may not have thought about the subject until you become pregnant yourself. Some women don’t worry about it and think it is either rare or happens to other people, whilst other women think about little else for the first few weeks of pregnancy.

Whatever your feelings about miscarriage, the facts are that sadly 1 in 4 pregnant women will lose their babies.

Symptoms of Miscarriage

Vaginal bleeding is the most common symptom of a miscarriage; it can vary from light spotting to a heavy bleed, heavier than a normal period. Some women are shocked by the volume of blood that they seem to lose.

You should be aware though that women can have a spell of bleeding during the early weeks of pregnancy and go on to have a normal pregnancy.

Other signs are cramping or abdominal pain. Some women describe simply not feeling pregnant anymore. They may have lost the pregnancy symptoms such as nausea or breast tenderness that they had previously been feeling.

Some women have no signs at all that their baby has died. This can be particularly painful if the first they know of this is when they go for their first scan and are told that the baby is no longer alive. This is called a missed miscarriage.

What you should do if you think you may be having a miscarriage

If you experience any of the symptoms of a miscarriage in your pregnancy you should seek help. It is generally better to ask for help than to wait and see at home. Bleeding in pregnancy should always be investigated. If you are bleeding put on a clean sanitary pad – don’t use tampons - and monitor your bleeding.

If you are experiencing severe bleeding, such as soaking through a sanitary pad every hour or less, or are having severe abdominal pain, feeling dizzy or faint you should go to your local A&E department urgently. Also, if you are having abdominal pain on just one side, or feel pain in your shoulders you should also go to A&E. These can be signs of an ectopic pregnancy where the baby is growing outside the womb.

If you have other symptoms such as lighter spotting, pink discharge or light bleeding, dull cramping in your stomach or back, your first choice may be to see your GP. Ask for an appointment for the same day and take a sanitary pad to show them the discharge and describe to them how you feel. Explain if you are no longer feeling your pregnancy symptoms or these have changed.

Your GP should discuss your symptoms and they may either send you to hospital or ask you to monitor minor symptoms and return at a set time. If your GP surgery is closed or you are unable to get an appointment you could ring NHS Direct on 0845 46 47, who will advise you where you should seek help.

What happens at Hospital?

If you go to hospital you may initially be assessed by a skilled nurse, who will assess if you need to be seen urgently. If your hospital has one, and it is open, you may be directed to go to an Early Pregnancy Unit or Emergency Gynaecological clinic.

If you are beyond approx 16 weeks you may be asked to go to the labour ward or the hospital’s antenatal assessment unit.

You will probably be asked a number of questions about your pregnancy and the symptoms you are suffering. It may be helpful to have written down what time any bleeding or other symptoms started to help you remember. They will probably ask you to give them a sample of your urine and your blood pressure and temperature will probably also be checked. Depending on your symptoms and the time of day you may be offered a scan at this point. They may also take blood tests.

Your notes will probably now say 'Threatened miscarriage'. This can seem very scary but the good news is that it doesn’t mean you are having, or that you will definitely have, a miscarriage. It is simply the medical term that is used if you have had symptoms of a miscarriage such as bleeding. Many women who have a threatened miscarriage still go on to have a healthy rest of their pregnancy.

What happens if a miscarriage is confirmed?

Once a miscarriage has been confirmed a scan can show if the miscarriage was complete. Meaning that the bleeding that you experienced resulted in the complete loss of the pregnancy. Otherwise the scan may show that you have yet to lose any or all of the pregnancy – although the baby has died. If this is the case you may be offered expectant management, medical treatment or surgical treatment.

Expectant management, sometime called conservative management, is basically the wait and see approach or sometimes described as letting nature take its course. This method works for around 50% of women. You will be able to go home and await the miscarriage. Most units will provide you with leaflets letting you know what to expect during this time. They may well also give you pain killers to take home with you. Some women prefer to be treated conservatively as they would like to avoid surgery and an anaesthetic. It may take a while before bleeding starts, if it hasn’t already, and it may take around 3 weeks for all the bleeding to stop. For many women this bleeding is heavier than a normal period and some women experience cramping pains with the bleeding. If during this time the bleeding becomes particularly heavy, the pain is severe or the bleeding does not start you may be advised to have the medical or surgical treatment.

Medical treatment is where you are given either tablets to take or pessaries to insert into your vagina which allow the cervix (the neck of the womb) to open slightly, allowing the pregnancy to pass. You will usually be able to return home after a few hours but will have to go back to hospital if the bleeding or pain is severe. You can take pain relieving drugs to help with cramping and abdominal pain. You will pass blood and possibly clots which are usually heavier than a normal period. You may continue to bleed for around 3 weeks.

The surgical treatment is successful in around 95% of cases. It is called an evacuation of retained products of conception (ERPC) or evacuation of the uterus. It is similar to a dilatation and curettage (D&C) operation. It is usually carried out as a planned operation in the few days after a miscarriage is confirmed. It is often done under a general anaesthetic but can occasionally be carried out under a local anaesthetic. You are sometimes given tablets or a pessary before the operation to soften and slightly open the cervix. During the operation the doctor gently opens the cervix and a suction device is used to remove the pregnancy.

As with all treatments there are some risks of surgery that will be explained to you before you give your consent for the operation. These include the risk of infection, heavy bleeding, needing to repeat the operation if not all the tissues are removed at the first operation, and less commonly a tear in the wall of the womb that needs repairing.

If the expectant or medical treatments have not worked, or your bleeding or pain is severe, there is infection or other complications of the miscarriage you may be advised to have the surgical treatment.

Recovery

Different women will feel differently about how long they need to recover physically and emotionally. The unit that you are seen at will probably give you some leaflets about the experience of having a miscarriage and they may have information about local support groups.

Recovering emotionally from a miscarriage can be very difficult. The loss of a baby in pregnancy can be a very unhappy, frightening and lonely experience.

For many people who have suffered a miscarriage feelings of great sadness and regret are common. Many also feel shocked and confused. Some feel angry. Others feel guilty and wonder whether they have been responsible in some way. Some talk about feelings of emptiness, longing, loneliness and a lack of self-confidence. Others feel stressed, panicky and out of control.

It is very common after a miscarriage to feel a huge sense of loss and grief. You grieve for a person you never knew, and for a relationship that ended before it really began. You grieve not for a person who has lived and died but for an unlived life. You grieve for the loss of your future as the parent of the baby who has died. You are sad not just because of what you have lost but because of what will never be.

This is different to grieving for, say, an elderly person who has died, and it can be hard for people who have no experience of miscarriage to understand.

It is also common to feel loss in physical ways. A lot of women find they feel very tired – even some time after the miscarriage.

Talk to the people who support you best. If you have a partner be prepared to give each other space and time to grieve and don’t expect each other to 'move on' or 'get over it' at the same time. If, after some time, you feel you are not coping with your feelings then do seek help. You may need more support such as professional counselling. See your GP if you need more help.

Some families choose to have a memorial service or write in a book of remembrance at the hospital. You can ask to see the hospital chaplain for more information about this. If you suffered a late miscarriage you may be able to see and hold your tiny baby – ask the hospital staff if this is possible. Some women have found it helpful to write letters to the baby or to themselves really writing out how they feel.

Some people avoid the subject of my miscarriage. Why?

Many people find another person’s loss and sadness very difficult to cope with and so they simply avoid talking about it. They may be afraid of saying the wrong thing and hurting your feelings, or worry about reminding you about it when you’re trying to forget. Some people may try to cheer you up in the hope that you will get over the miscarriage quickly. Sadly, some people will just not understand the importance of your loss.

Why did I miscarry?

Even though miscarriage is not a rare event, it is usually difficult to know the exact cause and most women never find out the cause of their loss, even if they have investigations. It can be hard to accept that no-one can say for certain why it happened. That doesn’t mean that it is your fault – your miscarriage is unlikely to have happened because of anything you did or didn’t do.

The main causes of miscarriage are thought to be:

Genetic: In about half of all early miscarriages, the baby does not develop normally right from the start and cannot survive.

Hormonal: Women with very irregular periods may find it harder to conceive and when they do, are more likely to miscarry.

Immunological: Problems within the blood vessels which supply the placenta can lead to miscarriage.

Infection: Minor infections like coughs and colds are not harmful, but a very high temperature and some illnesses or infections, such as German measles, may cause miscarriage.

Anatomical: If the cervix (neck of the womb) is weak, it may start to open as the uterus (womb) becomes heavier in later pregnancy and this may lead to miscarriage. An irregular-shaped uterus can mean that there is not enough room for the baby to grow. Large fibroids may cause miscarriage in later pregnancy.

Useful resources

The Miscarriage Association acknowledges the distress associated with pregnancy loss and strives to make a positive difference to those whom it affects.

The Miscarriage Association

c/o Clayton Hospital, Northgate, Wakefield WF1 3JS

Tel: 01924 200799; e-mail: info@miscarriageassociation.org.uk;

www.miscarriageassociation.org.uk

The Miscarriage Association offers the following support services:

A staffed helpline

Monday to Friday, from 9am to 4pm

e-mail support

E-mail at info@miscarriageassociation.org.uk and they will aim to reply the same or the next working day.

Support network

They have a UK-wide network of support volunteers, who have been through the experience of pregnancy loss themselves and can offer real understanding and a listening ear. Most offer support by telephone and some run support groups.