Miscarriage

It is a sad fact that many women will suffer a miscarriage in their child bearing years.  Some women are lucky enough never to go through this trauma whilst others will go through it several times in their quest to have a child.

If it happens to you, you may find statistics being quoted at you or you may read on the internet statistics.  Some quote the rate to be as high as 1:4 others to be 1:6.  This is an international statistic covering not only our country (UK) but third world countries too.  The statistic thought to be correct in this country is 1:6 reported miscarriages.  Meaning there are probably many women that miscarry and do not realise it or do not report it.

Types of Miscarriage

Most miscarriages take place before the 12th week of pregnancy but loosing a baby up to 24 weeks pregnant is classed as a miscarriage after this it is referred to as a still birth.

There are different types of miscarriage.  You can start bleeding shortly after having found out you were pregnant and have cramps or lower back pain.  It might be very early on in your pregnancy or slightly later.  This is called an inevitable miscarriage.  Inevitable because the neck of the cervix has opened and the miscarriage is unstoppable.

Incomplete miscarriage is where some of the placenta and membranes can be left in the womb.  This is why it is always important to see your doctor or the Early Pregnancy Assessment Centre at your hospital.  If the remains are not removed then you can get an infection which will make you very ill.  An ERPC (Evacuation of Remaining Products of Conception) is normally performed or you may have heard it called a D & C (Dilation & Curettage).  You will also be given a course or a one off dose of an antibiotic to prevent infection after the small operation.  When an ERPC is performed your cervix is held open with a small instrument and the remains of your pregnancy are gently removed from your uterus.

Delayed miscarriage or missed miscarriage (sometimes also called a silent miscarriage), this is probably one of the hardest types of miscarriage to find you have had.  This is where either the baby never started to grow properly (sometimes referred to as a blighted ovum) or dies very early on in the womb normally by about 6 weeks.  Unfortunately the membranes and the placenta stay intact and continue to grow.  So you will still have pregnancy symptoms and a pregnancy test will still be positive.  Some women will just sense that something is not quite right or they will notice that their pregnancy symptoms are not as strong.  A lot of miscarriages like this are not picked up until the 12 week dating scan so can be quite a shock.  You may experience light spotting, bleeding or a brown discharge.  This does not always mean that anything is wrong and many babies have been born successfully after these symptoms.  It is important if you notice any bleeding at all in early pregnancy no matter how insignificant you feel it is you speak to your midwife, local maternity unit or doctor and get referred for a scan.  This will confirm that either your baby is fine or that you have sadly lost your baby.

Complete miscarriage is where the baby, membranes and placenta have passed out of the womb.  An Ultra Sound Scan will confirm this.  Again it is important to get a scan to check that your womb is clear to prevent infection.  If you do a pregnancy test it may well still be positive as pregnancy hormones stay in your body for a few days afterwards.

There are two other rarer types of miscarriage that are not included in this article, ectopic pregnancy and molar pregnancy.  Fortunately these types of miscarriage are a lot rarer.

What Happens Next?

Once it has been confirmed that you have miscarried, normally by a scan you may have some choices to make.  If you have had a complete miscarriage then you will probably not need any further medical intervention.  But if in the following few weeks you notice a smelly discharge from the vagina or start to get painful stomach cramps then you need antibiotics, go and see your doctor who will prescribe these for you.

If you have had an incomplete miscarriage then you will need to undergo an ERPC.  This is a small operation carried out under general anaesthetic.  A small tube is placed inside the uterus and any remaining products of conception are gently removed.  You will probably be given a one off dose of antibiotics too, this is to prevent infection.  Again if you experience an offensive discharge, extreme cramps or a fever see your doctor.

If you have a missed miscarriage or delayed miscarriage you will be given three choices on how to proceed.  You can either let nature take its course, which some women prefer to do.  The downside to this is it might take a long time or it might happen that day.  But you will not know when it is going to happen because it takes your body a some time to realise that the baby has gone.  The plus side to this is you will not need to go into hospital and as long as you keep an eye out for infection you will probably need no further medical intervention.

You can choose to have your miscarriage handled medically.  This will entail you being given a hormone to induce labour.  Normally this will be given as a pessary and an oral tablet.  The downside to this is you will not know when the evacuation is going to take place and you may need more than one course of the pessary and tablet to kick start the labour.  Also it can result in an incomplete miscarriage which means you will then need an ERPC.

You can choose to handle it surgically.  This is where you will be admitted to hospital for an ERPC.  The downside to this is you may have to wait a week or two before it can be done.  It also means you will require a general anaesthetic and all operations no matter how small carry risks.  The plus side is that you will have an end date, once the ERCP is carried out your body will start to return to normal and there will be no pregnancy left.  Having an ERPC will not damage your womb or make it weaker and should not affect any subsequent pregnancies.

As with all operations there are some risks, these include: pain, bleeding, infection, very rarely uterine perforation which is normally handled conservatively meaning it is left to heal on it’s own, if serious bleeding occurs you may require a hysterectomy again this is very rare, small chance that not all products of conception are removed, rarely a decrease in fertility can occur, Deep Vein Thrombosis and Pulmonary Embolus.  These are all very rare side affects and an ERPC is a routine quick operation.  You have to be told of the risks before you sign a consent form for the operation, this is called informed choice.

If you have a complete miscarriage or elect to have your miscarriage treated medically then you can bleed quite heavily and for quite a while.  If you have an ERPC then you may have light bleeding or bleeding similar to a period for 7 to 10 days.  You may not have very much bleeding at all after an ERPC.

Moving on

You can feel a bit sore for a few days after an ERPC with light cramping as your uterus returns to its normal size.  Also you can have low back pain.  If at anytime you start to loose blood clots or bleed very heavily, have a smelly discharge, feel fluey you should contact your doctor as you probably have an infection.

Your periods should return to normal within 4 to 6 weeks but this will vary with each individual.  If your period hasn’t returned within 8 weeks then inform your doctor.  You can start to have intercourse again once the initial bleeding has stopped but remember you will be fertile before your next period so will need to use contraception.  You can resume normal sexual activity once the bleeding has stopped.  You should use a sanitary towel not a tampon whilst you are bleeding to prevent infection.

If you have had an operation you should be fit to return to work physically within 72 hours.  However, you may not feel emotionally ready to go back just yet.  Take your time.  You may not have told people at work you were pregnant and feel now you want to tell them what has happened or you see work as somewhere normal to return to where no body knows the sad thing that has just happened to you.  Everyone handles things differently do it in your own way.

Why?

It is normal to ask why.  Why did this happen?  Could you have done something to prevent it?  Sadly you may never find out the answer.  When your egg was fertilised and the chromosomes started to match up they just not have matched up correctly.  When the egg and the sperm come together they both contain half the information needed to grow a baby.  Some of that information is possibly not needed straight away so the fertilised egg starts to divide, later on when that information is required this is probably the point where things go wrong as the information is incorrect or missing. 

You and your partner could possibly both have a genetic disorder that meant that this baby could not form properly unfortunately you will not find this out until you have had several miscarriages or it may never happen again.  The medical profession tend not to investigate miscarriages until you have had three or four depending on the policy of your local health authority.

There is nothing you could have done to change this, wrapping yourself in cotton wool and having not moved from day one of a positive pregnancy test would not have prevented this from happening.  Nor would the fact you had a glass of wine just before your positive test affect the outcome.  Some say it is just bad luck but that bad luck is hard to understand.

There are things that can increase your risk of miscarriage.  These include:

• Multiple pregnancy (twins or more)
• Maternal age, risk of miscarriage rises with maternal age women under 35 have a lower risk than women between the age of 35 and 40, women over 40 have an even more increased risk.
• Uncontrolled diabetes or poorly controlled diabetes.
• Scleroderma a soft tissue disease.
• Smoking, women that smoke heavily are at a higher risk of miscarriage and chromosomal abnormalities.  Men that smoke heavily can have a poor sperm count and poor sperm motility.
• Occupational exposure to solvents.
• Women that have previously been on the contraceptive pill have a slightly decreased risk of miscarriage.  This is why the contraceptive pill is sometimes used for infertility treatment.

Emotions

It can all be a bit of an emotional rollercoaster.  Things can move very fast from you contacting the hospital to it all being over physically.  It can be a shock and take you a while to adjust to what has happened to you.

Once the physical side has been dealt with you are left a bit dazed and wondering how to move on.  It might take you a while to realise that you are not pregnant anymore and the dreams and hopes you had for this baby have gone.  There can be a grieving process; even if the baby never formed the joy of being pregnant was there and real.  Small things can trigger off emotions like something you eat that you can not eat when you are pregnant will bring it home again that you have lost your baby.

You may have a range of emotions to go through from complete devastation, to anger, blame, guilt and deep grief.  Handle each emotion as it hits you.  Find a way to cope.  If you need to cry, cry there is no shame in this.  If you feel you are able to talk with your partner, family and friends do this.  If you do not want to talk about it just gently tell people that care that you’re not ready to talk about it.

If you have other children you can try to take solace in them and enjoy their company, assuring yourself that you have successfully had a baby before and there is no reason why you will not in the future.  If you have no children you may find something else to sink your emotions into like a much loved pet, a hobby or job.

Everyone grieves in their own way.  It takes time.  Do not pretend this did not happen to you, don’t bury it and try to carry on because you need to handle and cope with how you are feeling in your way.

You can find sometimes of the year more difficult than others.  The date your baby was due to be born, the date you conceived, Christmas and family holidays can all be painful.  Try and focus on the good things that are happening not on the what ifs.

When to try again

Medically you can try for another baby after one complete cycle, some doctors will tell you two cycles.  They mean that you will have a period after about four to six weeks you can then start trying (a complete cycle).  This is because if you don’t wait you have a much higher chance of miscarrying again.  If you accidentally do get pregnant then you will be watched carefully but don’t panic many a successful pregnancy has been conceived in this way.

Emotionally as a couple you may not be ready to try again for some time.  It is up to you as a couple to decide when to try again.

Any subsequent pregnancy may be tinged with fear, apprehension and sadness that the same thing could happen again.  It may also remind you all over again of the baby that you lost.  This is normal of course you are going to be worried it will happen again and that your dreams will be destroyed for a second or third time.  See your doctor at about 6 weeks pregnant and ask to be referred to the Early Pregnancy Assessment Clinic for a scan to put your mind at rest.  They will do an internal scan that will show whether your baby has a heart beat by this stage.  If at any time in your pregnancy you do not feel right or get cramping or any bleeding no matter how light ring your doctor or maternity unit to have a scan.

Some women will know from the time of conception that their pregnancy just does not feel right.  It can just be a feeling nothing you can actually put your finger on, this is especially true if you have had previous successful pregnancies.

Do not give up if you have miscarried once it does not mean it will happen again.

Madmums now offers one to one support to Miscarriage and Still Birth sufferers via the Madmums Buddy Scheme. The scheme is free and confidential.

This is a members article written by MumSam

Add This Article To: Del.icio.us   Digg   Google   Spurl   Blink   Furl   Simpy    Y! MyWeb