Early Pregnancy Loss & Miscarriage
What is miscarriage?
A miscarriage is the spontaneous loss of a pregnancy and baby prior to 24 weeks gestation.
In Ireland approximately 15,000 miscarriages happen annually out of about 50,000 pregnancies. So you could say 25% of pregnancies end in miscarriage here in Ireland every year. You are not alone.
Why did it happen?
Often with miscarriage nobody can give you a reason as to why it happened.
In their guidelines on early pregnancy loss, the HSE say “It is often very difficult to give a definitive answer as to why you had a miscarriage. Many studies have shown that approximately 2 out of every 3 miscarriages are explained by a chromosome problem. This means that when the egg was fertilised by the sperm the process of fusing together was somewhat faulty and in many cases gave rise to one extra chromosome, though in some cases a baby with one less chromosome. It is normal to have 46 chromosomes, 23 from the mother and 23 from the father. Where there is a problem at conception this may give rise to a total of 45 or 47 chromosomes. Very often these chromosome problems are not compatible with life and nature will determine that these pregnancies do not progress and they will then become a miscarriage. Occasionally you may have a miscarriage because of an infection associated with a high temperature / fever, though this is unusual. Occasionally there may be a problem with the cervix, the back of the neck of the womb, and/or uterus (womb). An irregularly shaped womb or the presence of fibroids encroaching into the cavity of the womb are associated with a higher chance of miscarriage. Unfortunately in many cases we are unable to give a definitive cause.”
You might wonder if you have done something to cause the miscarriage but in the vast majority of cases this is not so. There is no known prevention of miscarriage.
What do I do now?
Surround yourself with information, love and support.
One of the most surprising things for me about my own miscarriage experience was that it went on for days where I had thought it happened in one day
Information: Your medical care team should supply you with information about what type of miscarriage you have experienced and they should answer all of your questions for you. If your miscarriage has been diagnosed as ‘complete’ it means your body has passed the pregnancy (foetus, placenta, womb lining etc.). This would have passed in the form of period like bleeding with perhaps some clot-like lumps in the blood. With a complete miscarriage no further medical treatment is required. But love and support are always required in the aftermath.
If your miscarriage has been diagnosed as ‘missed’ or ‘incomplete’ it meant that there are some pregnancy tissues retained in the womb. There are three ways of dealing with this type of miscarriage and your caregiver should discuss all of them with you.
HSE guidelines state these options as:
Wait and see approach (leaving things to nature): In the past an operation was nearly always performed in cases of miscarriage, however, with the use of ultrasound we can reasonably confidently predict those miscarriages that do not require any treatment. If you have had no bleeding it may take up to 3 weeks for you to start miscarrying. The bleeding may be heavier than a normal period and you may experience strong period like pains in your lower tummy as the womb contracts in an attempt to expel the pregnancy tissue. If the bleeding is very heavy, the pain very severe or you feel unwell you should attend the hospital for review. In a small number of cases an operation may still be necessary should there be some tissue left within the womb or if the bleeding becomes too heavy.
Medical approach: Medicines may be used to start a miscarriage if you prefer not to wait. Misoprostol is a medicine that you can take by mouth (or occasionally by placing the tablets in the vagina). You may need to take a few doses before bleeding commences (as described above). The advantages of this approach is that you avoid a hospital admission, an anesthetic and a surgical procedure all of which carry a small risk. In about 10% of cases an operation may still be necessary should there be some tissue left within the womb or if the bleeding becomes too heavy.
Surgery (D and C): D and C means dilation and curettage. We dilate the cervix (neck of the womb) and by using either plastic or metal instruments we remove the pregnancy tissue from the womb. It is correctly called an ERPC (evacuation of retained products of pregnancy). This is done under general anesthesia through the vagina and you will not have any cuts/stitches. Like with all operations there are small risks such as infection or injury to the womb and cervix. The advantage of this approach is that it clears out the womb quicker than the above approaches.”
Your medical caregiver should advise you on these options. In many cases a repeat scan is necessary after a week or 10 days of initial diagnosis to confirm miscarriage. This can be a very difficult and frustrating time to wait ‘in limbo’. During this time you should ensure you are surrounded with love and support and do whatever feel right for you. Some women will continue to work for example, some will take leave. Everyone is different and there is no right or wrong way of dealing with loss. It is important to do what you feel like doing and that others support you in that.
Other good sources of Information on early pregnancy loss and miscarriage:
You may have lots of questions about your body, future pregnancy etc. and your medical team should answer all of these for you. Some frequently asked questions are (answers from HSE guidelines):
Q. Should I be investigated after a miscarriage? A. As it is unusual to find anything abnormal, doctors do not usually investigate a woman unless she has had three or more consecutive miscarriages. Most women have a normal pregnancy after one or two miscarriages, whether they are investigated or not.
Q. Will I miscarry next time? This is unlikely. Even women who have had recurrent miscarriages have a high chance of having a normal pregnancy in the future. What will happen at my next period? There is no set rule. After a miscarriage, the next period may arrive early, on time, or late. The later in pregnancy a woman miscarries, the more likely that the next period will be late. The bleeding with the next period may be light, normal or heavy.
Q. When should we try for another baby? Whenever feels right for you and your partner. After a miscarriage, you may ovulate and get pregnant before your next period. If you wish to avoid becoming pregnant, therefore, contraception should be considered immediately after the miscarriage.
Love & Support:
Many experiencing pregnancy loss (both women and men) will need to talk about what is happening and should have people to listen. As a bereavement doula I am honoured to companion families through that. Having been through it myself, I understand the many emotions and frustrations of that wait for a confirmation of miscarriage diagnosis.
Family and friends can also play an important role and should not be afraid to talk to the mum about her loss or suspected loss. Enduring miscarriage while everyone is pretending its not happening can be very difficult. That said, most women find statements such as; “you’re young you’ll get pregnant again”, “at least you know you can get pregnant” or “at least you have another child” very unhelpful.
What is more helpful is to listen and let mum and dad articulate their feelings, be led by her, don’t try to lead her and don’t try to fix it. Be a loving companion. Often a miscarriage will occur before the couple have announced their pregnancy. This can make the experience very isolating and lonely. Sharing with a trusted family member or friend can really alleviate the isolation.
Alternatively you could seek support from
Hospital bereavement team (bereavement midwives/chaplains) at your
local maternity unit.
Things that can be helpful during that time:
taking time off work
engaging in some pampering
talking about how you’re feeling
writing, painting, music or other artistic expression
support and companionship from a bereavement doula
Marking my pregnancy - remembering my baby
Ritual can be very helpful to help the healing process after loss. You may have certain cultural or religious rituals you would like to perform to mark your pregnancy loss.
Certificate Sadly, babies lost prior to 24 weeks are not issued with a birth certificate. Many of the hospitals supply a certificate to mark your pregnancy. You can talk to the hospital Chaplain about this.
Memorial Stones The Miscarriage Association of Ireland has placed memorial stones in cemeteries around Ireland to commemorate babies lost prior to birth. You can find the location of these memorial stones here
Burrial If you have had a surgical procedure there may be remains to bury. It is possible to also have remains of your tiny baby after a complete miscarriage at home. Many mums find it helpful to see their baby's remains, though they may be very tiny and difficult to make out depending on when your baby stopped growing. If you feel this might be helpful for you, you can take measures to retain your baby's remains.
You can talk to your hospital bereavement team about how you go about arranging a burial or cremation of your baby’s remains. There is an Angels Plot in Glasnevin Cemetery for this purpose. You could also burry remains of your baby which may have passed at home. You can talk to me about how to go about that or get advice from your hospital/GP.
Remembrance Services Each of the hospitals holds remembrance services and may also have a book of remembrance in which you can have your baby’s details recorded. The Irish Miscarriage Association also holds remembrance services and you can get details here You can also hold your own remembrance ceremony with family and friends. Planting a tree or other plant can be a nice way of remembering your little one like Erin and her partner did in this short video
Don’t feel that you have to do something to mark your loss. You may feel it will make things worse or it may just not feel right for you. Everybody is different. There are no right or wrong ways to deal with pregnancy loss.
Useful links on Miscarriage: