On Monday’s TV AM we discussed miscarriage with Mary Seery Kearney who suffered multiple pregnancy losses.
Many of you reached out me. You shared your stories, your heartbreak and asked me a load of questions. I help clients heal after pregnancy loss so I figure it’s better to answer your questions here, with accurate info in a post. After all I’m a qualified gynae nurse and midwife as well as a therapist.
You wish you’d understood what miscarriage is before it happened, not blamed yourself. You wish took time and had help to heal. You wish it could have been easier…
Miscarriage isn’t discussed in sex ed class, and most people will meet it directly or indirectly. Isn’t it better to understand so you can support a relative or friend? Or at least avoid saying something hurtful?
I believe knowledge is power, and knowing more about pregnancy loss can mean you feel less alone, and more in control if it happens. And I’ll bust some myths about miscarriage.
Please share your experience, and let me know what else I can add.
Above all, be gentle with yourself, and each other,
If you’ve suffered pregnancy loss my heart goes out to you. My dearest wish is to help and support you.
Miscarriage is rare but it’s the commonest complication of pregnancy. About 1 in 4 women experience at least 1 miscarriage. It can be a very distressing and frightening experience in itself. The loss of a baby is devastating. Everyone’s experience is unique, and there’s no ‘right’ way to feel about it.
1. What Is It?
A miscarriage happens when a pregnancy ends before 20 weeks – the halfway stage of pregnancy.
Usually there’s spotting and bleeding, with cramps, back pain or abdominal pain. It’s important to check in with your doctor whether to go to the surgery, hospital A & E, or an early pregnancy unit (EPU) for assessment.
An ultrasound scan confirms the miscarriage when there’s no heartbeat present. Blood samples are drawn to check the HCG levels, full blood count for monitoring blood loss. This may include your Rhesus factor. If this is ‘Rh-negative’ an injection of Rh immunoglobulin is required to safeguard a future pregnancy.
2. Mind Your Womb
After miscarriage the womb may empty naturally. This conservative approach is called ‘watchful waiting’. The uterine lining is very thick in pregnancy and the contractions of the uterus are often very painful. It’s the same as labour pain. Not every woman has a lot of pain. Bleeding usually stops after several for days or may continue for longer. It depends on the stage of pregnancy. You may be advised to take your baby’s remains to hospital for lab tests.
When miscarriage isn’t complete an oral medication – methotrexate – may be prescribed to help the uterus contract and release any residual tissue. Otherwise, there’s a risk of infection setting in.
If the medication isn’t helping the process, a surgical procedure clears the womb lining. This is done under general anaesthetic and is often referred to as a D & C, or ERPC (evacuation of retained products of conception).
There may be further bleeding and cramping pain for up to a week or so afterward the operation.
There’s a risk of infection after surgical intervention. Look out for fever, chills and abdominal pain. Rest, pain meds, and recovery at home are important. Remember to complete any course of prescribed antibiotics.
Scar tissue may accrue in the uterus or cervix – known as Asherman syndrome it can prove unhelpful to fertility.
3. Mind Your Mental Health
Whatever you’re feeling is real and valid. It doesn’t matter how early your baby loss happens. It’s so sudden, unexpected and means the loss of being a pregnant mother, becoming mama to a newborn, and all those joyful milestones of first smiles, first steps and birthdays. There’s the profound shock of losing your baby coupled with the shock of bleeding heavily, severe pain and what you might see during a miscarriage. It may be the first time experiencing something beyond your control.
People around you may try to help by minimising your loss and grief: “You can have another…” or share their losses with you.
Your partner or husband may experience your loss differently, or out of synch with you.
Your grief matters, and you can grieve in any way that helps you heal.
Feelings generally cycle between numbness and disbelief, denial and anger, blame and guilt, hopelessness and anxiety. Eventually there may be acceptance of this loss as part of your family narrative, always remembered, always loved can allow you to continue growing your family.
Couples may choose a grief ceremony to acknowledge their baby when there can’t be a funeral – planting a tree, laying a wreath on grandparent’s grave, a rose cast on the shore, a memorial tattoo.
Everyone reacts differently to their pregnancy loss. About 1 in 6 women go on to develop post -traumatic stress, especially after early pregnancy loss. Research shows women are more vulnerable to post-natal depression after previous miscarriage.
I offer a brief and effective therapy known as EMDR to help my clients heal from miscarriage. Eye Movement Desensitization and Reprocessing is well researched and proven to help people recover from trauma, loss and grief.
4. What About My Period Returning?
Your body and mind need to heal after pregnancy loss, and getting used to not being pregnant. Depending on whether miscarriage was natural or treated with medication and surgery, the amount of bleeding periods usually return quickly.
Your next period may be early or late, and take a few cycles to regulate.
5. When Can I Conceive Again?
It’s possible to conceive even before having a period as quickly as two weeks following a miscarriage, because ovulation happens before a period.
There’s no increased risk of having another miscarriage if you conceive soon after loss. Some women prefer to check with the doctor in case of medical reasons to wait before trying to conceive again.
Recommendations are to avoid penetrative sex, toys and tampons until all pain and bleeding stop. Many like to have regular periods established first.
Research shows that women who conceive again within 6 months of miscarriage have reduced risk of pregnancy loss.
IVF increases risk of miscarriage, so a brief intervention like the EMDR I offer can reduce anxiety before a new cycle.
6. Why Should I Wait?
If there’s been a lot of heavy bleeding leading to anaemia
If pain and bleeding persist more than 7 days after a miscarriage it needs medical investigation and treatment.
If you’ve had surgery after ectopic pregnancy – Salpingectomy – to remove a damaged Fallopian tube.
If you’re not ready yet – grieving hard, feeling anxious or depressed.
If your doctor wants to investigate your fertility health to help prevent future pregnancy loss. This may check for causes related to thyroid function, swabs infection, underlying medical conditions and medications, endometriosis and polycystic ovarian syndrome (PCOS), uterine scans for shape, fibroids, and tubal patency, blood clotting issues, dna, and lifestyle areas of diet, weight, smoking and caffeine intake for both partners.
If you’re awaiting test results from your baby.
7. What Are The Other Types Of Miscarriage?
Missed miscarriage – also known as a silent or delayed miscarriage, often discovered when no heartbeat is detected at ultrasound.
Chemical pregnancy – happens within 5 weeks of a positive test. It’s often diagnosed when a heavy period follows a positive pregnancy test.
Ectopic pregnancy – when a fertilised egg implants outside the womb, often in a Fallopian tube, which cannot nourish a pregnancy. This occurs in about 1% of pregnancies. Loss usually occurs between 6-16 weeks.
Blighted ovum – early pregnancy miscarriage (7-12 weeks) where a fertilised egg implants in the uterus, but never develops into an embryo.
Molar pregnancy – few people have heard of this type of pregnancy which is a rare. Cells destined to be placenta cells – trophoblasts – can form fluid-filled cysts, stopping fetal growth which may be absent entirely.
TFMR – terminating a pregnancy for medical reasons. A pregnant mother with medical or pregnancy complications posing a significant threat to her life, or that of her baby, may confront the possibility of ending the pregnancy. When an unborn baby is diagnosed with a life limiting medical condition, or fatal fetal abnormality, parents may face the heart-breaking decision to end the pregnancy.
Late miscarriage – pregnancy loss in the second trimester of pregnancy when a baby dies in the womb between 14 and 24 weeks of gestation. The risk od this is low, happening in 1-2% of pregnancies.
Recurrent miscarriage – three or more miscarriages in a row. It’s rare, affecting about 1% of pregnancies.
Stillbirth – is the death of a baby in the womb after 24 weeks of pregnancy but before or during birth.
Myth Busting Around Miscarriage
Q. Why did I miscarry? What did I do wrong?
A. Rarely is it possible to pin-point a reason for pregnancy loss. That makes it easy to start blaming yourself or finger-pointing. The commonest cause is believed to be chromosomal abnormalities occurring entirely by chance.
Q. Was it the few drinks I had before I even knew I was pregnant?
A. Many women who have alcohol in early pregnancy go on to have healthy babies. Heavy drinking ups risks and is never recommended.
Q. Did my stress and anxiety cause it?
A. NO! Stress and anxiety don’t cause miscarriage.
Q. We had lively sex and I orgasmed – did that harm my pregnancy?
A. Sex in pregnancy is fine, totally normal and good for you and your body. Unless you had cervix or placenta issues in a previous pregnancy. If either of you have sex with different partners condoms re essential to reduce risk of infection.
Q. Was I over-exercising?
A. There’s no evidence that exercise brings on miscarriage. Babies are very securely anchored in the womb. Regular exercise of like you usually enjoy is fine.
Q. The cat jumped on my belly – did that do it?
A. NO! Your womb is waaay down inside your pelvis, protected by heavy bones.
Q. Did I eat the wrong food?
A. Eating well nourishes your baby. Food poisoning does pose very slight risk. It’s helpful to avoid raw or undercooked meat, poultry, burgers, liver, ham, pork, sausages, and limit sushi, mackerel and tuna. Paté and deli coleslaw, raw milk, mouldy/green cheese, raw eggs.