About Miscarriage Trauma...
Miscarriage can be a traumatic event in the life of any woman. Also referred to as spontaneous abortion, miscarriage is the end or premature termination of pregnancy in which the fetus is not developed enough to survive. Although there is no particular cause of miscarriage there may be several contributing factors. Such factors may include disease, infection, poor nutrition, abnormalities of the uterus, alcohol and/or drug use and physical trauma.
Symptoms of miscarriage can include a brownish discharge, light to heavy vaginal bleeding, abdominal cramps and back pain. A piece of whitish tissue may pass through the vagina along with the bleeding. A woman that experiences pain or bleeding should consult her physician immediately. Any remaining material must be removed following a miscarriage to prevent infection. This is done by a surgical procedure called a D and C (Dilation and Curettage). It consists of scraping the residual material from inside the uterus.
Miscarriage commonly occurs in the early stages of pregnancy and may occur shortly after the first period has been missed before the woman even has any confirmation of pregnancy. Although there are usually no lasting adverse physical effects from miscarriage, the emotional trauma can be more devastating particularly the further along a woman is in her pregnancy. To know there is a life growing within your body and then suddenly it is gone is quite an emotional blow.
Many women suffer from depression following a miscarriage. This is normal when dealing with loss. But in the event that the depressed state worsens or tends to be prolonged professional help should be consulted such as a grief counselor or other trained professional.
Subsequent healthy pregnancies can occur after miscarriage. As long as the physician finds the woman to be healthy and capable of carrying a pregnancy to full-term, there is no reason why she should not try again. Many women who have miscarriages also have perfectly normal births and deliver beautiful, healthy babies.
You see I know women that have a miscarriage can still have normal births and healthy children because I had two miscarriages but I also have four healthy children. My mother was told that she would probably never be able to have children but then she gave birth to me.
Sometimes nature works in mysterious ways. A miscarriage may occur with no apparent physical cause but nature may know best even if we don’t. At times a fetus may be defected or deformed in some way that goes undetected. Miscarriage may be nature’s way of saving a child from a lifetime that would be miserable and painful. As mothers, we don’t want to hear excuses. We would choose to have our child live and care for him or her no matter what that care involved. But this is where we would need to think of the child and what he or she may have had to endure had the child survived. Remember that everything happens for a reason even if we can’t understand.
Take care of yourself and don’t give up hope.
Understanding Late Miscarriage
Written for BabyCentre UK
Approved by the BabyCentre Medical Advisory Board
How common are late miscarriages?
What causes a late miscarriage?
How do I know if I'm having a late miscarriage?
What happens after the miscarriage?
Will I be able to find out what went wrong?
What practical arrangements need to be made?
I can't seem to get over the loss of my baby. Where can I find help?
How will my body recover?
Am I more likely to have another miscarriage?
How common are late miscarriages?
About 98 per cent of women who miscarry do so in the first 13 weeks, but miscarriages can also occur much later in pregnancy. The loss of a pregnancy that occurs between the 14th week and 24 completed weeks is usually referred to as a late miscarriage. It may also be called a late loss, second trimester loss or mid-trimester loss.
In technical and legal terms, "stillbirth" is used specifically to refer to a baby who was born dead after 24 weeks. However, many parents who have lost a baby after 14 weeks prefer the term stillbirth, since they feel that the word "miscarriage" - although technically correct - underestimates the gravity and impact of their loss.
What causes a late miscarriage?
There are a number of possible reasons for a late miscarriage, including:
• problems with the placenta, such as bleeding, placental insufficiency (where the baby does not receive the optimum amount of oxygen and nutrients) or placental abruption (premature separation of the placenta)
• problems with the uterus (womb), such as a weak cervix, fibroids or an abnormally shaped uterus
• an infection in the mother caused by organisms that can cross the placenta, such as listeriosis or toxoplasmosis, or that can cause premature labour, such as Group B Streptococcus
• other problems affecting the mother's health such as auto-immune disorders, diabetes, epilepsy, high blood pressure, kidney disease or sickle cell disease
• problems with the baby's development (including chromosomal abnormalities, Edwards' syndrome, neural tube defects, hydrocephalus, rhesus incompatibility, congenital heart problems) or a multiple pregnancy.
Unfortunately, two of the tests used to detect abnormalities in babies - amniocentesis and chorionic villus sampling (CVS) - can also cause miscarriages. Amniocentesis, generally performed between the 15th and 18th week of pregnancy, results in miscarriage for around 1 per cent of women. CVS, which is performed at around 12 weeks of pregnancy, causes miscarriage in between 1 and 2 per cent of women.
Women who are expecting two or more babies have a higher risk of miscarriage and stillbirth.
Age also plays a role. The miscarriage rate increases substantially from age 30, and increases again from age 35. Older women are also more likely to conceive babies with chromosomal abnormalities, and these pregnancies are more likely to be lost.
How do I know if I'm having a late miscarriage?
The most obvious signs of late miscarriage are labour-like pains, bleeding (which may be heavy and include blood clots), or a rupture of the membranes (waters). This is called a spontaneous miscarriage.
However, sometimes there are no warning signs and the miscarriage is discovered only during a routine antenatal visit, when the doctor or midwife can't find the baby's heartbeat. This is called a "silent" miscarriage or an intra-uterine death.
If this happens labour may have to be induced (started artificially) to deliver the baby and you will be admitted to hospital. Some parents want to have the induction as soon as possible, others prefer to wait for a few days so that they have time to take in what has happened and to see if the labour starts naturally. Doctors will advise you on the timing of an induction, as a long delay can have adverse effects on your health.
What happens after the miscarriage?
Depending on the stage of your pregnancy and circumstances of your loss, you may be asked if you would like to see, touch or hold your baby. Research has shown that many parents find this practice extremely helpful. If you want to see your baby but are worried about what he or she might look like, you could ask the midwife to describe the baby first, or look at a photograph, or perhaps one partner can look. Some parents choose to take photographs of the baby. They may also choose to wash and dress the baby. However, if the baby is very premature, bathing may not be possible as the baby’s skin may be too fragile.
You may find that creating memories of your baby in this way provides some comfort and a focus for your grief. However, decisions about what to do in this situation are very personal, there is no right or wrong. You and your partner may have different wishes, or you may both need time to think about what would be best for you. Whatever you ultimately decide, the hospital staff should respect your wishes.
Will I be able to find out what went wrong?
This can sometimes be determined by testing your blood, examining the placenta, or conducting a post mortem examination ("autopsy") of the baby.
A post mortem examination may:
• identify a cause or causes of the death
• provide information about the baby’s development
• provide information about any health problems which will help your doctor to care for you in a future pregnancy
• confirm the baby’s sex.
A post mortem does not always provide a specific reason for what happened and this can be very frustrating. You do not have to agree to a post mortem examination. Some parents decide against it because of personal, religious or cultural reasons.
To help you make a decision, the hospital staff should give you as much information as you need. No investigations or tests will be done without your consent, and your views and wishes should be respected. You may need a little time to think about your decision. However, the sooner the post mortem is done, the better the information is likely to be.
If you decide to have a post mortem examination, you will be asked to give written consent before it is carried out. Depending on the size and condition of your baby, it may be possible for you to see him again after the post mortem. The staff should tell you in advance if this will be feasible and, if so, what the baby is expected to look like. If staff advise you against seeing him after the post mortem, you may want to say your goodbyes beforehand. You should also be told when the post mortem results are likely to be available, and given an appointment to discuss them with the doctor.
What practical arrangements need to be made?
If you miscarried before 24 weeks, the baby does not need to be registered and there is no legal requirement for a burial or cremation, although most hospitals offer a simple funeral and burial or cremation service. Alternatively, you may prefer to make your own arrangements with a funeral director. In this case you will need a form or letter from the hospital, confirming that the baby was born dead before 24 weeks' gestation - see the Miscarriage Association website for further information.
Many parents decide to mark their loss with a formal or informal memorial ceremony. There are ideas for planning a memorial ceremony, including suggestions for poems and readings, on the Sands (stillbirth and neonatal death charity website.
I can't seem to get over the loss of my baby. Where can I find help?
While some people want to get "back to normal" as quickly as possible, others need time to recover. You are coping with the trauma of loss and you need time to mourn. You might find it helpful to contact the Miscarriage Association or Sands for support and further information, or talk to people who have been through a similar experience on our Coping with miscarriage board.
How will my body recover?
During the first few weeks you will have some vaginal bleeding ("lochia") and intermittent period-like pain. If the bleeding or pain gets worse or you have a foul-smelling vaginal discharge, contact your GP straight away.
Depending on how many weeks pregnant you were, you may find that your breasts produce milk. This can be uncomfortable and very distressing, as it's a constant physical reminder of your loss. There is medication that can stop lactation. However, research shows that the discomfort can return for a short time after the course of medication is finished. Some women prefer to avoid medication and let their milk dry up naturally. If you decide to let nature take its course, your midwife should be able to suggest ways to keep you as comfortable as possible.
You will be offered a check-up after six weeks, either at the hospital or with your GP. This is a good opportunity to ask questions about the possible causes of the pregnancy loss and the implications for any future pregnancy. It may also be a chance to discuss the post mortem results if they are available. If they are not, you should be offered another appointment.
Your GP can also give you a sickness certificate for your employer if you and your GP think that you need more time to recover. It may take a little time for your body to get back to its pre-pregnancy state. Some gentle activity will aid your physical recovery and help you get your strength back. Accept offers of practical and emotional support from friends and family, but only if you find what they're offering is really helpful.
Am I more likely to have another miscarriage?
This depends on the reason for your previous miscarriage. If the cause of your baby's death is known, you'll want to find out whether it is likely to recur in another pregnancy. Discuss any possible medical factors with your GP or ask to be referred to a specialist pre-pregnancy clinic, consultant or genetic counsellor.
Auto-immune disorders, diabetes, epilepsy, high blood pressure, kidney disease or sickle cell disease can be a cause of miscarriage. However, if these conditions are well managed by you and your doctors, the risk is much lower.
If you know you had a miscarriage because of a weak cervix, you may be able to have a special stitch put round it to keep it closed until your baby is ready to be born. This is called a Shirodkar suture or cerclage.
Coping with a late miscarriage is very hard, but it may be of some comfort to know that most women are able to get pregnant again and give birth to a healthy baby. The decision to try for another baby can be difficult. It may be the last thing on your mind, or it may be all you can think about. Some women have an overwhelming urge to be pregnant again as soon as possible.
Any subsequent pregnancy is likely to be very stressful. Some women are happy to return to the same hospital and the same medical team. Others prefer to ask their GP to refer them to another consultant or another hospital. Some hospitals offer extra support to parents who have had a previous loss. You can talk to other parents in a similar situation on our Parents after loss board.
Created October 2007
