WHAT YOU NEED TO KNOW ABOUT MISCARRIAGE
Miscarriage is a term used for a pregnancy that ends on its own, within the first 20 weeks of gestation.
Most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed about miscarriage, in the unfortunate event that you find yourself or someone you know faced with one.
If a miscarriage happens during the second trimester of pregnancy (between weeks 14 and 26), it's sometimes the result of an underlying health condition in the mother.
For most women, a miscarriage is a one-off event and they go on to have a successful pregnancy in the future.
There can be many confusing terms and moments that accompany a miscarriage. There are different types of miscarriage, different treatments for each, and different statistics for what your chances are of having one.
If you have experienced multiple miscarriages, you have been on a journey that few people understand. It is one filled with waiting, hope, fear, anxiety, terrible disappointment, grief, and so much uncertainty. Not to mention the physical effects of intense hormonal surges and drops, and the heart-wrenching emotional toll. All this can seem insurmountable when you are experiencing it.
For many women, this tumultuous combination results in a deep sense of alienation and isolation. Because about 20 percent of pregnancies end in miscarriage, it isn't hard to find someone who's been through a similar situation. But recurrent miscarriage is a relatively rare experience: Only 5 percent of women have two miscarriages, and only 1 percent of women have three or more.
After a loss, women report feeling:
Very afraid of being pregnant again and very afraid of not being pregnant again
A loss of innocence – meaning now that the worst has happened, it can seem that there is no way to recapture the sense of joy or ease around trying to conceive or conceiving
Detached and terrified at the same time
Numb from the cycle of anxiety and disappointment
Alienated from others who say insensitive things like, "Everything happens for a reason," or "You're young. Try again."
Distrustful of medical professionals who treat this kind of loss as ordinary
Worried about what they might have done to cause it
That their body is "broken" or that they have "failed"
During a subsequent pregnancy, women described:
Having anxiety about every sensation that they don't recognize as "usual"
Being vigilant for blood in their underwear or other signs of miscarriage
Wanting to avoid any future planning, such as planning a baby shower or shopping for the nursery
Worrying that their need to protect themselves from disappointment will keep them from making a healthy attachment to their pregnancy
Feeling as if they are always holding their breath
Constantly ticking off the timetable in relation to the time of their last loss
Experiencing disbelief if their pregnancy continues past that point
Feeling simultaneously happy like the "sun is shining" and afraid that "a big thunder cloud is threatening"
If you have experienced multiple miscarriages, there are many other ways you may be feeling. These experiences are normal, understandable, and happen often.
Here are some coping techniques you can try:
Figure out what you need to know about recurrent miscarriage so you can work with your doctors to come up with a plan for taking the next steps. Uncertainty can make you feel helpless. Learning what you can will help you regain a sense of control in the process.
Work with a healthcare provider who "gets it". If you feel your doctor or midwife doesn't understand how you may be feeling during or between pregnancies or take your concerns seriously, find one who does. You will benefit from a compassionate healthcare provider who will listen as well as provide you with the information and support you need.
Reach out to people you trust. Identify the people in your life you feel comfortable opening up to and who can handle your simultaneous emotions, such as fear about and fragile hope for a full-term pregnancy. Many people don't understand the seemingly conflicting feelings this experience can bring. Find someone who is willing to listen without judgment.
Join a support group, online or in person, of women who have experienced recurrent miscarriage. Talking with women who truly understand what you are going through can make a huge difference in your sense of isolation. But if you find your participation is increasing your anxiety, step away when you need to. Take care of yourself above all.
Pay attention to your sleeping and eating. Grief and stress can interfere with your regular sleep cycle (making you wake up early in the morning or get sleepy in the afternoon, for example) and make it hard to eat healthfully. Do what you can to maintain a regular bedtime and provide yourself with nutritious food. This will help stabilize your emotions and give you the strength you need to weather all of them.
Get moderate exercise if your provider says it is ok. Physical activity – even just a walk around the block – can bring you out of your head, regulate your body and mind, and help you feel more like yourself.
Consider one-on-one supportive counselling so you can feel free to say anything, no matter how dark or scary. You will most likely have these types of thoughts and feelings, and it can help to get them out so you don't end up believing the worst-case scenarios and so you know that what you are feeling is ok. Look for health professionals who specialize in reproductive health issues.
Why Do Miscarriages Occur?
The reason for miscarriage is varied, and most often the cause cannot be identified. During the first trimester, the most common cause of miscarriage is chromosomal abnormality – meaning that something is not correct with the baby’s chromosomes. Chromosomes are blocks of DNA. They contain a detailed set of instructions that control a wide range of factors, from how the cells of the body develop to what colour eyes a baby will have.
Most chromosomal abnormalities are the cause of a damaged egg or sperm cell or are due to a problem at the time that the zygote went through the division process. If a baby has too many or not enough chromosomes, it won't develop properly.
Other causes for miscarriage include (but are not limited to):
Hormonal problems, infections or maternal health problems
Exposure to radiation or toxic substances
Implantation of the egg into the uterine lining does not occur properly
Smoking during pregnancy
Drug misuse during pregnancy
Drinking more than 200mg of caffeine a day – one mug of tea contains around 75mg of caffeine, and one mug of instant coffee contains around 100mg of caffeine; caffeine is also found in some fizzy drinks, energy drinks and chocolate bars
Drinking more than two units of alcohol a week – one unit is half a pint of bitter or ordinary strength lager, or a 25ml measure of spirits, and a small 125ml glass of wine is 1.5 units
Paternal factors: Little is known about how the father's condition contributes to a couple's risk for miscarriage, though the risk does rise with the father's age. Researchers are studying the extent to which sperm could be damaged by environmental toxins but still manage to fertilize an egg. Some studies have found a greater risk of miscarriage when the father has been exposed to mercury, lead, and some industrial chemicals and pesticides.
Your risk of miscarriage is also higher if you get pregnant within three months after giving birth.
Other risk factors include:
Long-term health conditions
Several long-term (chronic) health conditions can increase your risk of having a miscarriage in the second trimester. These are:
diabetes (if it's poorly controlled)
severe high blood pressure
an overactive thyroid gland
an underactive thyroid gland
Problems and abnormalities with your womb can also lead to second trimester miscarriages. Possible problems include:
non-cancerous growths in the womb called fibroids
an abnormally shaped womb
In some cases, the muscles of the cervix (neck of the womb) are weaker than usual. This is known as a weakened cervix or cervical incompetence.
A weakened cervix may be caused by a previous injury to this area, usually after a surgical procedure. The muscle weakness can cause the cervix to open too early during pregnancy, leading to a miscarriage.
What are the chances of having a miscarriage?
For women in their childbearing years, the chances of having a miscarriage can range from 10-25%, and in most healthy women the average is about a 15-20% chance.
An increase in maternal age affects the chances of miscarriage
Women under the age of 35 yrs old have about a 15% chance of miscarriage
Women who are 35-45 yrs old have a 20-35% chance of miscarriage
Women over the age of 45 can have up to a 50% chance of miscarriage
A woman who has had a previous miscarriage has a 25% chance of having another (only a slightly elevated risk than for someone who has not had a previous miscarriage)
Miscarriages are much more common than most people realise. Among women who know they're pregnant, it's estimated one in six of these pregnancies will end in miscarriage. Many more miscarriages occur before a woman is even aware she has become pregnant.
What are the warning signs of miscarriage?
If you experience any or all of these symptoms, it is important to contact your health care provider or a medical facility to evaluate if you could be having a miscarriage:
Mild to severe back pain (often worse than normal menstrual cramps)
True contractions (very painful happening every 5-20 minutes)
Brown or bright red bleeding with or without cramps (20-30% of all pregnancies can experience some bleeding in early pregnancy, with about 50% of those resulting in normal pregnancies)
Tissue with clot like material passing from the vagina
Sudden decrease in signs of pregnancy
What happens if you have a miscarriage?
If there's no pregnancy tissue left in your womb, no treatment is required.
However, if there's still some pregnancy tissue in your womb, your options are:
expectant management – wait for the tissue to pass naturally out of your womb
medical management – take medication that causes the tissue to pass out of your womb
surgical management – have the tissue surgically removed
The risk of complications is very small for all these options. It's important to discuss these options with the doctor in charge of your care.
Why Bleeding Doesn't Always Mean Miscarriage
You're finally there. Just about through your first trimester of pregnancy, you are anxiously looking forward to telling all your family and friends about your upcoming bundle of joy. You are nervous, excited, and still a little bit nauseous, but you're so ready to spill the beans on baby.
And then, one morning, you wake up to blood in your underwear. Your first thought is simple--and scary--does this bleeding mean you are having a miscarriage?
What you need to know
The first thing you need to do if you are experiencing bleeding during early pregnancy is, don't panic! Bleeding during a pregnancy does not always mean that a miscarriage is imminent. Bleeding can occur in a completely healthy pregnancy. In fact, many women experience some form of bleeding, especially in the early weeks, during their pregnancies.
Causes of bleeding during pregnancy
Instead, as many women discover after visiting with their pregnancy care providers, vaginal bleeding during pregnancy can be normal and not an immediate cause for concern. Some types of bleeding can be caused by implantation, (most commonly occurring the day your period is due) an infection of some sort in the body, or irritation (like from intercourse).
Dr. Elizabeth Nowacki, an OB/GYN at St. Vincent Fishers Hospital Indianapolis explains that one of the most common causes of bleeding is "lag time" before the placenta is fully formed. Before the placenta starts forming around 12 weeks, the ovary that released the egg provides the main source of hormonal support to the pregnancy, which can cause some time to pass before the placenta is ready to go, and thus, bleeding. "It always seems to happen at 2 o'clock in the morning!" says Dr. Nowacki. "If it's just light spotting or spotting with wiping, it's not a big deal and you can wait to call your doctor in the morning."
Bleeding that occurs later on during a pregnancy, in the second and third trimesters, can also have different causes that won't result in a miscarriage, such as cervical irritation (again, which can occur after intercourse) or even cervical changes (a growth or polyp on the cervix may cause slight bleeding).
Sometimes, the outside of the cervix (which connects the uterus to the vagina) can bleed or an area of bleeding can occur in the space between the placenta and the uterus, which will usually resolve on its own. Slight bleeding, especially if it is tinged with a mucus-like discharge, could also be a sign of early labour.
Some bleeding during pregnancy is simply unexplained; a patient can experience moderate bleeding, almost as heavy as her regular period flow, throughout her pregnancy--with no known cause and no need for any further treatment. She can be delivered of healthy infants in full-term. And who among us hasn't heard the stories of women who didn't know they were pregnant because they continued to have monthly bleeding? Bleeding that is not a direct indication of a miscarriage can definitely occur during pregnancy.
What should I do if I experience bleeding?
Although bleeding during pregnancy may not necessarily mean a miscarriage is inevitable, consistent bleeding at any point during a pregnancy always needs to be evaluated by a healthcare provider. If you are experiencing bleeding, take the following steps:
- Note the time the bleeding started and any activities that may have contributed to the bleeding (for instance, did you have intercourse in the last 24 hours or have a vaginal exam performed recently?).
- Place a pad or panty-liner (never use a tampon!) for absorption and as a means to gauge the amount of bleeding. Your healthcare provider may ask you how quickly you are filling up a typical overnight pad as a way to determine how much bleeding you are experiencing. Also be sure to note the colour of the blood--your doctor may need to know if it is bright red or brown in colour.
- While waiting to be seen by your doctor, try to sit down, put your feet up, and drink a large glass of water.
- Ask yourself if you are experiencing any other symptoms such as contractions, back pain, nausea, vision changes, or decreased activity of the baby.
The Different Types of Miscarriage:
Miscarriage is often a process and not a single event. There are many different stages or types of miscarriage. There is also a lot of information to learn about healthy fetal development so that you might get a better idea of what is going on with your pregnancy. Understanding the early fetal development and first-trimester development can help you to know what things your health care provider is looking for when there is a possible miscarriage occurring.
Most of the time all types of miscarriage are just called miscarriage, but you may hear your health care provider refer to other terms or names of miscarriage such as:
Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.
Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.
Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
Blighted Ovum: Also called an embryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.
Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.
Molar Pregnancy: The result of a genetic error during the fertilization process that leads to the growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.
Treatment of Miscarriage:
The main goal of treatment during or after a miscarriage is to prevent haemorrhaging and/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a dilation and curettage, known as a D&C. Drugs may be prescribed to help control bleeding after the D&C is performed. Bleeding should be monitored closely once you are at home; if you notice an increase in bleeding or the onset of chills or fever, it is best to call your physician immediately.
Prevention of Miscarriage:
Since the cause of most miscarriages is due to chromosomal abnormalities, it's not usually possible to prevent a miscarriage but one can employ some ways to reduce the risk. One vital step is to get as healthy as you can before conceiving to provide a healthy atmosphere for conception to occur.
Keep weight within healthy limits
Take folic acid daily
Do not smoke
Once you find out that you are pregnant, again the goal is to be as healthy as possible, to provide a healthy environment for your baby to grow in:
Keep your abdomen safe
Do not smoke or be around smoke
Do not drink alcohol
Check with your doctor before taking any over-the-counter medications
Limit or eliminate caffeine
Avoid environmental hazards such as radiation, infectious disease, and x-rays
Avoid contact sports or activities that have risk of injury
Unfortunately, miscarriage can affect anyone. Women are often left with unanswered questions regarding their physical recovery, their emotional recovery and trying to conceive again. It is very important that women try to keep the lines of communication open with family, friends and health care providers during this time.
After a miscarriage
A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.
Misconceptions About Miscarriage
An increased risk of miscarriage is not linked to:
a mother's emotional state during pregnancy, such as being stressed or depressed
having a shock or fright during pregnancy
exercise during pregnancy – but discuss with your GP or midwife what type and amount of exercise is suitable for you during pregnancy
lifting or straining during pregnancy
working during pregnancy – or work that involves sitting or standing for long periods
having sex during pregnancy
travelling by air
eating spicy food
Having Sex and Trying for Another Baby
You should avoid having sex until all of your miscarriage symptoms have gone. Your periods should return within four to six weeks of your miscarriage, although it may take several months to settle into a regular cycle.
If you don't want to get pregnant, you should use contraception immediately. If you do want to get pregnant again, you may want to discuss it with your healthcare provider. Make sure you are feeling physically and emotionally well before trying for another pregnancy.
It's important to remember that most miscarriages are a one-off and are followed by a healthy pregnancy.
....making effort to "STAYWELL"