The loss of a pregnancy can be an extremely challenging time for you and your loved ones and it is vital that expectant parents get the right support throughout this difficult time. Although miscarriages are common, affecting 15-20% of pregnancies, such a loss can be devastating and can often leaves parents feeling isolated due to the lack of conversation surrounding the subject. WellVine wants to open up that conversation and provide parents with the support they need.
One of WellVine’s experienced GPs, Dr. Anna Brodski, has an extensive knowledge of miscarriage and the various ways it can have an impact on you, both emotionally and physically. Below, Anna has provided a doctor’s perspective on the most common questions asked about miscarriages:
What is miscarriage?
Miscarriage is the most common form of pregnancy loss (1 in 4 pregnancies end this way) and is defined as the loss of a pregnancy during the first 23 weeks. In the majority of cases, having a miscarriage does not reduce the chances of falling pregnant and giving birth to a healthy baby in the future. When a pregnancy is lost in early stages, it is called a miscarriage. Miscarriages in the first trimester can be divided into different types: threatened, inevitable, incomplete and missed miscarriage. If the loss occurs after 24 weeks, it is referred to as a stillbirth.
Threatened miscarriage: In this scenario, you experience symptoms that may indicate a possible miscarriage (e.g. vaginal bleeding and pain), but an ultrasound scan does not reveal any cause for alarm; the doctor may suggest that this is a threatened miscarriage. This means that the symptoms may settle and the pregnancy may be successfully carried to term. However, there could be a potential risk of miscarriage and your doctor will discuss this with you and make recommendations. Please remember than many women experience vaginal bleeding in the early days of pregnancy; while such bleeding may turn out to not be related to anything serious, it is always advisable to seek the help of a healthcare professional who can guide you on the next steps, including getting a scan if necessary.
Inevitable miscarriage: This is a scenario where the miscarriage is underway and cannot be avoided, for example: the cervix may be open, and the bleeding may be heavy and increasing. The doctor will be able to identify this on a scan and conclude an inevitable miscarriage.
Incomplete miscarriage: In an incomplete miscarriage, you will also experience symptoms of a miscarriage (e.g. vaginal bleeding and pain) but the ultrasound scan shows that foetal tissues have already been partially expelled from the uterus and therefore a miscarriage is almost certain.
Missed miscarriage: In some cases, you will experience none of the usual symptoms of a miscarriage and you will only find out at a routine scan that the embryo has stopped developing. This is called a missed or silent miscarriage.
More information on miscarriage symptoms can be found here.
Experiencing any of these types of miscarriage can be heartbreaking and alongside the physical symptoms, there is often a big emotional impact on you and your family. It is perfectly normal to go through a grieving process for your loss, which can be especially hard to deal with if you haven’t yet told any of your family, friends or work colleagues that you were expecting. Every family’s experience of miscarriage will be different. It is important to allow yourself to experience the feelings you may be having, and to seek support in a way that suits you and your family.
More information on types of emotional support available to parents can be found here.
What causes miscarriages?
There is still a lot we don’t know about miscarriage and most women never find out the cause of the their loss, even after having investigations.
However, the following causes have been implicated:
- Genetic: the genetic material from sperm and woman’s egg do not combine in an orderly way;
- Blood clotting issues in the mother;
- Infection such as rubella;
- Hormonal abnormalities in the mother;
- Anatomical problems including large fibroids, weak neck of the womb and irregularly shaped womb
It is very natural to want to know why a miscarriage happened and it can be hard to come to terms with the lack of answers. Not knowing can result in a feeling of guilt or anxiety, but try to bear in mind that many miscarriages are a result of a one-off problem with the development of the foetus. It is very unlikely to have happened because of anything you did or didn’t do.
Is there anything that raises the risk of miscarriage?
There are a few things that increase the risk of miscarriage. These include:
- Drug misuse during pregnancy
- Excessive caffeine consumption
- Alcohol consumption (even small amounts have been implicated)
- Increased maternal age
If you think that you may be at a raised risk of having a miscarriage due to any of the above, you can discuss your concerns with a WellVine medical professional or your local GP.
What investigations will I have?
To find out whether you have had or are having a miscarriage, an ultrasound scan is the most important action. If your ultrasound scan is inconclusive, you will be offered a follow up scan usually within a week and you may also be offered blood tests for hormonal levels.
Recurrent miscarriages get investigated with mapping out of the parental genetic material as well as foetal genetic material, pelvic ultrasound and investigations for clotting abnormalities in the mother.
What are common miscarriage signs & symptoms?
The symptoms of miscarriage are pelvic cramps and bleeding. The amount of blood loss can vary from nothing (missed miscarriage) to spotting, to heavy blood loss. So can the pain. Some women get very little pain or none (like in missed miscarriage) while others have more pronounced pelvic cramps. In practice however, psychological suffering goes hand in hand with physical symptoms, and most women feel very emotional and anxious, which is entirely natural under the circumstances.
Vaginal bleeding with or without pain can be a sign of miscarriage. However sometimes there may be no other signs as in missed miscarriage.
What should I do if I am having a miscarriage?
In case of vaginal bleeding, especially heavy with or without pain, it is a good idea to seek medical help. Usually going directly to your nearest early pregnancy unit is the quickest way to get assessed and to have a scan done. If it is of out of hours, going to A&E is an alternative.
What happens to my body during a miscarriage?
During a miscarriage, foetal tissue that is not surviving separates from the lining of your womb causing bleeding. This can cause pain that feels like a period. You may be passing clots, which include foetal tissue.
You may experience bleeding that may be heavier than usual, as well abdominal cramps. The bleeding may last up to two-three weeks or more. Occasionally, however, if larger clots get stuck in the neck of the womb, the woman may experience severe pain and very heavy bleeding and dizziness. This is rather rare, however if this happens, it is reasonable to call for an ambulance and be taken directly to A&E.
Experiencing these symptoms can be very upsetting and it is important that we acknowledge the emotional impact of what is happening too. You may experience all or none of the following: sadness, guilt, grief, anger, anxiety, fear and shock.
How do I cope with the emotional impact of the miscarriage? Can I get help somewhere?
Losing a baby can have a big emotional impact and it is important to remember that your miscarriage is very unlikely to have been due to anything that you did or did not do.
Having a miscarriage can be a deeply upsetting experience and early pregnancy unit doctors and specialist midwife/nurses can signpost to counselling for women undergoing miscarriage. If you or your partners are having problems coping with your grief, you may need further counselling and there are support groups that can help you as well. Details of how to find support groups and counselling services near you can be found here.
Talking to other women who have gone through the experience may be a great source of support. You could also consider making use of online forums such as those offered by the Miscarriage Association. Also it may be helpful to give the baby that has been lost a name when you talk about it with your partner. Some women feel it is very helpful to write a letter to the baby they have just lost.
How will doctors tell if I have had a miscarriage?
After a scan, the doctors will be able to tell if you are having a miscarriage. In some cases, when it is difficult to tell because it is too early on in the pregnancy, they will arrange for a follow up scan.
If subsequently a miscarriage is confirmed and all the foetal tissue has come out as blood and clots, nothing further needs to be done. However if there is remaining foetal tissue in the womb, you may be offered a choice of expectant (conservative), medical or surgical management.
With expectant or conservative management, we wait for the body to naturally expel foetal tissues. This is possible when your condition is stable and you feel comfortable waiting.
Medical management relates to the use of tablets or vaginal pessaries to progress the process of miscarriage. This is an option for when your condition is stable, but you don’t wish to wait for the foetal tissue to be expelled naturally and yet, you prefer to avoid invasive procedures such as surgery.
Surgical management, or surgical evacuation of foetal tissue, is done under general anaesthetic if the tissue is stuck in the neck of the womb causing excessive bleeding and pain. There is also the option of surgical care of miscarriage under local anaesthetic, using manual vacuum aspiration (MVA). During an MVA, local anaesthetic is applied to the cervix (neck of the womb) to numb any pain, and a narrow tube is then used to enter and empty the womb using gentle suction.
Following a miscarriage, when can we try to conceive again?
You can try to conceive again when you feel emotionally and physically ready to do so. Some women do find comfort in this knowledge. Do keep in mind that following a miscarriage, you can continue to test positive for pregnancy for days, and in some cases weeks. Trying for a baby immediately after miscarriage can result in a confusing positive pregnancy test, when it is not clear whether it is still positive due to the pregnancy just lost or the woman is pregnant again. This situation can result in distress in some cases.
It is often suggested to wait for at least one period before trying again, although this is primarily for the purpose of being able to accurately identify a date of conception of a potential pregnancy.
What are the chances that it will happen if I get pregnant again?
With first trimester miscarriages that are not recurrent, the chances of falling pregnant again are not impacted.
With recurrent miscarriage (i.e. having three miscarriages in a row), further chances of conceiving may change. However, recurrent miscarriages only affect 1% of women. This really depends on whether there is an underlying problem such as a clotting disorder. The doctors will usually run tests and inform you of the results. They will also provide guidance on how to increase the chances of carrying the next pregnancy to term.
Miscarriages can be devastating, and expectant parents may feel the emotional trauma far longer than the physical symptoms and experience of miscarriage. While it is often said that miscarriages are nature’s way of ensuring that pregnancies that reach full-term produce healthy babies, this may be of little comfort to the expectant mums and dads. It is important to remember that the following do not cause miscarriage: spicy food; having sex during pregnancy; a woman’s emotional state; and working during pregnancy. With the exception of recurrent miscarriage, future chances of having healthy babies are not affected. Please do reach out to a WellVine doctor if you have any further questions on miscarriage. We are here to help.