Miscarriage

Miscarriage now happens to as many as 1 in 4 women in the UK and it's a worrying statistic for all those planning to become pregnant or who are already in the early stages of their first trimester. A miscarriage is defined as the spontaneous end of a pregnancy where the foetus is incapable of surviving outside of the womb and usually occurs during the first 12 weeks of pregnancy. It can be a frightening and lonely experience for many women who may never have gone through a miscarriage before and for those who have and fear losing another baby in the same way.

The following symptoms may be associated with the onset of a miscarriage but you must always check with a health professional before you start to panic as many pregnancies go on to carry to full term despite a few niggles and pains here and there:

• Bleeding from the vagina - this may range from light pink spotting to something resembling a period or a brown discharge.
• Pain in the lower abdomen - this can be a dull ache, a sharp stabbing pain in one side or you can also experience back ache and/or pain in the shoulders.

Again, you can still experience these symptoms and not be miscarrying but it is always better to be safe than sorry. Depending on the advancement of the pregnancy and the discretion of your GP you may be told to go home and rest or to go to hospital for an ultrasound scan - if it is earlier than 6 weeks, it is highly unlikely that even a trans-vaginal scan will show anything so going home to rest, whilst frustrating and upsetting, is probably the only good advice available. There are lots of odd pains and grumbles that can be experienced during early pregnancy as the ligaments stretch and the hormones start racing to prepare for the next 9 months and beyond - but if you have any doubts or worries, go and see your GP who will be able to reassure/refer you accordingly. If this is not the first time you have miscarried, your GP will be well aware of this and will already be monitoring you more closely but even if the same symptoms as before begin to present themselves, please don't panic just yet as it does not necessarily mean the same outcome is inevitable.

What are the causes of miscarriage?

Believe it or not, no one is entirely sure. Because many miscarriages occur before anyone is aware of the pregnancy, it is hard to pinpoint an exact reason for the loss but the most likely causes are:

• Genetic: In about half of all early miscarriages, the baby does not develop normally right from the start and cannot survive.
• Hormonal: Women with very irregular periods may find it harder to conceive and when they do, are more likely to miscarry.
• Immunological: Problems within the blood vessels which supply the placenta can lead to miscarriage.
• Infection: Minor infections like coughs and colds are not harmful, but a very high temperature and some illnesses or infections, such as German measles, may cause miscarriage.
• Anatomical: If the cervix (neck of the womb) is weak, it may start to open as the uterus (womb) becomes heavier in later pregnancy and this may lead to miscarriage. An irregular-shaped uterus can mean that there is not enough room for the baby to grow. Large fibroids may cause miscarriage in later pregnancy.
• Smoking, whether passively (breathing in another's cigarette smoke) or through your own habit can increase the chance of a miscarriage and/or foetal abnormalities - it is always best to try and stop smoking before becoming pregnant or as soon as you find out.
• Drinking alcohol has been linked to miscarriage, although it issaid to be ok to drink a small amount each week if you are pregnant. Better to be safe than sorry though and cut out all alcoholic intake for the duration of your pregnancy.
• Drugs - over-the-counter and prescription drugs could possibly cause a miscarriage, so always check with your doctor or pharmacist before taking any medications whilst pregnant. Recreational drugs are incredibly dangerous anyway, without being pregnant, and if you are taking any illicit substances you run the risk of miscarriage or seriously harming your baby.

It is unlikely, however, that you have done anything to cause a miscarriage - sadly, it seems to be just one of those things that happens and there is very little chance of preventing it or stopping it once it begins.

What happens if I'm sent to hospital?

First of all, please try to stay calm - it's probably very frightening and maybe you were sent straight from the doctor's surgery to the hospital without a chance to go home first or call anyone, but be assured that the people you are going to see will be used to dealing with worried women and they will explain everything to you. Ask plenty of questions and don't be afraid to double-check anything you don't understand. When we are stressed out, we tend to miss parts of what people are saying and sometimes need further clarification just be sure. You will most likely be asked to give a urine sample which they will test for the pregnancy hormone ßHCG and may also need to check you don't have a urine infection - another cause of abdominal pain which can be similar to the sharp stabbing pains of a potential miscarriage. Then a scan will be performed to see if anything can be seen in the uterus. You will be asked to lie down and lower any clothing below the waist so that the top of your bikini line can be seen. The person doing the scan will then pour a little jelly on the area and use hand held instrument to push down and sweep over your lower abdomen - whatever he/she can see is also viewable by you on a small screen and often you will be talked through what they can see so you understand. This is completely painless, although as you will probably have a full bladder for the scan, the pressure of the instrument may make you a little uncomfortable! If nothing can be seen, they may do a trans-vaginal scan which is a smaller scanning instrument placed inside the vagina - this can feel odd and a little uncomfortable, but shouldn't be painful.

If anything can be seen, you will be told but if it really is to early to tell anything yet, you will be asked to go home and come back at a later date to repeat the process. You may be asked to give a blood test if they feel it is necessary in order to check the levels of ßHCG - this may be repeated two days later to see whether it is rising or dropping. If it doubles, it is indicative of a normal developing pregnancy. If the results are different, then it can give some indication of what may be happening inside.

Being told to go home and wait can be alarming and frustrating - you may be wondering why they aren't taking your concerns seriously - but rest assured that they come across women in your situation every day and would never send you home if they had the idea that something could be seriously wrong. If there is no pregnancy visible from the scan it could well be that you have indeed miscarried - if this is the case, they will talk you through what has happened and answer any questions you may have. If you are still experiencing a lot of pain and/or bleeding they may wish to do further tests to eliminate the possibility of an ectopic pregnancy - one that develops outside of the womb.

Further investigations? Don't like the sound of that...

Who does? But trust me - it is essential that they eliminate the option of an ectopic pregnancy as if it is left to continue, it could rupture and become a life-threatening situation. In Angel's blog, Guess who almost died??, she writes about a rare situation whereby she conceived twins but whilst one was miscarried from the womb, the other was lodged in her Fallopian tube and because she wasn't displaying textbook signs of an ectopic pregnancy, it was missed for almost 4 weeks. The embryo finally ruptured and she was rushed to theatre where she almost died. Scary stuff and yes, it is an extreme example, but the truth is that an ectopic pregnancy can endanger the mother's life and therefore will have to be removed upon discovery. Catch it early enough and you will be able to save the Fallopian tube - ignore the symptoms and you could ultimately be left with only one tube and ovary. Sharp pain in one side, fever, dizziness and vaginal bleeding are all signs that a pregnancy may be ectopic so you must see your GP immediately so that the appropriate care can be sorted out for you. An ectopic pregnancy happens to 1 in 100 women each year and the pregnancy never survives, so whilst it is shocking and incredibly upsetting to lose your baby please understand that there is nothing you could have done to prevent it and there is no medical way of saving the baby either.

If a further investigation is required, it will most likely be an operation known as a laparoscopy - tiny telescopic cameras are inserted through your abdomen in order to view the problem more closely. Obviously, this is not without risk as with all surgery, but the people operating on you are very familiar with this particular procedure and you are in safe hands. If, whilst they are investigating, they find an ectopic pregnancy or anything else that may be causing the problems they may well operate there and then to save time - this will be explained to you beforehand when they ask for your consent to surgery. If there is no time for consent, in the rare circumstance that you may have collapsed for example, they will inform you of their actions once you have woken up from surgery - after a day or so, someone will explain in more detail once you are recovering. The good news about a laparoscopy is that it is done in a way that means you will not be left with huge long scars across your abdomen - it is much more cosmetically friendly than open surgery and you will be left with just a few puncture wounds which heal up by themselves over a few weeks. If necessary, they may do a laparotomy which involves a bigger incision and will leave a scar - but the main thing is that they fix you up and make you healthy again.

If nothing can be found through further investigations, they may give you antibiotics to combat any possible infection that could be causing your symptoms. If you are not miscarrying and have an infection, they will ensure that the drugs you are given are safe to use during pregnancy; it is likely you will be told to go home and rest but to keep an eye out for any further symptoms.

I've miscarried - what now?

First of all, I am so sorry you have had to experience such a traumatic event. Even if you were not aware of the pregnancy until you lost the baby, it is still a horrible shock and you have every right to mourn your loss. If it has not already been offered to you, see if you feel comfortable speaking to someone for support and advice. Often doctors are very good at diagnosing and treating a problem, but the person gets lost in a cloud of science and efficiency. So whilst the immediate physical issue may be dealt with, the emotional impact can last a lot longer.

You may find others are quite insensitive to your loss - unfortunately, some people just don't appreciate that as far as you're concerned a baby existed even if it was only a few weeks old in the womb. To some people, it is just a clump of cells or a "blob" - often they may try to make you see it this way too to make you feel better and depersonalise the whole event as something unfortunate but inevitable. Even healthcare professionals may struggle with giving your baby an identity and may regard the miscarriage as "fate" or "nature's way of getting rid of something unhealthy". It may be offensive to you that people are like this, but it's more their problem than yours to be honest. They are the ones unable to react to the situation and you do not need to take their reactions to heart. Speaking to a counsellor may help you or finding a group of miscarriage-sufferers may be better as you all know what it is like. There are many online communities which specialise in women's health and many of them will have a section for miscarriage and ectopic pregnancy loss - always keep your identity safe, however, and follow basic internet safety guidelines.

Communicating with your partner may be difficult but it is essential - you need to know how he feels too, as he has lost his baby as well. Try not to cocoon yourself and reject his feelings - it will only lead to friction and that is the last thing you need right now. You may also want to discuss trying for another baby in the future - don't push yourselves into decision-making just yet, but when the time is right, you will need to talk about it together and be sure you are both ready to try again. If you have other children already, sit them down and talk to them so that they understand what has happened - if they are very young, you may need to use simple clear phrases but avoid anything that may confuse them like saying the baby "went away" or was "lost". Be honest and explain that the baby has died which means he/she will not be coming back and that it is ok to be sad about it if they want to. Children are remarkably resilient but avoid the common assumption that it won't affect them at all - for more information regarding children and grief, see our Bereavement article.

If the miscarriage was early-on in the pregnancy, you may feel robbed of a proper mourning period as there is no funeral to attend or scans to keep showing your baby. This being said it is still ok to be upset and you may find yourself crying or feeling quite low from time to time when you realise your loss. If you do come across people who are unable to be sympathetic about your loss and even quite abrasive with your grief, I'd say to avoid them if possible - you don't need people like that upsetting you further and you have every right to protect yourself from harsh and insensitive comments. If your partner is being unsympathetic, be aware that he is probably not trying to hurt you but is more likely hurting inside too and doesn't know how he ought to react to his feelings. Talk to him and let him express his anxieties and emotions just like you - it will help build a stronger relationship in the long run.

Be honest about your feelings - the first few weeks may feel most raw, but it is not unlikely to feel grief much later on, say for example on a particular anniversary or occasion which reminds you of the miscarriage. Again, allow yourself the time to grieve as and when the feelings come but if you are finding it all overwhelming it might be an idea to speak to someone who can help you deal with your grief in a way that doesn't cause you to feel unable to cope.

It could be that you feel nothing much at all after your miscarriage - you may not have even been planning on children and the pregnancy was over before you had a chance to realise what was going on. Relief can be another experience as you may not have been sure whether you wanted a baby or not just yet...it is not wrong to not be sad but be aware that your feelings may change further along down the line, so be prepared for emotions you hadn't banked on feeling. This may never happen, but it doesn't hurt to be able to identify them if they do arrive unexpectedly.

What about trying for another baby?

Well, that depends on how you feel about becoming pregnant again - unless you have been suffering a series of miscarriages in succession, there is unlikely to be any serious problem affecting your chances of carrying a baby to full-term. Because so little is known about the causes of miscarriage, you may just have to chalk this one down to an upsetting experience and when you feel ready, start trying again. If there has been an underlying cause identified by your GP, then they will discuss your options with you but there is no reason to assume you will never have another child. If you have had a miscarriage or ectopic pregnancy before then the chances of it happening again do increase but it's not a dramatic rise so there is no need to make yourself sick with worry, although it is perfectly understandable for you to have a degree of apprehension.

As with any couple trying to conceive, you need to make sure you start taking folic acid supplements before conception and during the first 12 weeks to help the baby develop properly. Cut down your alcohol intake, try to stop smoking and make sure any regular medications you may be on are checked with your GP to ensure they are safe to use during pregnancy. If you have any particular concerns, your doctor will be aware of your previous history and will be more than happy to talk over anxieties with you as well as monitor you more closely to ensure that if there are any potential problems then they can catch them earlier.

There are many women who suffer miscarriages but then go on to have healthy babies - even after two or three miscarriages. I used to live next door to a woman who had two still births, four miscarriages and three healthy children inbetween. Complete mystery as to why she suffered so many losses, but her three children who she carried to full term are a testament to how it is certainly not the end of your fertility if you do experience a miscarriage or ectopic pregnancy.

Above all, talk it over with your partner and GP - do not feel you have to hurry up if you are not comfortable with the thought of conceiving again any time soon. There are no rules and you ought to look forward to a new pregnancy, not be filled with dread and worry that it could all go wrong again. Obviously if you have only miscarried very recently you must give your body a chance to recover before trying again - your GP will advise a suitable time frame for waiting, although it is usually about 2 months. You periods will need time to get back to normal too, so it is usually suggested that you wait for your cycle to regulate itself again. During this waiting period, use contraception to prevent any chance of becoming pregnant before your body is ready to cope with it or you risk the chance of miscarrying again. If you have any infection after your miscarriage, take any medication given to you until it is all finished - even if you feel better halfway through the course - and then use a barrier method of contraception such as condoms to reduce the risk of any further infection until your body has recovered enough to try for another baby. You may be anxious about having sex again, but just take your time and do not feel pressured into doing anything you don't want to do. Explain to your partner that you are not rejecting him but you need him to be patient whilst you recover; after all, sex is not the only way to be intimate with one another and there is little point in having sex if you are not going to enjoy it. Spend plenty of time together, if possible, and just take one day at a time.

Please don't forget to speak to someone if you feel you need further support on this issue - you are most welcome to discuss your story and feelings in our Miscarriage Forum here at My Stopgap or if you would rather speak to someone in private about it then feel free to use our Contact Form and don't forget it is in complete confidence; whatever you choose to do, you are always welcome here at My Stopgap and we are more than happy to help in any way we can.