A miscarriage is a pregnancy that ends on its own within the first 20 weeks of pregnancy. Most miscarriages (more than 95%) occur in the first 12 to 14 weeks of pregnancy (1st trimester).
Miscarriage affects approximately 1 in every 4 women. A miscarriage may start and complete naturally or it may be discovered (often by scan) that the baby has died and the pregnancy has stopped but the baby is yet to pass from the woman’s body.
There are many reasons why miscarriages occur. However it seems that most occur because something happened with the development of the baby during or soon after conception. For example this could be related to a problem with cell development as the baby forms, health of the mother, infection or issues with the development of the placenta.
Symptoms of miscarriage:
The symptoms experienced will depend on the cause of the miscarriage and how advanced the pregnancy is/was so may take hours, days or even weeks to complete. These may include
- Vaginal bleeding, which varies from light spotting to heavy bleeding
- Fluid, blood clots or tissue passing from the vagina
- Abdominal pain or cramping
- Lower back pain
- Fever and chills (these may indicate infection)
The process of a miscarriage is individual to each woman. Bleeding during early pregnancy with some cramping is not necessarily a sign that you are miscarrying. Less than half the cases of bleeding, or ‘threatened miscarriages’ go on to actual miscarriages.
In general, the heavier the bleeding and the more severe the pain and cramping, the more likely that you may be miscarrying. In some cases the miscarriage is spontaneous and complete and no further treatment will be required. In others you will require tests, such as blood tests and an ultrasound scan, to see whether you have miscarried fully or whether you will require medical treatment or a procedure known as evacuation of retained products of conception (ERPOC), also known as a dilation and curettage (D & C).
What to do if you are concerned that you may be starting to miscarry or you are having any vaginal bleeding and/or pain.
- Your lead maternity carer midwife (if you have registered with one)
- Or your general practitioner
- Or go to the emergency department at the local hospital if your bleeding is heavy (soaking pads) and/or passing blood clots and/or having pain.
- If you require hospital care you will be cared for by the hospital team.
If you do experience a miscarriage then
- Rest as much as you can, especially in the first few days. It helps to take some time off work, or to get someone else to help with older children.
- Use sanitary pads instead of tampons, and avoid sex (or use a condom) while you are still bleeding. This reduces the risk of infection.
- If the miscarriage is complete, you can expect the bleeding to taper off rapidly, i.e. over the next week it should get lighter and lighter and stop.
It is normal for parents to feel emotional and physical symptoms of grief following a miscarriage. It is important to give yourself time to recover from the physical process of miscarriage, to acknowledge your feelings and to understand what has happened.
Some of the following may be helpful:
- Look after yourself physically. Try to eat well, get some gentle exercise and have enough sleep.
- Visit your health practitioner for a follow-up appointment. Knowing you are recovering physically will be reassuring.
- Expect that your emotional recovery will take longer than your physical recovery. Seek emotional support from family, friends, support groups, clergy, social workers or counsellors. It helps to discuss how you are feeling with a compassionate listener.
When can we try again?
This will depend very much on the circumstances and nature of your miscarriage and is best discussed with the health professional or professionals who advise and/or treat you during and after the event. Most women who have miscarriages go on to have normal pregnancies and healthy babies.
You may be told different advice about how long you should wait before trying again after a miscarriage. The main things to know are:
- It is advised not to have sexual intercourse after miscarriage until all the bleeding has stopped. This is to avoid infection.
- It can be helpful to wait until you have had at least one period after your miscarriage before trying again. This makes it easier to calculate dates in the next pregnancy if you conceive straight away.
- If you conceive before you have a period, it doesn’t make you more likely to miscarry in the new pregnancy.
- In most cases, the best time to try is when you and your partner feel physically recovered and emotionally ready to.
Support following miscarriage
While miscarriage is not uncommon it can be a very difficult and distressing time and people can find it hard to talk about, especially if they hadn’t announced the pregnancy to family and friends. However when parents do talk about having a miscarriage they are often surprised to learn how many others have experienced this and this sharing can provide strength and comfort for them.
Many District Health boards have information on their websites about the support available following miscarriage.
Miscarriage Support Auckland is no longer an active group but their website has advice and information for parents who have experienced a miscarriage
Information is also available from SANDS, the organisation that supports parents who have lost babies during pregnancy or infancy.