One of the most devastating things any parent can experience is the loss of a child. Whether in early or late pregnancy, during childbirth or later in life, it can be an overwhelming and heartbreaking experience. The month of October is Pregnancy and Infant Loss Awareness Month. During this time, we take time to remember those babies we have lost and the parents and families who remain to mourn. As we go through this month, we consider why these events happen, so that we can work to prevent them happening again.
What is a miscarriage?
A miscarriage is the loss of a pregnancy before viability. While it is not certain exactly how many miscarriages occur each year, it has been said that 1 in 4 women will experience a miscarriage in their life. It may be diagnosed by ultrasound or by drawing blood tests for the pregnancy hormone hCG (human chorionic gonadotropin). Sometimes these tests must be repeated more than once to confirm the loss.
What causes miscarriage?
Very often, the cause of the loss is not known, but when it can be identified, it is frequently due to abnormal genetics. Although parents may have normal genes, in the process of the baby forming in the womb, changes in the genes can be severe enough that the baby cannot survive and a miscarriage occurs.
Who is at risk for miscarriage?
Mothers over the age of 35 have a higher rate of miscarriage as do moms who have lost pregnancies before. Miscarriage is also more common in moms with certain medical problems, such as uncontrolled high blood pressure and diabetes or infection.
What are the symptoms of miscarriage?
While patients may experience no symptoms initially, miscarriage is typically associated with pain and bleeding. Sometimes, a patient may notice a gush of fluid if her water breaks.
How are miscarriages managed?
Once a miscarriage is diagnosed, the management depends on your symptoms.
If you have no pain or bleeding, your doctor may discuss waiting to see if these begin. Alternatively, your doctor may recommend a medication or procedure to help you pass the pregnancy. The medication will cause cramping and bleeding until the miscarriage is complete. Your doctor may recommend a follow up ultrasound about a week later to ensure that the uterus is empty. If the medication does not work, or if you prefer to have a procedure, your doctor may recommend a dilation and curettage (D&C), a procedure we have discussed in previous blogs.
If you are already having bleeding and pain, your doctor will usually perform an ultrasound to verify whether the pregnancy has been completely passed. If it has not, your doctor may, again, discuss taking a medication or undergoing a D&C to complete the miscarriage. If all tissue does not pass in a timely fashion, there is a risk of heavy bleeding requiring blood transfusions, or infection of the tissue left inside. It is very important, after a miscarriage, to ensure that the uterus is empty of all pregnancy tissue.
What should I expect after a miscarriage?
After a miscarriage, you will typically have bleeding and cramping. While it will get lighter over time, bleeding can last a month depending on how far along you were at the time of the loss. Your first period will often occur after that month and may be heavier than usual. Any very heavy bleeding or fevers should be reported to your doctor.
After a miscarriage, when can I try to get pregnant again?
The timing of your next pregnancy depends on the circumstances of your loss. Depending on how far along you were and the events that occurred around your pregnancy, your doctor may advise waiting a few months or trying immediately. You should also consider whether you are ready to be pregnant again – many parents need time to grieve the loss before trying again. If you are not ready to get pregnant right after, talk to your doctor about whether some form of birth control is a good option for you.
Will this happen again?
Most people who have a single miscarriage in early pregnancy do not have another. If you have had recurrent miscarriages (two or more miscarriages in a row), you may have an increased risk of more and your doctor may suggest testing to try to identify a cause.
Can I prevent miscarriage?
While nothing can definitively control what happens in your pregnancy, attending prenatal care visits regularly and managing medical problems can help prevent miscarriage. In some cases, based on your history and blood tests, your doctor may consider whether medications like aspirin or progesterone might decrease your risk of miscarriage. While not all patients benefit from these interventions, your doctor can discuss the pros and cons of these options, taking your specific situation into account.
Where can I get help coping with my miscarriage?
The loss of a pregnancy can cause a range of emotions, including sadness, anger, or numbness. If you feel that you need counselling or support, your doctor can help connect you with resources.
