A miscarriage is the loss of a pregnancy that happens sometime during the first 20 weeks. A miscarriage obviously comes as a terrible and unexpected shock to most women. Unfortunately it is all too common, happening in about 10-20 % of women once they realise they pregnant. Around three quarters of miscarriages happen during the first 12 weeks of pregnancy (the first trimester). The incidence decreases after 12 weeks to low single figures – so it is relatively rare after this stage. A miscarriage usually starts with some bleeding followed by bad period pains and usually needs urgent medical attention and assessment. If you think you are miscarrying then you should call your GP or midwife if you already have one. They will instruct you on what to do next. If you are closer to 12 weeks, you will probably be asked to go into hospital for a scan.
The causes of a miscarriage are often undetermined. Often they can be due to abnormalities in the baby such as chromosomal problems and sometimes due to diseases of mother or anatomical problems in the pelvis. Other causes may be subtle immunological and clotting problems. The incidence of miscarriage also increases with the age of mother.
The diagnosis is usually made by a scan and examination. Occasionally, a miscarriage is not detected until the 12 week scan. This is because there has been no bleeding and no other signs to suggest that the pregnancy has ended. This can be particularly distressing and is called “a missed miscarriage”.
Treating a Miscarriage
Once the diagnosis is made there are several choices. The conventional method is to have short operation to empty the womb. This is a very safe and short procedure usually done under a short general anaesthetic. This is called an evacuation of retained products of conception (ERPC). Alternatives to this procedure include a medically induced procedure which is often supervised in hospital or over phone at home. You will be given 2 courses of tablets. The first course is to switch off the pregnancy hormones and facilitate the action of the second course of tablets. The second course will give you contractions which will cause the cervix to open and the womb to expel the tissue. The tablets work pretty quickly, within a few hours and you may feel like you are having a very heavy period with some cramping and heavy bleeding. You are unlikely to see anything that is recognisable, just clots and tissue. The bleeding may last up to 3 weeks. Alternatively the most conservative approach is to wait for a natural miscarriage. The results of this will also be like having a heavy and painful period, and again, bleeding can last for up to 3 weeks. For more than half of miscarriages, this method is unsuccessful in removing foetal tissue. In this situation, you will need either medication or surgery. These last 2 options are a little unpredictable and occasionally bleeding can be heavy and distressing and need emergency treatment.
After a Miscarriage
Recurrent miscarriages are rare and the chances of a successful pregnancy the next time are usually unaltered by having one or two miscarriages. Occasionally, after miscarriages, if the cause is known or suspected, then treatment with hormones or special procedures such as a stitch in cervix may be necessary in future pregnancies.
Whilst a miscarriage does not normally seriously affect a woman’s physical health, it can have a significant emotional impact. Many women and even men can experience feelings of loss and grief, particularly if the miscarriage occurs during a first pregnancy. If you find you are having difficulty coping after a miscarriage you should speak to your GP who can help you by perhaps organising some counselling.
Sex after a Miscarriage
You should not have sex until all of your miscarriage symptoms such as bleeding and pain have gone. If you do not want to get pregnant again soon you should use contraception every time you have sex.
You should get a period within four to eight weeks of your miscarriage, although it may take several months to settle into a regular cycle. If you would like to get pregnant again, there is no reason why you cannot try as soon as you feel psychologically and physically able to do so.
A Chemical Pregnancy
A chemical pregnancy is one that has never been confirmed clinically, by blood tests or scans, and that results in an early miscarriage in about the 5th week, or a week after your missed period.
For example, you may do a pregnancy test that gives a positive result, yet start to bleed a few days later.
For many women who are trying to conceive, this is as devastating as any miscarriage as one day they think they are pregnant and the next day they are no longer.
The causes are thought to be the same as an ordinary miscarriage. Noone knows how common they are as some women who are perhaps not trying to conceive or who do not watch they cycles closely may experience these without noticing.
A Story of a Miscarriage at 6 Weeks
I knew I was pregnant as I have only ever had heartburn once before and that was when I was pregnant with my first baby. So I took a test 9 days after ovulation and got a very very faint line. I knew how many days Post Ovulation I was as I had been doing Ovulation tests at home and knew the day I ovulated so there was no confusion there. I then had some dark brown bleeding on the 11th day which lasted one day and the next day I had a tiny bit of pink bleeding. Very light pink and that was just a wipe. Obviously I was very concerned, probably more so since I did not experience any bleeding in my first pregnancy. I did a pregnancy test everyday and for about 3 days the line was not getting any darker, but eventually it did get darker until it was darker than the control line, so I felt more confident about things. That said, I decided to have an early trans-vaginal scan to see how things were looking. I went on what should have been (according to my ovulation dates) 6 weeks and 3 days, and whilst there was a sac, and fetal pole (heartbeat) the sonographer was slightly concerned that the baby was only measuring 5 weeks something…I knew that this was not possible as I was 100% sure of my dates, so I was obviously very worried but hoped that it was just a mistake with the measurements (which apparently can happen at this early stage) so I asked my GP for a referral to get a scan 2 weeks later. During this 2 weeks, I didn’t feel pregnant at all, I didn’t have full or painful breasts like last time, and whilst morning sickness appeared, it was in no way as bad as I had it before. I didn’t have any more bleeding, but at the same time, I didn’t have any symptoms at all, and even though you are told that each pregnancy is different, its very hard not to compare with the last time.
After 2 weeks I went for another trans-vaginal scan at which point I should have been 8 weeks 4 days, but as soon as the sonographer said that the sac and baby were measuring 6 weeks, I knew that meant bad news. Also she didn’t immediately say that there was a heartbeat, which looking back I should have noted as that’s something they like to confirm asap. So I asked her if there was a heartbeat and she said that there wasn’t and the baby had probably stopped developing at about 6 weeks. I was obviously devastated as was my husband, and its a horrid feeling, lying there with your pants down and legs apart and with some nice woman apologising to you and saying how sorry she is for your loss. I just wanted to say thanks and get up and leave and go and have a meltdown on our own, but we had to stay and wait for a room to become available so that we could talk to a nurse about our options.
The nurses were very sympathetic and talked us through our options. Wait for the miscarriage to occur naturally, (there is no telling how long this might take) which would involve some heavy bleeding with clots sometimes as big as your hand, with significant pain (intense period pains), or an ERPC (Evacuation of Retained Products of Conception) which is done under a general anaesthetic. The thing that I found the hardest was that they do expect you to make the decision there and then which I couldn’t do. However, they were happy for me to call them later in the day with my decision. Its a lot to take in, to find out that you have lost your baby, but then to have to decide what to do immediately before you really have time to digest the information I found to be really tough.
We decided to have the ERPC. We both wanted to have some kind of closure and wanted to be able to move on and start again, and I knew someone who had gone through the process naturally and they said it was extremely traumatic and given the choice they would have had the ERPC. Also I am working and have a 12 month old daughter so we had to consider all of that before we came to a decision.
The process was very straightforward. You are taken into theatre and the procedure actually only takes 5 mins but you are normally under for about 45 mins to an hour. I came round in tears, it was almost automatic and I was obviously distressed, although I wasn’t conscious of being so, if that makes sense. I was given some painkillers and some antibiotics to take, and my recovery was very quick, I had very light bleeding with some cramps for about 4 days and then heavier bleeding for about 5 or 6 days, like a medium period, dark red blood. You cant wear a tampon and you are not meant to swim whilst you are still bleeding.
You are asked to take a pregnancy test 3 weeks after the procedure to make sure there are no retained products and if you get flu like symptoms or very heavy bleeding with clots you are advised to seek immediate medical help.
It took a long time to get my head around not being pregnant, especially when you spend all that time thinking about BEING pregnant, it was like a bad dream, but talking to people about it really helped, although initially I asked my husband to tell people as I didn’t want to talk to anyone apart from close family. I couldn’t bear to tell people but I wanted them to know to save their own embarrassment. My worst fear would have been for people (that knew I was pregnant) to ask how I was feeling and for me to have to tell them we lost the baby, causing them to feel awful. We are both realistic about why this happened and we understand that it was for a reason. I am looking forward to moving on and trying for a baby again and realise this is incredibly common and one of those things that happen to people, you just never think it will happen to you.
A Story of a Miscarriage at 16 Weeks
I had been well all during this, my 4th pregnancy, with no worries bar some spotting which I’d had with both the girls throughout. My first pregnancy had ended with a miscarriage just before 12 weeks, and I had found it very upsetting, since I had no idea whether I would ever be able to have babies. Luckily I got pregnant again very quickly and had two healthy babies within 18 months.
I was spending a week by the sea with the two girls and my mother, since my husband was working, and was around 15 weeks pregnant. On the weekend my husband came down to stay and I became unwell with a slight fever, headache and aching limbs, but this only lasted for 24 hours and then all was well again.
Halfway through the week I returned to London for my ante-natal appointment, but to our horror, my obstetrician was unable to find a heartbeat. A scan confirmed that there was no live pregnancy. I went straight to hospital, and had an ERPC that evening and went home the next day. It had been quite a shock as I had not felt “unpregnant” and the whole thing was quite a mystery. This all happened in the 1980s but only a bit later did it appear that there might be a link between Listeria and miscarriage, and that this might be linked to certain foods, such as pates, unpasteurised cheese etc so we think perhaps this was the cause. While we were very sad that this pregnancy came to such an unexpected end, we were grateful that we still had our lovely girls and felt that even if there were to be no more babies, we had been lucky. However, I happily went on to have a son a year later.
You may like to read these reader questions related to Miscarriage.