Miscarriage: What Every Woman Needs To Know
What is the actual definition of a miscarriage?
“A miscarriage is a spontaneous loss of a pregnancy before 24 weeks. When the pregnancy is unsuccessful after passing 24 weeks and the foetus dies, this is a stillbirth. At 24 weeks’ gestation, the foetus is described as viable, meaning it is more likely than not that the baby will survive outside of the womb. Miscarriage is sadly much more common than we think. We know there is around a 25% chance of a first pregnancy ending in miscarriage before 12 weeks. However, there are also more pregnancies that are unsuccessful so early that the woman herself may be unaware, as this could be perceived as a late or slightly different period.” – Dr Penelope Law, consultant obstetrician & gynaecologist at The Portland Hospital
It's not talked about that much is it...
“A lot of people are very uncomfortable talking about death and loss, and that perhaps originates from being raised in a culture which encourages us to focus on new life and happy things, rather than sadness and loss. The British stiff upper lip is very much a real thing, and it's surprising how deep this can be rooted in people’s brains. In addition to this, people are encouraged not to tell anyone they are pregnant until after their first scan at 12 weeks, just in case they have a miscarriage. This saying has done unbelievable damage, as people now feel bound by this social rule. A rule that states, ‘Don't tell anyone just in case you lose the baby’, just reinforces that baby loss is not something to be discussed. There are other reasons too, but the culture we live in definitely encourages people to remain silent when it comes to child loss.” – Zoe Clark-Coates, founder of The Mariposa Trust
Are there different types of miscarriage?
“Yes, there are various names given to a miscarriage depending on the nature of the physical signs seen. However, these names do not affect the outcome unless it is a ’threatened miscarriage’, which is the term used to describe when abnormal bleeding and abdominal pain occurs while the pregnancy continues.
Early miscarriage
This refers to an event that takes place within the first 12 weeks of pregnancy. This may be very early at about six weeks when the cells are implanting into the wall of the womb. If the timing of cell implantation is not quite right, a miscarriage can occur. Additionally, a miscarriage at this time may be related to a mismatch of DNA or an immune response to the ‘foreign’ sperm.
Late miscarriage
This occurs between 14 and 24 weeks and may be due to a more generalised problem: for example, a mother’s pre-existing illness, or delayed or abnormal development of the embryo, or because the cervix has opened too early.
Missed miscarriage
This occurs without any symptoms and is usually identified by a scan. This can be a very distressing kind of miscarriage as it occurs with no previous signs.
Inevitable miscarriage
This can come after a threatened miscarriage or without warning, and there is usually more vaginal bleeding and abdominal pain. Upon examination, the cervix might be described as open – this is when there is a gap in the centre of the external opening, meaning it is almost certain that without intervention (only possible for late miscarriages), the pregnancy will fail.
Chemical pregnancy
This is said to happen when a pregnancy test, either a urine or blood test, picks up the pregnancy hormone levels before any embryo can be seen on a scan. Although this indicates a pregnancy has occurred, the embryo does not develop. It is in fact a very early miscarriage. This happens more than we know about as women may only experience a slightly later or different period than usual.” – Penelope
Who is at risk of miscarriage?
“According to research, the risk of miscarriage is greater in older women and increases quite significantly after the age 40. This is because as we age, so do our eggs, causing a greater chance of DNA errors, which can lead to a miscarriage. The risk of miscarriage is also higher for those with some types of pre-existing illnesses, and women with a sub-clinical clotting disorder. A raised BMI over 30 is also associated with risk of miscarriage – either directly due to a heavier weight and a potentially higher blood sugar level, or due to the likelihood of polycystic ovaries. Smoking is also associated with miscarriage.” – Penelope
Why exactly does miscarriage happen?
“We don’t understand the main or exact cause – however, most early miscarriages are either because the sharing of genetic material does not occur at the right time, or if this sharing does happen, the ball of cells is unable to successfully attach itself to the inside wall of the uterus. Pregnancy is likely to be more successful if both partners during the pre-conception months and during pregnancy don’t smoke, take banned drugs, and are of normal weight. It is so important that women don’t blame themselves, as in nearly all cases, there is nothing that can be done to avoid a miscarriage.” – Penelope
“No one knows why any loss happens – there are many varying factors. It’s similar to asking why does death happen? It’s estimated that at least one in four pregnancies are lost, which equates to around 250,000 a year here in the UK. Research has shown a large number of pregnancy losses are caused by abnormal chromosomes in the baby, but a vast amount more research needs to happen.” – Zoe
What happens when you miscarry?
“When you miscarry, the tissue, which comprises the embryo and the placenta, will be passed through your cervix, which can lead to cramps and bleeding. The amount of bleeding is related to how early the miscarriage occurs and your body’s response to the loss. Some women can bleed heavily, requiring medical intervention, but this is rare. If your healthcare professional detects an early missed miscarriage, the process is often completed by your body without complications. If the miscarriage is as a result of ectopic pregnancy – meaning the pregnancy has implanted itself in a fallopian tube rather than the womb – you might need more surgical or medical intervention.” – Penelope
How long does the average miscarriage last?
“A miscarriage can take up to two weeks to be resolved completely, with intermittent vaginal bleeding during that time. If, however, you are having a missed miscarriage, there may in fact be no bleeding, as the body can completely resorb the tissue internally.” – Penelope
How is a miscarriage confirmed?
“A miscarriage is usually confirmed by two vaginal ultrasound scans which are seven to ten days apart. It is described as a confirmed miscarriage when there is no evidence of a foetal heartbeat.” – Penelope
How long does it take your body to recover?
“Physically, your body will likely have recovered by the time you experience your next period, but this can vary depending on the stage your pregnancy had reached. Emotional recovery takes longer, typically several months, with guilt and sadness being the most common emotions during this time.” – Penelope
How likely is it you’ll have another miscarriage?
“If you have previously had a miscarriage, your chance of having a second is only marginally raised from 25% to 26%. There are a minority of women who will go on to have three or more miscarriages, and around 15% of those will be found to have a sub-clinical clotting syndrome in their blood. These women will be offered a combination of aspirin and heparin during a future pregnancy, which has been shown to improve outcomes and lead to them having healthy babies. If you’ve had three or more miscarriages, ask your GP to refer you to a specialist miscarriage clinic to investigate if there is an underlying cause, such as an undiagnosed clotting syndrome.” – Penelope
Where can you go for support?
“If all goes well, you will get support from your friends and family, but this doesn’t always happen because miscarriage is an experience that’s often misunderstood. If you miscarry, or discover you’ve had a ‘missed miscarriage’ at hospital (where the 12-week scan reveals your baby has died), you may get brilliant supportive care from staff either at an Early Pregnancy Unit or, if it’s a later miscarriage, on a labour ward. However, many women and couples leave hospital unsupported, as resources and training aren’t equal throughout the UK. Charities such as Tommy’s and the Miscarriage Association have online and offline support groups, and many find great support on social media. Not everyone needs psychological support after a miscarriage, but we do know that women are at a higher risk of anxiety, depression and trauma. If so, professional support, via counselling or psychotherapy, is wise. This may be especially so if the miscarriage was life-threatening or one of many suffered.” – Julia Bueno, psychotherapist & counsellor specialising in miscarriage & baby loss
How can you cope with painful dates?
“Due dates can be particularly painful to bear, and it’s normal to be hit hard. Prepare yourself – perhaps your partner, or close friend, can be with you. Many bereaved find it helps to perform a ritual to acknowledge the loss, such as burning a candle or small fire, writing a letter to your unborn (and then burning it), or planting seeds for new growth.” – Julia
“The dread of the date is often worse than the reality. When you’ve journeyed through loss, you remember and honour your baby every single day, and it’s not reserved for special occasions, so when a key date comes around, it can often feel pretty similar to the day prior. My advice would be to take time to grieve and make sure you have the space to express your feelings. If you want to do something to mark a birthday or death anniversary, consider planting a tree or doing some fundraising in honour of your little one. The critical thing to remember is it's okay to talk about your story and it’s healthy to cry and be real about your pain, so share with those you love and let them walk this path with you.” – Zoe
How can you accept a future pregnancy will succeed?
“Pregnancy after loss is filled with varying emotions – joy and terror often sit side by side. No one can guarantee a healthy pregnancy. With this lack of certainty comes a tremendous amount of anxiety, and nine months can feel like a lifetime. We hear a lot about the statistic that one in four pregnancies are lost; when you are pregnant, it's helpful to flip that on its head and remember that this means three in four people will get to bring their baby home.” – Zoe
How can you support a friend who’s had a miscarriage?
“It’s incredibly hard to see someone you love in pain, and it’s tempting to try and remove that pain, but you have to remember that when it comes to death and loss, that’s just not possible. Here are my top tips for supporting a loved one:
Be Direct
When people are in a state of grief, they often struggle to reach out for support, so it’s essential to be direct. Don’t just say, ‘Call me if you need anything.’ Instead, offer to drop over a cooked meal.
Just Listen
Be willing and available to listen to the same story over and over again. When people are suffering, their brain finds it hard to come to terms with the loss and trauma. Recovery starts with talking, so be a great friend or family member by sitting and listening. Avoid making any unhelpful comments such as, ‘At least they are in a better place now.’
Lose The Fear
Don’t be scared to ask how they are doing and start the conversation. So many people fear raising the subject of grief in case it triggers upset, but what it actually does is make people feel loved and heard.” – Zoe
MY MISCARRIAGE EXPERIENCE: GINA DI CARLO, 35
“There’s nothing quite like the panic of bleeding when you’re nine weeks pregnant. No matter what advice you look up online or words of wisdom from friends, you know what’s happening and you’re powerless to do anything about it. That’s what happened to me this year. Twice. It was made especially hard thanks to the pandemic, but it wouldn’t have been much better without it. The first pregnancy had started well in February and I had the usual symptoms of nausea in the mornings, tender breasts and general fatigue. But in mid-April, when the UK had been in lockdown for almost three weeks, I had to make the call to the Early Pregnancy Unit when the bleeding wouldn’t stop. Several more panicked phone calls were made over the next ten days but unfortunately, due to the risk of spreading infection, I couldn’t be seen until my scheduled 12-week scan.
“Walking into the hospital for the ultrasound was incredibly hard. Partners were not allowed, and I couldn’t help but compare it to the 12-week scan from my previous pregnancy. There, my husband and I arrived excitedly together, hand in hand, not thinking for a moment that anything would be wrong and luckily there wasn’t. This time, I was crying before I knew the result. The sonographer was kind and knew my concerns, although her face was hidden with a surgical mask. She turned off the monitor so I couldn’t see the foetus and quickly confirmed there was no heartbeat. Instead of a lovely printout of my growing baby to show off to family and friends, I was handed a leaflet on how to manage a miscarriage.
“Surgery and medical management were no longer options, but I was grateful to the nurse for not sugar-coating what I was about to go through. I was told to expect labour-like contractions and spend a lot of time on the toilet passing blood and tissue – not ideal in lockdown with only one bathroom. In normal circumstances, my four-year-old daughter could stay with grandparents until I had recovered but this was yet another option not available. A couple of friends who had been through miscarriages had told me what to expect. Like many people, I imagined a miscarriage to be a one-day event – traumatic and sad but over quickly. I never imagined it to drag on for weeks and weeks. But it did.
“Not wanting to deal with the emotional aspects of losing a baby, I put all my efforts into trying again. After three months, I saw the happy pink line on a test and believed things would be different this time. Unfortunately, one week later the bleeding started again. The second miscarriage wasn’t nearly as traumatising as the first as it was physically no different than a late period. But after several calls to nurses and doctors, I’ve been told that until I have three in a row, I can’t be examined medically. I’m now at the stage of trying again, fully expecting to miscarry, but at least getting closer to knowing the cause, if there is one. In all likelihood, it’s just been bad luck for me but the not knowing is incredibly hard. Being able to talk about miscarriages was really helpful as I soon discovered many women I know had gone through something similar. But it shouldn’t be an exclusive club that only people who have experienced it can talk about it. Everyone should talk about it.”
For more information, visit TheMariposaTrust.org, JuliaBueno.co.uk and DrPenelopeLaw.com. The Miscarriage Association can also offer support at MiscarriageAssociation.org.uk
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