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Miscarriage Resources

What is a Miscarriage?

A miscarriage is the spontaneous loss of a pregnancy before 20 weeks gestation. The majority of miscarriages occur within the first 13 weeks of pregnancy. Miscarriage is the most common form of pregnancy loss with as many as 15-25% of all clinically recognized pregnancies ending in miscarriage. After 20 weeks, a fetus is technically viable outside the womb; a pregnancy loss at this point is considered a stillbirth.

Contrary to popular belief, sex and exercise will not cause a miscarriage.

If you have suffered a miscarriage, YOU ARE NOT TO BLAME. Please remember that. 

Symptoms Of Miscarriage:

If any of the following symptoms occur during pregnancy, it is important to call your doctor as soon as possible. Possible symptoms of miscarriage may include:

  • Lower back pain, or abdominal pain that is dull, sharp, or cramping.
  • Tissue or clots passing through the vagina.
  • Brown or bright red vaginal bleeding (with or without cramps)
  • A sudden decrease in signs of pregnancy.
  • White-to-pink mucus from the vagina.

Types Of Miscarriage:

Threatened Miscarriage – any vaginal bleeding during early pregnancy without cervical dilation or changes in cervical consistency. Mild cramping may occur; however, usually, no pain exists. No tissue or fetal membranes have passed through the vagina. Threatened miscarriages are very common – about 25-30% of pregnancies have some amount of bleeding; less than half of all threatened miscarriages lead to a true miscarriage. 

Inevitable Miscarriage – an early pregnancy that has vaginal bleeding and dilation of the cervix. Generally speaking, the vaginal bleeding is heavier than with a threatened miscarriage and the pain is greater.

Incomplete Miscarriage – a pregnancy that has vaginal bleeding, dilation of the cervix and passage of the fetus and other products of conception. Often the cramps are extremely painful and the bleeding from the vagina is heavy. While a complete miscarriage may not have occurred, the miscarriage is inevitable.

Complete Miscarriage – a full miscarriage; all products of conception have been passed through the vagina, and the mother notes that the amount of bleeding and pain have diminished. The cervix is closed and high. Ultrasound examination reveals an empty uterus.

Missed Miscarriage – the presence of a nonviable intrauterine pregnancy that remains in the uterus without bleeding, abdominal pain, passage of tissue or cervical changes. A missed miscarriage is generally diagnosed by the absence of fetal heart tones or by an ultrasound.

Chemical Pregnancy – a pregnancy lost shortly after implantation. May occur so close to normal menstruation that many women do not realize they are pregnant.

Molar Pregnancy – a genetic error during fertilization leads to growth and proliferation of abnormal tissue within the uterus. Molar pregnancies don’t usually contain an embryo, but will often have more severe pregnancy symptoms. A molar pregnancy is diagnosed via ultrasound.

Blighted Ovum (also called anembryonic pregnancy)- a fertilized egg implants into the uterine wall, but fetal development does not occur. Often ultrasonography will reveal a gestational sac (with or without a yolk sac) without fetal growth.

Chances Of Having A Miscarriage:

Most women of childbearing age have between 10-25% chance of having a miscarriage.

Women under 35 = 15% chance of miscarriage.

Women between 35-45 = 20-35% chance of miscarriage.

Women over 45 = up to 50% chance of miscarriage.

Why Do Miscarriages Occur?

Typically, the cause for miscarriages is idiopathic, meaning that no cause can be easily identified.  In the first trimester of pregnancy, chromosomal abnormalities of the embryo are the most common cause of miscarriage.

Other causes of miscarriages include:

  • Hormone imbalances
  • Improper implantation of the fertilized ova into the lining of the uterus
  • Maternal infections such as the German measles, CMV (cytomegalovirus), mycoplasma pneumonia, etc.
  • Structural abnormalities of the uterus including fibroids, endometriosis, abnormal growth of the placenta, and poor muscle tone in the mouth of the uterus
  • Cervical incompetence
  • Chronic maternal infections, including polycystic ovarian syndrome, poorly controlled diabetes, renal disease, Lupus, untreated thyroid disease, maternal hypertension, and antiphospholipid syndrome.
  • Drinking, smoking or recreational drug use (especially cocaine)
  • Advanced maternal age
  • Trauma to the mother

Treatment For Miscarriages:

The number one goal of medical professionals is to prevent and/or treat complications of the mother while allowing the body to do what it needs to do. Common complications include loss of blood (hemorrhage) and infection. If the body passes all of the fetal tissue, generally no medical intervention is necessary, although medications may be given to prevent excessive blood loss or assist the body during the process.

If the body does not manage to pass the fetal tissue properly, medical intervention may be required. The medical procedure practitioners use when fetal tissue is improperly passed is called a D&C, which stands for “dilation and curettage.” This is a relatively minor surgery during which a doctor enlarges the cervix (dilation) and removes (curettage) any residual fetal tissue from the uterus. A D&C is generally performed in an outpatient surgery center or hospital and under sedation. A D&C is also performed for other medical issues besides miscarriages, such as to remove uterine fibroids or polyps, to control irregular menstrual bleeding, and to rule out endometrial cancer.

Bleeding and pain should be monitored. Any changes or signs of infection (chills, nausea, vomiting, and fever) should be reported to the doctor immediately.

A miscarriage should always be reported to the doctor so that potential complications can be ruled out.

Following a miscarriage, do not use a douche, have sex, or insert anything into your vagina until your doctor says it is okay. The waiting period is typically about 6 weeks.

Prevention Of Miscarriages:

Unfortunately most miscarriages occur for reasons we can’t identify, which makes prevention and prediction of miscarriage very difficult; however, there are things that can be done to give any pregnancy the very best chance:

  • Get adequate prenatal care.
  • Follow the advice of your doctor or midwife.
  • Take steps to control high blood pressure (called “preeclampsia” in pregnancy).
  • Avoid alcohol, nicotine, and recreational drugs.
  • Discuss all prescription drugs with your doctor or midwife.
  • Avoid or cut down on caffeine intake.

Emotions Following A Miscarriage

Emotional responses of individuals who have experienced a miscarriage vary. Many grieve the loss of pregnancy just as they would grieve the death of a living person, which means that they may experience shock and denial followed by feelings of guilt, depression, and anger before finally feeling acceptance. If you have experienced a miscarriage, give yourself time to grieve your loss. Seek support from friends, family, bereavement groups, and/or a therapist to aid you in healing emotionally.

It is important to note that men and women may react differently to the loss of a pregnancy, which can further complicate a relationship. Men do not consider themselves to be a father until they hold their baby for the first time; because of this, it is not uncommon for a man to feel confused about how to react to pregnancy loss or to experience the loss to a lesser degree than a woman.

In addition, men tend to grieve more privately, and their grief may be funneled into projects or the examination of facts and information surrounding the pregnancy. Women, on the other hand, feel a connection to the pregnancy earlier and tend to be more outwardly emotive regarding the loss. No matter how your partner reacts, it’s important to stay communicative and be respectful of their feelings and any differences in how they grieve.

Women who have suffered miscarriage are susceptible to postpartum depression. It can be difficult to differentiate between grief and depression, but typically if the symptoms are severe and impinge upon one’s ability to function for a prolonged period of time, professional help should be sought.

How To Help A Loved One Who Has Miscarried:

As with any loss, a miscarriage can be hard for friends and family to navigate. Knowing what to do or say can be hard. Here are some tips:

  • Take cues from your loved one: because everyone grieves differently, try to take your lead from her to determine how she’s taking the loss and what she needs.
  • Listen: she may want to talk about thoughts and emotions, or she may need to talk about the pregnancy and baby. Listen carefully, focusing on what she’s saying (not on what you’re going to say) and showing you’re paying attention by making eye contact, nodding, gestures, etc.
  • Choose your words carefully: don’t tell her she can try again or that it was “meant to be” – these cliches, while common, aren’t always comforting. Don’t criticize or offer advice; listen to how she talks about the miscarriage and go from there.
  • Be genuine: don’t tell her you know how it feels or what she’s going through unless you actually do – even though you mean well, this can come off as very offensive. As well, it’s okay to be honest and say, “I don’t know what to say. I’m so sorry for your loss.”
  • Consider sending a card: this can be a good way to reach out and let a loved one know you’re thinking about her and sorry for her loss.
  • Don’t be afraid to check in: continue asking her how she’s doing and give her the opportunity to talk about her thoughts and feelings. As well, don’t leave out Dad: he’s grieving, too, so make sure to ask how he is doing.

 

Additional Miscarriage Resources:

Parents or other family members who have experienced the loss of a baby between conception and the first month of life can receive a free March of Dimes bereavement kit by contacting the Fulfillment Center at 1-800-367-6630 or using this link.

Grief Issues Special to Miscarriage – Miscarriage Support Auckland, Inc. is based in New Zealand and provides information about miscarriage issues.

Share – This organization provides mutual support for bereaved parents and families who have suffered a loss due to miscarriage, stillbirth, or neonatal death. SHARE provides newsletters, pen pals, and information regarding professionals, caregivers, and pastoral care.

HopeXchange – Information, support, and hope after pregnancy loss.

Unspoken Grief – A site dedicated to being open, honest and raw about healing after miscarriage, stillbirth or early infant loss.

Still Standing Magazine – an online magazine focusing on encouraging women, men, and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family, and even medical professionals, to know how to support someone enduring child loss and/or infertility.

Still Birthday – Wonderful resource page full of love, support, and information about all things related to miscarriage and baby loss. In addition to information about the loss, there is information about how to care for yourself during this incredibly difficult time. It also contains information about how to start the process again after a loss

Page last audited 7/2019

Stillbirth Resources

What Is A Stillbirth?

Stillbirth is defined as fetal death after 20 weeks of pregnancy. Stillbirths happen in approximately one in every 160 pregnancies, at seemingly random times. Stillbirth is used as a distinction between the miscarriage or live birth.

Losing a baby to stillbirth is a tragic and tender time when all hopes and dreams are born, only for those hopes and dreams to be shattered upon delivery. The body recovers from the birth, but the heart is forever injured.

How is Stillbirth Diagnosed?

Most stillbirths occur prenatally – stillbirths are relatively infrequent during labor and delivery. Often a woman notices her baby is not moving as usual and may suspect that something is wrong.

Once a woman suspects that there is something wrong and calls her doctor, a fetal death is confirmed (or denied!) via ultrasonography. Sometimes, these images may explain what caused the stillbirth.

What Happens After Stillbirth Diagnosis?

After it’s determined that the fetus has, in fact, died, the health care team will work with the woman to discuss options for delivery. Some women may, for medical reasons, need to deliver immediately.

If not medically necessary, couples are often given the option of when they want to deliver their baby – waiting for labor does not usually pose any problems for the mother.

A couple can wait to go into labor naturally with their baby; labor usually begins within 2 weeks of a stillbirth. If labor does not begin within two weeks, most doctors push to induce their patients because there is a risk of blood clots for the mother after that time.

Most couples, however, opt to have labor induced after they’ve learned that their baby has died. A vaginal suppository is inserted into the cervix, if it has not begun to dilate naturally. Then, an IV drip of synthetic oxytocin, which stimulates uterine contractions, is begun.

Barring any problems with labor and delivery, most women can deliver vaginally.

Why Does Stillbirth Happen?

There are many known causes for stillbirth; however, not all stillbirths have a known cause. Here are some common causes for a stillbirth:

Birth Defects – According to the March of Dimes, 15-20% of stillborn babies have at least one birth defect; 20% of these have chromosomal problems, such as Down Syndrome. Others have birth defects caused by genetics, environmental, or unknown causes.

Placental Problems – According to the March of Dimes, placental problems cause 25% of stillbirths. Placental abruption (the placenta peels away partially or entirely from the uterine wall prior to delivery) results in heavy bleeding that can threaten the life of the mother and fetus. It may cause fetal death due to lack of oxygen. Women who use cocaine or smoke cigarettes while pregnant are at increased risk of placental abruption.

Poor Fetal Growth – Fetuses that grow too slowly are at an increased risk for stillbirth. According to the March of Dimes, 40% of stillborn babies have poor growth. Women who smoke cigarettes or have high blood pressure are at increased risk for small babies. If poor growth is noted prior to fetal demise, a woman will be closely monitored by her OB-GYN.

Infection – Maternal, fetal, or placental infections appear to cause 10-25% of stillbirths, according to the March of Dimes. Some infections, such as genital and urinary tract infections and certain viruses, may go undiagnosed and asymptomatic through a pregnancy until they cause complications like stillbirth or preterm birth.

Chronic Maternal Health Conditions – According to the March of Dimes, 10% of stillbirths are related to chronic health conditions of the mother. These include high blood pressure, diabetes, kidney disease, and thrombophilias. These conditions may lead to placental abruption or poor fetal growth. Preeclampsia also increases the risk for a stillbirth, especially in subsequent pregnancies.

Umbilical Cord Accidents – 2-4% of pregnancies involve umbilical cord accidents, such as knots in the cord or abnormal placement of the cord into the placenta. Umbilical cord accidents can deprive the fetus of oxygen.

Other stillbirths may be caused by maternal trauma (like a car accident), pregnancy longer than 42 weeks, Rh Disease (incompatibility of maternal and fetal blood), and lack of oxygen during a difficult delivery.

Risk Factors for Stillbirth:

  • Maternal age over 35
  • Maternal Obesity
  • Multiple gestation (twins or triplets)
  • African-American Ancestry
  • Malnutrition
  • Smoking
  • Drug and alcohol abuse

How Do I Reduce My Risk for Stillbirth?

A woman should schedule a visit with her doctor before she gets pregnant to allow the doctor to identify and treat any maternal conditions before pregnancy to reduce risks during pregnancy. This is also a time when a woman should share all medications, including herbal supplements, with her doctor to identify and discontinue any potentially harmful medications.

Women who are obese should consider losing weight prior to conception. A doctor or other health care provider can help a woman develop a weight loss plan before pregnancy. No woman should try to lose weight during a pregnancy.

Women shouldn’t smoke, use street drugs, or drink alcohol during pregnancy because these can increase the risk of stillbirths.

I Had a Previous Pregnancy End in Stillbirth – Can it Happen Again?

Understandably, those who have suffered a stillbirth are worried about subsequent pregnancies also ending in stillbirth. The risk for those who have had a previous stillbirth is lower than those who have not. For example, placental problems and cord accidents are unlikely to occur in another pregnancy.

If the stillbirth was due to maternal health complications or genetic disorders, the risk of a subsequent stillbirth may be higher. These couples should visit a genetic counselor and discuss the risks of pregnancy complications, including stillbirth.

Doctors carefully monitor any woman who has had a previous stillbirth for any signs of fetal problems – this may assure the woman that all steps necessary for prevention of another stillbirth are taken.

Can We Prevent Stillbirths?

Stillbirth rates, since the 1950’s, have declined dramatically. This is due to better management of certain conditions – high blood pressure and diabetes. Rh disease can be prevented by administering a dose of immunoglobulin at 28 weeks to an Rh- mother carrying an Rh+ fetus.

Women who have high risk pregnancies are monitored more carefully by their doctors during late pregnancy. Women who are carrying high-risk pregnancies are often told to do a “kick count” starting around week 28 of pregnancy. If a woman counts less than ten kicks an hour for two hours or if she feels the baby is moving less than usual, she should call the doctor for additional testing.

Any bleeding during pregnancy should be reported to the doctor immediately. Vaginal bleeding during the second trimester may indicate placental abruption, and an emergency c-section may save the baby.

Since stillbirths are often a complete mystery, there are very few ways to eradicate them entirely; however, with proper prenatal care and monitoring, some stillbirths may be prevented.

How Do I Handle the Grief of a Stillbirth?

Any couple who has lost a baby due to stillbirth needs time and space to grieve. A pregnant woman and her partner have already bonded with their child, well before it is born, so having a stillbirth means that most will feel an intense, pervasive loss when their baby dies. Grief is a very unique process, and each parent may feel the loss differently. Some common emotions are anger, sadness, denial, shock, numbness, depression, despair, and guilt.

Often a woman and her partner cope with a stillbirth differently, which may create tension within the relationship. These couples may benefit from seeing a grief counselor together so that they can be there for one another at a time when they are both in desperate need.

Many stillbirth parents find strength from joining a stillbirth support group. These groups are full of people who understand the unique grief journey that accompanies a stillbirth. This may help each person feel less alone.

How Do I Help a Loved One Who Has Suffered a Stillbirth?

  • Follow their lead – everyone grieves a loss – any loss – differently. If you find out how your loved one is coping and what they need from you, it can help you figure out how to respond. Acknowledge your friend’s feelings. Maybe they’re not the reactions you’d have, but they are hers and she is allowed. A little, “I understand why you feel this way” can go a long way. Don’t be afraid to ask questions or talk candidly about the loss with your friend.
  • Don’t ever say these things: “You can try again.” “There must’ve been something wrong with the baby.” “At least it happened now.” Even if these are all true statements, they’re about the most unsupportive thing you can say to someone who is grieving.
  • You probably DO NOT know how your friend feels, so don’t say so. When you say, “I know how it feels…I lost my cat once,” you’re minimizing the loss your friend just experienced. There’s nothing more hurtful than being told that someone else “gets” their pain when they truly cannot.If you weren’t informed of the stillbirth by the parents, be careful what you say. It’s wonderful to want to be supportive and send love and condolences, but if the couple hasn’t officially told many about their loss, they may feel their confidence has been betrayed. Let them come to you.
  • Send a card – just a simple card saying that you are sorry and available if your friend wants to talk. Those sort of words can be extremely comforting when someone is brokenhearted over the loss of their unborn child.
  • Follow up grief is an ever-evolving thing, coming in all sorts of stages and waves. What may be comforting one week may be not the next. So keep calling. Keep emailing. Keep sending notes and letters. Your friend will appreciate it.
Additional Stillbirth Resources:

Now I Lay Me Down To Sleep: a non-profit network of professional photographers around the country that will come to the hospital and offer free professional portraits to families who have lost a baby.

International Stillbirth Alliance: a non-profit coalition of organizations dedicated to understanding the causes and prevention of stillbirth. The group seeks to raise awareness of stillbirth, promote the prevention of stillbirth through international collaboration, and help provide appropriate care for parents whose baby is stillborn.

Empty Cradle, Broken Heart: Surviving the Death of Your Baby -by Deborah L. Davis, PhD: This book has wonderful information on issues such as the loss of multiples, stillbirth, miscarriage, ectopic pregnancy, and infant loss. There is a special chapter for fathers, and it’s an exceptional book for doctors, nurses, grandparents, and others to read to help them offer comfort to the grieving parents.

Still Standing Magazine – an online magazine focusing on encouraging women, men and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family and even medical professionals, to know how to support someone enduring child loss and/or infertility.

Still Birthday – Wonderful resource page full of love, support, and information about all things related to miscarriage and baby loss. In addition to information about the loss, there is information about how to care for yourself during this incredibly difficult time. It also contains information about how to start the process again after a loss.

Page last audited 7/2018

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