Understanding miscarriage

Hannah Dahlen
Tuesday, May 6, 2008
Image: Getty

The story of Jana Horska miscarrying in a NSW hospital toilet gripped the public's attention in 2007 and triggered an important inquiry into our health care system. Miscarriage (loss of a baby before 20 weeks) affects the lives of many women and their partners, with the true effect often underestimated. Miscarriage might be a relatively common event, but this does not mean it is insignificant or that it is, or should be, forgotten.

Why does miscarriage happen?
Around 20-25 percent of pregnancies end in miscarriage before 12 weeks, although, many women will not be aware they were even pregnant. Around 80 percent of these will occur in the first 12 weeks of pregnancy, with only 1-2 percent of couples experiencing recurrent miscarriages.

A miscarriage usually occurs because the baby is not developing properly and the body's normal response is to recognise this and expel it. As a woman's age increases, so does her risk of miscarriage and this is mainly due to the rising incidence of genetic abnormalities.

What happens with miscarriage?
In the general course of a miscarriage, a woman experiences: a missed period; pregnancy symptoms, a positive pregnancy test, which is followed days or weeks later by vaginal bleeding; lower abdominal cramping; backache and the miscarriage of the baby.

You should contact your health provider if you experience:
  • Prolonged heavy bleeding
  • Blood clots or increasing abdominal pain
  • Changes in your vaginal discharge (especially strong odour)
  • Fever or flu-like symptoms

Management of miscarriage
For many years, the routine management for women experiencing a miscarriage has been to surgically empty the uterus (commonly referred to as dilation and curettage or a D&C).

Women now have more options:
  • They can "wait and see" if all the tissue passes through the vagina on its own. Where the "wait and see" approach is used (more likely for miscarriages before 12-13 weeks), around 80 percent of women will not need surgical intervention.
  • The "medical evacuation" approach uses hormones, such as prostaglandins, to encourage the tissue to be passed.
  • The third approach is traditional "surgical evacuation" (D&C) where the tissue is removed by gentle scraping or suction of the uterine lining.

What happens after the miscarriage?
It is important to have a medical follow-up a couple of weeks after the miscarriage to make sure you are healthy.

Important points to remember
  • If you lost a lot of blood during the miscarriage, make sure the iron levels in your blood are at a healthy level.
  • If you have a Rhesus (Rh) negative blood group, you will need an injection of Anti-D to prevent problems with Rh factor in future pregnancies.
  • Breast milk is produced from 16 weeks onwards, so if you had a late miscarriage you may find your breasts produce milk.
  • Vaginal bleeding continues for one to three weeks and progressively becomes lighter. Women who experience ongoing heavy bleeding or pain, or pass blood clots, should seek medical advice.
  • Waiting to have sex for at least a couple of weeks, until the bleeding has ceased, reduces the risk of infection. Remember, you will ovulate two weeks later so pregnancy can occur quickly following a miscarriage.

Coping with loss
It has been said that while the loss of an adult represents the loss of the past, the loss of a baby represents the loss of a future. It is not just memories that cause grief but also the lost hopes and dreams. There are great support groups and books that can help you realise you are not alone (see below).

Common feelings following a miscarriage are:
  • Emptiness
  • Anger and disbelief ("why me?")
  • Disappointment
  • Sadness and a sense of isolation

Future pregnancies
Around 97 percent of couples who experience a miscarriage end up having a baby in the future. Even after several miscarriages, your chances of having a successful pregnancy are higher than miscarrying again. Future pregnancies don't negate the losses of the past. They give hope and meaning to our lives and a reason to move on beyond grief and into joy once more.

Good books Loss of a Baby, Margaret Nichol, Bantam Books, Sydney Australia, 1990 A Silent Love, Adrienne Ryan, Penguin Books, Australia, 2000 Miscarriage: information for parents and families booklet, SANDS NSW
For more information on support groups visit: SANDS or Bonnie Babes Foundation

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