Miscarriage

Early miscarriage | What to do if you think you're miscarrying | Preventing blood loss and infection | Dilation and curettage | Trying to get pregnant again | Late miscarriage | Warning signs | Medical treatments | Coping

Sadly, micarriage is very common: one in four women who become pregnant experience at least one miscarriage. The actual numbers are even higher as some women miscarry before they realise they're pregnant.

Early miscarriage

Around three-quarters of miscarriages occur in the first three months of pregnancy but a miscarriage can be a huge loss, no matter how many weeks pregnant you are.

"I discovered that I had a missed miscarriage at my 12 week scan. I would have been far more prepared for it had I realised that it was quite possible to be feeling all the symptoms of pregnancy and yet have actually lost the baby. As it was, it was just a huge and horrible shock at a time when I had hoped to see a scan and share the good news." Nauseous

"Women of our mothers' generation may just have thought they were having a late period. It's a form of progress in that the earlier we find out we're pregnant the better we can start to look after ourselves, but it does bring heartache with it." Sobernow

There are three types of early miscarriage:

• Complete - when the body naturally expels the foetus
• Incomplete - when remnants of pregnancy tissue remain in the uterus
• Missed - when an embryo dies but the placenta keeps growing, so your pregnancy still tests positive

"I had a missed miscarriage and no one mentioned how I would feel after and particularly did not mention that hormones would cause random emotions, which of course they did. I went from being fine one minute to bursting into tears when I saw parent and child car park spaces. I spent many car journeys driving home from work in tears simply because I had to let it all out, or not being able to look at pregnant women and so forth." Chants73

Every miscarriage is different - they're very painful for some women, but not for others - but it's common to experience heavy bleeding (possibly passing blood clots) and have strong, period-like pains.

"I've had three miscarriages - two involved heavy bleeding, pain, the whole lot. The other one had no symptoms at all, tiny amount of spotting and no pain. I knew in all cases I'd miscarried as my breasts deflated immediately and I could touch them without pain." MABS

If you have three or more miscarriages, it's diagnosed as recurrent miscarriage.

What to do if you think you're miscarrying

Bleeding is actually quite common in early pregnancy so it can be a very confusing time - is it a miscarriage or isn't it? What do you do and where do you go?

First off, ring your GP, your midwife or your hospital for advice. If it's available in your area, you may be referred to the Early Pregnancy Assessment Unit (EPAU) of your nearest hospital. You'll probably be offered an ultrasound scan to confirm if the miscarriage has actually taken place.

Be prepared for what can seem like endless waiting – waiting for a scan to get the definitive diagnosis, waiting for your body to let go of the last of your pregnancy.

"That feeling at the scan...the silence. I did get pregnant immediately, after just one period, and am 19 weeks now, but STILL utterly paranoid every time I go to see anyone that it has died again." dan39

Mumsnetters complain of having to share a waiting room with pregnant mums or women waiting for a voluntary abortion (and based on your criticisms we drew up our Miscarriage Standard Code of Practice recommendations).

Preventing blood loss and infection

If you're treated at an EPAU or hospital, the aim will be to prevent excessive blood loss and infection. If you're bleeding very heavily or feel feverish and generally unwell, make sure you contact your GP or hospital.

Severe pain that's only on one side can be a symptom of an ectopic pregnancy. This can be life-threatening, so it's essential to get medical attention immediately.

• Natural miscarriage (also known as expectant miscarriage)

This is when nature is allowed to take its course. It's an option if you miscarry before six weeks, aren't in great pain, running a fever or bleeding heavily. Your womb discharges the pregnancy tissues or absorbs them.

"If you're sent home to miscarry 'naturally', you need industrial strength sanitary pads and someone sympathetic with you – you don't want to have to flush a baby away on your own, if it comes to that. Plus I'd stock up on Ibuprofen or get the doctor to prescribe something stronger, the last thing you need is physical as well as mental pain." Biza

If the uterus isn't entirely cleared, there's a risk of infection and you may need dilation and curettage (D&C).

• Dilation and curettage

This is also known by the horribly clinical and insensitive term Evacuation of Retained Products of Conception.

The dilation is of your cervix, so that your womb can be scraped or suctioned out to remove any remaining pregnancy tissue. A D&C is done under a general or local anaesthetic.

A D&C is more common the further along you are in your pregnancy, and is usually recommended for an incomplete or missed miscarriage. There isn't the same waiting that comes with a natural miscarriage, but because it's an invasive surgical procedure it carries a very slight risk of infection.

"I was 10 weeks pregnant when I realised that I had miscarried but the scan showed the baby had died at six weeks. I opted for the ERPC and it was OK. I stopped bleeding, mostly spotting, after nine days. The procedure was quick and painless - about ten minutes. I felt a bit groggy afterwards and had light bleeding for a week. My reason for this choice was that I just couldn’t face miscarrying naturally or by medicine. I was very upset and thought this would be too much. It is a personal choice though." Lcy

• Medical management

Medicine that speeds up the natural process of miscarriage, without surgery, might be an option if you have had an incomplete miscarriage.

Side-effects may include pain, nausea, vomiting and diarrhoea. You're usually sent home to pass the last of your pregnancy, but some women may still require a D&C to completely clear their uterus.

Why early miscarriages happen

Unfortunately, the reason miscarriages happen in the first trimester aren't usually identified. In most cases, the miscarriage occurs because the fertilised egg has not developed properly, or because the baby isn't developing normally.

"Many women feel frustrated that until you have had more than three miscarriages, there is no follow-up to try and determine the cause," a mother says. "Even though it isn't regarded as recurrent until three, I felt that there must be something wrong with my body that I couldn't hold on to these babies."

Don't be surprised if friends and family come out with platitudes you find hurtful, or a doctor comes out with something along the lines of "you're young, you can have more".

"Letting go of the idea that you're having that particular baby on that date is so hard. People tend to say things like 'I'm sure it'll be OK next time', but that's not the point. You wanted this baby. I also felt my husband didn't really feel the same way as I did, which was hard to cope with. He just thought it was a minor setback whereas I felt like everything was falling apart." Gingernut

Trying to get pregnant again

Some doctors suggest waiting for your next period or any signs of infection before trying again to get pregnant, but not everyone agrees. One mum says: "My husband was in the room with me when I asked how long we needed to wait before trying again and, with a slight twinkle in her eye, the doctor advised waiting until we got home."

Late miscarriage

All miscarriages are terribly upsetting if it's a wanted pregnancy, but a late miscarriage - between weeks 14 and 24 - can be heartbreaking.

Around a quarter of miscarriages happen in the second trimester. Possible causes include:

• Chromosome and genetic problems
• Infections
• Bicornuate uterus (a womb that's partly divided in two)
• Problems with blood vessels supplying the placenta
• Large fibroids
• Weak cervix
  

A quarter of late miscarriages are thought to be caused by an 'incompetent' or weak cervix, where the cervix opens too early. It's more likely if you've had surgery for a previous miscarriage or abortion.

"I have an incompetent cervix - I found out by going into very early labour and losing a baby. In my next pregnancy I was scanned to see if my cervix was shortening and they put in a stitch (suture). I went on to have two perfectly naughty children." DimpledThighs

The cause is discovered in roughly half of all late miscarriages; this can be a source of comfort and help if when considering future pregnancies. "Finding out that my baby was genetically perfect helped me get further treatment and testing to discover why it kept happening to me," says one mum. "The only downside was the waiting which took six months."

Warning signs of late miscarriage

Possible warning signs are cramping pains and a pinkish vaginal discharge. It may be nothing but it's always best to check with your midwife.

• 'Spontaneous miscarriage' starts naturally - your waters might break and most women feel something like labour pains
• 'Silent miscarriage' is when a baby dies in the womb and you might not find out until you have a scan

Medical treatment

Most women are induced, which means they're given hormones (in pessary, tablet or injection form) to start labour.

"I was four-and-a-half months pregnant when I found out during a scan that the baby had died," says one mum. "I was induced. Despite it being traumatic, it was the best way to do it for me. I was able to leave the hospital 12 hours later and go home. They gave me very good pain relief. If I had a caesarean I would have had to stay in hospital for days and the emotional and physical recovery would have been prolonged."

You may be offered the chance to hold your baby. Mums' suggestions for how to say goodbye include naming your baby, taking photographs and wrapping your baby in a shawl if they're too fragile to dress.

Many hospitals offer a burial or cremation service. You can also make your own arrangements. You may be asked for your permission to carry out a post-mortem examination on your baby. This may help give to reveal why your baby died.

You might want to make up a box of mementoes to keep. Some parents plant a memorial to remember their baby: "We bought a rowan tree to plant in our garden in memory of our daughter," says one mum. "The most important thing is not sweeping everything under the carpet and pretending the baby never existed, which is what some members of our family wanted to do."

Physical effects of a late miscarriage

Your body has been thrown into an abrupt hormonal reversal, which can be very physically and emotionally unpleasant. Getting back to your pre-pregnant self physically can take a while.

You'll probably feel very tired afterwards and may bleed for several weeks. Your breasts will produce milk, which can be very upsetting, but you can take hormones to slow down production. You might lose your pregnancy shape very quickly or continue to look pregnant for a while.

Coping after a late miscarriage

Emotionally, late miscarriage is an enormous strain. Mumsnetters who've had late miscarriages recommend seeing a bereavement midwife or specialist grief counsellor: "It was fantastic for helping me let the feelings out as trying to make sense of it all was sending me insane in all sorts of ways."

And, of course, your partner is also suffering: "I think the impact on your partner is less obvious initially as they are trying to be strong for you but my DH broke down about three months ago and poured his heart out." scotlass

Many, many Mumsnetters have shared your experience and there's a wealth of understanding, information and empathy waiting for you on the Talk boards. Here's one thread about late miscarriage, as an example.

One mum's experience of miscarriage

"I miscarried 11 days ago. I was 17 weeks pregnant (or so I thought) and had some bleeding. Went to EPU for a scan and they told me no heartbeat - it had stopped at 14.5 weeks. Went home, they told me to come back the next day to take a tablet that would kick off the evacuation process. As it happens, the next morning I woke up at home with cramps - rushed to the loo and baby came out. Placenta didn't follow though, so I sat on the loo holding baby underneath me, as cord was still up inside. DH phoned hospital and they advised just stay there till placenta comes out, then bring it all in to hospital. Waited half hour having terrible pain then phoned ambulance. Went to hospital, where they cut the cord and took baby away. I spent all day having contractions trying to deliver placenta. Ended up having D&C. Sent home that night. Was heartbreaking to walk out of the maternity ward empty-handed after a whole day having contractions. It was so reminiscent of when we walked out with my DD (2.5). My DH and I were in pieces. We had to talk about the disposal of the baby's body, did we want to name it, did we want to see it, etc. I didn't realise they did all that at such an early(ish) stage. It sort of made it harder for us both, I think. The first few days were terrible. I cried buckets, felt so desolate and empty. I aready feel much better though, and have resumed TTC." LittlePeanut