Miscarriage mysteries unravelled

Birth and parenting expert Janine Gard.

Janine Gard is a diploma-qualified birth educator (2005) and founder of Bellies to Babies antenatal and postnatal classes. She has helped more than 3700 parents prepare themselves mentally, emotionally and physically for their journey to parenthood and loves what she does. This week she talks about miscarriage.
The information on this page details miscarriage which can be upsetting for some people, so please take care while you're reading.

In New Zealand, the Ministry of Health defines a miscarriage as losing a baby in the first 20 weeks of pregnancy. Miscarriage is fairly common – one in every four pregnancies are affected by miscarriage - but its frequency doesn't make it any less devastating for those who go through it.

About half of early pregnancy losses are from problems with genes or chromosomes. But other things can also play a role.

The term "miscarriage" might suggest that something went wrong in the carrying of the pregnancy. But this is rarely true. Most miscarriages occur because the fetus isn't developing as expected.

There are different types of pregnancy loss:

● Embryonic pregnancy - an egg is fertilised, but it never develops into an embryo

● Miscarriage - this is pregnancy loss before 20 weeks of pregnancy. It is also called spontaneous abortion

● Ectopic pregnancy - this is when the baby develops outside the uterus. This might be in a fallopian tube, the cervix, or the pelvis or abdomen

● Molar pregnancy - the placenta and fetal tissues do not develop normally

● Stillbirth - this is when the baby dies after 20 weeks of pregnancy

Various factors increase the risk of miscarriage, including:

● Age. People older than age 35 have a higher risk of miscarriage

● Previous miscarriages. People who have had two or more consecutive miscarriages are at higher risk of miscarriage

● Chronic conditions. Someone who has a chronic condition, such as uncontrolled diabetes, has a higher risk of miscarriage

● Uterine or cervical problems. Certain uterine conditions or weak cervical tissues (incompetent cervix) might increase the risk of miscarriage

● Smoking, alcohol and illicit drugs. Those who smoke during pregnancy have a greater risk of miscarriage than do nonsmokers. Heavy alcohol use and illicit drug use also increase the risk of miscarriage

● Being underweight or being overweight has been linked with an increased risk of miscarriage

● Invasive prenatal tests. Some invasive prenatal genetic tests, such as chorionic villus sampling and amniocentesis, carry a slight risk of miscarriage.

What happens during a miscarriage?

During a miscarriage, the severity of the symptoms will depend on how far along a person is in their pregnancy and the cause of the loss. Vaginal bleeding (varying from light spotting to heavy bleeding) or period-like cramps can be the first signs of a miscarriage. Some people have lower back pain, fever or chills, a loss of symptoms like morning sickness or breast tenderness, or intuitively feel that they are no longer pregnant.

If you think you might be miscarrying, call your LMC or your GP and describe your symptoms. They may refer you for a blood test or suggest going for an ultrasound scan at your local hospital for an assessment. If your bleeding is heavy (soaking pads) and/or you're passing large blood clots and/or you're in pain, it is advised to go to the emergency department at your local hospital. It can be helpful to have a support person during a miscarriage as it can be frightening and traumatising for some people. If you are having a miscarriage at home you may need to go to the hospital and in this instance, you cannot drive yourself.

How is pregnancy loss treated?

Your healthcare provider will figure out the best treatment based on:

● How old you are

● Your overall health and health history

● How you may cope with specific medicines, procedures, or therapies

● Your opinion or preference

Once pregnancy loss occurs, the fetal tissues must be removed from the uterus to prevent further complications. How this is done depends on the week of pregnancy and the type of loss. In early pregnancy loss, the body may naturally get rid of all of the pregnancy tissues. Sometimes the healthcare provider may suggest medicines which help the body absorb the tissues or get rid of them more quickly. Other times, they may need surgery to remove the tissues.

Are there any complications from miscarriage?

A miscarriage is a significant loss to the woman and her family. It is appropriate and normal to grieve because of the loss. Miscarriage does not usually cause other serious health problems, unless there is an infection or the tissues are not passed. A serious complication with a miscarriage after 20 weeks is severe blood clotting. Women with Rh negative blood may need treatment after a miscarriage to prevent problems with blood incompatibility in a future pregnancy.

Many grieving families have found the following to be helpful:

● Seeing or holding the baby if possible. This is especially important in later pregnancy losses and with babies with a birth defect who die

● Remembrances. These include a lock of hair, hand or footprint, photographs, or naming of the baby

● Counselling with a professional who is experienced in grief counselling

● Holding a memorial or funeral service

Can pregnancy loss be prevented?

● Most of the time pregnancy loss cannot be prevented. Good prenatal care is always important.

● Seek early antenatal care

● Avoid known risk factors - such as smoking, drinking alcohol and illicit drug use

● Limit your caffeine intake. A recent study found that drinking more than two caffeinated beverages a day appeared to be associated with a higher risk of miscarriage

A father's grief

A new baby is supposed to be a time of happiness and excitement. No father expects their baby to die. They may be feeling numb, shocked, disappointed, confused, sad or angry. Perhaps they are feeling inadequacy or guilt about the reasons behind the baby's death, or maybe they are struggling to accept the fact there is no medical explanation for why it happened. Bereaved fathers commonly experience intense emotions like these, but sometimes try to block them out to protect their partner and keep their everyday life functioning. It's crucial, however, that they give themselves time and space to grieve. What this looks like will be different for each dad. But one thing is for certain, there is no need to feel guilty for prioritising time spent working through thoughts and emotions.

Some fathers find it helpful to take a step back from work and social obligations to focus on their family at this time. Consider exploring options for parental leave, temporarily reducing work hours, or other flexible working options to help through the next few difficult months.

Men and women sometimes grieve differently, and fathers can benefit from talking to each other about the grief and confusion they may be feeling after their baby has died.

Supporting your partner during a miscarriage:

● Your partner may be very upset following a miscarriage, but not everyone reacts the same way.

● The impact of pregnancy and miscarriage may mean that it takes your partner a while to recover, both emotionally and physically.

● It is important to let your partner know if you feel upset about the miscarriage and that you need her support too. Understanding that you are both grieving may make you both feel less alone.

Things you can do:

● Talk to your partner, let her know that you support her, and try not to rush her through her grief

● Do activities that you enjoy together

● Support each other around the home and with other children you may have

● It may take time for either or both of you to want sexual intimacy again. This is normal, and is best managed by talking openly to each other.

If you are worried that you and your partner need some support, talk to her about getting some independent help. Your family doctor or the support organisations mentioned below are a good place to start.

● www.sands.org.nz - Sands New Zealand is a network of parent-run, non-profit groups supporting families who have experienced the death of a baby. We have over 25 groups/contact people around the country

● www.sands.org.au/mens-support-services - Whether you're a bereaved father or grandfather looking for support, or another family member who would like to better understand the grief experience from a male perspective, our male volunteer parent supporters can help.

● www.miscarriagesupport.org.nz - a team of volunteers of various ages who have all experienced the loss of their babies, provide emotional support and information for women and their families during and after miscarriage and subsequent pregnancies

● www.skylight.org.nz - offer a wide range of services to support those facing tough times of change, loss, trauma and grief

● www.babyloss.co.nz - is set up to support parents and their families who have experienced the death of a baby during pregnancy, at birth or in infancy. They also support parents facing the difficult decision after a poor prognosis

● www.stillbirthalliance.org.au - The Australia and New Zealand Stillbirth Alliance (ANZSA) is an alliance of organisations and individuals focusing on stillbirth prevention through conduct of high-quality research and supporting evidence-based maternity care

■ Bellies to Babies Antenatal & Postnatal Classes, baby massage courses and baby and infant first aid courses, 2087 Pakowhai Rd, Hawke's Bay, 022 637 0624. https://www.hbantenatal-classes.co.nz/

Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians.