Miscarriage Q & A

A miscarriage can be a distressing experience. Apart from the emotional upset of losing a baby, your body has been changing in pregnancy and now has to return to normal. Changes inside your body can also affect the way you are feeling.

Your feelings

I feel very upset and depressed. Is this normal?

When you started to miscarry, you probably felt both frightened and helpless, as there is usually nothing you can do to prevent it happening. Some women recover quickly, others take a long time. Some cope well at the time, but find a great sadness engulfs them later on. You may never forget the baby you have lost, but the pain will get easier You have lost a baby – you are very likely to feel sad and you may need time to grieve. Don’t expect too much of yourself. You may never forget the baby you have lost, but the pain will get easier.

Many women are left with feelings that they find difficult to cope with and talk about. Not everyone is the same, but many women experience some of these feelings:

• Shock
• Anger
• A feeling of emptiness
• Sense of bereavement
• Sadness and crying
• Depression
• Loss of interest in everyday life
• Loss of concentration
• Constant tiredness
• Feelings of guilt and failure
• Sleeping too much or too little
• Isolation and loneliness
• Lack or loss of interest in intimacy
• Pain or jealousy at the sight of pregnant women, babies or anything to do with motherhood
• Talking about it all the time, or finding it too painful to discuss

Many people find that these feelings arise or come back some time after the miscarriage. This may be on the date the baby was due or the anniversary of the loss. It may help to talk about your feelings with your partner, with friends and, possible, with others who have had similar experiences.

The physical process

In some miscarriages the womb empties itself completely. In some cases, though, the baby dies but is not miscarried, or there is still some pregnancy tissue remaining in the womb. In these cases a doctor may suggest that you have a small operation called ERPC (or D&C) to empty your womb. You may be offered the option of treatment with pills (medical management), or of having no treatment at all. You may choose to let the miscarriage happen naturally and this process might take some time.

How long will I bleed for?

After the miscarriage, you may bleed for up to two weeks and you may also have cramping pains during this time. The amount of pain and bleeding varies from woman to woman but can depend on the size of the pregnancy and also the way in which the miscarriage is managed (surgically, medically or naturally). The bleeding and any pain should gradually become less. If they become worse, if there is an unpleasant vaginal discharge or if you have a high temperature, contact your doctor as soon as possible, since these may be signs of an infection.

It is best to use pads rather than tampons during this time to avoid the risk of infection. You can bath and shower as usual, but it is best not to swim until any bleeding or discharge has stopped.

You are likely to get your next period four to six weeks after the miscarriage. This period may be heavier than usual. It is possible to become pregnant before your period is due, so if you haven’t had your period after six weeks, and if you have been intimate, it might be a good idea to do a pregnancy test.

Are there other things I should know?

In a later miscarriage, your breasts may stay larger and may leak milk for several days. This can be very distressing. A well-supporting bra may relieve discomfort and, if your breasts are painful, you could take a mild pain-killer such as paracetamol. You may wish to ask your GP or midwife for their advice.

Returning to normal

When you return to normal varies from person to person. You may feel physically low for a week or so and it is worth taking things easy during this time, if you can. You will find that your physical strength returns gradually and you can then do whatever you feel like. If you are at all worried, consult your GP.

What about doing housework or going back to work?

Again, this varies from person to person and possibly will depend on how you are feeling physically and emotionally. If you go out to work, you may find it difficult to face people and harder still to concentrate on your work. On the other hand you may find it helps to return to the routine and focus of work and you may also find comfort from the support and sympathy of colleagues.

Causes of Miscarriage

Why did I miscarry?

Even though about one in four pregnancies ends in miscarriage, it is usually difficult to know the exact cause. It can be hard to accept that no-one can say for certain why it happened. That doesn’t mean that it is your fault – your miscarriage is unlikely to have happened because of anything you did or didn’t do.

Could it be because I didn’t stay in bed when I started to bleed?

If you miscarried in the first three or four months, then staying in bed would not have stopped you miscarrying. Lying down can slow down bleeding but it won’t stop a pregnancy from miscarrying. It is very sad but true that once a pregnancy starts to miscarry, there is very rarely anything that can be done to stop it.

The main causes of miscarriage are thought to be:

Genetic: In about half of all early miscarriages, the baby does not develop normally right from the start and cannot survive.

Hormonal: Women with very irregular periods may find it harder to conceive and when they do, are more likely to miscarry.

Immunological: Problems within the blood vessels which supply the placenta can lead to miscarriage

Infection: Minor infections like coughs and colds are not harmful, but a very high temperature and some illnesses or infections, such as German measles, may cause miscarriage.

Anatomical: If the cervix (neck of the womb) is weak, it may start to open as the uterus (womb) becomes heavier in later pregnancy and this may lead to miscarriage. An irregular-shaped uterus can mean that there is not enough room for the baby to grow. Large fibroids may cause miscarriage in later pregnancy.

Some pregnancies can be ectopic. This is when the fertilized egg starts to grow in the wrong place, usually in one of the Fallopian tubes.

A small number of women who miscarry are found to have had a molar pregnancy (hydatidiform mole). In this situation, a fertilized egg which is genetically abnormal implants in the uterus (womb) but the cells of the placenta grow very quickly and prevent it developing further.

Looking to the future: what happens next?

Will I be offered any follow-up treatment?

You may be offered a follow-up appointment at the hospital. If not, you may want to make an appointment with your GP, midwife or health visitor if you want to ask questions or talk over anything that may be worrying you. Some areas offer pre-pregnancy counseling for people who want to discuss future pregnancies.

How long should we wait before trying for another baby?

Many doctors suggest waiting until you have had one period. This makes it easier to calculate the number of weeks the pregnancy may be. If you do become pregnant earlier, the risk of having a miscarriage should be no greater than if you wait. In some cases, however, your doctor will advise that you wait for longer, perhaps because of a medical complication. Ask if you are not sure.

Is there anything I should do to prepare myself for another pregnancy?

Try to take care of yourself with a healthy diet and regular exercise. It is recommended to take folic acid supplements before trying for a baby and in early pregnancy; your chemist can provide up-to-date information.

Will this miscarriage affect my chances of having a baby in the future?

After one miscarriage, most women go on to have a normal pregnancy. Research shows that even if you have several miscarriages, you still have a good chance of having a baby.

The information provided is for informative purposes only and in no way is intended to give either medical or halachic guidance. Please consult your doctor or rabbi for any questions in these sensitive areas.