Miscarriage

What is a miscarriage?

A miscarriage is the term used to explain the loss of a pregnancy in the first 23 weeks. Later loss is known as a stillbirth. For many women, it is a one-off event and a healthy pregnancy follows.

In early miscarriages, especially within the first nine weeks, some women prefer to let nature takes its course and this may take days or weeks before the miscarriage begins. There are three options for women who would prefer to actively manage their miscarriage. These are:

• Medication - Your healthcare provider may be able to offer tablets or pessaries to begin the miscarriage.
• Surgical procedure - A woman who has been pregnant for less than 14 weeks may be advised to undergo an operation to empty the womb.
• Induced labour - If pregnancy comes to an end after 14 weeks, you may go into labour naturally. If this does not happen, your healthcare provider may recommend medication that will help to induce labour. Although this can be very distressing, it is much safer for the woman than to have an operation to remove the baby.

Your doctor can give advice on what to expect.

Miscarriage symptoms

There are several types of miscarriage and they can happen for many reasons. Many women are unaware they have had a miscarriage as the majority occur before the pregnancy has been recognised.

For most women though, abdominal cramps (ranging from a dull ache to severe pain) and bleeding are the first signs of miscarriage. On the other hand, some women have no symptoms at all and may only learn that their pregnancy has come to an end when it is detected during a routine scan.

Missed miscarriage

Sometimes known as a 'delayed' miscarriage, this is where the baby has failed to develop or died and is still in the womb. This type of miscarriage causes no warning signs such as bleeding or tissue loss. For this reason, it is also called a silent miscarriage, because the body often still acts as if it is pregnant.

Although the pregnancy will fully miscarry in time, your doctor may recommend surgical or medical help for you and you may need to decide which would be most suitable.

Causes of miscarriage

Most women never find out the cause of their loss, even after investigations. It’s thought that the majority of early miscarriages are caused by abnormal chromosomes in the baby which become rejected by the body. In later pregnancies, the problem may be with the womb or cervix.

Coping with your miscarriage without being given an exact reason as to why it happened can be extremely difficult. Usually, understanding why something has happened helps us to make sense of it, and to a certain extent allows us to plan for the future.

Often, lacking an explanation of what happened leads to speculation or a feeling of guilt. A miscarriage may bring a woman to question her own responsibility by asking herself whether she did anything to cause it, such as overexertion or drinking alcohol.

The emotional impact of miscarriage

A miscarriage can have a profound emotional impact, not only on the woman herself but also on her partner, friends and family.

For many, the term of the pregnancy, as well as other factors, will impact how you feel about what has happened. An advanced pregnancy may have a more emotional and hormonal impact. One which follows a long-awaited pregnancy may also be particularly upsetting.

Even if the pregnancy is in its early stages, this does not mean that the woman or her partner suffer less when a miscarriage happens.

You may feel stuck and unable to move forward after a miscarriage and this is completely normal. The emotional trauma can lead to feelings of anxiety or depression and it’s thought that as many as four in 10 women report symptoms of post-traumatic stress disorder (PTSD) three months after pregnancy loss.

Women vary greatly in what they need at this point. Some search for answers to the question of why this has happened, whilst others accept the outcome without such answers. You might find that your emotions vary intensely; some days your mood might feel particularly heavy and other days you may feel calmer and more accepting.

It’s important to remember that all bereavements require a period of mourning and miscarriage is no different. This will take longer for some people than for others - there is no right or wrong way to feel after a loss.

What is needed is the affirmation that this loss is real. And, sometimes, there can be nothing more important than the space to grieve. No matter how painful the feelings of grief may be, there can be no way out of grief without the opportunity to experience those feelings.

- Counsellor Gill Tunstall, MBACP.

Many women also experience unexpected emotions such as numbness, depression or anger. The anger may be aimed at yourself or, very often, your partner. You may also feel angry toward other people who perhaps don't seem to care or realise how you are feeling.

Miscarriage counselling

Miscarriage brings with it a wide spectrum of possible feelings and implications for those who experience it. Most people manage their own feelings with the support of partners, friends and family, but counselling may be a welcome support for some people at such a time.

A counsellor will help you to accept your feelings, whatever they may be, without making a judgement about whether they are right or wrong. Many people feel that they can’t overburden their friends with their grief, therefore, counselling gives the opportunity to talk to about your feelings in a way that is not usually possible with even the closest of friends.

Relationships too can be affected by loss and in these cases, counselling can help you to understand and process some of the feelings to allow a way forward. Grief in couples can be complex and the pain experienced by each individual can make you both feel isolated or abandoned.

The sense of loss may be profound and may have triggered feelings about other past losses in a surprising way – and this can be difficult to understand sometimes. With the support of a trained counsellor, it may be possible to reach a greater understanding and recognition of what the loss actually means to you.

After a miscarriage

For many, this is a personal time of loss and distress. As well as dealing with your grief, there are practicalities to address about the management of the miscarriage and what to do afterwards. For instance, when a baby dies before 24 weeks there is no legal requirement to have a burial or cremation, so you may need to make a personal decision about whether to have your own ritual.

Saying goodbye

Quite often, in early miscarriage, there is no funeral. But one thing that helps many people is having a ritual to say goodbye. This may help you and your partner feel a sense of peace. You may wish to ask friends and family to say goodbye with you, or you may prefer to keep it private.

You may choose to return to work and ‘normal life’ after a miscarriage as a way of helping you move on. However, you may wish to take some time off, by way of compassionate or bereavement leave. This may help you to mourn and deal with the loss you have faced. Remember, you are entitled to feel unhappy and ask for support but equally, it is OK to need your own space at this time.

It’s normal to be sad when faced with a loss and many women who have suffered a miscarriage spend some time grieving then look forward to life again and planning another pregnancy. However, this is a very personal decision and is not one that should be encouraged by others.

After a miscarriage, hopeful parents often say that the comments which hurt the most are those which make light of the loss - such as suggestions to “try again”. Although loved ones may mean well by trying to help you focus on the future, this can feel hurtful and insensitive. Often, the best way to provide comfort is by recognising the significance of what has happened.

It can be a very lonely time as the bereaved parents don't feel understood by others. Well-meaning friends and family can be experienced as insensitive when they focus on the next pregnancy.

- Counsellor Katie Leatham, BACP Accred, UKRCP.

Although it can feel painful, it’s important to talk about how you feel and to share thoughts and feelings about the end of the pregnancy. There was a real, hoped for baby that is now lost and your feelings and well-being deserve attention.

What should I be looking for in a counsellor or psychotherapist?

Whilst there are no official rules and regulations in place that stipulate what level of training and experience a counsellor dealing with miscarriage needs, we do recommend that you check your therapist is experienced in the area for which you are seeking help.

NHS Choices recommends that those struggling to cope with the emotional impact seek counselling or a support group. 

Further help

• Cruse Bereavement Care
• The Miscarriage Association
• Royal College of Obstetricians & Gynaecologists