A miscarriage is the spontaneous loss of a pregnancy before 20 weeks gestation. It is suspected that one in every four or five pregnancies ends in miscarriage, but often the loss is so early the pregnancy has not yet been detected. Doctors often refer to a miscarriage as a spontaneous abortion, but they are not suggesting you chose to end your pregnancy – this is the medical term for a miscarriage.
A miscarriage can happen any time between conception and up to and including the 19th week of pregnancy. However, most miscarriages (80 – 90 per cent) occur within the first trimester (up to week 13). Miscarriages between week 13 and 19 of the pregnancy are termed ‘late miscarriages’. From week 20 weeks onwards the loss of a baby is considered a still birth.
The most common symptom of miscarriage is spotting or bleeding that gets heavier and becomes more like a period, along with period-like pain. Not all bleeding pregnancy results in a miscarriage, so if you suspect a miscarriage you should visit your doctor. It is the bleeding that gets heavier, rather than lighter, that suggests a miscarriage may be imminent. Prior to this you may feel like your pregnancy symptoms have disappeared.
Treatment for your miscarriage will depend on how far along you are in your pregnancy. Once a miscarriage has begun there is nothing that can be done to stop it. Treatment focuses on avoiding heavy bleeding and infection.
If you are very early in your pregnancy, often doctors will let nature take its course and allow your body miscarry the pregnancy naturally. If you are further along you may be required to have a D&C (Dilation & Curettage). This is a day-stay hospital visit where you will be put to sleep and the doctor will perform a curette to remove the products of conception.
The causes of miscarriage are uncertain. The most commonly found cause is chromosomal abnormality. This is when the foetus is found to have uneven numbers of the chromosomes required for life, and as such, the pregnancy ends when it reaches a stage where it needs those chromosomes to continue developing. The most well-known chromosomal abnormality is Down Syndrome, but this is one instance where a pregnancy will continue despite the abnormality. Other causes may be the age of the mother or the father, a faulty egg or sperm or low progesterone.
It can be difficult to determine what has caused a miscarriage – doctors can test the products of conception (if a D&C is performed) but if there is no evidence of a chromosomal abnormality there is little opportunity to investigate beyond this. This can be quite difficult for the mother as she may feel that it is her fault.
One thing is clear, there is very little a mother can do to induce a miscarriage so women who have suffered a miscarriage should be aware that it is not her fault. A single miscarriage is considered to be a natural event, although sad and often traumatic, it is not believed to be part of a bigger problem.
Some women will go on to miscarry again, but two miscarriages in a row is also not considered to be unusual. It is only on a third miscarriage that doctors will initiate investigations into any possible underlying conditions that may be causing the miscarriages. After two miscarriages in a row a woman is still, statistically, more likely to carry a third pregnancy to term.
Three or more miscarriages is termed Recurrent Miscarriage and is considered to be worthy of investigation. Around one per cent of women will suffer recurrent miscarriage, so it is a small portion of women. There are several tests that your doctor can undertake to try and determine if there is an underlying issue that may be causing problems.
Issues such as auto-immune disease (for example; Lupus and Celiac disease), an underlying genetic issue where the mother or the father carry a faulty gene but are not aware of this, blood clotting problems, weakness with the cervix, thyroid problems, among other things, may cause recurrent miscarriage. If a cause is isolated, doctors will offer appropriate treatment for underlying problem. However, even those women who never find a cause for their miscarriages have a very high chance of carry a normal healthy baby to term.
Having a miscarriage can be a very distressing experience. You may experience shock, anger, grief, deep sadness and a sense of loss. Every woman’s experience is different and there is no wrong or right to how you feel. The most important thing is that you be kind to yourself and allow yourself time to get over the loss. You may need support, and there are several places you can go. Your doctor should be able to provide you with the contact details of a counsellor who is experienced in dealing with women who have suffered miscarriage. There are also several charities and support groups that exist to provide the help you may need.
Bears of Hope: http://www.bearsofhope.org.au/a/181.html
Pregnancy Loss Australia: http://www.pregnancylossaustralia.org.au