Miscarriages are more common than most people imagine with as many as one in every four pregnancies ending this way. Some women are reluctant to talk about this unhappy experience and wish to put the set-back behind them as quickly as possible, while others need to process the feelings more slowly. For many, the term of the pregnancy and other factors impact on how they feel about what has happened? Some may also need to make certain decisions and manage some practicalities.

What is a miscarriage?

A miscarriage is the term for 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. There are several types of miscarriage and in most cases the womb empties itself but there are other types which include:

• Blighted ovum - Usually occurring in the early weeks of pregnancy, this type of miscarriage is where the pregnancy sac has developed but contains no embryo.

• Ectopic pregnancies and molar pregnancies - Both are often classed as miscarriages. A molar pregnancy is a pregnancy that has not developed normally, resulting in an influx of abnormal cells which develop inside the womb instead of a baby (usually detected during the first ultrasound scan at 10-16 weeks). An ectopic pregnancy happens when a fertilised egg implants itself outside of the womb, meaning it is unable to develop.

• Incomplete miscarriage - The miscarriage has started but some of the pregnancy tissue remains in the womb.

• 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. However, a missed miscarriage causes no warning signs such as bleeding or tissue loss and is often diagnosed at a scan.

 

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.  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.  For women who would prefer to actively manage their miscarriage there are three options:

 

1. Medication - Your healthcare provider may be able to offer tablets or Pessary to begin the miscarriage.
2. Surgical procedure - A women who has been pregnant for less than 14 weeks may be advised to undergo an operation known as an evacuation of retained products of conception (ERPC). This procedure empties the womb by gently widening the cervix so that the contents can be removed by suction.
3. 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 women than to have an operation to remove the baby.

 

Your doctor or hospital can give advice on what to expect.

Who suffers?

Many women are unaware they have had a miscarriage as the majority occur before the pregnancy has been recognised. Miscarriages have a very personal meaning, depending on the length of the pregnancy, the woman’s outlook and history.

An advanced pregnancy may have more emotional and hormonal impact. One which follows a long–awaited pregnancy may also be particularly upsetting.

Women who have experienced three miscarriages account for one in a hundred but three-quarters will go on to have a healthy pregnancy. Research in miscarriage related matters reveals that being informed and having some control of the situation usually helps women and couples cope.

For many it is a personal time of loss and distress and is an unhappy experience to go through. As well as feelings of distress there are practicalities to address about the management of the miscarriage and what to do afterwards. When a baby dies before 24 weeks there is no legal requirement to have a burial or cremation so a personal decision may need to be made.

Abortion in India is legal only up to twenty weeks of pregnancy under specific conditions and situations which are broadly defined as:

• the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury of physical or mental health, or
• there is a substantial risk that if the child were born, it would suffer from such physical or mental abnormalities as to be seriously disabled.

Recently, the Supreme Court permitted a rape survivor to terminate her pregnancy at 24 weeks, which is beyond the permissible 20 weeks limit prescribed under the Medical Termination of Pregnancy Act, 1971.

An adult woman requires no other person's consent except her own.  In many parts of India, daughters are not preferred and hence sex-selective abortion is commonly practised, resulting in an unnatural male to female population sex ratio due to millions of developing girls selectively being targeted for termination before birth

Miscarriage symptoms

Far from the drama often portrayed in films, for most women abdominal cramps - from a dull ache to severe pain - and bleeding are the first signs of miscarriage.

Additional miscarriage symptoms can include very heavy bleeding, spotting, brown vaginal discharge and/or strong abdominal cramps (like bad period pain), or sharp or severe pain - especially if it is an ectopic pregnancy.

On the other hand, some women have no symptoms at all and may only discover that their pregnancy has come to an end when it is detected during a routine scan.

Causes of miscarriage

Most women never find out the cause of their loss, even after investigations. It is 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 on to speculation - sometimes leaving devastated families blaming themselves for the miscarriage, or their partner.

Although it is easier said than done, it is important to remind yourself that your miscarriage (or ectopic or molar pregnancy) is highly unlikely to have occurred as a direct result of anything that you did or did not do.

According to professional opinion on miscarriage, the main causes of miscarriage are as follows:

• Genetic - This is thought to occur in around half of all early miscarriages, and happens when the baby is unable to develop normally from the very start and cannot survive.

• Hormonal - Women who have an irregular menstrual cycle may find that they find it difficult to conceive, and when they do they are at a higher risk of miscarrying.

• Immunological/ blood-clotting - This is where there are problems in the blood vessels that supply the placenta, sometimes resulting in a higher number of blood clots and leading to miscarriage.

• Infection - Although minor infections such as common coughs and colds are unlikely to have a detrimental effect on a pregnancy, a very high temperature and some illnesses and infections such as German measles may result in miscarriage.

• Anatomical - The three main anatomical causes of miscarriage are as follows:
  • If the cervix (the bottom of the uterus) weakens, it may begin to open as the uterus grows heavier in the later stages of pregnancy - possibly leading to miscarriage.
  • If your uterus is irregular in shape, this may mean that there is not enough room for the baby to develop.
  • Fibroids are growths which occur in the uterus, and though they are harmless, large ones may cause miscarriage in the latter stages of pregnancy.

 

How could counselling help?

It is 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.  Others may find themselves stuck and unable to move forward as grief turns into depression.  In this case the sense of loss may be profound and may have triggered some earlier unresolved loss resulting in despair.

Relationships, too, can be affected by loss or guilt or anger which cannot be voiced following such a disappointment.  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 them feel isolated or abandoned and that the other partner is unavailable to them. Couples counselling can help unravel the tangle of sadness and despair.

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.

If you are struggling to cope with the emotional impact, it is advised to seek counselling or a support group and with regards to the physical treatment of miscarriage, you may want to seek medical opinion of your doctor.