Pregnancy Loss

Losing a baby can be devastating.  An overwhelming sense of sadness is common for women and their partners when pregnancy does not result in a healthy, live baby. 

There is no one ‘right’ way to feel when pregnancy ends unexpectedly. 

Every woman and her partner are unique.

WHERE TO SEEK HELP:

Pink Elephants 

Provides information and support for women through miscarriage, pregnancy loss and beyond. The group supports women through their grief, nurtures them as they heal and empowers them as they move into the future.  There are a number of resources available on their website including useful information about miscarriage stages, support brochures and downloadable resources.  

SANDS 1300 072 637

Provides information and confidential 24/7 support by a trained parent supporters who have a personal understanding of the grief and confusion that may be experienced following miscarriage, stillbirth or the death of a baby. SANDS also holds group support meetings and more details about these are available on their website.

Miscarriage

A miscarriage is the loss of a baby before 20 weeks of pregnancy.

Miscarriage happens when your baby stops growing and the pregnancy tissue is shed by vaginal bleeding. The chances of miscarrying are higher in the first 12 weeks of pregnancy. 

Miscarriage is reasonably common; around 1 in 5 confirmed pregnancies end in miscarriage. In fact, women can miscarry so early in pregnancy that they may not have even had their pregnancy confirmed. Very early miscarriages happen around the time a woman expects her period. Sometimes an extra heavy blood loss or clots are the only sign of a miscarriage. 

Some people view miscarriage as being less significant than stillbirth - however, it can be devastating for individuals. Generally miscarriage occurs through factors outside of anyone’s control. Reassuringly, most women who’ve had a miscarriage will go on to have healthy subsequent pregnancies.

Types of Miscarriage

There are a few different types of miscarriage. Although each results in the loss of your baby before 20 weeks gestation, it can be helpful to understand the different types.

Blood tests and ultrasound are used to confirm if the pregnancy is still viable. Some women continue to experience pregnancy symptoms even though their baby has died.

Threatened: Happens when bleeding and cramping is present but the pregnancy continues. You may be showing signs that you are going to miscarry but this eventually settles. Many women continue to have a successful pregnancy after a threatened miscarriage. 

InevitableCan happen after early signs of a threatened miscarriage or without any signs beforehand. Vaginal bleeding and abdominal cramping tend to become worse with inevitable miscarriage. Your developing baby, sometimes in its sac, is passed along with blood and clots from the vagina.

Complete: This happens when all the products of conception have left the uterus. Vaginal bleeding may continue for several days until your uterus is empty. With a complete miscarriage there is no need for a surgical procedure, known as a D & C (dilatation and curettage) to empty your uterus.   

Incomplete: Is when there is still pregnancy tissue remaining in your uterus. A "D & C procedure" in hospital is necessary to stop ongoing bleeding and prevent infection.

MissedHappens when your baby has died but remains in your uterus.

Other reasons for early pregnancy loss:

Ectopic pregnancy – Where your developing baby has implanted somewhere outside of your uterus. Most commonly this is within one of the two fallopian tubes.

Molar pregnancy – This happens when your baby fails to develop, even from the earliest stages of conception.

Blighted Ovum – occurs when the sac develops but there is no baby inside. 

Signs of miscarriage:

  • Heavy vaginal bleeding.
  • Uterine cramping which feels like period pain.
  • Passing blood clots or tissue.
  • A sudden loss of fluid from the vagina.
  • Some women feel a vague sense of ill ease, as if something isn’t right or is about to happen.

What to do if you think you are having a miscarriage:

Go to your GP or present at your nearest hospital’s emergency department. Most commonly, miscarriage is inevitable. Unfortunately, this means that if it’s going to happen, there’s nothing which will stop it.

Some people refer to miscarriage as ‘nature’s way’ of ensuring babies who are unlikely to progress and be born healthy and well do not survive beyond the 􀂂rst few weeks of pregnancy.

Exercise, stress, working too hard, having sex or doing too much does not cause miscarriage. 

Sometimes your baby does not form as it needs to and there is a major interruption in foetal development. Chromosomal abnormality can happen for no apparent reason, even where there is no family history of problems. 

Miscarriage may be caused by:

  • Your pre-existing medical condition/s. Diabetes, thyroid problems and uterine fibroids all increase miscarriage risk.
  • An infection which resulted in an elevated temperature.
  • Structural problems within your uterus or cervix.
  • Hormonal imbalance.

Risk factors for miscarriage:

  • Increased age – older women are more likely to miscarry than younger women.
  • A past history of miscarriage. A history of three (or more) miscarriages in a row is reason for medical investigations to determine if there is a cause.
  • Smoking cigarettes, drinking alcohol and/or using illicit substances. More than three alcoholic drinks in the first 12 weeks of pregnancy increases miscarriage risk.
  • A high intake of caffeine – more than 500 mgs of caffeine per day (around 3-5 cups of coffee) increases miscarriage risk.

Stillbirth or Newborn Death

Stillbirth happens when your baby has died before they are born. A baby who is born anytime from 20 weeks into pregnancy or weighing 400 grams or more, and is born with no signs of life is known as a stillborn. Sometimes baby has died during pregnancy (called intrauterine death) and other times they die during labour or just before birth (called intrapartum death). 

Stillbirth is uncommon, but unfortunately, it is not rare. In Australia 1 in 120 births will be a stillbirth or a newborn death. 

A newborn death (also known as neonatal death) is one that occurs in the first 28 days after birth.

What causes stillbirth?

Sometimes the cause is not clear. All seems to be going fine with mother and her pregnancy and for no apparent reason, her baby dies. 

Risks for stillbirth:

  • Congenital abnormalities – this means there are problems with your baby’s development.
  • Prematurity – when your baby is too immature to survive.
  • Maternal infection.
  • Problems with the placenta or umbilical cord.
  • Maternal obesity.
  • Smoking cigarettes, drinking alcohol and/or using illicit substances.
  • Trauma to mother’s abdomen.
  • Back sleeping.
  • Advancing maternal age.
  • Pregnancy complications such as pre-eclampsia, gestational diabetes, kidney or heart disease.
  • Growth restriction for your baby.
  • Multiple pregnancy.

What can I do to reduce my risk of having a stillbirth?

  1. Try to stay healthy and attend all of your antenatal appointments.
  2. Take folic acid supplements in the first trimester of your pregnancy.
  3. Avoid drinking alcohol, smoking cigarettes or taking medication or drugs which are not prescribed for you.
  4. Avoiding any X-rays – tell your doctor or dentist if 4 you are pregnant.
  5. Sleep on your side, especially in the third trimester of your pregnancy.

It’s important that you present immediately to the closest maternity hospital if you have:

  • A decrease or any change in your baby’s movement.
  • Pain or cramping in your abdomen or back.
  • Any trauma to your abdomen. This may be the result of a fall, a car accident or domestic or other violence.
  • You feel unwell, have a headache, sudden swelling or, pain in the region of your stomach or chest.
  • You feel nauseated or are vomiting.
  • You feel as if you have a temperature.
  • You have vaginal bleeding.
  • You have a sense that something is not right.

How would I know if my baby will be born stillborn?

If your baby’s heartbeat cannot be heard or there are no signs of life on an ultrasound, it is likely your baby will be stillborn. 

Parents are highly supported by hospital staff through the process of diagnosis and your baby’s birth.

There are benefits to your baby being born vaginally. And although this could be considered to be unnecessarily traumatic for parents, research has proven overall advantages.

  • Parents can spend time with their baby.
  • Less recovery time for mother and quicker discharge home.
  • Less chance of infection from surgery.
  • More chance of a vaginal birth with subsequent babies.
  • More time to emotionally process what has happened. 

Written by: Jane Barry, Midwife & Child Health Nurse