Mother’s Prayer Following A Miscarriage/Stillbirth
Our Diaconal Call: Accompanying Families Through a Miscarriage or Stillbirth
By Deacon Gerard-Marie Anthony and Dr. Sabine Heisman
A deacon is an icon of Christ the servant. Christ came to serve, search out the sick (Mk. 2:17), and help heal the brokenhearted (Ps. 147:3). We too, as His deacons, must serve in these ways to be the icons we are called to be through our ordination. Thus, the National Directory of the Formation, Ministry, and Life of the Permanent Diaconate states:
“The deacon must strive, therefore, to serve all of humanity …while devoting particular care to the suffering… Ultimately, the deacon’s principle diakonia—a sign of the Church’s mission—“should bring [all whom he serves] to an experience of God’s love and move [them] to conversion by opening [their] heart[s] to the work of grace.”(paragraph 85).
As servants who should “strive to particularly care for the suffering.” One forgotten but a common group of people who suffer are families, particularly mothers, who have miscarriages or stillborn babies.
The March of Dimes tells us that almost half of the pregnancies may end in a miscarriage (many are unknown because they happen in the first trimester), but 1 in 4 of known pregnancies end in miscarriage (loss of a child under 20 weeks)/stillbirths(loss of a child 20 weeks and older).
Brokenhearted After a Miscarriage or Stillbirth
Many of our flock have been brokenhearted at some point in time due to a miscarriage or stillbirth, but if we’re honest, how many of us as clergy have helped accompany a family through this traumatizing time of life? How many of us have helped the family “experience God’s love” and “open their hearts to a work of grace”? This is the reason for this article.
Some married permanent deacons may have experienced a miscarriage first-hand, but many of the clergy do not know miscarriages/stillbirths are a prevalent problem because it is a taboo topic.As a clinical psychologist and mother who has suffered a miscarriage (twins, in 2016), I can speak to the devastating impact of child loss to our community.
One of the most difficult things to navigate after such an experience is the lack of “appropriate,” albeit well-intentioned, responsiveness from members of the community.
Through A Mom’s Peace (an organization that assists with burial arrangements for families who have experienced child loss), we were able to bury our twins, as well as an incredibly helpful Catholic priest, was present in overseeing the burial rites.
However, as I attempted to navigate and process the grief, I reached out to several clergy members who were not as helpful as they could have been.
Our goal is to assist members of the clergy with information and strategies so they can more effectively serve their community through the specific grief process of child loss.
Thus, we, as a deacon and clinical psychologist/mother, will address three important items to help deacons serve their people. We will examine those items clergy need to be aware of when ministering to families/mothers who are going through a miscarriage.
Secondly, we will look at helpful and non-helpful things experience to say/do when interacting with a mother who has gone through this traumatizing event. Third, we will look at things the Church can do to help families develop resiliency and not lose hope.
Speaking as a mother, one of the most important points for clergy to understand is the immediate physical state a woman is in after suffering a miscarriage/stillbirth. This is not often addressed because the immediate priority is logistics (i.e.
, burial of the child). Oftentimes, a woman is not only attempting to process the loss of a child, but also the physical pain associated with the experience.
A miscarriage is incredibly painful; at times, surgery is even necessary as part of the process.With stillbirths, women often still have to go through the process of actually giving birth. Yet, despite her own physical pain, she has to worry about the logistics of burying or memorializing a child, perhaps caring for other children or family members, and financial concerns (i.e., going back to work).
I was never asked how I was physically doing after my miscarriage. Rather, people would attempt condolences, “God needed another angel,” or “At least you can be grateful you already have a child.
” These statements are not helpful! Not only acknowledging that a woman has been through a physically gruelling experience, but also, asking how you can help alleviate the burden is validating.
Deacons and Clergy Can Help
Deacons can help by empathizing with the mother and meeting her needs, such as offering to organize a week of meals to be brought to the home, or gathering youth groups to help with light household duties so the mother can physically recover.
Psychologically, grief is a very long process. Supporting a mother who has lost a child is an ongoing journey that does not end after the burial of the child. Saying their child’s name, honoring their memory (e.g, during the holiday season especially), and acknowledging the long- term impact of the loss is critical to the family’s acceptance process.
Clergy should do check-ins with the mother (not only in the immediate weeks following the loss but in the months, even years after), offer continuous support through the grieving process, and encourage mothers to seek out professional, therapeutic interventions as a priority. Mothers tend to worry about everyone else, but they often neglect their own self-care. Society continues to view child loss as something we “shouldn’t dwell on,” but a mother may need extra support even years after the loss of a child.
Finally, and perhaps, most importantly, spiritual support is often not readily available. There are very few active, clergy-run support groups for mothers who have suffered miscarriages/stillbirths.
One of the most disappointing experiences after my miscarriage was going to a priest for spiritual counsel and hearing that according to church doctrine, “we don’t really know where your baby is, hopefully, heaven.
” This was not helpful! Mothers often feel lost after losing a child, and while fully recognizing that there may not be definitive answers, being provided with hope would be helpful. For example, I later learned about the concept of “baptism by desire,” and how that was ly applicable to my children (see CCC1260-1261). This provided hope that I would be reunited with them.
When a mother seeks spiritual support, sometimes she seeks to know “why,” other times, it’s more a matter of “will I see them again?” Spiritual guidance and support are critical to the long-term acceptance process when dealing with child loss. Discussing the loss of a child may be uncomfortable for the listener, but a mother often wants and needs to discuss the experience.
Members of the clergy need to become more comfortable discussing this topic as an absolute minimum of 20% of their congregation has experienced child loss either directly or indirectly.
Thus, it could be addressed in respect-life Sunday homilies or mentioned in marriage preparation since it is ly to happen with having children.
Ultimately, clergy should be active companions to families who have suffered child loss to provide hope in God’s mercy as well as heaven and to help the family navigate the journey from grief to acceptance.
Our Primary Diakonia
In Conclusion, we see that Mark 5 is an analogy of how we should live out the National Diaconate Directory’s focus towards our primary diakonia.
There, we hear about 3 different kinds of health that Jesus offers- an exorcism of the demoniac, the healing a woman hemorrhaging for 12 years, and raising Jarius’s daughter from the dead.
These all relate to parishioners who have experienced the tragedy of miscarriage or stillborn birth. First, through the symbol of exorcism, we realize we must help the mother to be delivered from the demon of despair through grace.This means we strive to understand what she is going through physically, emotionally, psychologically, and spiritually. Next, the mother must touch Jesus’ cloak stopping the hemorrhage of shock and grief which keeps her and/or family unable to move forward.
Touching Christ’s cloak means being wrapped in the Church’s accompaniment so clergy should go the extra mile to accompany hurting families.
Finally, with grace and accompaniment, the mother can place her child and grief in Christ.
This can help transform grief into acceptance while continuing to live out her vocation as mother/beloved of God just as Jesus transformed death into life with Jarius’s daughter.
The clergy, especially the deacon, have a pivotal role to imitate Christ in each of these three aspects of healing. Christ came to serve by seeking out the sick and healing the brokenhearted. As His icon, we must do the same by serving those who have broken hearts from miscarriage/stillbirth and point to Jesus, the Divine Physician, whose love can heal all wounds.
A M.O.M.S Peace can be found at https://www.amomspeace.org
Deacon Gerard-Marie Anthony is a deacon for the diocese of Arlington, VA. He is currently a counseling candidate at Divine Mercy University and received his B.A in Theology from Christendom College and his M.A in Theology from the Catholic Distance University. He has written for Deacon Digest, Our Sunday Visitor Newsweekly, CatholicMatch, Lay Witness, and Immaculate Heart Messenger. He can be contacted at email@example.com Dr. Sabine Heisman is a clinical psychologist who specializes in neuropsychological assessments and forensic consulting. She is also an adjunct professor at George Mason University.
Stillbirth and miscarriage: where to get support
When the TV personality, Jack Osbourne, and his wife, Lisa, announced that they experienced a late-term miscarriage earlier this year, they were flooded with messages of sympathy from well wishers.
Singer, Lily Allen, was six months pregnant when she had her second miscarriage and asked her fans to say a 'little prayer' for her loss.
One in four pregnancies ends in miscarriage. Most happen in the first 12 weeks, but a small number of expectant mothers lose babies in the second or even third trimester.
The loss of a foetus is termed a miscarriage if it occurs before 23 weeks. After that time, it is a considered to be the stillbirth of a baby.
But it still remains the case that most people don't talk much about the loss of a pre-term infant.
Opening up about stillbirth and miscarriage
Ruth Bender Atik, national director of the Miscarriage Association, said at the launch of a recent campaign to encourage people to use the charity's helpline: 'Miscarriage affects many thousands of people throughout the UK every year, yet it's rarely spoken about openly.
'We know that talking about it can make a huge difference to the women, men/partners, families and friends affected by miscarriage.'
Susan Harper-Clark, 35, found it hard to hard to talk about her own feelings of grief and loss when she suffered two late miscarriages; one at 19 weeks in 2010 and the second at 22 weeks in 2011.
'It was just too painful at first. That said, my husband Graeme and I wanted people to acknowledge what had happened and I really appreciated their well wishes.'
Preventing miscarriage and stillbirth is one of the primary goals of doctors who look into why babies die in utero.
Professor Siobhan Quenby is a consultant at University Hospital Coventry and Warwickshire NHS trust.
After years of research, she has discovered that natural killer cells, which are present in ur bodies, are linked with repeated miscarriages.In one of her studies, 160 women who had a history of miscarriages were examined to see if they had high levels of natural killer cells in the lining of their wombs.
Those who were found to have high levels of these cells were randomly given either steroid treatment, which blocks natural killer cells, or a placebo once they became pregnant.
Women who had the steroid treatment were 20 per cent more ly than those on placebo to carry a baby to full-term.
However, Professor Quenby says that more work still needs to be done before steroid treatment can be rolled out on a larger scale.
Tests showed that Susan had what's known as an 'incompetent cervix,' despite being fit and healthy, and being free of risk factors such as smoking or a high BMI.
'After I got over the initial shock, I did find it hard to talk to people about what I had gone through.
'I found it easier to talk to some people than others and I felt that some people were embarrassed about the situation.
'Luckily, my husband is brilliant and I have a very close family. We helped each other get through it.'
Information on where to get support
The Miscarriage Association offers support in a number of ways.
'We are there to offer information. When things go wrong in pregnancy, there is often a great need for information about what is happening and what is ly to happen,' says Ruth.
'There may be questions about the physical process of loss and the options available; about what happens to the remains of a miscarried baby; about further tests or treatments; and especially about whether there is anything that can be done to reduce the risk next time.'
Staff needs to be supported too. Caring for women who've had an miscarriage or stillbirth can be emotionally demanding on health care professionals.
'We support medical staff and have a range of leaflets available, which can also be downloaded from our website. We have telephone support workers and a team of volunteers to offer peer support.
'This is combined with the support offered through our forum and pages.'
Support for future pregnancies
Although they were devastated after two miscarriages, Susan and Graeme were determined to keep trying to have a baby. After doing some online research, Susan contacted the charity, Tommy's, and was referred to the Preterm Surveillance Clinic at St Thomas' Hospital, London.
Under the team's care, she underwent an abdominal stitch, regular fetal fibronectin testing and cervical length tests, and gave birth to her son, Thomas, at 38 weeks in July 2012.
'It's an amazing feeling having little Thomas, but we'll never forget his two sisters, Emilia and Grace, who paved the way for him,' says Susan.
'As soon as he is old enough – he is 14 months old now – we will tell him about them and they will always be part of our family.'
Other people also read:
Miscarriage:The facts on miscarriage.
Stillbirth: The facts on stillbirth.
The Miscarriage Association: The Miscarriage Assocation offers help and support to people struggling with a bereavement.
Last updated 07.10.2013
Miscarriage: a guide for men
A miscarriage (sometimes called pregnancy loss) is when a fetus dies before 20 weeks of pregnancy.
If your partner doesn’t know how long she’s been pregnant, the doctors will say she’s had a miscarriage if the fetus weighs less than 400 gm.
Miscarriage is common, but it’s hard to say exactly how often it happens. This is because many miscarriages happen before a woman knows she’s pregnant. Around 15-20% of confirmed pregnancies are miscarried.
Miscarriage happens for many different reasons. Usually it’s because the fetus isn’t developing properly. Once a miscarriage begins, no medical treatment can stop it.
The miscarriage really came as a surprise the first time. It was after six weeks and it was a blighted ovum, which means that the fetus had stopped growing at 2-3 weeks.
– Marcus, father of one
Sharing grief about miscarriage
You and your partner are ly to feel very sad, helpless and distressed if your doctor tells you that the fetus has died.
Most ly, your partner’s body had begun to change and she had started to think of herself as a mother. You might have started to think about being a dad. Instead, you’re faced with loss and grief.
But because most miscarriages happen in the first 12 weeks, some women don’t know they’re pregnant. Even if you both knew, you might not have shared the news with others. This can make the grief more complicated.
Many people don’t have rituals or ceremonies to help them with the grief of miscarriage. It can also be hard to talk about miscarriage with other people.
It’s OK if you decide to put on a ‘brave face’, but people might not realise that you’re going through a lot of grief.
Many people find that it does help to tell others. You could let close friends and family know what your baby meant to you, what support you need and how much you want to share your experience. If you don’t feel talking, you could consider sharing it in writing.
Supporting your partner after miscarriage
Although miscarriage is a loss for both of you, it happened physically to your partner. If your partner keeps bleeding for days or weeks after the miscarriage, it’s normal for her to feel that it’s still happening.
Your partner is also ly to be in a raw emotional state. She might have formed a special relationship with the growing baby. She could have done little things patting her tummy or speaking to her fetus.
Simply being there for your partner by listening and giving her ‘a shoulder to cry on’ is often what women want most from their partners.
The only thing I thought was just to let my wife take her time with the grieving process instead of trying to rush it and be overly positive – which I think you tend to do as the husband or the partner. In a relationship, you tend to really focus on the positive straight away.
– Marcus, father of one
Caring for her, caring for yourself
Some men feel as though they have to hide what they’re going through so they can be there for their partner.
But you both need time and support.
Try to make time to do activities you both enjoy, something you usually find relaxing or rewarding as a couple. This can help nurture your relationship and create some positive feelings.
I suppose I could never understand that physical loss, to have life inside you and then to lose it. To somehow feel partially responsible even though you’re not. My wife was ‘to the book’ – she didn’t touch alcohol, and she geared her diet so strictly. To this day I still don’t feel that I was able to do enough for her.
– Marcus, father of one
Trying for another pregnancy
You or your partner might be keen to start trying to get pregnant again. You could also feel pressure from family, friends or colleagues about trying for another baby.
Grieving and recovery don’t happen overnight, and the process is different for everyone. If you try again straight away, your grief might be put ‘on hold’ as you focus on the new pregnancy.
It could take some time to get pregnant again. If this happens, any thoughts of fear, failure and disappointment might get worse. If you’re using IVF, you might both need to take some time to build up your strength before starting another cycle.
Getting help with grief
Eventually most parents find their way grief, or at least feel less consumed by grief. Your life keeps going, but you will probably be changed – sometimes a lot, sometimes a little.
If you’ve focused entirely on your partner, you can take a very positive step by taking time to explore your own feelings. Tune into what you’re going through, and talk with your partner or someone else you trust about it.If you or your partner feel you aren’t coping or are feeling depressed, you might need professional help. See your GP or a counsellor.
You could also call MensLine on 1300 789 978 or the Bereavement Information and Referral Service on 1300 664 786.
People tend to forget the male partner. When somebody has two or three miscarriages, it’s the woman who breaks down. She starts crying and she’s very upset. Sometimes women end up with psychological problems. But not many people look into the effect it has on the male partner.
– Male obstetrician and father
Things you can do
- If you need to tell your story or share what you’re going through, ask for the support of trusted friends and family.
- If you feel you’re not coping, you’re feeling depressed or your relationship is under a lot of stress, see your GP, a counsellor or a community spiritual leader, if you have one.
- Give yourself permission to feel what you’re feeling. Grief isn’t a hurdle to get over or something that will go away if you ignore it. It’s an individual process that happens over time.
- Say yes to practical help from others – you don’t have to go it alone.
Lies, Damned Lies, and Miscarriage Statistics
Trying to figure out your chances of miscarrying? Sadly, you are going to have a hard time finding good information.
Many websites claim to tell you your risk of miscarriage, citing statistics that look these:
Commonly reported chances of miscarriage by pregnancy week
But problems abound with their numbers.
Problem 1: These sites rarely provide their sources, so you cannot tell whether their information is reliable.
Problem 2: These sites do not breakdown miscarriage risk by other known risk factors, the mother’s age.
Problem 3: Nearly all these sites derive their statistics from just two small studies, one which tracked 222 women from conception through just the first 6 weeks of pregnancy, and another which tracked 697 pregnancies, but only after a fetal heartbeat had been detected–a key point, because heartbeat detection dramatically lowers the chances of a miscarriage.
The lack of good information frustrated me when I was pregnant, and I bet it frustrates you too. So I have compiled a summary of the best research on risk of miscarriage. Where possible, I break down the risk by…
Edit: I also have a new post on how morning sickness signals a lower risk.
Risk of Miscarriage by Pregnancy Week
Miscarriage risk drops as pregnancy progresses. The risk is highest early in the first trimester. Fortunately, for most women by 14 weeks their chance of a miscarriage is less than 1%.
Miscarriages rates declined between 6 to 10 weeks, according to a study of 697 pregnancies with a confirmed fetal heartbeat:
- 9.4% at 6 weeks
- 4.6% at 7 weeks
- 1.5% at 8 weeks
- 0.5% at 9 weeks
- 0.7% at 10 weeks
A similar study of 668 pregnancies with a confirmed fetal heartbeat between 6 and 10 weeks, found a similar decline in miscarriage risk by week:
- 10.3% at 6 weeks
- 7.9% at 7 weeks
- 7.4% at 8 weeks
- 3.1% at 9 weeks
But for women in their mid to late 30s and early 40s, these studies understate the risk. Even after confirmation of a fetal heartbeat, miscarriage risk remains high for women 40 and older through 12 weeks, according to a study of 384 women 35 and older.
Chance of miscarriage by 12 weeks but after confirmation of a fetal heart rate by the mother’s age.
Despite the higher risk for this age group overall, a normal ultrasound result from 7 weeks remains a promising sign. Women who entered the study in their 4th to 5th week of pregnancy had about a 35% risk of miscarriage. Women who entered the study later, and who therefore had a normal ultrasound and heartbeat at 7-10 weeks, had a risk under 10%.
Miscarriage Risk by Fetal Heart Rate
A fetal heartbeat often indicates a healthy, viable pregnancy. But a fetal heart rate that is too slow can instead signal an impending miscarriage.
The chance of a first trimester miscarriage varies by fetal heart rate, according to a study of 809 pregnancies. The lower the heart rate, the higher the miscarriage risk. (Normal fetal heart rates change with fetal age, so these tables break down the risk by pregnancy week.)
Up to 6 weeks 2 days gestation:
Chance of miscarriage by fetal heart rate up to 6 weeks 2 days of gestation.
Between 6 weeks 3 days and 7 weeks 0 days:
Chance of miscarriage by fetal heart rate at 7 weeks gestation
After 7 weeks, the fetal heart rate was at or above 120 beats per minute for almost all ongoing pregnancies.
Miscarriage Risk by Week Before Confirmation of a Heartbeat
Many women will not have an ultrasound and fetal heartbeat confirmation until sometime between 8-10 weeks. What are their chances of a miscarriage before that crucial piece of news?
In a large prospective study of 4,887 women trying to conceive, 4070 became pregnant. Their rate of miscarriage was 4-5% in week 6. By week 7, this risk fell to 2.5%. Rates hovered around 2% per week until week 13, when chances of a miscarriage dipped below 1%
Personal Risk Factors
Your personal characteristics and behaviors alter your miscarriage risk. The most important risk factor, as is well known, is the woman’s age: Miscarriage rates climb as women age, especially after the late 30s. The man’s age matters too, especially after they turn 40.
Risk of Miscarriage by the Woman’s Age
Anne-Marie Nybo Anderson, of the Danish Epidemiology Science Centre led the largest population-based study ever conducted on age and miscarriage. Anderson tracked every “reproductive outcome”– every pregnancy, miscarriage, birth, stillbirth, or abortion–in Denmark between the years of 1978 and 1992–ultimately tracking outcomes of over a million pregnancies.
What did she find? Miscarriage risk rises sharply during a woman’s late 30s and reached nearly 100% by age 45.
Risk of pregnancy loss by the mother’s age at conception.
Rates of ectopic pregnancy also rose with age:
Risk of ectopic pregnancy by the mother’s age
As did the chances of a stillbirth:
Risk of stillbirth by the mother’s age at conception
(In Anderson’s study, stillbirth was defined as a loss after 28 weeks. In the U.S., any loss after 20 weeks is usually considered a stillbirth)
Take heart though: as scary as the rise in stillbirths sounds, the risk remains under 1% through age 45.
Anderson’s study’s findings parallel those of another large and well-studied sample: U.S. pregnancies conceived via IVF.
Data from the Centers from Disease Control’s report on all 2010 IVF cycles.
Just as in Anderson’s study of Danish pregnancies, the uptick in miscarriage risk among IVF pregnancies begins at age 38.
Intriguingly, the overall miscarriage rates among IVF pregnancies is lower than in the Denmark sample. This is probably due to selection effects. Only some women manage to become pregnant through IVF, and embryos transferred during IVF are chosen early signs of normal development. Passing through these early hurdles ly ups the odds of a successful pregnancy.
Risk of Miscarriage by the Man’s Age
Researchers often ignore the man’s age when studying miscarriage. Most women marry men who are about the same age, so researchers have trouble teasing apart the effects of the woman’s age from the man’s age.
Fortunately, several studies have now included couples in which either the woman or the man is much older than their partner.These studies provide a clear and consistent picture: older prospective fathers raise the risk of miscarriage by about 25-50%. One study found an a 60% increase in the odds of a miscarriage if the father was over 40. Another reported a roughly 25% increase in the risk of miscarriage for fathers over the age of 35.
Other studies report similar effects; all showing most marked rise after age 40 (see here and here).
Risk by the Couple’s Combined Age
A young partner can offset some of your personal age-based miscarriage risk, especially if you are a man. Men whose partners are young, under 30, have relatively low chances of miscarriage regardless of their own age, according to large retrospective European study.
For women, alas, young partner only partially offset their age-based risk. Women over 35 with relatively young partners, under age 40, still face double to triple the odds of women in their 20s.
Older partners do, however, compound the risk for women in their 30s. A woman in her early 30s with a partner over 40 has roughly triple the odds of a woman with a partner the same age or younger.
Risk of Miscarriage After Confirmation of a Fetal Heartbeat for Older Women
On a more positive note, women in their late 30s and early 40s have a good chance of an ongoing pregnancy after confirmation of fetal heartbeat.
For women over 40, once a heartbeat has been detected at 7-10 weeks, the risk of a miscarriage falls to around 10%. After 20 weeks, the risk plummets to less than 1%.
Chance of miscarriage by 12 weeks but after confirmation of a fetal heart rate by the mother’s age.
How Does a Prior Miscarriage Affect Your Risk of Miscarriage?
Aside from age, the best predictor of whether a woman will miscarry is the number miscarriages she has already suffered. Most websites quote these statistics:
From these statistics, one prior miscarriage seems inconsequential; while just two prior miscarriages appears to dramatically raise your chances of another miscarriage.
Fortunately, these statistics are too dire for women who have had two prior miscarriages. The outcomes from a study over a million pregnancies paints a much more reassuring picture, at least for women who have had fewer than 3 prior miscarriages
Here’s the risk of a subsequent miscarriage for women who have never given birth before:
And for women who have given birth before:
The Bottom Line
In early pregnancy, miscarriage risk falls with each passing week, with significant drops around the 7-week mark, and again after the 12-week mark.
Your age, your partner’s age, and your number of prior miscarriages all affect your overall risk of miscarriage. Miscarriage risk rises dramatically after about age 37 for women, and age 40 for men.
Ammon Avalos, L., Galindo, C. and Li, D.-K. (2012), A systematic review to calculate background miscarriage rates using life table analysis. Birth Defects Research Part A: Clinical and Molecular Teratology, 94: 417–423. doi: 10.1002/bdra.23014
If a miscarriage has begun, there is nothing that can be done to stop it. Any treatment you have will be aimed at avoiding heavy bleeding and infection.
A discussion with the doctor or nurse will help you to work out which treatment options are best and safest for you.
On this page:
No treatment (expectant management)
You can choose to wait and see what will happen. This is called 'expectant management'. If nothing is done, sooner or later the pregnancy tissue will pass naturally.
If it is an incomplete miscarriage (where some but not all pregnancy tissue has passed) it will often happen within days, but for a missed miscarriage (where the fetus or embryo has stopped growing but no tissue has passed) it might take as long as three to four weeks.
While you are waiting you may have some spotting or bleeding, much a period. When the pregnancy tissue passes, you are ly to have heavier bleeding with crampy, period- pains. You can use sanitary pads and take pain relieving tablets, such as paracetamol.If your miscarriage is incomplete, with just a small amount of pregnancy tissue remaining, it’s probably best to take a wait and see approach. But if there is heavy bleeding or signs of infection you will need treatment.
If the tissue does not pass naturally or you have signs of infection, the doctor will recommend a dilatation and curettage (D&C). You and the doctor can discuss and decide the preferred option for you.
Things to know
- There are many reasons why some women prefer to wait and see. It may feel more natural, it may help with the grieving process or it may give you more of a sense of control.
- Some women become worried or frightened when the bleeding gets heavier, especially if blood clots, tissue or even a recognisable embryo is passed.
- Usually, the wait and see approach takes longer than any other approaches such as surgery or medication.
Sometimes bleeding can last for up to four weeks.
- Although excessive bleeding and blood transfusion are very rare, they are slightly more common with expectant management than with surgery.
- A few women still need to have surgery – sometimes urgently – if they develop infection, bleed heavily or if the tissue does not pass naturally.
- The waiting time can be emotionally draining for some women.
Treatment with medicine
Medicine is available that can speed up the process of passing the pregnancy tissue. For an incomplete miscarriage, the medicine will usually encourage the pregnancy tissue to pass within a few hours. At most it will happen within a day or two. For a missed miscarriage, it may happen quickly, but it can take up to two weeks and, occasionally, longer.
- Medication is not suitable if there is very heavy bleeding or signs of infection. It is usually not recommended for pregnancies that are older than about nine weeks.
- If the tissue does not pass naturally, eventually your doctor will recommend a dilatation and curettage (D&C).
Surgical treatment (curette)
A D&C (or ‘curette’) is a minor operation. The full name is dilatation and curettage. It is done in an operating theatre, usually under general anaesthetic.
There is no cutting involved because the surgery happens through the vagina. The cervix (neck of the uterus) is gently opened and the remaining pregnancy tissue is removed so that the uterus is empty.
Usually the doctor is not able to see a recognisable embryo.
The actual procedure usually only takes five to ten minutes, but you will usually need to be in the hospital for around four to five hours. Most of this time will be spent waiting and recovering.
You may have to wait a day or two to have a curette and sometimes, while you are waiting, the pregnancy tissue will pass on its own. If this happens and all of the tissue is passed you may not need to have a curette.
A curette is done in the following circumstances:
- You have heavy or persistent bleeding and/or pain.
- The medical staff advise that this is a better option for you; this may be because of the amount of tissue present, especially with a missed miscarriage.
- This is an option you prefer.
Waiting for treatment
If you have heavy bleeding with clots and crampy pain, it is ly that you are passing the pregnancy tissue. The bleeding, clots and pain will usually settle when most of the pregnancy tissue has been passed. Sometimes the bleeding will continue to be heavy and you may need further treatment.
You should go to your nearest emergency department if you have:
- increased bleeding, for instance soaking two pads per hour and/or passing golf ball sized clots
- severe abdominal pain or shoulder pain
- fever or chills
- dizziness or fainting
- vaginal discharge that smells unpleasant
- diarrhoea or pain when you open your bowels.
What to do while you are waiting
- You can try to rest and relax at home.
- Usual activity that is not too strenuous will not be harmful. You can go to work if you feel up to it.
- If you have pain you can take paracetamol.
- If there is bleeding, use sanitary pads rather than tampons.
After a miscarriage
- It is usual to have pain and bleeding after a miscarriage. It will feel similar to a period and will usually stop within two weeks. You can take ordinary painkillers for the pain. Your next period will usually come in four to six weeks after a miscarriage.
- See a doctor or attend a hospital emergency department if you have strong pain and bleeding (stronger than period pain), abnormal discharge, (especially if it is smelly), or fever. These symptoms may mean that you have an infection or that tissue has been left behind.
- Try and avoid vaginal sex until the bleeding stops and you feel comfortable.
- Use sanitary pads until the bleeding stops (do not use tampons).
- All contraceptive methods are safe after a miscarriage
- See a GP (local doctor) in four to six weeks for a check-up.
Anti-D injection after a miscarriage
It is important to have your blood group checked. If you’re RhD negative and the fetus is RhD positive this can cause problems for future pregnancies. This is because the fetus’s blood cells have RhD antigen attached to them, whereas yours do not.
If small amounts of the fetus’s blood mixes with your blood, your immune system may perceive this difference in blood cells as a threat and produce antibodies to fight against the fetus’s blood. Once your body has made these antibodies they can’t be removed. This is unly to have caused your miscarriage and is more ly to affect future pregnancies.
Women with a negative blood type usually need an Anti-D injection, which will stop the antibodies forming.
Future pregnancies after a miscarriage
One of the most common concerns following a miscarriage is that it might happen again. However, if you have had one miscarriage the next pregnancy will usually be normal.
We suggest that you wait at least until after the next normal period (four to six weeks) before trying again, as there is a slightly higher risk of miscarriage if you get pregnant straight away. It is possible to become pregnant straight away, so if you plan to wait, use contraception.
If you do try for another pregnancy, try and avoid smoking, alcohol and excess caffeine as they increase the risk of miscarriage.It is recommended that all women take folic acid while trying to conceive, and continue until three months of pregnancy. In your next pregnancy you are encouraged to see your GP and have an ultrasound at about seven weeks.
If ultrasound is done too early in pregnancy the findings are often uncertain and cause unnecessary worry.
Feelings and reactions
There is no ‘right’ way to feel following a miscarriage. Some degree of grief is very common, even if the pregnancy wasn’t planned. Partners may react quite differently, just as people can respond differently to a continuing pregnancy.
Feelings of loss may persist for some time and you may have mixed feelings about becoming pregnant again.
Some friends and family may not understand the depth of emotion that can be attached to a pregnancy and may unreasonably expect for you to move on before you are ready.
Some couples decide that they want to try for a pregnancy straight away, while others need time to adjust to their loss.
If you feel anxious about a possible loss in future pregnancies, you may find it helpful to talk to someone about this.
If it’s difficult to speak with your friends and family about these issues, your doctor, community support group and counsellors can provide information and assistance.
The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference.The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner.
If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.