A miscarriage is often accompanied by feelings of anxiety, distress and sadness. For many women these feelings pass quite quickly and normal life is resumed as before. For some, however, these feelings are more profound, prolonged and may be accompanied by other emotions such as:
- loss of confidence,
- a sense of failure,
- a perceived destruction of future hopes and plans.
Recovery may then be a much more gradual process. Occasionally it may require extra help, for example by discussion with a doctor, a counsellor or with others who have experienced a miscarriage.
Following a miscarriage a great number and variety of questions are often asked, but there are several common concerns. At first it is natural to ask, ‘What exactly has happened and why?’ After these very immediate issues, thoughts turn to the future and questions such as, ‘What is likely to happen next?’ and, ‘Will it happen again?’ are asked.
What has happened ?
Miscarriage is the term most commonly used to describe the situation where a pregnancy ends unexpectedly, often within the first twelve weeks. It is likely that you will have experienced symptoms such as bleeding and/or pain that caused you to see your doctor. Alternatively, the situation may have been discovered by your doctor without you having had any symptoms, for example during your routine visit to the antenatal clinic.
Whichever way your miscarriage has become apparent, you will probably have then had a dilatation and curettage in hospital (commonly called a ‘D and C’ or a ‘scrape’). This is necessary in the majority of cases of miscarriage. It is done to remove any pregnancy tissue that remains in the uterus (womb) after the miscarriage has occurred. These tissues are often termed retained products of conception (RPOC). The operation may therefore be called an evacuation of retained products of conception (or ERPOC). If these tissues were not removed, infection or heavy bleeding could occur.
There are many medical terms for miscarriage because there is more than one sort of miscarriage. It is unfortunate that one of the medical terms for all the types is abortion. Most women regard the word ‘abortion’ as one relating to voluntary termination of pregnancy rather than miscarriage. They are naturally upset to see or hear the term used to describe what has happened to them. Doctors are now generally much more sympathetic to these feelings and tend to use the term miscarriage. Unfortunately, however, you may still see or hear the term abortion to describe a miscarriage. Two common examples are ‘incomplete abortion’ and ‘missed abortion’. Incomplete abortion refers to the situation where some of the pregnancy tissue has already been lost with the bleeding and an ERPOC needs to be performed. A missed abortion occurs when the pregnancy has failed to develop properly and, although no bleeding may have occurred, a D and C is needed to remove the remaining tissues.
Why has it happened?
There have been many attempts to define the true incidence of miscarriage. Whichever of the statistics one believes, there is no doubt that miscarriage is a very common occurrence, with at least one in six (15 %) of all pregnancies ending this way. In the vast majority of cases there is no obvious cause. A great number of factors have been claimed to cause miscarriage. Emotional stress or worry and working with visual display units (VDUs) are commonly cited, but there is little or no evidence to support these or any of the other claims. Numerous studies, both in the UK and elsewhere, have shown that working in front of a VDU has no known harmful effects, either in terms of miscarriage or causing abnormalities in the baby.
It is very likely that the miscarriage has occurred because of an abnormality in the developing baby. This would be very difficult for doctors to detect but it has been recognised by the mother’s body which has then rejected the pregnancy as a miscarriage. In view of this, it is rare that the cause for a miscarriage is found. Since it is very likely that a subsequent pregnancy will proceed normally, doctors do not usually perform extensive investigations except where three or more consecutive miscarriages have occurred.
Was there anything I could have done to stop it happening?
Try not to feel guilty as it is extremely unlikely that anything you did caused your miscarriage. A common concern is that having sex caused the miscarriage, but there is no evidence to suggest that sex in early pregnancy is harmful. Once the bleeding has started, if a miscarriage was going to occur it would happen no matter what you did. Even staying in bed would not have prevented it from happening.
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