It is thought that as many as one in five pregnancies ends in miscarriage, but some of these occur before a woman is even aware she is pregnant. Although many women miscarry, the vast majority of them go on to have healthy babies afterwards - nevertheless, the emotional impact of miscarriage, for both women and men, should not be underestimated.
What is it and what are the symptoms?
Miscarriage refers to the loss of a baby during the first 23 weeks of pregnancy. The majority of miscarriages occur during the first trimester (12 weeks) and it is thought that most of these happen because there is a problem with the foetus's chromosomes. Late miscarriages (those which occur between the 13th and 24th week) are more likely to happen because there is an underlying problem with the mother's health.
The most common symptom of miscarriage is vaginal bleeding, which might also be accompanied by cramps and vaginal discharge (either fluid or tissue). Light bleeding, or spotting, is not uncommon during the first trimester and it doesn't necessarily mean you are having a miscarriage. Abdominal cramps, too, are a symptom experienced by many women. However, if you experience any sort of bleeding - whether light or heavy, dark brown in colour or bright red, do get yourself checked out as soon as possible.
What causes miscarriage?
The majority of miscarriages just happen. If you suffer a miscarriage during your first trimester, it's quite likely that something went wrong at the point of conception. A foetus needs to have 46 chromosomes - 23 from each parent. It's thought that as many as two thirds of miscarriages occur when not enough, or too many, chromosomes are present, because the foetus simply can not develop properly.
Sometimes an early miscarriage will occur because there is a problem with the placenta - if it doesn't develop as it should, then it will be unable to carry out its important job of supplying your baby with oxygen and nutrients.
Later miscarriages sometimes occur as a result of a problem with the mother's health: if she suffers with diabetes (and it's not well controlled), lupus, kidney or coeliac disease, or an over active or under active thyroid, all these things can make miscarriage more likely. Sometimes miscarriages can occur as the result of an expectant mother having an infection - rubella, toxoplasmosis, listeriosis and vaginosis, for example.
How can I reduce my risk?
Although most miscarriages are probably not preventable, there are some risk factors.
These days, many women wait until they are in their 30s to have their first baby - but you should be aware that the older you are when you conceive, the higher the chances of miscarrying. According to the NHS, in women under 30, one in 10 pregnancies ends in miscarriage; in women aged between 35 and 39, that risk doubles to two in 10 pregnancies; and in women over 45, more than half of pregnancies will end in miscarriage.
There are some ways to reduce your risk, and much of it is common sense. Smoking, of course is a big no-no. If you want to have a baby, then try to stop smoking before you conceive and definitely don't smoke while you are pregnant. Your GP or midwife will point you in the direction of where you can obtain free help to quit. Although the idea of using nicotine patches when pregnant has had some negative press, many doctors feel that if a pregnant woman can stop smoking only with the help of nicotine replacement products, then that would be better than continuing to smoke cigarettes.
Don't drink alcohol, or if you do, drink no more than two units per week. Limit your caffeine intake to no more than 200mg per day (that's about two mugs of instant coffee) and make sure that you are eating well and gently exercising, because being obese carries a higher risk of miscarriage too.
Do be aware of the foods you should avoid - as much as you love a brie and bacon sandwich, you need to ditch the soft cheese because no amount of yumminess is worth a dose of listeriosis. And also be aware of medication that you can not take during pregnancy - if you are on any long term medication, your GP should discuss with you whether you can continue with it or whether it needs to be changed. But as for over-the-counter medicines, many are not recommended, and common medicines we all have in the cabinet – such as ibuprofen – must be avoided until after your baby is born.
The use of illegal drugs when pregnant - especially cocaine - can increase your chances of miscarrying. Many drugs can lead to serious problems with your pregnancy, and cause health issues for your baby in the womb and after they are born.
If you are pregnant, or want to get pregnant, but you feel you have a problem with drug or alcohol use, then talk to someone about it as soon as possible. Be honest with your doctor or midwife, don't be ashamed to admit you have a problem, because no-one will judge you doing the best for your baby. If you are honest, then you and your baby will receive the help you need.
If you are worried about your alcohol consumption, contact Drinkline on 0800 917 8282.
If you are worried about your drug usage, then you can contact FRANK on 0800 77 66 00.
What will happen if I have a miscarriage?
If you suspect you are having or have had a miscarriage, you need to see someone as soon as possible. You will be checked to see if the pregnancy has ended - this might be done with blood tests (which will be looking for pregnancy hormones) or a vaginal ultrasound scan.
If your baby has died, what happens next = in the case of early miscarriage = depends on whether you still have some foetal tissue left in your womb. If all the tissue has passed out of your body, then you won't require any physical treatment, but you should be given information about where you can receive some counselling (see more below).
If there is still some foetal tissue remaining, it's sometimes recommended to wait and see if it passes of its own accord. If it does not, it will need to be removed (because it could become infected) and this will be done either with medication or minor surgery. The surgery is done under general anaesthetic, and the tissue extracted through the cervix. If medication is to be used, then you may either be given tablets to swallow, which will make your cervix open so the tissue can be passed, or you may be given a pessary, which is inserted into the vagina.
When the medicine starts working, you'll experience some cramps and heavy bleeding – the bleeding might continue for up to three weeks.
If you are one of the few women who experiences late miscarriage, then you will have to go through labour and delivery. The Miscarriage Association has provided some specific advice.
Will it happen again?
Most of the women who suffer a miscarriage go on to have one or more subsequent healthy pregnancies. If you have recurrent miscarriages (three or more in a row), there are tests that can be carried out to investigate possible causes - you might have a weakened cervix, for example (and this could be treated with a minor operation). In some cases, though, a specific cause can not be found.
Where can I get support?
Perhaps the emotional impact of a miscarriage - particularly an early one - is underestimated. But it shouldn't be. Even if you were just a few weeks in to your pregnancy, you might go through a very painful grieving process. You might feel shock, anger, despair or loneliness. You may feel a very heavy sense of depression or sadness. All these feelings can be experienced by dads too.
Don't suffer alone - talking to your friends or family can help, but sometimes an anonymous voice at the end of a phone is easier.
The Miscarriage Association has lots of advice, and a help line you can call Monday to Friday 9am - 4pm on 01924 200 799.
Cruse is a bereavement counselling service that understands the sense of loss that comes with a miscarriage. Call them on 0844 477 9400 or email firstname.lastname@example.org.
SANDS is a charity that help families who lose a baby before, during or soon after birth. Call them on 020 7436 5881.
Tommy's is a national charity which offers bereavement counselling support for anyone that has lost a baby during pregnancy or birth. Call its midwives for free on 0800 0147 800 or email email@example.com.