Miscarriage

The loss of a pregnancy, whether planned or unplanned, no matter how early, can be devastating, bringing up a range of feelings and concerns. You need support, and you need clear information. As a midwife, I offer pregnancy loss support, which includes processing and planning for a loss, support during a miscarriage or abortion, and postpartum care. 

How do I know if I'm no longer pregnant?

Typically, someone discovers that they're miscarrying when they no longer feel pregnant. It could mean that they stop feeling nauseated, that their breasts stop aching, and that they just don't feel pregnant anymore. This normally happens in a pregnancy around 11-13 weeks, but when it happens earlier it may be a sign that a miscarriage has occurred.

Bleeding on its own it not unusual in the first trimester, and there are different things that can cause it. Bleeding with cramping usually suggests a miscarriage. I would confirms this either by drawing your blood and looking at pregnancy hormone (hCG) levels (drawn two days apart to see if levels are falling), or through an ultrasound. 

What happens during a first trimester miscarriage? How do I know it's really happening?

80% of people who miscarry will go into labor within 2-3 weeks. A person will experience cramping and heavy bleeding (soaking a pad every 30-60 minutes). It can start slow and then typically peak with the passing of the fetus, placenta, and other tissue, then rapidly resolve, very similar to labor. One to three weeks of period-like bleeding follows. The normal process of miscarriage can take under an hour or as long as 24 hours. 

One in four pregnancies ends in miscarriage, most in the first trimester around 10 weeks, but many happen so early that the person may not realize that they're even pregnant (FYI, after 20 weeks, it's considered a still birth). It's important to realize that it's very common, even though it's rarely openly discussed in the United States, which means it can still be a very isolating experience.


How can I explain to my family, friends, and community how to support me?

Not everyone knows how to support you in a healthy way. Some people will say the wrong thing, usually with the intention of trying to take away your grief and make you feel better. Comments like "at least it happened early" or "at least you know you can get pregnant" and so on can contribute to feelings of isolation and depression. Check out the links I posted for support groups and online community, and send the below like to your friends and family to help them understand.


What should I do if I'm Rh negative? Do I need Rhogam?

After a miscarriage, the recommendation is for Rh- mothers and gestational parents to receive Rhogam at or after 10 weeks, however, it should be offered regardless of how early you are in pregnancy and you have every right to request it. You can also opt not to receive Rhogam. The risk of sensitization is very low for a first trimester miscarriage, but is thought to be higher if there is any form of medical evacuation of the uterus.


How do I heal after a miscarriage?

Physically, I recommend much of the same as I would for any postpartum parent. You will heal best if you take it easy for a few days. Rest. Ask for practical support with meals and caring for other children. You lost blood, so nourish your body with plenty of fluids and foods that will build you back up. Think soups, stews, fresh vegetables, and bone broth. 

Emotionally, consider what you might need to process your experience. Is there a meaningful ritual? Is there a special place where you want to bury what came out of your body? There is a wide range of what might come up (including feeling totally okay and not needing to do any of this).

For lots of ideas, check out this manual: Holistic Healing After Miscarriage.

 

What are my options for a first trimester miscarriage?

There are two main approaches to miscarriage: expectant management and active management. Expectant management would mean waiting for the miscarriage to complete itself, as in, waiting for your body to pass the pregnancy on its own. In active management, steps are taken to induce labor (using a medication such as Misoprostol) or to manually remove what is in your uterus (there are a couple of options). According to a BMJ study, most people who choose expectant management (81%) will complete the process of their own. You also have a choice of who can help you with this process, including me as your midwife at home, or a doctor in a medical setting. 


What does this mean for my fertility? How long should I wait before getting pregnant again?

After one miscarriage, the risk of another is the same as if you'd never had one. After two, however, the risk starts to increase. After two miscarriages it's a good idea to have a conversation with a knowledgable provider who can help to determine why it might be happening (hormone imbalance? thyroid issues? all sorts of reasons) and work with you to prepare for a pregnancy.

Typically, you'll hear that you should wait three months before getting pregnant again. Recent research has disproven this, and even suggests that the first three months is a favorable time to conceive and have a healthy pregnancy. That said, you might not be emotionally ready. Check in with yourself and feel out whether it's the right time.


What if I'm lactating after the miscarriage?

Beginning in the second trimester, people may have milk come in around three days after a miscarriage (the same hormonal mechanism is triggered as after a live birth). To stop making milk:

  • drink sage tea
  • homeopathic Bryonia Alba 9C 3 pellets 3x daily to help with engorgement
  • homeopathic Pulsatilla 9C, 3 pellets 3x daily for overabundant milk supply
  • put cabbage leaves in your bra, cold packs over your bra, and wrap a scarf around tightly
  • Vitamin B6 200 mg for 5 days
  • a more gradual option is to pump, then space out pumping while reducing the duration of pumping sessions (you can combine this with some of the above options)

Another option is to donate your milk. The milk that we produce after a miscarriage or still birth is extremely valuable in the treatment of premature babies. 


I could really use some connection right now


I'm Muslim. What do I do after a miscarriage?

Check out the archives at Seekers Hub for responses to common questions about miscarriage.