Miscarriage
This publication was written for and by parents who have experienced a miscarriage.
While the information contained in this publication will hopefully to give you useful tools and ideas, it is not intended to replace professional health and medical care.
A Note from the Author – Introduction – What is a Miscarriage? – What Happens? – After a Miscarriage – Seeing, Touching, Holding – Mementos – Burial/Cremation/Services – Feelings – Special Days – Coping Strategies – Grief Work – Appendix I: Definitions – Appendix II: Signs and Symptoms of Grief – Appendix III: Endnotes and Recommended Readings – Acknowledgements
When I miscarried my daughter Anna, my first feelings were of relief. The long uncertainty of the pregnancy was over. I briefly saw her before the nurse took her away. Although I did not name her, I wanted to know what would happen to her. My husband and I arranged to have her buried in the same grave as my maternal grandmother.
The months following her death were full of turmoil and discovery. I needed to name her and put her name on the marker. I also wanted and arranged a memorial service for my immediate family.
I attended a support group where I was given the opportunity not only to share my experience and listen, but encouraged to grieve in a way that was healthy for me.
When a pregnancy ends in a miscarriage you may experience many different feelings.
Some parents accept miscarriage as another life experience that they deal with quickly and then move on. Other parents are confused or devastated by the strong impact that a miscarriage has on them.
If your miscarriage occurred after a period of uncertainty about the outcome of your pregnancy, you may be relieved to have it end. This may be true if you have had days or even weeks of bleeding, cramping or other symptoms that all was not well.
At whatever stage your miscarriage occurred, you have the right to deal with the end of your pregnancy in a way that is right for you.
This booklet contains thoughts, ideas and personal experiences for you to consider.
A miscarriage is the unplanned ending of a pregnancy (before 20 weeks or weight less than 500 grams1). Your doctor may refer to your miscarriage by the medical term abortion. There are many different types of abortions. (See Appendix I).
Current statistics show that 20 to 30 percent of confirmed pregnancies end in a miscarriage and most of these miscarriages occur in the first 12 weeks of a pregnancy2. Many of these early losses occur because of major malformations. Other known causes are:
- Improper attachment to the wall of the uterus
- Premature dilation of the cervix
- Problems of the umbilical cord development and/or function.
Often the exact cause of a miscarriage cannot be determined. Not knowing the reason may be a great source of stress and anxiety. There may be no way of preventing it from happening again.
If you experience three or more miscarriages, further medical investigation is usually advised
During a miscarriage the uterus contracts and the cervix opens. There may be a lot/little pain and bleeding caused by your labour.
“All I felt before my miscarriage was a lot of pressure.
The next thing I knew a tiny baby still in the sac slid from my body.”
A miscarriage may occur suddenly or take hours, days or even weeks.
“I was surprised at the length of time and the pain involved to birth such a tiny baby.”
Sometimes it is necessary for you to have a D&C (dilation & curettage) to complete a miscarriage. (See Appendix I)
Following a miscarriage it takes time for your body to return to its pre-pregnant state. Your breasts may be tender and your milk may come in. This temporary discomfort can be lessened by wearing a firm supportive bra until the milk is absorbed naturally.
“When my milk came in, I was really shocked. It was only then that I realized that I actually had delivered a baby.”
You may continue to experience cramping, bleeding and spotting for a week or more. It is important to ensure adequate rest and good nutrition to help you in your recovery.
” I was surprised how weak I was after my miscarriage. Part of me still felt pregnant while the rest of me was struggling to get back to normal”
The death of a baby through miscarriage can be confusing and painful.
When a miscarriage occurs in the very early weeks the growing baby may be hard to identify. Some parents have found it helpful to see the tissue.
“I was 14 weeks pregnant when I lost my baby. I was amazed to see how perfectly formed the baby was.
I am glad I had the opportunity to say good-bye.”
You have the right to see and care for your baby.
“I never saw my baby and to this day I wonder.”
“I wish someone had asked me if I wanted to see it. I didn’t know that it would be alright.”
“I felt frightened at seeing my tiny baby. Now I’m glad that I did. It gave me a chance to care for him
if only for a little while.”
Some parents have found it comforting to wrap their baby in a blanket and/or wash their baby.
Naming your baby even if you do not know the sex can be comforting and helps make the experience real. Parents often choose a unisex name.
“We didn’t know if we had a boy or girl but we wanted to name our baby so we chose Jamie.”
Having mementos of your baby can be helpful. A blanket, crib card, ID bracelet, hand/footprints are all lasting memories.
“The pictures of my baby help me to say good-bye and make the experience real.
It is hard for others to understand this.”
” I didn’t see my baby, but I’m glad the pictures are available to me if I should change my mind.”
Many hospitals routinely keep mementos on file and they are available on request. Chaplains, nurses or social workers can assist you.
When a miscarriage occurs, you have choices. You may choose to let the hospital make arrangements. This usually means burial in an unmarked grave or cremation without collection of ashes.
You may choose to have a private cremation or burial. This can be arrange by a funeral director for a modest fee or by directly working with the staff of the hospital and cemetery.
“I never knew that I had choices. Sometimes that still makes me angry.”
A service can be comforting and acknowledges what has happened. It can be held in the hospital, a funeral home, at a cemetery or a religious institution.
“When I lost my baby so unexpectedly, it was comforting to me to bury her with my grandmother.
I’m so glad I know where she is.”
The feelings you and your partner have may vary in intensity and duration. Although it is a shared loss, no two people experience the same grief.
Some parents do not develop a sense of closeness with their growing baby until nearer the time of delivery. Others personalize the baby from the time of conception. When a miscarriage occurs you may grieve the loss of your plans and dreams.
“When we learned we were expecting I went right out and bought a baseball glove.
Already I began to plan all the games we would play and watch together.
What a father-son team we would have made.
I lost more than I thought when we lost the baby.”
The experience of a miscarriage may draw you closer to your partner but it can also move you apart.
“Because my husband never talked about our miscarriage, I thought he didn’t care”
Much unnecessary strain and pressure can be put on a relationship by the unrealistic expectation that you both should feel the same way.
Women
Following a miscarriage there are a wide range of feelings you may experience such as fear, relief, guilt, anger, shock and numbness. Conflicting emotions can occur.
Many feel a great sense of loss as it is common for women to become attached to their growing baby early in the pregnancy.
When a miscarriage has taken place it is not unusual to still feel pregnant.
“For a while I imagined my stomach was getting bigger.
I still felt that my baby was with me.”
It is normal when grieving to have nightmares, heart palpitations, loss of appetite, fatigue or sleeplessness, lack of concentration and headaches. You may want to withdraw from family, friends and social activities.
“I dreaded grocery shopping. First I could never decide what to buy and then I was in terror of running into pregnant women or babies.”
Men
Men too may feel intense emotions when their partner has miscarried. Forming a ‘bond’ with the developing baby does not always happen at the same time for men and women. After a miscarriage talking openly about how you feel shows that you care.
“I couldn’t believe I was crying alone in my car. I never cry.”
“We had tried 9 years to get pregnant. I was devastated that our hopes had been dashed again.”
Some men initially put their feelings on hold until they are sure their partner is alright.
“She lost so much blood I never even thought about the baby until several weeks later.
I just wanted her to be healthy.”
“Everybody wanted to now how she was, they didn’t know that I was so angry
I wanted to break something. After all it was my baby too.”
There will be certain days that you may find difficult. Planning for these days is usually less painful and requires less energy, than avoiding thinking about them.
Some of these special days may be:
- Your expected due date
- Your postpartum office visit
- Mother’s/Father’s Day
- Religious holidays
- First anniversary of miscarriage
“Part of me felt pregnant until my baby’s due date came and went. Each month I would think of how I should be getting bigger.”
These special days tend to be a time of remembering and will become less painful.
Some of the helpful things you can do are: Staying in touch with your feelings, searching for the cause of miscarriage, finding support and reading.
Staying in Touch With Your Feelings
It is healthy and helpful to allow yourself to feel, name and express your emotions. Holding in feelings may cause delayed grief reactions.
Searching
It is not always possible to determine the cause of miscarriage. You may find it helpful to make a special appointment with your doctor.
“I couldn’t understand why a normal healthy woman like myself would miscarry. It must have been something I did to cause me to lose the baby. ”
“I thought I got pregnant too soon after my last baby and my body wasn’t ready.”
Support
Finding supportive family and friends who are able to listen allows you to grieve in your own way. Attending a self-help group can provide you with peer support. You will have the opportunity to hear how others have coped. Sometimes it is helpful to talk to a professional who understands grief.
Reading
Reading books on pregnancy loss will help you to understand what is normal and what to expect.
Grieving is the process of coming to terms with your loss. Each person’s grief process is unique; however, there are some common phases. Most parents experience shock and numbness. This seems to be evident in the first few days and weeks.
“I felt like I was having a bad dream and nothing seemed real.”
Tirelessly looking for a reason for your miscarriage is a common response.
Withdrawing socially and feeling you are going crazy is normal. Lack of energy, exhaustion, a sense of failure ore general feeling of disorientation may be present.
It may take months for acceptance and realization of the miscarriage to be reached. Once this occurs a deep sense of loss and sadness may be felt.
Eventually a new sense of release and energy is occurs. The length of time you grieve is as individual as you are. Taking time to work through your grief in a manner that is right for your promotes a healthy re-adjustment.
Abortion
The medical term for a miscarriage or the premature termination of a pregnancy before 10 weeks.
Complete Abortion
A term used when the fetus and all the tissue has been expelled. A D&C is not always performed.
Habitual Abortion
A term used when 3 or more consecutive miscarriages occur. Further medical tests may be advised in such instances.
Incomplete Abortion
A term used when some of the products of conception remain in the uterus. A D&C is usually performed.
D&C (Dilatation and Curettage)
This is a surgical procedure performed under a general anaesthetic to remove any remaining tissue from the uterus. The cervix is dilated and the wall of the uterus is scraped.
Products of Conception
Products of conception are the fetus, fetal tissue and the placenta.
Inevitable Abortion
Term used when a non-viable fetus and other products of conception are retained in the uterus. Pregnancy tests are usually done and sometimes a D&C is necessary.
Partial Abortion
In a multiple pregnancy, abortion of only one fetus or less than the entire number is called a partial abortion.
Therapeutic Abortion
An abortion medically and legally performed before viability.
Threatened Abortion
A term used when there is some bleeding while the cervix is still closed. One half of these do not miscarry5. If the embryo is still alive and attachment to the uterus has not been interrupted, the pregnancy may continue.
APPENDIX 2:
Signs and Symptoms of Grief
The following are some of the signs and symptoms that are normal. You may experience some or all of these symptoms It is important to consult you doctor if any symptoms are causing you concern.
| PHYSICAL EFFECTS | ||
|
- always tired |
- weight loss/gain |
– inability to relax - unable to see clearly - nausea |
| EMOTIONAL OR PSYCHOLOGICAL EFFECTS | ||
|
- denial |
- depression |
– concentrating only on problems - always thinking of your baby - getting annoyed easily - failure to accept reality |
| SOCIAL EFFECTS | ||
|
APPENDIX III:
Endnotes and Recommended Readings
Endnotes
- Narod, Steven A., M.D., and Roch Khazen, M.D., “Spontaneous Abortions in Ontario, 1979 to 1984,” Journal of Public Health, Vol. 80, May/June, 1989, p.209.
- Beer, Alan E., “New Horizons in the Diagnosis, Evaluation and Therapy of Recurrent Spontaneous Abortion”, Clinics in Obstetrics and Gynecology, Vol. 13, No. 1, March 1986, p.115.
- Ibid., p.116.
- Ibid., p.116.
- Laferla, John J., “Spontaneous Abortion”, Clinics in Obstetrics and Gynecology, Vol. 13, No.1, March 1986,p.110.
Recommended Readings
- Fritch, Julie & Sherokee Ilse. The Anguish of Loss. Wintergreen Press.
- Ilse, Sherokee and Linda Hammer Burns. Miscarriage; A Shattered Dream. Wintergreen Press.
- Luebbermann, Mimi. Coping with Miscarriage.
- Nelson, Lennart. A Child is Born. Delacort Press.
This publication was written by Ute Nunes, Jan Pearce, and Anne Smith, co-founders of Perinatal Bereavement Services Ontario.
Illustrations by Janet, 1993.
We would like to thank the parents who shared their experiences with us and helped make this publication possible.
A Note
We would like to hear your comments about this publication. Your responses will help us improve our information and educational programs. Please Contact Us.
Written copies of this publication are available by contacting the PBSO office. Multiple copies are available for caregivers to help support bereaved parents.
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