Understanding Miscarriage

Even though statistics show that miscarriage affects approximately one in four women, strong social expectations lead us to believe that pregnancy will end with a healthy, normal live birth and few doctors would warn a woman that during the first trimester she faces the highest risk of losing her pregnancy. Consequently bonding between a woman and her child can occur very early during gestation, (especially if she sees her baby in a scan), and when miscarriage happens unexpectedly it can be a shocking experience for a woman and her partner.

Symptoms of early miscarriage

The highest risk period for miscarriage is between 6 to 8 weeks. Once pregnancy goes beyond 9 weeks and the baby's heart beat is seen on a scan the percentages fall to around 5% and continues to drop as the pregnancy progresses.

The symptoms of miscarriage depend on the cause of miscarriage and how advanced the pregnancy is. Copious bleeding,(not to be confused with a mild spotting that can occur around the 6^th week where there is an 80% chance that the baby is fine,) the discovery of no fetal heartbeat during a routine scan, and an empty fetal sac, are the most common evidence of a spontaneous abortion.

Difference between a threatened miscarriage and an inevitable miscarriage

A threatened miscarriage, where in 80% of the cases the baby is just fine, occurs around 5 to 7 weeks. During a threatened miscarriage a small amount of blood is lost when the placenta matures and takes over progesterone production. In these situations a woman loses a small amount of dark blood at about the time when her period is due. Cramping, and a pain similar to period pain and the absence of nausea and tender breasts may usually be just a very frightening experience for the young mother but in most of the cases the baby is not harmed.

During a real (or inevitable) miscarriage, the cervix opens and the placenta breaks free from the uterine wall. In these cases the following symptoms are usually reported

• Faintness and nausea and a general feeling of being unwell

• Bad period pain and birth contractions

• Heavy bleeding that fills more than 1 sanitary pad in half an hour

• Passing the fetus or pieces of the placenta that looks like blood cloths or liver

The grieving process

The grief following a miscarriage is a complex issue. In a very short period of time a woman experiences the thrill of being pregnant, and the trauma of death and the loss of her baby. Whereas in other circumstances a funeral gives people their cue of how to behave appropriately with protocols to follow, when there isn't one, friends and family are often at a loss themselves, and may not even have a clue about the severity of the mother's pain.

In such situations the mother's loss can be minimized or invalidated by others which might lead the mother to question her feelings of grief. At this point it is important to note that it is the strength of the bond with the baby and not the length of the pregnancy that determines the depth of the mother's grief. Grief is the mother's normal reaction to the loss of this broken bond and for recurrent miscarries, the grief is further compounded by the previous losses.

Special issues pertaining to grieving after a miscarriage

While in most cases woman physically recover from a miscarriage in the first trimester in a matter of weeks, the emotional wound may take months sometimes years to heal. Many women feel they have been cheated of the joys of pregnancy, birth and motherhood. They lose trust in the body they feel that has betrayed them and might feel 'less woman' because they have not carried their pregnancy to term.

In cases where a woman has lost a considerable amount of blood for a number of weeks and went through traumatic medical procedures, she might fear she will never be able to have a normal pregnancy in future. She might worry that this amount of grief over losing someone she has not even met, is not normal.

The start of her normal cycle will bring with it the certainty that she is no longer pregnant. Feelings of shame, guilt or embarrassment accompanied with a strong desire to get pregnant again will often change her relationship with her partner and her loved ones.

She might feel guilty because she is jealous of another friend or relative, who is already a mother or has an unproblematic pregnancy. She might also experience others lack of understanding when it comes to her feelings, and a sense of isolation and loneliness that can hinder her emotional recovery.

While all the above feelings are a common reaction to the loss of a child, the length of the grieving and recovery process varies from person to person. It can take months or sometimes even years for a woman to heal after her trauma especially if the pregnancy was very desired.

The healing process

Resources for mothers who need support following a miscarriage or still birth

Women often feel they have to put on a brave face and keep going with their lives even though they are hurting inside, yet they should not be afraid to reach out for support. Many times talking to other mothers who have gone through the same experience will help. Here are some sites and communities with information and forums about miscarriage.

Miscarriage support Auckland inc and Hope Exchange are specialized websites with information for grieving mothers and their families.

I village miscarriage support website , and Daily Strength are open forums where you can chat with other mothers who have gone through a recent loss.

It is important not to underestimate the consequences of depression. If you feel you need professional help, ask your doctor to refer you to a therapist or support group for parents dealing with miscarriage or child loss.

Resources for friends and family members who want to support a love one
It might be difficult to understand how the loss an early pregnancy can so deeply affect a woman, if you have not gone through the experience yourself. Though on the exterior a woman's body changes very little in the first trimester, a pregnant woman spends a lot of time day dreaming about her new baby and her instinct pushes her to bond with her child even though it is barely a tiny bean on an ultrasound scan. The loss of a baby can be devastating and the healing may take years.

Click here to learn more about the stages of grief and how to cope with the emotions resulting from a miscarriage. Finally this website offers the advice on how to help someone who has recently suffered a miscarriage or still birth.

Works consulted

"Dealing emotionally with miscarriage" www. womens- health.co.uk

"Grief feelings in general." www. miscarriagesupport.org.nz

"Finding closure." www. miscarriagesupport.org.nz

"Coping with Pregnancy loss." www pregnancy -info.net

"Coping with miscarriage - a woman's perspective" www ourmiscarriage.com