Miscarriage

Miscarriage is a natural termination of a pregnancy that occurs within the first 20 weeks. It occurs in approximately 1 in 5 pregnancies. Miscarriage is one of the greatest fears that couples who are expecting a child will face.

Most miscarriages (80% to 90%) occur early in pregnancy, during the first 12 weeks. However, studies show that if the fetus is alive and well developed at 8 weeks of pregnancy, the risk of miscarriage decreases to around 3%. From the 12th to the 20th week of pregnancy, losing the baby is quite rare and is usually due to a problem with the cervix.

What are the signs of a miscarriage?

• Vaginal bleeding that may be light or dark in colour.
• The sudden disappearance of certain pregnancy symptoms, such breast pain or nausea and vomiting.
• Painful, heavy menstruation up to the 12th week of pregnancy.
• After the 12th week of pregnancy, contractions similar to those during childbirth.

When should you call a doctor?

Go to the emergency room if you are experiencing alarming symptoms, such as hemorrhaging (bleeding through more than one sanitary pad per hour), severe abdominal pain, or loss of consciousness.

If this is not the case, there are other options if you suspect a miscarriage.

• If you are being monitored by a family doctor, you can contact the nurse at your family medicine group (FMG), who can begin to assess your situation. The nurse will work with the medical team and you will be given a same-day appointment for hospital tests such as blood work and an ultrasound. A medical consultation will be arranged if a miscarriage is confirmed.
• If your pregnancy is being monitored by a midwife, gynecologist, or family doctor who is not part of an FMG, you can contact the professional who is monitoring your pregnancy, wait for your follow-up appointment, or visit a walk-in clinic to have your pregnancy hormone level tested. These tests will help the doctor determine if your pregnancy has ended.

Many hospitals also have a special service for women with first trimester bleeding, called a Clinical Access Service – First Trimester Vaginal Bleeding. This service makes it easier for pregnant women to access hospital services and avoid long waits in the emergency room.

What will the doctor do if you’re having a miscarriage?

• Medication
  Medication such as misoprostol can help expel the fetus and placenta in the event of a miscarriage. You will also be given medication to relieve pain and nausea. You can take this medication at home. Within 12 to 24 hours of taking the medication, you will experience menstrual cramping and vaginal discharge. Sometimes a second dose is needed. Normal menstrual bleeding will continue for several days. An ultrasound or blood test will be performed in the following weeks to confirm complete expulsion.
• Curettage
  After week 10 to 13, a curettage may be necessary. This procedure ensures that the fetus and placenta are completely expelled and that there is no infection or hemorrhage. You will receive pain medication and a sedative. The procedure only takes a few minutes, but you’ll stay in the hospital under observation for several hours. It’s normal to experience menstrual bleeding for a few days following a curettage. No specific follow-up is needed.
• Natural miscarriage
  Your health care professional may also recommend that you allow your miscarriage to happen naturally. There are many factors that inform this choice, so it’s important to discuss your situation with a gynecologist to determine the best course of action.
  
  If you prefer to wait for a natural miscarriage, you’ll need to take your temperature regularly and return to the hospital for follow-ups until the miscarriage is complete. When the fetus is expelled, you’ll experience cramping and bleeding. Normal menstruation will follow. A follow-up by a blood test or ultrasound will be performed, depending on the week of pregnancy.

While there is no way to stop a miscarriage, it’s still important to consult a health care professional if you think you’ve had one. If you are experiencing stomach pains, the medical team needs to make sure that it is not an ectopic pregnancy, i.e., that the embryo did not implant in a fallopian tube rather than in your uterus. Furthermore, if you are bleeding, you may need a special vaccine (WinRho^®) if your blood type is negative. This injection will prevent your immune system from reacting to the baby’s blood.

Most women who have had a miscarriage can have a normal pregnancy afterwards. However, it is recommended that you wait at least two weeks before having sex and one to three months before becoming pregnant again.

Causes and risk factors

There are several possible causes for a miscarriage.

• A genetic anomaly in thefetus. In these cases, the fetus is eliminated naturally because it’s unable to develop normally. This is the most common cause of miscarriage. Because the cause is genetic, there is no way to prevent it. In the vast majority of cases, genetic anomalies are spontaneous accidents that occur during the development of the fetus. Neither parent is responsible.
• Certain health problems in the expectant mother. These may include blood clotting or hormone issues, the presence of uterine fibroids, or a uterine malformation.
• Placental abruption. Placental abruption can be caused by a serious fall, a car accident, or domestic violence.
• Mother’s age. The risk of miscarriage increases as a woman gets older. More than half of all pregnancies after age 45 end in miscarriage, while only 13% of pregnant women in their 20s miscarry.

Tobacco, alcohol, and coffee in very large quantities. Some natural products and chemicals increase the risk of miscarriage, as does using a sauna or hot tub.

• Amniocentesis. Approximately 1% of amniocentesis procedures cause a miscarriage.

Grieving after a miscarriage

Miscarriages can be devastating. More than half of women who miscarry say they go through a grieving period. Feelings of emptiness, unfairness, sadness, anger, and guilt are common emotions that grieving mothers experience. Fathers also experience pain and disappointment. They often feel helpless in the face of their partner’s emotions. Grieving for a lost child can take time, depending on the individual and the circumstances surrounding the miscarriage.

It’s important to talk about the experience and share your feelings as a couple, especially since family and friends tend to move on more quickly and downplay the significance of the loss. Don’t hesitate to speak with an expert if you feel like you need help during this difficult time. Your CLSC can refer you to a professional or a support group (see the list of resources below).

Telling a child about a miscarriage

If your child knew about the pregnancy, tell them about the miscarriage, preferably with your partner. Having both parents present will make your little one feel more secure. For the same reason, pick a quiet moment to talk about it so that they can ask all their questions. Opt for simple words, as in the following example: “The baby wasn’t developing well in mommy’s belly. Sometimes, these things just happen.” There are a number of children’s books on the topic that can help you start the conversation.

Things to keep in mind

• Most miscarriages occur during the first trimester of pregnancy.
• The most common cause is a genetic defect in the baby.
• Many people face real grief after a miscarriage. Don’t hesitate to talk about it and to seek help if you need to.

Scientific review: Dr. Chantal Ouellet, physician Research and copywriting: The Naître et grandir team Updated: December 2021

Photo: iStock.com/KatarzynaBialasiewicz