Finding out about a pregnancy can be a moment of intense joy, surprise, excitement, fear, or anxiety. This moment is the beginning of a rollercoaster of plans, dreams, conversations, practical, physical, and financial changes. Often, even without realising it, we start to prepare to become a family.
However, the journey to having a baby is not always smooth. Unfortunately, early pregnancy loss can occur in 1 in 5 pregnancies. The end of a pregnancy before 20 weeks gestation is called a miscarriage. This can be caused by malformation of the fetus or be an ectopic or molar pregnancy.
An ectopic pregnancy is one where the fertilised egg implants outside of the uterus. It cannot survive here and can cause damage to the mother’s organs. Surgery may be required to remove the pregnancy and potentially organs that are affected. A molar pregnancy is abnormal growth of the cells that would have been a placenta. There can be a fetus and some placental tissue, or all the tissue can be abnormal. A fetus cannot survive this, and the pregnancy will miscarry or need to be ended as it can cause serious complications for the mother.
What happens during early pregnancy loss
Bleeding or pain are the most usual signs of a problem, or it may be discovered at an ultrasound appointment that there is no heartbeat, or the baby is not growing as expected. Often the people giving bad news are emergency department staff, GP’s or radiographers. What follows next is usually lots of questions and an examination to find out what is happening and to manage the physical aspects of losing a baby. Lots of difficult decisions must be made at a time when emotions can be taking over.
There are three main paths from this moment. To wait and let the body work naturally to pass the baby, to take medications to assist this process or to have surgery. If there is heavy bleeding or an infection, then caregivers might suggest surgery as the best option. This is often the quickest but does involve a general anaesthetic and a short hospital stay. Medication can take a little longer and may have some unpleasant side effects such as fever, nausea, vomiting or diarrhoea
Choosing to wait is the longest option for many people but can allow time to work through what is happening. Pain relief and other medications will be available to ease symptoms. There is no right or wrong choice here. Listening to advice helps, but the decision must feel the best option for the person experiencing it. During this time people with a rhesus negative blood group may need to have an injection of anti D. This is because if the baby is rhesus positive and there is a mixing of their blood with the mothers, the mothers immune system can react to future pregnancies.
After the pregnancy has ended, it is advised to rest, to use pads rather than tampons to manage bleeding and to avoid vaginal sex until any bleeding stops, and it feels comfortable to attempt intimacy.
What happens after?
After early pregnancy loss, the baby will not be registered. There will not be a birth or death certificate, which can feel like the baby is not being honoured. Talk with a partner, family, or staff about how to acknowledge the baby, maybe by naming them, planting a tree, or making a plaque. Parents may be able to hold a cremation or burial, this needs to be discussed with caregivers. There are many cultural and emotional reasons for choosing to complete a ceremony such as this and it can give a sense of acknowledgement for the loss.
Physically, the body returns to a pre-pregnancy state within a few weeks and fertility can return with the menstrual cycle within 2-8 weeks. The most common cause of early pregnancy loss is chromosomal issues and the chances of subsequent pregnancies being successful are high. Losses are not usually investigated until there have been three or more. It is recommended to wait at least one menstrual period before trying to become pregnant again. However, after molar or ectopic pregnancies it may be advised to delay getting pregnant again or fertility may be affected by the treatment/surgery required. It is very common to worry about fertility and the chances of having a successful pregnancy. The hospital may recommend discussions with a fertility specialist or discuss this with a GP or mental health professional.
People may want to know what they can do to optimise their chances of a successful pregnancy and advice is very general around maintaining a healthy lifestyle, taking supplements, reducing caffeine intake, and avoiding alcohol, cigarettes, and drugs.
During pregnancy loss people can experience all or some of the emotions that are part of the grief cycle. These include shock, numbness, denial, frustration, anger, guilt, confusion, sadness, acceptance, relief, or jealousy. All reactions are normal and may be experienced multiple times in different ways. Services should have systems in place for emotional support during this time. These should also be available to partners or support people. Each person may respond in different ways and be in a different stage of the grief process. It is possible to ask for time, space, and professional help to make decisions and process emotions.
Because western societal conventions discourage sharing pregnancy announcements prior to the 12-week gestation mark, people can feel extremely isolated as they have no readily available support system if something goes wrong in the pregnancy.
People’s journeys to pregnancy are varied and there may have been a lot of time, effort and money invested or it may have been unplanned. This will in turn create different concerns or considerations for the future. The emotional impacts of early pregnancy loss can be extensive and influence greatly decisions about having children and the experience of future pregnancies. It is very normal to want extra appointments and care during a pregnancy following a loss.
Not everyone feels that their loss is handled well and things that are said and done by caregivers or family and friends can leave a lasting impact. It is still a taboo topic to discuss, and many people do not know how to respond. However, there can be conversations that lead to deeper bonds as others who have experienced loss are able to share their stories, often for the first time.
There are services available through hospitals and in the community to support anyone going through pregnancy loss. WACPPS offers counselling services that cover perinatal mental health to women within the Perth metro area and also telehealth consults for rural and remote.
SANDS: www.sands.org.au – 24/7 helpline 1300 308 307
#hadamiscarriage on Instagram
Beyondblue: 1300 224 636 or chat online beyondblue.org.au
Craven, C. (2019). Reproductive losses: Challenges to LGBTQ family-making. Routledge. Doi.org/10.4324/9780429431715
Mercier, R. J., Senter, K., Webster, R., & Henderson, R. A. (2020). Instagram users’ experiences of miscarriage. Obstetrics and Gynecology, 135(1), 166-173.
RANZCOG & SANDS. (2016) Pregnancy loss. www.sands.org.au
Miscarriage. The Women’s.