Miscarriage: what to expect and how to prepare

Miscarriage: what to expect and how to prepare
If you've been around for a while now, you'd know that last year, I miscarried at home. Looking back at what I know now, there were big gaps in my knowledge of what to expect and limited info out there. So I teamed up with our Tiny Hearts Midwife to write this blog to help mamas who are going through it now or will experience a miscarriage at home in the future. It's also for those mamas who have already been through it and are still trying to make sense of what happened and those supporting loved ones going through a miscarriage at home. But before we start, we want you to know that regardless of whoever you are and whatever your circumstance, you are not alone. 

What is a miscarriage?
When a mama is pregnant, but the pregnancy stops progressing due to natural causes before 20 weeks, this is known as a miscarriage. Miscarriage is common, with the stats quoting 1 in 4 mamas experiencing a miscarriage in their lifetime. Around 85% of those occur in the first trimester, with the remainder occurring between 13-20 weeks [referred to as a late miscarriage]. In fact, some miscarriages happen so early that some mamas don't even realise they are pregnant, with their only clue that they're having a miscarriage being a period that is heavier than usual. 

Causes + prevention
Research suggests around 50% of miscarriages happen because of chromosomal abnormalities and an abnormally developing embryo [a medical word that describes bub in the early stages]. In other cases, there is usually no treatable cause found for a miscarriage.

There are some factors that increase a mama's risk for having a miscarriage, such as:
  • Medical conditions, such as thyroid problems, uncontrolled diabetes and uterine fibroids
  • Smoking and alcohol use in the first trimester
  • Mamas who drink more than 500mg of caffeine a day [around 3-5 cups of coffee]
  • Some medical and obstetric tests, such as an amniocentesis
  • High fever
  • Older mamas compared to younger mamas

Unfortunately, there are limited things a mama can do to prevent a miscarriage in most cases. However, if you've had three miscarriages in a row, get in contact with your GP or Obstetrician to discuss further testing and management.

Identifying a miscarriage
In some cases, the first sign of a miscarriage is when a mama goes to an ultrasound, and bub's heart has stopped beating. In other cases, a mama will begin experiencing cramps or bleeding unexpectedly. If a mama is pregnant and has a bleed before 20 weeks, that's a good indication to see a GP or attend the emergency department, depending on the circumstances. Blood tests and an ultrasound may be ordered to check a mama's pregnancy hormone levels and bub's growth. In some cases, a doctor may also recommend doing a speculum to double-check the bleeding is coming from the uterus and inside the cervix where bub grows. Based on the results of these tests, a miscarriage may be diagnosed, with mamas who haven't already passed all of the pregnancy generally being offered two options:
  • Surgical management called a D+C
  • Miscarrying at home

Miscarrying at home
Supplies
If a mama has a miscarriage at home, there are a few things you'll need on hand:
  • Plenty of pads [tampons aren't recommended when experiencing a miscarriage]
  • Pain relief such as panadol and ibuprofen [for something stronger, chat to your GP beforehand]
  • Heat pack
  • Snacks + water
  • A way to call for help if needed, such as mobile or home phone
  • Emotional support, such as a support person
  • Babysitting for other kids

What to expect
Every miscarriage is different, and every mama's experience will be different, but in general, a mama can expect to begin with some spotting. From there, spotting can turn into bleeding, similar to a period. As the miscarriage continues, a mama may begin feeling lower abdominal cramps, back pain and general discomfort, which can become quite intense. At some stage, a mama may pass some clots and tissue that may [or may not] resemble a baby and placenta, depending on bub's gestation and development. Passing pregnancy tissue can be confronting, particularly if your pregnancy was past the first trimester and you can make out the shape of a tiny baby. Many mamas don't know what to do in these cases. When a mama is experiencing a miscarriage in hospital and needs to use the bathroom, we place a towel under the toilet, and a mama passes urine like normal. The urine will drip through the towel into the toilet, but if any clots or pregnancy tissue are passed, it lands on the towel. Whilst it might be uncomfortable, it prevents reaching into the toilet to pick up pregnancy tissue. While bleeding time varies from one mama to the next, the general consensus is that bleeding may last from around a week up to four weeks. The heaviest part is usually when the pregnancy tissue is passing and may be accompanied by clots. 

Aftercare + follow up
If you have a miscarriage and see what appears to resemble an embryo or baby, what to do is a sensitive, personal and difficult decision. Some mamas choose to place the clots/ embryo/ pregnancy tissue in a beautiful box of some sort and bury it. Some plant a tree over it. Others give any clots they pass to their Doctor for them to manage. Regardless of what you choose, remember that it's a personal decision, and there is no self-judgement necessary. Having a miscarriage is devastating enough without adding guilt, shame or judgement to the mix. 

After your bleeding begins to settle, you should follow up with your GP or Obstetrician to make sure all of the pregnancy tissue has passed and that you're beginning to recover. What's important to remember is that part of your recovery encompasses your mental health. Miscarriage is traumatic. Trauma can impact your mental health, so please, mama, keep an eye on yourself. If you're concerned about your mental health, chat to your GP, organise a mental health plan, organise an appointment with a psychologist or have a chat with a friend/ family member. Looking after yourself is important, so don't forget to include your mental health. 

Red flags
When miscarrying at home, there are a few red flags to be aware of:
  • Heavy bleeding or bleeding that gets heavy again after getting lighter
  • Severe pain
  • You develop a fever which may indicate an infection has developed
  • Your bleeding or vaginal discharge is smelly or an unusual colour
  • Lightheadedness, dizziness or feeling faint
  • You are concerned


How to support a loved one experiencing a miscarriage at home
Supporting a loved one through a miscarriage at home can be challenging. If you get an opportunity, chat with your loved one about how best you can support them through this before it happens. Offer regular snacks and water. Offer pain relief. Give them space if they need it. Warm up the heat pack, or hold the showerhead on their back. Remind them you're there for them. Look after yourself too. The reality of this situation is that miscarriage is devastating, and unfortunately, there's nothing you can do to take that pain away. But you can be there for them through it. In some states, you can get a certificate similar to a birth and death certificate. For some families, this recognition that they had a bub is enormous and helps with the healing process. Chat to your Doctor, GP or Midwife about this if you've got more questions.



Final notes
From going through a miscarriage myself, here are 10 things I wish someone had said to me:

  1. Be kind to yourself.
  2. Crying is therapeutic.
  3. Try not to take your anger and hurt on your partner; they've lost a bub too.
  4. Buy more pads than you think you'll need.
  5. The shower might be the only place you'll be able to get comfortable.
  6. You're allowed to give the bub you lost a name or nickname.
  7. Your older kids might be confused or scared about what's happening. The decision whether to tell them honestly what's happened or not is yours, but be sure to acknowledge their fears and confusion.
  8. You're allowed to grieve the baby you lost and the hopes, dreams and life you had imagined for your family.
  9. Don't be afraid to ask for help and support.
  10. It's not your fault.

With 1:4 mamas experiencing a loss, the chances of someone you love being 1:4 are high. The more we talk about miscarriage, the less taboo it becomes. And if you ever need someone to talk to, I'm only ever one DM away. I'm so sorry for your loss, mama.

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Comments

Emma Williams 12 days ago

Hi, I’m so sorry you went through this. I have too, except I had a missed miscarriage and zero bleeding. I feel like information about missed miscarriages needs to be added to this. I had no idea that a miscarriage could happen when I had zero symptoms or bleeding. I had the choice of d and c or taking the tablets to make me miscarry at home. I think it’s so good to talk about this stuff I was very open with everyone at work, and I am so glad I did, I ended up with a huge amount of support. X

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