Miscarriage: How to Care after a Miscarriage

Miscarriage can bring a depression-like feeling into your life, but knowing how to care for yourself after a miscarriage is essential. It is known that from the moment a woman confirms her pregnancy, she becomes very self-conscious and starts to form a special kind of bond with the little miracle growing inside her.

The pain and sorrow of losing her growing baby following a miscarriage takes a physical, emotional, and psychological toll on the woman after a miscarriage.

Only a few things are as painful as the sorrow of realizing your growing baby is no more, after a miscarriage. Unfortunately, losing a baby via a miscarriage is a common occurrence as studies show that about 10-20% of all pregnancies end as miscarriages.

On April 5th, 2021, Nigerian celebrity couple, Banky W and Adesua Etomi took to Instagram to recount their experience after they lost their twins to miscarriage.

“She [the doctor] was scanning and scanning and I was like what’s wrong and she said ‘oh nothing’ and I looked at the nurse’s face and asked what’s wrong and she said ‘Adesua’ I’m looking for the heartbeats and I said ‘for the two of them?’.”

“…I remember collapsing on the floor wailing. Wailing is different from crying, it’s like a deep groin in your chest. I’m sharing because many women go through this and nobody talks about it because it is almost like a thing of shame for whatever reason and I don’t know why,” Adesua wrote.

For many women who have experienced a miscarriage, coping with the pain of loss takes its toll both physically, psychologically, and emotionally. No matter the angle it is viewed from, moving on after a miscarriage requires a great deal of time and patience.

In this article, we discuss this aspect of pregnancy as well as outline helpful steps to take after a miscarriage.

What is a miscarriage?

Simply put, a miscarriage is the termination of pregnancy or the expulsion of an embryo from the uterus before 20 weeks gestation or before the fetus can live on its own. The earliest symptom of a miscarriage is heavy bleeding which usually occurs with abdominal cramping.

Depending on how far the pregnancy has gone, symptoms can be mild or severe. Speak to a Doctor immediately if you experience any of these symptoms.

A miscarriage is usually confirmed through an ultrasound and a pelvic exam by a health practitioner. What the ultrasound actually detects is whether or not there is a heartbeat from the fetus while the pelvic exam checks if the cervix is dilated. When these have been confirmed, a miscarriage can be said to have occurred.

A blood sample can also be taken to determine the amount of blood loss, and check the level of Human Chorionic Gonadotropin (HCG) and Rhesus factor incompatibility (especially if the woman is rhesus-negative). If Rhesus factor incompatibility is detected, an injection called RhoGAM is administered to avoid future problems with subsequent pregnancies.

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Rhesus Factor Incompatibility and Miscarriage.

Risk Factors for Miscarriages

Certain factors can increase a woman’s chances of having a miscarriage. They include:

• Advanced maternal age
• Alcohol abuse
• Cigarette smoking,
• Illicit drug use or abuse,
• Uncontrolled medical conditions like diabetes, hypertension, obesity, and hormonal imbalance, etc
  
  

Warning Signs of Miscarriage

There are different types of miscarriages which can present with a variety of symptoms.
The earliest symptom of a miscarriage is bleeding from the vagina, which can range from mild bleeding in spots to heavy bleeding with clots.

There may be accompanying lower abdominal cramps or pains and passage of fleshy products. There could also be associated passage of fleshy materials or products, as well as gush of fluid from the vagina as well.

A certain type of miscarriage called “missed miscarriage” may present with sudden loss of initial early pregnancy symptoms like vomiting, tiredness, or breast tenderness.
Speak to a Doctor or visit the nearest healthcare facility immediately if you experience any of these symptoms.

What to Expect at the Hospital after a Miscarriage

When a miscarriage occurs, the process of confirmation typically involves a pelvic examination and an ultrasound scan performed by a healthcare professional. During the pelvic examination, the condition of the cervix, which can either be open or closed, is assessed, providing insight into the type of miscarriage that has taken place.

In the cases of incomplete or inevitable miscarriages, the cervix is usually found to be open, accompanied by potentially heavy vaginal bleeding. Conversely, in cases of threatened, complete, and missed miscarriages, the cervix remains closed, and bleeding tends to be minimal.

The ultrasound scan goes further by determining the viability of the pregnancy and identifying any retained products from the nonviable pregnancy. Once these aspects are confirmed, the specific type of miscarriage is identified, paving the way for appropriate management strategies.

Additionally, a blood sample may be collected to evaluate the extent of blood loss and assess the levels of Human Chorionic Gonadotropin (HCG) as well as the compatibility of Rhesus D factor, particularly if the woman is Rhesus-negative while her partner is Rhesus D positive.

Should Rhesus factor incompatibility be detected, the administration of Anti D immunoglobulin injection becomes crucial to mitigate potential complications in subsequent pregnancies.

After a miscarriage, what next?

Now that a miscarriage has been confirmed, the next point of call is to evacuate the dead fetus from the uterus. This is to avoid further complications like infection and to also help set the uterus to resume menstruation and the chance to take in again.

Depending on what stage of pregnancy the miscarriage happened, it could be marked as either complete or incomplete. Complete miscarriage likely occurs when the fetal tissue is a couple of weeks old and weighs less than 500g. It is usually flushed out with the bleeding.

However, incomplete miscarriage usually happens in pregnancies that have gone past the first trimester, where parts of the fetal tissue remain in the uterus, and therefore will require to be removed by a health practitioner. Whether or not a procedure is done after a miscarriage, it is important to keep seeing one’s healthcare provider for follow-up appointments.

Moving on after a Miscarriage

Beyond the physical changes of a miscarriage, there’s often a plethora of emotions the experience stirs in the pregnant woman. These feelings range from grief, shock, emptiness, guilt, fear, confusion, post-traumatic stress disorder (PTSD), and loneliness.

What to do

There are no hard and fast rules on how to overcome such loss because people process pain differently. Even though there is no easy way to grieve the loss of a baby, the following are some practical ways that can help go through the phase after a miscarriage.

1. Feel the pain

There is no point in struggling so hard to put it behind since you never held the baby. So, you do not have to force yourself to move on. Matter of fact, it is okay to allow yourself to feel the pain as it is a healthy part of the grieving process. After a miscarriage, it is absolutely normal to cry; scream or pour your heart out in whichever way suits you.

2. Acknowledge your loss

Make peace with the fact that the baby is no more and look forward to better days ahead including a new pregnancy journey. In acknowledging your loss after a miscarriage, it is important that you do anything you can to ensure you say a proper goodbye to your lost baby while closing that chapter for good. No point living in denial or wallowing in self-pity or the guilt of what you would have done differently. No miscarriage is ever the mother’s fault.

3. Seek professional help from a certified therapist

The period after a miscarriage is a good time to talk to a professional. Africans, especially Nigerians, are highly religious people, so it is not unusual to depend on prayers to heal. Without a doubt, praying and speaking with a religious leader (priest, alfa or Imam) can be very helpful. However, it is also possible that merely talking to these people may just not cut it. Therefore, if you feel you need to express the series of emotions you are feeling to a more knowledgeable person who understands trauma, depression, and general mental health, feel free to Speak to a Therapist and receive professional help.

4. Be deliberate about self-care

Yes, the pregnancy has been lost but your body still needs all the care now more than ever. Make conscious efforts to drink lots of water in order to stay hydrated all day long. After a miscarriage, endeavor to eat right and carry out simple exercises. Pay attention to relaxation and better sleep. You can also get a massage routinely as it can help mind and body recovery in no small measure.

5. Give it Time

The saying that ‘Time heals all wounds’ is not just a cliche because it truly does. After a miscarriage, giving your mind and body time to heal is a good step in the recovery process. Needless to say, a new pregnancy does not in any way erase the fact of a previous miscarriage, so it is advisable not to be in a hurry to try again. Moreso, the uterus requires some time to normalize after a miscarriage. Try to wait a few months before trying to get pregnant again.

Ever experienced a miscarriage? Feel free to share your thoughts with us in the comment section. What tips helped you cope after a miscarriage and what would you advise someone going through one?

Frequently Asked Questions

1. I am bleeding or spotting, am I miscarrying?

Bleeding or spotting while you are pregnant, in some cases, does not necessarily mean you are miscarrying. But when you are spotting cramps in your lower abdomen, it will be wise to contact your doctor to have an ultrasound, especially when you are beyond 7 weeks of pregnancy, to get a clear picture of what is going on.

Other reasons to contact your doctor when you are bleeding or spotting while pregnant:

• You have a history of ectopic pregnancy.
• You have sharp pain in a specific spot or in your shoulders.
• You feel dizzy or faint.

Diagnosing and treating ectopic pregnancy early helps prevent severe complications and life-threatening procedure; even the treatment won’t aid the pregnancy to term.

2. When can I have a scan?

A scan is one of the procedures that is carried out during pregnancy, and it is usually done around the 7-week period when the gynaecologist will be able to see the heartbeats of the baby. An early scan prior to 7 weeks will not give a clear indication of the state of the baby, whether it has died, is not progressing at all, or is still there but developing at a slow rate. Even after a miscarriage ultrasound is still recommended to check of any fetus remnant in the womb.

3. Why does a missed miscarriage happen?

Particularly, the reasons why missed miscarriages happen are not established. Missed miscarriage is when your body has not actually miscarried the baby; nonetheless, the baby has died and failed to develop further. When a scan is conducted, the embryo sac is shown, but the heartbeat of the baby cannot be found. Normally, when a missed miscarriage happens, the stage of the pregnancy looks smaller than it should be.

A missed miscarriage situation is a painful experience. It would be better to go for an early scan to detect any problems that arise earlier.

4. What are the options for treating a missed or incomplete miscarriage?

You can choose 3 procedures when you happen to experience a missed or incomplete miscarriage, and they are:

• Natural
• Medical or
• Surgical

A natural procedure is about you deciding to allow nature to complete the miscarriage that is already happening. Allowing the body system to push out the embryo or baby that has died, whatever time it takes, without any medical intervention.

A medical procedure is the use of pessaries or tablets to help speed up a missed or incomplete miscarriage. The doctor administers a medication that helps your body quicken the process and complete the miscarriage. There are some side effects that you may encounter when you have medical management, such as diarrhoea, chills, skin rash, and vomiting. Your doctor will let you know about the side effects of medical management for miscarriage.

A surgical procedure is the removal of what is left of a missed or incomplete pregnancy, and it is usually done by administering a local or general anaesthetic. This procedure ensures that no remains of the dead embryo or baby are left in the womb. However, there are some side effects that you may encounter when you have surgical management, such as bladder problems, vomiting, shivering, dizziness, and soreness.

You may also have some side effects from the general anaesthetic such as dizziness, blurred vision, numbness, and headaches. Contact your doctor if the after-effects of the anaesthetic continue beyond one day after the surgical procedure.

5. Can I choose how my miscarriage is managed?

There are options that you can choose from that you feel will work best for you; however, in some cases, you will be advised to not limit yourself to only one option. Sometimes, the reason is that the nature of your miscarriage requires one or another option or that the hospital does not have the resources or offers all types of miscarriage management.

You will be made aware of the options available for the management of miscarriage by the doctor; however, you will choose what you will cope better with. Whatever is going on with the miscarriage will determine the best option to adopt for optimal relief.

6. What happens to the remains of the baby?

This depends on your location, as medical practice varies. Unless you specifically request how you want the remains of your early loss to be managed, some hospitals advise treating the remains of an early pregnancy loss as clinical waste.

Some advice offers cremation or burial of miscarriage remains, or if you prefer, some hospitals have the options of taking the remains home at your request.

7. Can diabetes cause miscarriage?

There are increased risks in pregnancy when you are diagnosed with type 1 and type 2 diabetes, which include the risk of miscarriage. The risk of miscarriage with diabetes can be reduced when it is well controlled before you start trying to have a baby and through better management throughout your pregnancy.

Consult your doctor for better advice and health management.

8. What is a chemical pregnancy?

Chemical pregnancy, also known as biochemical pregnancy, is what doctors call an early pregnancy loss at or before 5 weeks. The painful loss usually occurs before ultrasound can show an embryo in a sac or right after the embryo implants. This early loss causes anxiety and distress, and no intervention or treatment can be administered.

9. When can we try again?

After a miscarriage, you and your partner can begin trying for another baby anytime you feel ready; however, to limit the risk of any kind of infection, do not have any penetrative sex until bleeding has stopped. There are different timings for different kinds of pregnancy losses.

It is better not to rush into falling pregnant immediately; just give it time, or if you must, at least start trying again after your first period. I am not saying that at this time the risk of miscarriage is low, but you should wait for your body to recover to some extent before trying for another baby.

10. When will I get my period?

The return of periods after miscarriage can vary for different individuals after a miscarriage; you can expect your period between 4 and 6 weeks after your miscarriage. Your menstruation cycle may take longer to regulate to normal, and also note that after pregnancy loss, your first period may be longer or heavier than it used to be.

The use of birth control options should be considered if you are having sex and do not want to fall pregnant too soon. Consult your doctor or do a pregnancies test if, after 6 weeks of pregnancy loss, and you have not had your period.

Reference

Okeke, G. O. (2022). Miscarriage: How to care after a miscarriage.

Umenze, C. (2023). Side effects of too much alcohol on the body.

• Medically reviewed by Dr. Bukola Popoola