Miscarriage blues

Around one in five women have had a miscarriage at least once in their lifetime. But once a woman is over 40, her chances of miscarriage increase due to the lack of quality of her eggs.

WHY DO MISCARRIAGES HAPPEN?  

Most miscarriages occur before the 12-week stage. And half of all of these early miscarriages are related to a genetic problem such as chromosomal abnormalities.

A chromosome abnormality is when some of the information taken from both parents' genes at conception is lost for no other reason than bad luck. This means the baby can't develop properly and is miscarried.

Most chromosomal problems happen by chance, have nothing to do with the parents, and are unlikely to reoccur. A miscarriage is the body's way of rejecting a pregnancy with abnormalities such as Down's syndrome.


PHYSICAL REASONS

Problem: A common anatomical problem is a weak cervix, which means the cervix is not strong enough to hold the baby. In this case, miscarriage usually happens after 15 weeks.

Treatment: If this has happened, you can have a stitch put in the neck of the cervix after you fall pregnant again to reduce your risk. It's a quick operation under general anaesthetic and the stitch is removed before you go into labour.

Problem: Another is antiphospholipid syndrome (APS), also known as sticky-blood syndrome. This is where the circulation of blood is poor, causing blood clotting, which means the egg can't attach to the uterus lining.

Treatment: APS can be treated with aspirin to thin the blood. Aspirin stops the blood cells sticking together and creates a better circulation in the lining of the uterus, reducing the risk of miscarriage.

Problem: Some women don't make enough progesterone, the hormone that prepares the lining of the uterus to nourish a fertilised egg. If the uterus lining can't sustain an egg, miscarriage will occur.

Treatment: A blood test and a biopsy of a small amount of tissue taken from the uterus lining can determine whether you are producing enough progesterone naturally. This hormone imbalance can be caused by diabetes mellitus or thyroid disease.

OTHER REASONS

• Minor infections such as coughs and colds aren't harmful.

• A high temperature and some illnesses or infections, such as German measles, may also cause miscarriage. So if you begin to get a temperature, contact your doctor.

• A miscarriage can also be caused by lifestyle choices such as flying and eating certain foods.

• One of the common questions asked is: 'Can I fly?' If you've had any bleeding, or previous miscarriages, then think twice about going on a long-haul flight. You don't want to be stuck at 30,000 feet having a miscarriage.

• You should also avoid putting yourself at risk by not carrying heavy objects or climbing up ladders.

• When it comes to food, it's unusual but not uncommon for a miscarriage to be triggered by listeria. This bacteria is found in unpasturised milk and some soft cheeses such as unpasturised brie and Camembert. Listeria is also found in liver pate. The bacterium causes food poisoning. There is a small risk if you're in the first trimester and up to the second trimester, which is six months.

• Ideally, you should avoid unpasturised foods while pregnant. Other lifestyle changes like drinking and smoking can also cause problems.

• Studies have shown that overindulging in alcohol effects the early stages of foetus development. Give up alcohol completely. However, if you want to enjoy the odd glass of wine you should be fine. And stop smoking completely.

• The chemicals in cigarettes narrow the blood vessels and make it difficult for the womb to provide enough blood supply for the baby to develop properly, which can lead to miscarriage.


DOES DRINKING COFFEE INCREASE THE DANGER?
Pregnant women who drink more than two cups of coffee a day may double their risk of miscarriage.

WHAT HAPPENS WHEN YOU MISCARRY?
At first you may experience slight bleeding and a bit of pain. At this point it's a "threatened miscarriage" and the neck of the womb is closed, so you may still be able to save your baby. Contact your midwife, doctor or go to your nearest accident and emergency department. In the next stage, the bleeding and pain increases. When examined, if the cervix is opening it's inevitable that a miscarriage will occur.

THE MEDICAL PROCEDURE
Women often have to wait a week and have a repeat scan before a miscarriage can be confirmed. But if the worst has happened, the doctor will help you choose the right option for you:

Let nature takes its course - where the foetus comes out naturally. This method can take anything from a few days to the next cycle of your period, how long depends on the stage of your pregnancy. So you may be on your own at home when it happens.

The doctor can give you misoprostil, a tablet which encourages the uterus to contract and expel the pregnancy, and also pessaries, which speed up the natural process of miscarriage. Often you're given the pill in hospital then asked to return when you start bleeding so you can be monitored.

Alternatively you may need to undergo a D&C, which stands for "dilation and curettage", where the uterus is cleaned out under general anaesthetic.

WHAT'S THE DIFFERENCE BETWEEN A MISCARRIAGE AND A STILLBIRTH?
A miscarriage occurs before 24 weeks. A stillbirth occurs after 24 weeks, once the baby is fully formed — so you usually need to undergo an induced labour to deliver it.

YOUR AFTERCARE
If you've had two miscarriages, you can ask your doctor to refer you to an Early Pregnancy Assessment Clinic when you are five to six weeks pregnant, before your usual 12-week scan.

Three miscarriages in a row is known as a recurrent spontaneous miscarriage and you'll be referred to a gynaecologist for special investigation.

You should wait at least until you have had another cycle before trying to fall pregnant again. Three months is usually a good length of time.

Although you recover physically within about six weeks, miscarriage is a bereavement and is likely to affect you emotionally. Everyone reacts differently. But feelings of sadness, depression, self blame and anger are common. Talking to someone who's been through one can help.