Miscarriage

After the joy and excitement of finding out you’re pregnant, and making plans for the future with your baby, a miscarriage can be very distressing.

You may be feeling a range of emotions; grief, shock, anger, numbness, even guilt – and may be asking if it was something you did. Feeling like you need to know a reason is natural, especially if you’re planning to fall pregnant again.

In this article we’ll look at some of the signs and causes of miscarriage, and what, if anything, you can do to hopefully prevent it happening again.

A miscarriage ^{Footnote [1]} is when your baby (foetus) dies in the womb before the end of the 23^rd week of pregnancy.

There are many reasons you might experience a miscarriage - the majority are not caused by anything you’ve done.

Often, the cause isn’t identified but it’s thought it can happen because your baby wasn’t developing properly or had abnormal chromosomes.

Other less common reasons can include:

• Blood clotting disorders which affect the flow of blood to the placenta.
• Thyroid problems.
• The shape of your womb if it’s unusual, or a weak cervix.
• A vitamin D deficiency.
• Genetic problems with you or your baby’s father.
• Lifestyle factors such as smoking, drinking alcohol or weight issues.

Despite there being a number of possible causes, many women go on to have a successful pregnancy in the future.

Miscarriages are much more common than most people realise. Around 1 in 4 ^{Footnote [1]} pregnancies end in miscarriage and there may be more where you don’t know you’re pregnant.

The risk of miscarrying your baby becomes more common as you get older, with the risk increasing to about a 40% if you’re over 40.^{Footnote [2]}

Around 1 in 100 women lose three or more babies through miscarriage.^{Footnote [3]}

If you have heavy vaginal bleeding, and cramping and pain in your lower tummy that feels like period pain, you may be miscarrying your baby. You may pass large blood clots or recognisable pregnancy tissue.

You may also stop experiencing the pregnancy symptoms you’ve been having, such as feeling or being sick, and tender breasts.

You should know that light vaginal bleeding is quite common during the first three months of pregnancy and not always a sign of miscarriage.

If you think you’re having a miscarriage, contact your midwife or doctor as you may need to go to the Early Pregnancy Unit (EPU) at your local hospital to be checked over.

Your doctor may organise blood tests to check if the pregnancy hormone is still in your body, or refer you to the EPU for tests.

Depending on how many weeks pregnant you are, you may be given an internal ultrasound scan. If you have an early pregnancy, it might not show up on a scan so you may have to have the scan repeated a week or so later.

If you’ve had three miscarriages in a row it’s called recurrent miscarriage. It’s rare and only affects around 1% of couples ^{Footnote [3]}. You’ll normally be referred for tests to see if there’s an underlying reason causing the miscarriages.

Recurrent miscarriages can happen more than once, but try and stay optimistic as many couples who’ve had recurrent miscarriages still go on to have a baby in the future.

Most miscarriages occur during the first 12 weeks. Until the 7th week the pregnancy is known as the ‘embryo’, and from 8 weeks, the ‘foetus’.

An early miscarriage is one that happens in the first three months (the first trimester). You’ll usually find out there is no heartbeat from an ultrasound scan, or from tests conducted because you were bleeding heavily.

Your doctor will then advise you whether to wait for the miscarriage to occur naturally (expectant management) or have further treatment.

You may not need any medical intervention; quite often the miscarriage will occur naturally.

But, if after 14 days you haven’t passed the pregnancy tissue, you may need drug treatment or surgery to complete the miscarriage.

• Expectant management, where the miscarriage happens naturally.
• Medical management – this can take the form of a vaginal pessary or a tablet. It will start, or speed up the process of miscarriage.
• Surgical management which can remove any tissue from your womb, either under local or general anaesthetic.

If you lose your baby after 13 weeks and up to the end of 23 weeks, it’s known as a late miscarriage, or a second trimester loss. You’ll usually need to go through labour to deliver the baby.

Your baby may have failed to develop properly in the womb due to a chromosome or genetic abnormality such as Downs Syndrome or Ewards Syndrome. If this is suspected, doctors may be able to check the cause from samples of blood, or the placenta.

When looking for other causes, doctors may check for:

• A problem with your baby’s body, such as a congenital heart defect.
• A weak or damaged cervix which may have opened too early in the pregnancy – if this is found, you can have your cervix stitched up during your next pregnancy.
• An infection such as chicken pox, Group B strep or something caught from an animal, such as toxoplasmosis. ^{Footnote [4]} It can affect the baby, or the amniotic fluid surrounding the baby.
• A problem with the placenta.

If you lose your pregnancy after 24 weeks it’s called a stillbirth, not a miscarriage. So if you have a late miscarriage, especially near to 24 weeks, it can be a particularly distressing time, as you may feel more like you’ve lost a ‘baby’, rather than a foetus.

You may have been for a scan and received the devastating news that your baby has died, but has not been physically miscarried.

Known as a ‘missed miscarriage’ this news can come as a complete shock as your body has still remained in its pregnancy state.

This is often found at the routine ultrasound scan, 12 or 20 weeks, or at a private or non-routine scan, where the scan picture shows a foetus with no heartbeat. Sometimes there’s nothing there at all and the embryo (up to 7 weeks pregnant), has been absorbed by the body.

If there’s something there, you’ll still need to pass the pregnancy, either by the miscarriage occurring naturally or by medical intervention. Your doctor will advise you.

After your miscarriage you may find you need time to recover emotionally and physically, even though general advice is you can start trying for another baby after your next period. This is usually so you have a date to work with if you fall pregnant again.

If your doctor found a cause for your miscarriage you may be able to have treatment such as a stitch for your weakened cervix, or medicine for blood clotting or thyroid disorders.

When you and your partner feel ready, there are things you can do to improve your chance of having a healthy pregnancy.

You won’t be able to prevent another miscarriage, but this guidance may reduce the risk:

• Avoid alcohol
• Don’t smoke or use illegal drugs
• Maintain a healthy weight
• Take folic acid supplements
• Eat a healthy balanced diet, but avoid foods that are known to increase the risk of miscarriage such as unpasteurised dairy products.

The Miscarriage Association has a helpline and lots of articles and case studies which offer help and information for you, your partner, and family and friends.

You could use your health insurance cover to claim for treatment for a miscarriage. The first step is to get a referral from your GP, or through our Digital GP app^. Then you can make a claim through MyAviva, over the phone, or online. You can find a full list of the conditions we cover in your policy terms and conditions.

If we confirm that your claim meets the terms of your policy, we'll pay for the treatment directly. Just be sure to tell us if you need more tests or treatment, or if your hospital or specialist changes.

It’s good to have one less thing to worry about. It takes Aviva.

^ These services are non-contractual and can be withdrawn or amended by Aviva at any time.