Post-miscarriage care and recovery: All you need to know
In recent years, there’s been an increase in celebrities discussing their experiences with miscarriage. The likes of Chrissy Teigen, Meghan Markle and Michelle Obama have opened up about the heart-breaking situations, but also about the problem that we, as a society, have; the collective silence around miscarrying.
‘I felt lost and alone, and I felt like I failed because I didn’t know how common miscarriages were, because we don’t talk about them. We sit in our own pain, thinking that somehow we’re broken. I think it’s the worst thing that we do to each other as women, not share the truth about our bodies and how they work, and how they don’t work.’ – Michelle Obama
There is a culture of shame and fear around discussing this topic, and it’s understandable. No one wants to upset or cause more pain to the woman who has already gone through this awful life event. But in many ways, not talking about it and addressing the elephant in the room is not only unhelpful but can be dangerous.
That silence of respect can quickly turn into a silence that feels like shame. The mother can end up feeling isolated and alone in the experience, as talking about it makes others uncomfortable. Going through something like that alone is not an option.
Because miscarrying has become something of a taboo subject, women can be unprepared or not versed in how to handle this situation, not only emotionally, but medically. We have to keep this discussion open so as to make the frightening moment a bit more knowable. By opening up the topic, we all learn more about the process and information needed to make it through something like this.
Firstly, miscarriages are far more common than we realise. The HSE estimates that 1 in 5 women experience a miscarriage in their lifetime. Just because you don’t hear about them, doesn’t mean they’re not happening. Most cases of miscarriage do not have an identifiable cause and are not caused by anything the mother has done, especially if the miscarriage occurs in the first 12 weeks of a pregnancy.
After an ultrasound has confirmed a miscarriage, there is a procedure to follow. Your doctor or midwife will discuss options with you depending on whether or not any pregnancy remains in your womb. If so, you may need further treatment. There are three types of care you may need after a diagnosis:
- expectant management
- medical management
- surgical management
Expectant management
The HSE says: ‘Expectant management means waiting and allowing the remains of the pregnancy to leave your body naturally through bleeding. This is successful in about 50% of women who choose this option. If unsuccessful, you would need to use medical management or surgical management. It can take some time for the bleeding to start, and the bleeding can continue for up to 3 weeks.
'With a missed miscarriage, the pregnancy may not start to come away for a few weeks. You may be offered a follow-up appointment after 2 weeks. If the bleeding and pain has stopped by then, the pregnancy has probably completely left your body. You may be asked to do a urine pregnancy test one week later to make sure the pregnancy has left your body. If you still have pain and bleeding after 2 weeks, you may be offered another ultrasound scan to check if any of the pregnancy is still in your body.’
Medical management
The HSE says: ‘Medical management involves inserting medication into your vagina, or swallowing tablets. This medication helps the neck of the womb (the cervix) to open to allow the miscarriage to occur.’
You may experience pain after taking these tablets. You may feel cramp-like tummy pains and bleeding from your vagina after taking the medical management tablets. Sometimes you may need to take painkillers for the pain. Consult your doctor before taking any.
The bleeding may continue for 1-2 weeks and be moderately heavy with blood clots. You should use sanitary pads or towels instead of tampons or mooncups, as they may prompt infection. However, you should contact your maternity hospital if:
- the pain is severe
- the bleeding is too heavy
- you are feeling weak
You will usually have a follow up appointment 2 weeks later to have a scan again to see if the pregnancy has left your body.
If further action is needed – which is fairly rare, about 1 in 10 women who have medical management need to have an operation to remove the pregnancy – that is something that can be arranged at that appointment.
Surgical management
The HSE sys: ‘You might need to have an operation to remove the pregnancy. This is called an ERPC (evacuation of retained products of conception). Some people call it a 'D&C' (dilatation and curettage). You will be under either local or general anaesthetic during the surgery. The operation is safe, but like any surgery there are some risks. These include:
- bleeding
- infection
- damage to your womb
You might need a repeat operation to make sure the pregnancy is fully removed from your body.’
Recovery
Some experiences you are likely to have while recovering from a miscarriage are:
- bleeding from your vagina
- stomach cramps and pain
However, you should seek urgent medical help and contact your GP or maternity hospital after a miscarriage if you have:
- heavy bleeding from your vagina
- severe abdominal pain
- smelly vaginal discharge
These symptoms could mean that some of the pregnancy tissue is still in your womb or it could be early signs of an infection. Other symptoms include:
- feeling feverish – a temperatures above 38°C (100.4°F)
- flu-like symptoms like a sore throat, fever and muscle ache
You should go to the hospital if you are feeling unwell or feverish in the days after your miscarriage. Infection happens in about 2% of women who have had a miscarriage and can be treated with antibiotics. It is extremely important to seek medical help if you think you may have an infection.
Looking after your emotional recovery
This can be a deeply upsetting time for you and for your partner. It is an emotional pain that can come and go. At times, you may feel fine, and other times you may experience feelings of guilt, shock and anger after a miscarriage. You are entitled to feel these things and anything else after a miscarriage.
It is important to discuss these feelings, either with your partner, family or friends and to seek further help if you feel you are not coping well. Your GP will be able to advise you further as to your physical and emotional recovery.
Your maternity hospital may offer supports such as:
- chaplaincy or pastoral care
- clinical midwife specialist in bereavement and loss
- The Pregnancy and Infant Loss in Ireland website has information and advice for parents.
For further information, see HSE.ie.
