The Miscarriage Process

Most miscarriages begin in places away from hospital and like all births, miscarrying can take anywhere from under an hour to days or even weeks to unfold fully (see ‘Types of Miscarriage’). Miscarrying is a natural process and happens when a baby hasn’t formed completely. Unlike most of us who have experienced it, medically, miscarriage is considered a minor event, not necessarily requiring professional monitoring. Being checked out afterward though is a necessity.

Except for the timing, miscarriages usually happen in the same way. A fast miscarriage can be really shocking and frightening once the process begins to happen, especially if it is your first pregnancy and you have no idea what to expect. Pain can quite quickly reach a level beyond anything you have experienced before (each person’s level of pain is individual) and the amount of blood loss may seem too large an amount to survive. However, be reassured that miscarriage is very seldom fatal. Although no intervention can save your baby, for your own healthy recovery see the following suggestions.

A Typical Miscarriage

  • Take a few deep breaths and try to think about what is actually happening. If you can, it is a good idea to jot thoughts down including any questions you may have, before phoning anyone. Meantime, if you can find someone around to help, ask them to do it for you. Keep track of; when the pains started; their strength and location; when the bleeding began; how many sanitary pads have been used and how often changed.
  • Although unfortunately, no intervention can save your baby, you still need medical help for yourself at this stage
  • Contact your Lead Maternity Carer (LMC – whose information is always good to keep handy), Doctor or call Healthline 0800 611 116 and describe your symptoms so they can help you make a decision on what to do.
  • If you wish to complete your miscarriage at home and your LMC agrees to help you through this time, you will be in their hands.
  • However, if the advice suggested is to call the hospital the hospital will still need to know what is happening so they can check a) you receive the correct immediate care b) you received the appropriate after care including a D&C if necessary.
  • If/when you contact the hospital they will also advise a friend/relative to drive you in while they sort out arrangements for you to be admitted. In the car, lie down on your side on the back seat (the most comfortable position, and it also reduces blood flow) and take extra towels with you.
  • The loss of blood and lack of concentration means Never Driving Yourself. You could also lose consciousness.
  • It may be suggested at some point to dial your emergency number anyway or you may choose to yourself NZ 111 (or US 911) There is a fee for this service in NZ.
  • Meantime, if you haven’t already, try and find a support person.
  • Take things quietly. You may like to lie down and use a heat pack on your lower abdomen or back.
  • To relieve pain take paracetamol (Do not use Aspirin) for pain every 4 – 6 hours but do not exceed stated dosage, lie down and place a hot water-bottle, wheat bag or heat pack on your lower abdomen or back
  • To soak up the blood towels may be more useful. Do not use tampons or bathe. Shower only if you have a support person with you N.B.
  • If you are able and wish to, and have a strong stomach to cope, squat over a clean container so you can save everything which can then be seen by your medical professional. (A warning; you may also see your baby’s foetus.) The results can be sent for testing which may be useful with future pregnancies. You are entitled to have everything back for burial/cremation.
  • If you can’t manage that, saving the larger clots in a clean container would be very helpful.
  • If possible in the waiting time, pack a bag with 2 nighties, underwear dressing gown, slippers, toilet kit with toothbrush and paste, face cloth, soap and sanitary pads.
  • As you may need a D&C, avoid eating or drinking except for regular small sips of water. Your stomach must be empty for the anaesthetic.
  • If you have children or pets, have your support person make arrangements for their care or if there is no-one, let the ambulance people know when they come and offer them phone numbers.

If you are undecided about going to hospital;

It would be a better choice
a) if you are losing so much blood that you feel faint and as if you are going into shock
b) if you have persistent bleeding filling more than one sanitary pad in half an hour and pass pieces of placenta, which look like blood clots or liver.

For those who cope at home;

Once the miscarriage is over, ring your medical professional or the hospital to let them know you have passed your baby. It is important that you are examined later to determine whether or not the miscarriage is complete. You may be sent for a scan to confirm the findings. Remaining unpassed tissue can cause infection with serious consequences to following pregnancies and also cause sterility. (Your miscarriage also needs to be recorded on medical files for future reference.)

Choices around miscarriage treatment when there are options;

If a baby is found to have died (at a scan is not uncommon) the shock will be devastating although sometimes the mother may have an inkling, like morning sickness has stopped and she feels more herself, but none-the-less actually knowing is awful as the last of her hope has gone. As soon as reasonably possible, a medical professional needs to be consulted and decisions made with them and yourself and support person about the most acceptable action to be taken.

Without knowing the particular circumstances of a miscarriage or what NZ hospital is attended, a NZ medical professional can only offer fairly general advice about what to expect in our local hospitals;

  • Normally, when a woman is miscarrying the medical practitioner discusses all the options available, both for a medical and natural miscarriage. This is a discussion and a decision made together, bearing in mind the immediate health of the mother – a D&C may be the recommended option if the she is in danger for example.*
  • If the pregnancy is very early and undetected on an ultrasound, it would be normal practice for a woman to be sent home to wait and see, hoping that a miscarriage will occur naturally. If this is agreed on, a review date to come back is given if nothing happens. Instructions are given about when to seek help if necessary in the interim.
  • A scan may be required or offered.
  • Tablets to induce a normal delivery may be considered.

NB If women are confused or unhappy about the treatment they have received by the hospital they should always arrange a meeting with the medical professional involved so that the situation can be discussed and an explanation given as to why a particular form of treatment was decided on. (* See http://www.ncbi.nlm.nih.gov/pubmed/26534897 website if there is a choice for possible caution especially if more than one D&C is involved.)