Coping with miscarriage
A miscarriage is the loss of a pregnancy during the first 23 weeks. It is a common complication of early pregnancy and can be an unhappy, frightening and lonely experience. In the last of a three part series on miscarriage, we focus on how a loss might affect you, how to cope with your feelings and the process of trying again (with information from the Miscarriage Association).
Feelings after pregnancy loss
Every miscarriage is different and there is no right way to feel about it. Some women experience great sadness and regret for a long time afterwards, while others are upset at the time but recover quickly. How you feel will depend on your circumstances, your experience of miscarriage and what the pregnancy meant to you. Your feelings will be completely unique to you. However, it is perfectly normal to feel any or all of these:
- Sad and tearful;
- Shocked and confused;
- Numb;
- Angry;
- Jealous;
- Guilty;
- Empty and lonely;
- Panicky and out of control;
- Unable to cope with everyday life.
It is also common to feel loss in physical ways, which can add to your distress and make it hard to move forward. A lot of women find they feel very tired, even some time after the miscarriage. You may also experience bleeding, headaches or stomach aches, be constipated, have diarrhoea, or find it hard to sleep. These symptoms will probably disappear in time, but if you feel worried about them, it might be a good idea to talk to your GP.
Why don’t other people understand?
Mourning the loss of your baby’s future and your own future as that baby’s parent can be hard for others to understand and relate to. It can be hard to cope if people around you don’t understand how you are feeling or expect you to behave in a different way.
You may feel upset for longer than you – and those around you – expect. You may feel criticised and in the wrong if people suggest you should be getting over your loss and moving on with life. And when you are feeling low, insensitive reactions and words can hurt. But whatever other people say, remember that there is no right or wrong way to behave after miscarriage.
Sometimes people simply don’t know what to say or do. You may need to tell them how you feel and how they could help, and if you can, spend time with people who do understand. They may be able to find ways to help you cope.
What about my partner’s feelings?
Some couples find that the sadness of miscarriage brings them closer together. But grief can put a strain on even the best relationships. You and your partner may grieve in different ways or at different times. Your partner may find it very hard if all the attention is on you and his or her feelings are ignored. If the strain of your loss is pulling you and your partner apart, you may need to look for outside support (see end of article for details).
Ways to remember your baby
You may want to find a special way of remembering your baby and marking your loss. Some hospitals will give you a certificate in memory of your baby if you ask. Contact a nurse or midwife on the ward, the hospital chaplain, or the bereavement service; or try the hospital’s Patient Advice and Liaison (PALS) Officer. Here are some other ideas:
- Make an entry for your baby in your hospital’s book of remembrance; again ask on the ward or speak to the chaplain.
- Plant flowers or a tree in your garden or a local garden of remembrance.
- Light a candle on anniversaries and other ‘special’ days.
- Buy something special in memory of your baby.
- Write a letter or poem for your baby.
- Make a donation to a favourite charity.
Trying again
There will come a time when the pain of your loss eases and you start to think about trying again. Women and their partners often have mixed feelings about the next pregnancy: hope mixed with worry about why you previously miscarried, whether and when you might conceive again, and if you do conceive, whether you might lose the next baby too.
When is the right time?
There is no right answer to this. People’s feelings vary after the experience of pregnancy loss. You and your partner may each have different feelings about trying again and that may need talking through. You may need time to recover physically. You and your partner may both need time to come to terms with your loss and to grieve for your baby.
Many doctors advise waiting until you have had at least one period after your miscarriage before trying again, as this makes it easier to calculate the dates in the next pregnancy. This doesn’t mean that you are more likely to miscarry if you do conceive before then. There is even some evidence that conceiving in the first six months after a miscarriage actually lowers your risk of miscarriage next time [1].
In most cases, you and your partner are the best judges of when to try again. If you have had a late miscarriage or repeated losses, you may want to talk to your GP or specialist before trying to conceive. There are also some circumstances, such as after a molar pregnancy or ectopic pregnancy, or if you are coping with an illness or infection, when you will be advised to wait longer.
Will it happen again?
No one can say for sure. What we do know is that you are much more likely to have a healthy pregnancy than another loss after one or two miscarriages, an ectopic pregnancy or a molar pregnancy. But age is a factor too; and the older you are, the higher your risk of miscarriage, particularly over 40.
Can I reduce my risk of another miscarriage?
There may be things you can do but it’s important to know that you can’t completely rule out the chance of another miscarriage. However, you and your partner may be able to take steps to improve your general health, diet and lifestyle. This can make a difference to your chances of getting pregnant and having a healthy pregnancy. There are no guarantees, but you might find the following tips helpful.
Eat a healthy diet
A well-balanced diet, including food from the four main groups below, seems to reduce the risk of miscarriage:
- Fruit and vegetables
– Fresh or frozen is best
– 5 portions a day if you can
– Wash fresh fruit and salad thoroughly. - Meat, fish, eggs, lentils, soya, tofu
– Cook meat and eggs thoroughly
– Avoid pâté and foods made with raw eggs
– Don’t eat liver more than once a week. - Milk, cheese or vegan alternatives
– Avoid unpasteurised milk or cheese
– Avoid mould-ripened cheese like Brie, Camembert and blue cheeses
– Cream and cottage cheeses are fine. - Wholegrain cereal, breads and grains, including:
– Rice and pasta
– Breakfast cereals, which often have added vitamins and minerals.
Think about vitamins and minerals
A well balanced diet should give you all the vitamins and minerals you need. But there is some evidence that a multivitamin supplement specifically designed for pregnancy can reduce the risk of miscarriage (2) and of having a baby that is small for gestational age (3).
If you are trying to conceive, or you’re in the first 12 weeks of pregnancy, it’s good to take folic acid supplements. These reduce the risk of neural tube defects like spina bifida (where the baby’s spinal cord doesn’t develop normally). Once you are pregnant they are prescribed free of charge.
Aim for a reasonable weight
Whatever your shape it is best to avoid being very underweight (i.e. having a Body Mass Index (BMI) of less than 18.5) or being very overweight (i.e. having a BMI of more than 30). You may want to talk to your doctor if you are worried about your weight, diet or appetite. Your doctor might refer you to a dietician for advice on how to lose or gain weight safely before you get pregnant.
Cut down on alcohol, smoking and caffeine
Research shows that even moderate drinking, smoking or caffeine consumption can increase the risk of miscarriage.
- Alcohol: The miscarriage risk is highest for women who drink every day and/or more than 14 units per week. Heavy drinking by your partner can reduce the quantity and quality of his sperm. An occasional drink is unlikely to be harmful. But the usual advice is to stick to just one or two units a week, or stop drinking altogether before you conceive and during pregnancy.
- Smoking: Researchers don’t all agree about how much smoking affects the risk of miscarriage; but it is probably safest to give up in pregnancy or cut down as much as you can. This will reduce your risk of miscarriage and of having a very small baby.
- Caffeine: Pregnant women are advised to limit caffeine to 200mg a day – equal to about two mugs of coffee. Be aware, though, that caffeine is also found in tea, ‘energy drinks’ and some soft drinks, some medicines, such as cold and ‘flu' remedies and chocolate – there is about 6mg in a 30g bar of milk chocolate.
Take care with medicine and drugs
The general advice is to avoid all medicines and drugs unless your doctor or pharmacist says they are safe when you are trying to conceive or pregnant. This applies to prescribed medicines as well as those you can buy over the counter, including herbal remedies.
Coping with stress and anxiety
We all feel stressed or anxious at times and this is particularly likely when you are facing pregnancy after miscarriage. We can’t say whether stress on its own actually causes miscarriage. But we do know that women under a lot of stress are more likely to miscarry; and the more stressful events they have to cope with, the higher the risk. On the other hand, good care and support after miscarriage can increase the chances of things going well next time. That may be because your stress is reduced. Talk to your GP about any questions and worries you have about another pregnancy. Or you could try the local early pregnancy unit, or our helpline.
Ask about extra care, such as an early scan
This is especially important after an ectopic pregnancy, to check that the baby is growing in your uterus. But early scans – or extra scans at critical times – can be reassuring after any loss. This may not be true for you if the thought of a scan makes you more anxious rather than less.
Conclusion
It is natural and normal to feel anxious about pregnancy after miscarriage. Miscarriage affects many people and can have a devastating impact. However, you don’t have to struggle alone. We hope that that the information in this article will help you to feel calmer and more confident about the next pregnancy. And we wish you well for the future.
About the author
Ruth Bender Atik, National Director
Miscarriage Association, registered UK Charity
Telephone: 01924 200795
Email: ruth@miscarriageassociation.org.uk
Helpline 01924 200 799. Mon-Fri 9am-4pm
www.miscarriageassociation.org.uk
Where can I go for help and support?
- The Miscarriage Association has a telephone helpline, a volunteer support service, an online support forum and a range of helpful leaflets on all aspects of miscarriage. Tel: 01924 200799; www.miscarriageassociation.org.uk
- The British Association for Counselling and Psychotherapy can help you find a counsellor or psychotherapist. Tel: 0870 443 5252; www.counselling.co.uk.
- Relate can help with relationship problems. Tel: 0300 100 1234; www.relate.org.uk.
- The Samaritans can help people in serious emotional distress, 24 hours a day. Tel: 08457 909090; www.samaritans.org.uk.
Useful reading:
- About what was lost, by Jessica Berger- Ross, Published by Penguin Group 2007, ISBN: 977 0 452 28799 0
- Miscarriage:Women’s experiences and needs, by Christine Moulder, published by Routledge 2001, ISBN: 0 415 25489 2
- Our stories of miscarriage, edited by Rachel Faldet and Karen Fitton, published by Fairview Press 1997, ISBN: 1 57749 033 9
- When a baby dies: the experience of late miscarriage, stillbirth and neonatal death, by Nancy Kohner, published by Routledge 2001, ISBN: 0 415 25276 8
References:
[1] Love, E., Bhattacharya, S., Smith, N., (2010). Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland. British Medical Journal; 341:c3967.
[2] Maconochie, N., Doyle, P., Prior, S., Simmons, R., (2007). Risk factors for first trimester miscarriage: results from a UK-population-based case-control study. BJOG; 114(2): 170-186
[3] Brough, L., Rees, G., Crawford, M., Morton, RH., Dorman, E., (2010). Effect of multiple-micronutrient supplementation on maternal nutrient status, infant birth weight and gestational age at birth in a low income, multi-ethnic population. British Journal of Nutrition, 104, pp 437-445.
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