Coping with Miscarriage

 PERINATAL LOSS

by Rosemary Romberg

I am most fortunate to be the mother of six healthy, normal, beautiful children. Each of our children were carried to term easily and were born naturally with no problems. Three of them were born at home. It would seem that I would be an unlikely candidate for pregnancy complications and loss. However, I have also had the misfortune of miscarrying three times, once at the 12th week, and twice at the 19th week. Each of these have been horrible, devastating experiences and deep personal losses for me

My First Miscarriage – Caused by an IUD

Our first son was born in 1972. At my 6 week check up I had an IUD inserted. I thought it a wise decision at the time because I was nursing my baby and feared that birth control pills would interfere with breastfeeding. About a year later I was astonished to find that I was pregnant again with the IUD in. I wanted another baby (although I wouldn’t have planned it quite this soon) and I could never consider abortion. But I was fearful because I knew that I was in a high risk position to miscarry. (When a pregnancy takes place with an IUD in the uterus and the IUD is not removed, the chance of miscarriage is about 50%.) I called a doctor and made an appointment. Over the phone he told me that he would remove the IUD during my first visit. I didn’t know if such a procedure would be safe for the developing baby. I called another doctor for a second opinion. That doctor told me that removing the IUD would almost certainly induce a miscarriage. However, with further research I also learned that if the IUD was removed and the pregnancy did continue, it would then be as risk free as any other normal pregnancy – much safer for the baby without the IUD in. So I was uncertain about whether or not to agree to having it removed.

When I had my first appointment, at seven weeks, it was found that the strings to my IUD (which normally should protrude through the cervix and be felt during manual examination.) had disappeared up inside my uterus. Therefore the doctor was not willing to remove the IUD. If the strings were still outside the cervix, he felt that he could remove them easily with little risk to the baby, but since they were gone, searching up inside my uterus for the IUD would almost certainly induce a miscarriage. He was not willing to take that risk, so I was sent on my way, knowing that I might have a miscarriage. Still I was hopeful that I would have the baby. I have personally known other women who have carried their babies to term with IUDs in place, with little or no problems.

I wanted desperately to know what a miscarriage would be like. I found virtually no information available on the subject. (This was in 1973.) I had probably known dozens of women who had mentioned having had miscarriages. I had always given the matter very little concern, imagining little more than a heavy menstrual period.

During the next few weeks my uterus seemed to continue to grow normally. Curiously I experienced no typical nausea of early pregnancy. I had experienced plenty of normal nausea during my first pregnancy two years earlier. (And have subsequently experienced the same with all of my other pregnancies.) I have since been told that the IUD suppresses the normal hormones of pregnancy which was why I experienced no nausea and why I was unable to sustain the pregnancy.

From about the 9th week on I experienced intermittent spotting. Each time I saw blood on my underpants I would become terrified that I was “about to miscarry” and would call the doctor. He would then order me “off my feet” (not an easy accomplishment when you have a 16 month old child!) with a “wait and see” attitude. After an hour or so the spotting would cease, I would cautiously resume normal activities, and another day or two would go by uneventfully. I went through several such cycles of “spotting, terror, rest” like this which were leaving me an emotional wreck.

The actual miscarriage began, curiously, after I had not experienced any spotting for several days and was beginning to feel optimistic about continuing the pregnancy. Early in the afternoon I began feeling mild achy sensations in my lower back and pelvic area. It felt like being extremely constipated. At first I wasn’t sure if it had anything to do with the pregnancy. Throughout the afternoon the achiness became increasingly strong. I only wanted to lie down and do nothing. I experienced considerable denial. I did not want to acknowledge that what I was experiencing had anything to do with my pregnancy. Even though I had no appetite and was extremely uncomfortable, I ate dinner. I had myself psyched up with the idea that “good nutrition is everything” and that eating healthy food would help keep the baby alive and go to term.

Shortly after dinner the achiness turned into regular contractions, occurring about two minutes apart. They were as strong as regular labor contractions and I was using Lamaze breathing to get through them. I don’t think my husband realized what was happening except that I didn’t feel good. I was still denying that I was losing the baby and had not even mentioned the idea of miscarrying to him.

I was also actively praying, desperately, silently, “Please God, I want to have this baby!! Please let this baby live!! Please don’t let me lose this baby !!”

Suddenly I felt something slip down into my vagina and felt a little splash of water. I made a frantic dash to the bathroom and as soon as I sat down on the toilet a small fetus, about 2 ½ inches long slipped out! I shouted to my husband, “There went the baby!” He immediately called the doctor. I didn’t know that there would be any more to the miscarriage now that the fetus was out. But my husband said, “I’m taking you to the hospital. The doctor is going to do a D&C.” I wasn’t sure what a D&C was.

Steve fished the fetus out of the toilet with a slotted spoon and put it into a plastic margarine container. Our little son, Eric, was toddling around. It was a reassuring feeling to see that big, healthy, full-term baby that I had given birth to just 16 months earlier. At least I knew “I could do it.” I think this would have been an even worse experience for me had it been my first pregnancy. My husband quickly dropped Eric off at a neighbor’s and we drove to the hospital.

When we arrived at the hospital I still felt physically okay with very little bleeding. Emotionally I felt shaken up and numb. We mistakenly went in the front door instead of the emergency entrance, and had to ask several questions about where to go. Finally we wound up in the emergency room and I was put on a bed in a small cubicle in the corner with curtains around me. A nurse took my blood pressure and had me change into a hospital gown. Other than that no one was paying much attention to me. I hadn’t seen the doctor yet. I had not seen the IUD come out, so I figured it must still be in there. But I did not realize that there was a lot more placental tissue that must come out.

About an hour had gone by since we had arrived at the hospital. The doctor had briefly come in and checked me. He had another patient that needed a Cesarean delivery. He was trying to decide which one of us should be attended to first. He went away. Then suddenly I felt something huge pass out of my vagina. I thought it might be the placenta, but it was just a huge clot of blood about the size of a fist! It splashed all over the floor, up and down the wall, and seemingly everywhere!! Immediately the doctor was right there and I was receiving all sorts of attention! The doctor roughly massaged my uterus and I screamed out in pain and tried to pull his hand away!

As quickly is possible I was rushed into surgery for the D&C. My husband was not allowed into the operating room. The set up was even worse than a conventional delivery table. The stirrups were just little loops of straps that hung down from the ceiling into which my feet were placed. Since I had eaten (a big mistake!) they couldn’t give me any medication. Natural childbirth was a relatively new idea at that time. This doctor knew that I had had my first child with the Lamaze method and that I taught Lamaze classes. Therefore, he advised me just to use my Lamaze breathing and relaxation during the surgery. That too was a big mistake!! Not one should be allowed to endure a D&C without medication!! That is a totally different type of pain than labor contractions and normal birth. That was a more severe pain than I’ve ever had to endure under almost any other circumstances!!

Soon the doctor removed the IUD. It was a Dalkon Shield, the same IUD which, I later learned, was responsible for the deaths of 17 women due to septic spontaneous mid-trimester abortions!! I was lucky that mine was “only” a simple, relatively early miscarriage! (This experience has been a major factor in my present day stance of soundly questioning all medical procedures!) The doctor showed me the IUD which looked like a bloody, evil insect! I announced, “I am NEVER getting one of those things again!” He also showed me about a cup full of placenta. I was surprised at how much placenta there was – a lot more placenta than baby during this stage of pregnancy.

I was able to go home a few hours later. My husband went back to work the next day. I had my little toddler to take care of and no one there to help me during the daytime. For the first several days I passed out frequently, fortunately immediately coming to each time. I had lost a lot of blood and was anemic for a while.

The immediate aftermath was one of physical and emotional shock to my system and at least semi-grief. But mostly I was filled with an intense desire to become pregnant again as quickly as possible, and then to get past the point where I had lost that last one. There was nothing wrong with my body. The miscarriage was caused by the IUD which was gone now. Therefore any future pregnancy would be okay. I had already easily carried one baby to term. The experience did not threaten my self-concept or my future child-bearing ability. I was even secretly somewhat pleased that my extremely fertile body had defied this artificial device. I was in my optimum childbearing years (26 at the time) and had only one child. There was no question about attempting another pregnancy.

About 5 months later I did become pregnant again. The following year our second son, Jason was born in October of 1974. I considered myself a healthy, low risk mother who became pregnant easily, carried my babies to term with absolutely no problems, and gave birth easily and naturally. Later our third son, Ryan was born at home in 1977 and then our fourth child and first daughter, Lisa was born at home in 1981. We considered our family complete with four children. I never would have dreamed that in the future I would turn into a “high risk” mother who would suffer extremely devastating childbearing loss.

Fibroid Tumors – the “Nemesis of my Life”
Uterine fibroid
In the Winter of 1983, two years after Lisa’s birth, I found, much to my surprise, that despite precautions I was pregnant again. Although it was a shock, again I could not consider an abortion. Soon we began making plans for our fifth child that was due in November. I could imagine nothing other than another healthy full term pregnancy and baby. So despite my age (36) and number of pregnancies, I again began nonchalantly making plans for another home birth. Three years earlier during early pregnancy with Lisa the doctor had told me at my 11th week that my uterus seemed quite large, more like a 15-16 week pregnancy. He mentioned that it “felt like I had fibroids” which was probably what made my uterus seem so large. I scarcely even knew what fibroids were. He gave the matter very little concern. I gave it no more thought. I carried Lisa to term easily and she was born at home with no problems.

Now during this subsequent pregnancy my midwife first examined me during my 8th week and said it felt like a 12 week pregnancy. She described an egg sized lump that she could palpate in the upper portion of my uterus. She was worried about it and wanted it checked out with the doctor before we made a decision about another home birth. She and the doctor (who was the same one I had seen while pregnant with Lisa) were both concerned about the fibroid(s) predisposing me to a greater likelihood of postpartum hemorrhage. Neither of them mentioned anything about a threat of miscarriage. In all my previous years as a childbirth educator, while garnering an immense amount of knowledge about every sort of obstetrical complication I had never heard of anyone having problems due to fibroid tumors.

We continued to make plans for our expected baby. This included moving to a larger house. When I was about 17-18 weeks along we were in the process of moving. I was working extremely hard with packing, unpacking, and lifting things. I was very much exhausted. I was not sure if I had felt the baby move yet. Something did not seem right about this pregnancy. It seemed like there was “nothing there.”

Two nights before the miscarriage I had a dream about the baby being born dead (but full term in my dream!) I felt overwhelmingly depressed! I also passed several bits of brownish mucus, but gave it little concern. I did not have any cramping or bleeding. In the morning of the day that the miscarriage began I was feeling “toxic” – that achy all over feeling as if I were coming down with the flu. Still, I chalked it all up to overwork from moving.

At around 5 p.m. that afternoon I had an ominous feeling that I would not be carrying this pregnancy much longer, but I tried to push the thoughts out of my mind. At 8:30 that night my water broke!! What had always been an exciting, welcome event at my babies’ births (my last 3 births had all begun with my membranes rupturing!) was an evil, sickly omen at 19 weeks! I tried to call my midwife but she wasn’t in. Then I called the doctor. He ordered me to bed, with the instructions to abstain from intercourse and to drink plenty of fluids. He explained that sometimes the membranes can rupture during an early stage of pregnancy, and then, after a few days of bed rest, will seal up again and the pregnancy will continue normally. So I still didn’t know for sure if I was losing the baby. My uterus was considerably smaller now and I felt no movement. I lay there in bed in a state of absolute, total, raw terror! I desperately prayed for the life of this baby. I had no idea what would be happening! Would I lie here like this for the next few days and then go on with the pregnancy? Would everything be okay? Would I give birth to a baby too small to live right here in this bed? Would it be alive? Would I have to watch it die? Was it dead already? This was all the deadest, sickliest, most terrifying experience I could have ever imagined!!

This went on for about 6 hours. Finally at about 2:30 a.m. I went to the bathroom. A small fetus, about 7-8 inches long slipped out of me. It was very skinny and limp. There was virtually no face left and the head was swollen. I was sure it was deformed – it looked so awful! But my immediate emotion was relief! I didn’t have to worry any more about what would happen. I held it in my hand and it was attached by a tiny umbilical cord. I couldn’t break it loose so I had my husband bring me a pair of scissors and I cut it free. I got on the phone to the doctor again and he advised me to wait until the placenta came out. But I told him about my experience with hemorrhaging with my first miscarriage, so he told me to go ahead and come to the hospital. I went back to the toilet and blood started gushing out of me as if someone had turned on a faucet! I immediately called the doctor and told him to meet me there. Then we raced to the hospital. I was put in an outpatient operating room in the emergency area. Steve was able to stay with me. By the time I arrived I had entirely soaked with blood a large sized sanitary pad and the large bath towel that I had been sitting on. The doctor looked at the fetus and said that it appeared to be normal, but that it looked as bad as it did because it had started to decompose in utero. He thought it had been dead for several days. (It was later pronounced a 16 week fetus by size and development, even though by dates I was 19 weeks along.)

All this time I had felt virtually no physical pain, and had passed the fetus without any noticeable contractions. Now the doctor inserted a speculum and eased the placenta out. I had an IV in my arm and the doctor put me out briefly so he could do a small D&C to get out the remaining fragments of tissue. Some Valium and Demerol were added to the IV and I was woozy and almost out of it for a few minutes and then came to. I remember very little about it. We were able to go home about 3-4 hours after we got there.

The aftermath was extremely emotionally devastating. I had always spoken of my first miscarriage, nearly 10 years before as “easily the worst experience of my life,” but this time was, it seemed, at least 100 times worse!

I was further along in pregnancy this time. It was totally unexpected. My chances of ever having a full term, successful pregnancy and healthy baby again were not so promising. This was my first experience with total, hard-core, irrational grief! I went through numerous hard crying spells and panic attacks in the middle of the night. More than once I was up the entire night crying. For several months I was filled with a constant, pervading feeling of overwhelming depression. I had profound feelings of guilt, fearing that overwork on my part might have caused it. I wracked my brain for other possible causes. Every cookie or unhealthy food I might have eaten was suspect. I felt anger at the baby for leaving me. If felt angry at God for allowing this to happen. The experience was a severe stress on my marriage and on my other children, since the loss seemed to be mine alone. Neither my husband nor my children felt any sense of loss over the baby. But they did suffer from the loss of their normal wife and mother. My kids were having crying spells in school. My husband and I seriously considered divorce. My daughter Lisa was 2 at the time so she was the nearest thing to a “baby” that I still had. I would often hold her for hours at a time, feeling unable to do anything else.

Five weeks after the miscarriage I had an ultrasound which confirmed the presence of a lemon-sized fibroid tumor in the right half of my uterus. The doctor advised me that as the pregnancy had begun to advance the baby was not able to get nutrients because the placenta had apparently been attached where the fibroid was. That was why it had died. He then advised me that with a future pregnancy it would entirely depend on where the egg would happen to implant, and that I would face a 50- 50 risk of miscarrying again in the same way or carrying it to term.

This has been the most sickly, horrifying, hideous thing I have ever had to face in my entire life — to know that there was something growing in my body, an evil, alien thing, that could not let my baby live, and that I (apparently) had no control over it!! I can now imagine how people with cancer must feel. The presence of that tumor profoundly affected my feelings about myself. I considered that tumor my greatest enemy in the entire world and it was hidden inside my body where I could not even see it. I hated it with every cell of my being for murdering my baby, but I could do nothing about it!! (Because fibroid tumors grow inside the uterine muscular wall, they cannot easily be removed, and the doctor advised against such an operation.)

I had been “natural health” oriented for many years, so I decided that many things must be going on in my life that weren’t right for my body to malfunction so horribly. I began reading and studying all the books on nutrition and wholistic cures that I could find. There was precious little information available on fibroid tumors, but I read a great deal about nutritional cures for cancer, since I figured the same type of principle applied. I went on a totally vegetarian diet, took a large number of vitamin supplements, undertook a number of short juice fasts, and constantly tried to visualize and positively think about the tumor going away. I felt a lot of trepidation about attempting another pregnancy. Finally in March of 1984, about 9 months after the miscarriage, I made an appointment with the doctor. He confirmed that the tumor had regressed, and he could no longer palpate the lemon-sized lump that had been quite prominent after the ultrasound the previous July. He did say that my uterus was still irregularly shaped. He suggested that I have a hysterosalpingiogram, a technique in which radioactive dye is injected up into the inside of the uterus so that they could get a picture of the inner contour of my uterus and see if the tumor was still there on the inside. Since I have been so oriented towards non-interference, the idea of that repulsed me and I decided against it. He suggested that I now had probably a 70% chance of successfully carrying a future pregnancy to term since the tumor had apparently regressed. I naively assumed that all of my dietary and wholistic attempts at reducing it had been successful.

“The Nightmare Continues”

I became pregnant again in May of 1974, almost a year after the miscarriage. I again made appointments with the same midwife, again planning a home birth. This time, during each prenatal visit, no tumor was apparent and my uterus was always exactly the right size for the stage of pregnancy. (During my previous pregnancy the tumor had always been quite prominent and my uterus had always been about 3-4 weeks larger than it should have been for dates.) I felt quite optimistic about this being a successful, full term pregnancy.

Still, I felt moments of extreme anxiety. I knew that I would not be able to rest entirely easily until I got past the point where I lost the last one. By the 17th week I kept feeling that my uterus seemed too small for this stage, but I wasn’t sure because during the previous year ms uterus had been too large.  I just couldn’t remember for sure how it had been during my previous successful pregnancies. My midwife insisted it was exactly the size it should be. She also thought she could hear the heartbeat, although she only had an ordinary fetascope (not an electronic one.) By the 18th week I kept thinking I was feeling very faint movements. I knew that “the time” was almost here, where I would finally be past the point where I lost the last one. I desperately wanted everything to be okay!

On Saturday morning of the end of my 18th week I passed a little bit or brown mucus. It was hardly any, but I remembered that had been the only warning before my last miscarriage. I felt alarmed but tried to stay busy and be optimistic, especially after I stopped passing mucus. On Sunday I was passing more of that brownish mucus and was becoming increasingly worried. My husband and three boys were away on a backpacking trip and I was alone with my 3 year old daughter Lisa all that weekend. Late Sunday night my father-in-law phoned with the news that my husband’s ailing grandfather had just passed away. Suddenly everything in the world seemed to be death and sadness. That night I slept fitfully and was filled with a feeling of despondency.

The next morning I continued to keep busy. I knew it would just be a matter of time before it was all over. I was still passing bits of brownish mucus. My uterus seemed much smaller than it had been even a week ago. I felt totally dead and defeated.

My husband and sons returned from their trip at around 3 in the afternoon. I told Steve about his grandfather’s death, but did not tell him about the mucus or my fears about losing the baby.

At around 9 p.m. that night I was rocking Lisa and getting her ready for bed when I felt some achy sensations in my pelvic area. I tried to tell myself they were gas pains, but I knew they were coming from my uterus. At 9:30 I went to the bathroom and felt something coming out of my vagina. I looked down and saw a dark red, bulging thing which must have been my membranes. I barely touched it and it burst, splashing bloody water all over the inside of the toilet. I called out to Steve and told him I was losing this baby. I immediately called the doctor (who hadn’t even known I was pregnant again.) This time I knew what would be happening and I wanted to get to the hospital immediately. I did not want to wait around to pass a dead fetus or risk hemorrhaging at home again.

We arrived at the hospital. It was horrible to see that same ugly room again. I assumed that the experience would be similar to that of the year before. I thought I would be treated in the outpatient operating room, and then go home again in a few hours. But this time, since the fetus was still inside of me and I was only a little bit dilated the doctor was going to admit me to the maternity floor and start a Pitocin drip. I didn’t want to be there with all the full term mothers and babies, but he said that the O.B. staff were the only ones who were trained to deal with Pitocin. Fortunately I was the only one there in a double room. I couldn’t see any of the babies or other mothers, but three or four births took place while I was there and it was difficult for me to hear the new babies crying.

I lay there in the bed with the Pitocin drip in my arm. My husband went home to be with the kids and get some sleep. While the year before I had felt stark, unbelievable raw terror, this time I only felt bored. The room was dark and I was alone. One nurse checked in on me from time to time, but she was also busy with other women in the labor rooms. I soon began having noticeable, mildly crampy contractions. Although I was in very little pain I asked for a shot of Demerol to help me relax, (ME!! The big natural childbirth advocate, who has had all of her babies without medication!!) All I wanted was to get this ugly experience over with and to go on with my life. The Demerol only mildly relaxed me. I don’t remember being any less sharp in my senses because of it. Maybe it made the time pass more quickly. Finally at about 1:30 a.m. I passed quite a bit of blood and then the fetus came out right there in the bed. I screamed for the nurse to come in and help me. The fetus looked very much like the one I lost the year before, maybe not quite as big, but just as macerated and horrible looking. I begged her to take it away immediately. I didn’t even want to see it, but the nurse made a point of showing me its features. She told me it was a girl. She handled and treated it carefully, as if it were a living baby. I suppose it was best that she handled the situation in this manner. She insisted that she couldn’t cut the cord until the placenta came out. She put a small paper sheet over it so I wouldn’t have to see it. I told her about how I had cut the cord myself with the one that had come out at home the year before. Then she decided that she could put a clamp on the cord and cut it and take the fetus away. She kept pulling on the cord while I actively pushed, trying to expel the placenta, but I only kept passing blood. Finally she decided that I was bleeding too much so she called the doctor. He soon arrived and decided I should be taken to the operating room and be put under with anesthesia so he could do a D&C and get the placenta out. I couldn’t understand why he couldn’t ease it out manually and do a quick D&C under light anesthesia the way he had the year before, but at that point I didn’t care. At around 3:30 a.m. I was taken into surgery. The only other time I had ever been under general anesthesia was when I had my tonsils taken out at age 6.

Something was put into the IV tube that put me out immediately. Then I came to and I thought that nothing had happened yet, but it was all over. I heard the doctor saying something about “fibroid tumors.” Evidently he had felt one or more on the inside of my uterus while performing the D&C. I remember thinking that the words “fibroid tumors” had to be the ugliest two words in the entire English language. This man is one of the nicest doctors and human beings I have ever met, but at that point I felt like I wanted to blame him for the whole thing as if he was responsible for putting the tumor there.

There were oxygen tubes going into my nostrils and I asked, “What’s this in my nose?” Also there were little electrodes pasted all over me so that they could monitor my heartbeat. Soon the electrodes and tubes were removed.

I was wheeled back into my room and intermittently slept off the anesthesia during the remaining early morning hours. At about 8 a.m. they brought me a breakfast tray but I was only able to eat a little bit of it. I watched some news on the TV. My husband came to take me home at about 9 a.m. It was the last day that the kids would be home from school.

Again I was grieving. It seemed like a continuation of the same grief from the year before. At least this time it wasn’t the horrifying shock that the previous one had been. This time I had known that a miscarriage was a definite possibility. I had psychologically protected myself as best I could by refusing to build up any plans for the baby until I got past the point where I lost the other one. Still, as long as I had been pregnant I had kept alive that hope and now it was gone. I immediately made an appointment to have a tubal ligation. At this point the idea of even considering another pregnancy seemed absolutely impossible. I still had a lot of crying spells and feelings of depression. But I just could not grieve as sharply as I had the year before. I think I had reached my saturation point with grieving and simply could not grieve anymore. It was as if the same feeling and experience had been repeated over and over again so many times that it had all become merely a neutral sensation. I felt that I had been in a state of grief for such a long time that I could not feel any other emotion. I believe I now understand how people must adjust during war times or times of extreme natural disaster and other severe crises. The extreme, sharp practically unbearable state of shock and grief is eventually replaced by a self-protective psychic numbing. Without this I may have been pushed over the brink into insanity!

“A Happy Ending”

My story does have a happy ending. I decided to postpone my decision about permanent sterilization. I also decided to pursue the spiritual healing of my completely devastated mental and physical states. To make a very long story short I have experienced a spiritual and physical healing through Jesus Christ. I am actually a rather unlikely person to become strongly religious in the “traditional Christian” sense, had I not personally experienced something so astounding! I became pregnant, despite precautions, about four months after that miscarriage. This resulted in the successful, full-term pregnancy and birth of our son Kevin in October of 1985. This time the fibroid tumor apparently disappeared, or at least was not detected during ultrasound exams during the pregnancy

Despite my new found spiritual faith, my pregnancy with Kevin was filled with some understandable trepidation and refusal to make plans during the first 19-20 weeks, until I joyfully realized that I truly would be carrying this baby to term. I did have a hospital birth. Although the pregnancy and birth were completely normal, because of my age (38), number of previous pregnancies, and my two recent losses, local midwives were unwilling to accept me for home birth. The setting was extremely home like, however. My story of having a hospital birth after two previous home births is described in detail in another article that I wrote shortly after his birth. Article: Hospital Birth After Two Home Births  (Opens in another window)

Four years later, in December of 1989 I gave birth to our second daughter and sixth (and last) child. This time I gave birth at home in our large bathtub. It was by far the easiest and most peaceful of all my births. I was 42 years old at the time, but her birth took place after our family’s move to Alaska. The midwives here were much more accepting and understanding of me and my situation than they had been in Washington State. Article: Melissa’s Birth  (Opens in another window)

Out of my own personal experiences with perinatal loss I have learned much. It is my hope that the following will help others who have experienced pregnancy losses, or who may face them in the future.  Also, most importantly, I hope this will be read and heard by all those who must deal with others who have experienced these tragedies. This includes not only health care providers and childbirth educators, but those relatives, friends and acquaintances of grieving “would be” parents. (This would mean just about everyone.) Some of my friends were extremely helpful to me in offering their sympathy and comfort. However, there were others who said some extremely hurtful, tactless, non-understanding things. Part of this is because with my second and third miscarriages I lost what would hare been my fifth (living) child, and we have a society that does not value large families. Also, right or wrong, I believe that the ready acceptance and availability of abortion has made people less sympathetic towards those of us who lose our wanted babies. (This is not to ignore the fact that women who have planned abortions frequently do experience similar feelings of shock, grief, and remorse, even if they did choose it. Sometimes their experiences may be even more difficult because people have an even harder time understanding shock and grief over a chosen abortion.)

Common Causes of Miscarriage/Perinatal Loss:

1. Abnormalities: Something is wrong with the fetus, placenta, or both. Possibly the fetus began from a defective egg or sperm or had a faulty gene or chromosome. Sometimes no baby is developing at all. Often the defect is of a nature that if the baby were born full term it would die shortly after birth, or would be severely handicapped or retarded. (Regardless of people’s positions on deliberate abortions, when abnormalities are detected, most people would consider an early spontaneous miscarriage of a severely defective baby a “blessing in disguise.”)

Laboratory studies have often revealed significantly higher rates of defects among miscarried fetuses than among full term births. Since many early miscarriages are either flushed down the toilet at home or are only briefly looked at in the hospital, it is likely that a high percentage of miscarried pregnancies due to abnormalities are never diagnosed.

Abnormalities in development can be caused by exposure to radiation or dangerous chemicals such as pesticides and other drugs. Some types of genetic abnormalities are more common among older mothers. A few abnormalities are inherited. If a woman is planning to become pregnant or suspects that she might be, she should attempt to avoid all dangerous substances and radiation. Some occupations which involve handling toxic substances should be avoided by all fertile women in their childbearing years. Some non-emergency medical procedures (such as x-rays of the pelvic area) should be avoided during the latter half of a woman’s menstrual cycle (after ovulation) just in case a pregnancy has begun. A protective lead shield should always be placed over a woman’s pelvic area when other parts of her body must be x-rayed.

2.) Weakness of the cervix: (“Cervical incompetency.”) Normally a woman’s cervix (the opening of her uterus through which a baby is normally born) remains closed until she has carried her baby to term and labor begins.

In some women the muscles of the cervix are weak. Some women are born with weak cervixes. Other women have experienced damage to the cervix caused by intervention, such as from repeated deliberate abortions in which the cervix was forced open. (This rarely happens with a D&C following a miscarriage since the cervix has dilated by itself to expel the fetus.)

If a woman’s cervix is weak it has difficulty supporting the increasing weight of the growing baby and heavy uterus. Therefore it begins to open prematurely. Cervical weakness is also a common cause of premature birth. Generally the problem of cervical weakness becomes worse with each successive pregnancy.

Sometimes if cervical weakness is diagnosed, complete bed rest, at home or in the hospital, can help the woman carry the baby to term, or at least far enough along that the baby, though premature, will survive. Sometimes stitching the cervix together, or stitching a special cuff in place during early pregnancy will help a woman with this problem carry her baby to term, or at least far enough along to survive.

3.) Fibroid tumors: (This was thoroughly described in the sharing of my personal story.) If the placenta is implanted at the site of a fibroid tumor it may cut off the baby’s blood supply from the mother through the placenta, thus causing fetal death. Fibroid tumors are more common in women who are later into their childbearing years (late 30’s or 40’s), and their growth is often stimulated by female hormones. The tendency to fibroid tumors can be hereditary.

4.) Presence of IUD: An IUD (intra-uterine-device) is a foreign object in the uterus. It is intended to be a birth control device. Authorities are not certain as to how it works in preventing pregnancy, but it is believed to either prevent implantation of the fertilized egg, or to cause a very early, usually undetected miscarriage each month with the menstrual cycle. Women considering IUD’s for birth control should realize that the device does not actually prevent pregnancy, but instead causes the termination of pregnancy in the very early stages. IUD’s are also associated with other difficulties such as excessive cramping and bleeding during menstruation, infection of the uterus, perforation of the uterus, spontaneous expulsion, and pregnancy complications including miscarriage and premature birth. IUD’s are not known, however, to cause birth defects if the baby does go to term. IUD’s, however convenient, cannot be used for birth control indefinitely. Most women must have them removed after about 3-4 years.

During pregnancy an IUD can be removed. The act of removing it may induce miscarriage. However, if the pregnancy stays in place after its removal, the pregnancy will be as safe as any other normal pregnancy. If the IUD stays in, the chance of miscarriage is about 50-50. Some babies go to term and are perfectly healthy at birth even though the IUD stays in place.

5.) Severe Injury to the Mother: Normally healthy pregnancies in healthy women are very secure. Some women have survived devastating car accidents or falls from second story heights whose pregnancies have continued normally with their babies being born full term with no problems. There are even instances of women who have become brain dead due to injuries during pregnancy who have been kept alive artificially by feeding tubes, etc. long enough to allow their babies to go to term and survive.

6.) Severe Maternal Illness: This would usually mean a dire, life-threatening disease. Colds or minor bouts with the “flu” normally will not harm the developing baby. And exception to this is rubella (“German Measles”) which although mild for the mother can cause birth defects if contracted early in pregnancy.

A woman should consult with her health care provider about any necessary precautions, and for her own peace of mind, if she does become ill during pregnancy.

7.) Poor Implantation Site: Normally a fertilized egg implants along the upper portion or side of the uterus where there is normally plenty of blood supply for the growing baby. If the egg implants low in the uterus so that the growing placenta covers the cervix, this may cause miscarriage. If a pregnancy like this (placenta previa) continues, there can be dangerous complications with excessive bleeding during birth. Almost always a Cesarean delivery is necessary.

Rarely a fertilized egg will implant outside of the uterus, for instance in the Fallopian tube (tubal pregnancy), on the ovary (ovarian pregnancy), or in the abdominal cavity (abdominal pregnancy.) A pregnancy outside the uterus is called an ectopic pregnancy. An ectopic pregnancy is an extremely complicated, dangerous condition, often accompanied by severe pain and internal bleeding in the mother. In almost all cases the beginning baby cannot survive. Usually it dies in the very early embryonic stage. (There have been a very small percentage of abdominal pregnancies that have resulted in live babies.)

The rare but dangerous possibility of ectopic pregnancy is one of the reasons that mothers should seek prenatal care as early as possible during pregnancy, and all miscarriages, or threatened miscarriages should receive medical attention no matter how early.

8.) Accidents With the Umbilical Cord: Until the baby is born and can breathe on his/her own, the baby gets all of his/her nutrients and oxygen through the umbilical cord. Therefore anything which pinches or damages the cord can cause a baby to be severely depressed and blue at birth which sometimes can result in permanent brain damage or learning disabilities, or can cause death before or shortly after birth.

Sometimes cord injuries are “freak” accidents such a knot in the cord that pulls tight, a cord that becomes tightly wrapped around the baby during or before birth, or a blood clot forming in the cord. Rarely, cord accidents are caused by abnormalities in the cord such as an extremely short cord which breaks during birth.

Fetal heart monitoring during labor can detect slow or otherwise unusual patterns in the baby’s heart rate which are often caused by cord compression. In the event of a true emergency, special measures can be taken to get the baby born quickly, or perform an emergency Cesarean.

However, normally umbilical cords are extremely strong and resilient. They do not break or compress easily. Before birth the cord is stiff like a garden hose. (Cutting an umbilical cord is not easy!) Therefore almost all babies are born with an unusually high amount of red blood cells, which gives them several minutes of safe time in which they can survive without oxygen (in the event of an emergency), before permanent brain damage could set in. Almost all babies who are born depressed due to cord compression or other factors do get revived quickly, start breathing on their own, and are perfectly healthy. Also, fetal heart monitors frequently show unusual fluctuations in babies’ heart rates during labor, although the baby is totally healthy.

9.) Severe Malnutrition: A healthy, plentiful, well-balanced diet is essential for a normal pregnancy and healthy baby. However, it is unreasonable to blame small amounts of “junk” food, any specific type of food, or days of not eating much of anything (which is common during early pregnancy when troubled by nausea) for causing miscarriages. Overall good nutrition before conception will normally carry the mother and baby safely through the difficulties of early pregnancy.

Generally, severe malnutrition will first cause failure to ovulate or menstruate. Curiously, countless women in countries that experience extreme hardship and deprivation still carry their babies to term and are able to nurse them, with severe health problems and infant death usually not being a threat until after the child is weaned from the breast.

10.) Hormonal Problems: The female hormones estrogen and progesterone must be present in sufficient amounts for a pregnancy to continue normally. These hormones are also related to the normal nausea of early pregnancy. Therefore, ironically, the pregnancy in which the woman feels terrible from typical first trimester nausea is usually a healthy, normal pregnancy. Pregnancies that are miscarried early are frequently accompanied by little or no nausea.

If deficiencies of normal female hormones is determined to be a cause of repeated miscarriage, sometimes administering extra doses of hormones during a subsequent pregnancy will help that pregnancy go to term.

11.) Hytadidiform Mole: This is a bizarre condition that begins as a normal conception, but the embryo soon dies and disappears, while growth of clusters of tissue continues for several weeks. The causes for this are not clearly understood, but appear to be hormonally based, as “molar” pregnancies are usually accompanied with severe nausea. This condition occurs more frequently in women who are late in their childbearing years. The uterus usually grows more rapidly for dates than during normal pregnancy, and usually spontaneously expels its contents at around 15 to 18 weeks. If hytadidiform mole is detected early in pregnancy, most medical professionals will remove it. (Since there would be no living fetus with this condition, there would be no controversy about terminating it.)

Miscarriages, Stillbirths, and Newborn Deaths are not Normally Caused by:

l.) Normal or even vigorous physical activity or intercourse: Although bed rest is often prescribed for women who threaten to miscarry, most medical professionals doubt that inactivity will prevent a miscarriage that is inevitable. Conversely, a healthy, normal pregnancy is extremely secure and will not be “shaken loose” by life’s normal activities. The human race would never have survived if this were true.

Unfortunately, if a miscarriage occurs suddenly, a woman may tend to blame a recent activity for causing it, when almost certainly the miscarriage would have happened anyway.

2.) Over the counter medications, most prescriptions medications, herbs, alcohol, or “street” drugs: Alcohol and “street” drugs are harmful to a growing baby and should definitely be avoided during pregnancy. Most, but not all, herbs are harmless during pregnancy. An herbal specialist can advise you as to which herbs should be avoided when you are pregnant. A few herbs are purported to induce miscarriage, but medical documentation of this is questionable. Most popular herbs such as mint or chamomile make flavorful beverages that are soothing during pregnancy. All medications, either prescription or over the counter, should be avoided or used with caution under a medical professional’s direction only in cases of true medical necessity. However, the big concern about all of these substances is that they may cause birth defects or developmental difficulties in the baby, or possibly health problems in the mother. It is extremely difficult to induce a miscarriage by anything taken orally. Deliberate attempts at drinking poisonous concoctions to induce a miscarriage almost always fail.*

(* – Update: This was originally written before the early abortion inducing drug RU-487 was on the market. However, this is not likely to be inadvertently taken by a woman with a wanted pregnancy.)

Just as was discussed with normal physical activities, women who miscarry sometimes want to look for something to blame, often unfairly punishing themselves. But, (for example) it is unreasonable to blame the miscarriage on an aspirin taken two days before, or an alcoholic drink during the previous week.

3.) Diet: A well-balanced, nutritious diet is essential to a normal, healthy pregnancy. However, just as with normal physical activities or medications and drugs, miscarriages cannot be blamed on eating “junk” food (i.e. candy, soft drinks, potato chips, etc.), or eating any specific type of food such as highly spiced foods.

4.) Bad thoughts: Miscarriages are not caused by negative thoughts about the pregnancy or other things. There is no concrete evidence that miscarriages are caused by even severe emotional trauma such as anger or fright. Miscarriages are not caused by our previous sins or bad “karma.” Although there may be spiritual factors at work in our lives that do interrelate with perinatal loss and other tragedies, it is not fair to believe that some previous sin in one’s life may have caused this, or that God sent the miscarriage as a punishment.

None of us are perfect. Even highly responsible mothers with planned and wanted pregnancies have some negative feelings about pregnancy or previous transgressions. Although an inner state of calm and happiness in the mother is undoubtedly best for the growing baby, and unborn babies almost certainly do sense the emotional mood of the mother (especially as pregnancy advances and the fetus becomes more developed and aware), there is no reason to believe that occasional spells of maternal depression or emotional traumas have any long lasting effect on the baby. (Her emotional state is more likely to have an effect on the baby after he/she is born if depression or other difficulties prevent her from giving the baby the love and attention he/she needs. Depression is a recognizable medical condition which can be treated and cured.)

5.) Minor illnesses: Miscarriages are not caused by ordinary colds, mild cases of the “flu”, or most other types of minor illnesses. It is true that some particularly severe diseases will cause a pregnancy to abort, and some rare types of uterine infections have been associated with miscarriage. The bigger concern is that illness during early pregnancy may cause birth defects or developmental difficulties in the baby. Therefore any illness during pregnancy should be brought to the attention of your doctor or health care provider. Fortunately , most pregnancies go to term normally and the babies are healthy, even if the mother was ill during pregnancy. It is unreasonable for a woman who miscarries to blame the cold she may have had the week before.

I am personally opposed to deliberate abortion, except, perhaps in cases of extreme medical emergency. However, in instances in which medically supervised abortion has not been available, women who have not wanted to be pregnant have sometimes done terrible things to themselves such as jumping out of second story windows or drinking toxic concoctions in the hopes of inducing a miscarriage. In almost all cases the woman would either make herself violently ill or seriously injure herself, but the pregnancy would continue normally. The point is, it is extremely difficult to terminate a normal, healthy pregnancy by even severe measures such as these. Therefore, those of us who lose our wanted pregnancies are not justified in blaming the “every day” events in our lives, such as normal physical activities or diet, for causing the miscarriage.

The point in this discussion is not to minimize the importance of good diet, avoiding dangerous substances and other reasonable concerns during pregnancy. The purpose of this is to eliminate unnecessary guilt. Although the rates of perinatal loss are significantly lower in women who are in good overall health, a high percentage of miscarriages, stillbirths, and infant deaths do, unfortunately, happen to healthy, conscientious mothers with no explainable reason.

“A Shocking Traumatic Experience”

A miscarriage, or the threat of one, particularly if it is unexpected, or the first time a woman has ever experienced a miscarriage, is extremely frightening and traumatic for most women Every cell of one’s being wants to make that pregnancy be healthy and go on to term. It is not an experience that can normally be shrugged off or quickly forgotten. In general the further along a woman is, the more attached she is to the pregnancy and the larger and more developed the baby is, and therefore the more traumatic the experience is. However, some women are devastated by a very early miscarriage, at 6 or 7 weeks or even earlier.

“Symptoms May Vary”

The symptoms of a threatened or inevitable miscarriage can vary. My three miscarriages had many similarities as well as differences. But it would have helped me great1y, especially the first two times, if I had known more about what to expect. It may be preceded by bleeding, cramps, labor-like contractions, brownish or blood-stained mucus, or rupture of the membranes. If she is further along she may notice that the baby is no longer moving or that her uterus is getting smaller. The symptoms of pregnancy such as nipple sensitivity and breast swelling or typical first trimester nausea may disappear. In some cases ultrasound can detect whether or not the baby is still alive and/or developing normally, and if so every possible effort can be made to save it. Some women who experience a threatened miscarriage do continue the pregnancy successfully and end up with a living baby. Some of the complications associated with threatened miscarriage are also related to prematurity or other high risk complications. However, some women who threaten to miscarry do carry their babies full term with no complications.

However, frequently when symptoms of miscarriage are well underway, with uterine contractions and/or dilation of the cervix there is nothing that can be done to prevent it. It may mean that the fetus is already dead.

Although doctors commonly recommend complete bed rest for women who threaten to miscarry, in almost all instances reduced activity has no effect in preventing a miscarriage.

What Will Come Out?

What will come out during a miscarriage varies. A definite fetus may come out first. Sometimes with earlier miscarriages there may be only clumps of tissue, or the fetus and placenta will come out together in one piece, usually with the placenta surrounding the fetus (which is technically an “embryo” if before the 8th week.) Sometimes women experiencing inevitable miscarriages receive immediate medical attention including being put under anesthesia for a D&C and never see any of it. Also in some instances women experience only bleeding without any recognizable tissue. In cases like this, probably the pregnancy began with a defective egg and no baby ever developed.

If any tissue (fetus, placenta, large clots, etc.) are passed at home, they should be saved and brought to the hospital. They need to examine it to determine if everything has come out, and whether or not a D&C is necessary. Sometimes by examining it they can tell whether or not the baby was normal or can determine what might have gone wrong and can advise you about a future pregnancy.

Get Medical Attention

Get medical attention immediately, even if it is a very early miscarriage. If you do not have a doctor or midwife, just go to the nearest hospital emergency room at a hospital where maternity care is provided. You may need a D&C if you are unable to expel the placenta on your own or pass only parts of it. A D&C is not always necessary. Some women, especially those experiencing early miscarriages, expel all of the uterine contents by themselves. You may only need to be examined to make sure everything is okay. Still it is important to get medical attention to be sure. Even fragments of tissue remaining in the uterus can result in infection or hemorrhage. Also symptoms of miscarriage could indicate an ectopic pregnancy (one that begins to grow outside of the uterus such as in the Fallopian tube or abdominal cavity) which can be extremely dangerous.

“Not a Time to be Political”

Be aware that the technical, medical term for all pregnancies that end in the early stages is “abortion” whether it was a deliberate abortion or one that happened by itself (which lay people commonly call “miscarriage.”) Therefore, if you hear the doctor or nurses using terms such as “spontaneous abortion” or “incomplete abortion”, realize that they are just using a correct medical term. They are not implying that you deliberately tried to end the pregnancy. Similarly, terms such as “fetus”, “uterine contents” or “products of conception” are just medical terminology to doctors and nurses and have nothing to do with their or your stand on deliberate abortion. Unfortunately the abortion controversy has become a war of terminology. It can be hard to hear such impersonal terms used about a much wanted and hoped for baby, but when you are in the middle of a miscarriage, this is no time to get political.

On the other hand, I would also admonish all medical personnel to be especially careful and tactful about the type of terminology they use or comments that they make during this extremely vulnerable, traumatic event in a woman’s life.

Generally the term ‘abortion” (i.e. “miscarriage”) is applied to all pregnancies that end before the 28th week. After that arbitrary time it is considered a “premature birth” up until the 36th or 37th week. However, occasionally babies born earlier than the 28th week do survive with excellent medical care and technology.

Avoid Food

Do not eat, if you suspect that you may be about to miscarry. Eating at this time will do you and your baby no good. Normally you will have little appetite. If surgery is necessary and you need general anesthesia, there must be nothing in your stomach. (This is because there is a danger that one could vomit and then inhale undigested food while unconscious.) If, however, you are experiencing threatening symptoms for several days or longer obviously you will have to eat. Consult your doctor for advice about your dietary needs if you are in this position.

The Placenta

If you pass only the fetus, realize that there is a placenta, which, if you cannot expel it, must usually be removed by a D&C. (“D&C” means “dilation and curettage” – in other words the doctor or attendant dilates the cervix manually and carefully scrapes out the inside of the uterus with a sharp instrument called a “curette.” Usually when a miscarriage is underway and part or all of the contents of the uterus have been passed, the cervix has already dilated by itself and the doctor only has to be concerned with the “curettage.”) Usually following a normal, full term birth, the fully developed placenta comes out easily. The full term uterus is quite large and after the birth of the baby becomes considerably smaller. This process helps to detach and close down the blood vessels and helps to expel the placenta. However, following a miscarriage the uterus is much smaller and thicker and the placenta is immature and not ready to detach. Therefore it can be much more difficult to expel the placenta.

For a D&C, Insist on Medication

Do not, under any circumstances, allow anyone to perform a D&C without medication!! This is more pain than anyone should ever be allowed to endure! It is not the same as normal labor contractions which can be dealt with by relaxation and breathing techniques. (I would rather have had my stomach pumped or been given a spinal anesthetic than been forced to go through what I did during my first miscarriage.)

The Emotional Aftermath

Be aware that during the aftermath, feelings of shock, grief, anger, remorse, guilt, trauma, and emptiness are totally normal. This can be true even if the pregnancy wasn’t very far along, or even for women who have unplanned pregnancies which they were not sure if they wanted.

Some women experience “psychic pregnancy” during the remaining months that would have comprised the pregnancy had it gone to term. Sometimes women are haunted by feelings of “I should be ____ months pregnant now” during the months that follow. Feelings of loss around the time that would have been the baby’s due date are very common.

Also some women may feel extremely uncomfortable around other babies, especially newborns, or around other women who are in advanced pregnancy. Some women even feel disturbed the following year when they see babies who are the same age that their babies would have been. Realize that these feelings are normal and you are not going crazy.

The sensations during and immediately after a miscarriage can also trigger instinctive feelings and behaviors that surround normal birth, making the absence of a baby especially painful. This may be particularly true for the woman who has given birth successfully in the past, as she may be reminded of memories of her previous baby(ie)’s births. The smell of the lochia (the normal bleeding which follows birth or miscarriage), the sensations of soreness around the perineum, and the feeling of one’s body suddenly no longer pregnant can arouse instinctive “mothering” behaviors and feelings associated with birth. Women who lose babies later during pregnancy or at term often have their milk come in. Although a “dry up shot” of chemicals intended to suppress lactation can be given in the hospital, it often is not effective. The experience of breasts full of milk and no baby to give it to can be excruciating! Milk production works on a supply and demand basis. Therefore, with nothing to stimulate its production, engorgement should subside within a few days and the milk should completely disappear within a few weeks.

“Intense ‘Baby-Craving'”

It is also extremely common to experience an intense desire to become pregnant again as quickly as possible and to get past the point where you lost this one. The craving is for both a successful, full term pregnancy and for a baby. (Women who give birth prematurely often experience an intense feeling of loss and grief over losing the final months of pregnancy, even when the baby survives and is healthy.)

A woman who has recently miscarried has just had her pregnancy torn away from her right in the middle! Her mental and physical state is similar to that of a drug addict undergoing withdrawal.

Most importantly, intense craving for a successful pregnancy and living baby is not confined to women in “socially acceptable” circumstances for having another baby. This phenomenon is not confined to married, middle-class women in their 20’s or early 30’s who either lost their first pregnancy or only have one or two other children. Right or wrong, regardless of other people’s value judgments, unmarried women, teenagers, or women who are later into their childbearing years and previously had considered their families to be complete (like myself!) also frequently experience an intense desire for another successful pregnancy and baby. This does not seem to reflect social, economic, or even medical circumstances, (although practical realities may prevent a future pregnancy from ever being realized.) The feeling is one of “life is sorrow, emptiness, death and pain right now, and only once I am pregnant again and then past the point where I lost this one will life feel okay again!” The feeling is totally understandable to anyone like me who has been there, although it is admittedly irrational in the eyes of others who do not understand. But other people’s personal judgments about who should or should not have children, or how many children people should have can be extremely cruel to a woman in this position.

I would strongly admonish others to keep such opinions (however justified or unjustified) to themselves when dealing with a woman who has just lost a baby.

The Decision About a Future Pregnancy

However, depending on your life’s circumstances, it may be necessary to delay the decision about whether or not to attempt another pregnancy. (For example, when I miscarried at age 26 it was caused by an IUD. Therefore, there was nothing wrong with me that would affect a future pregnancy. Also I had only one child at the time, so the decision to get pregnant again was an extremely easy, unquestioned one. However, when I miscarried again at ages 36 and 37, I had a fibroid condition in my uterus that seriously threatened any future pregnancy. Also I had four children by this time. Therefore the “reasonable” decision was not to attempt another pregnancy – despite my intense baby-craving. Only a true miracle was to bring us Kevin and Melissa.)

Depending on your situation, it may be a good idea to consult with medical professionals about the advisability of a future pregnancy and the cause of the miscarriage. Perhaps some steps can be taken now before becoming pregnant again that would help to prevent a future loss. For example, some miscarriages are caused by disease, hormone deficiencies, or problems with the cervix which can be corrected before becoming pregnant again.

It is also important to remember that future baby will be a totally different individual than the previous one that was lost. Every child has the right to be loved and wanted for him or herself. No child should be brought into this world just to replace another. Sometimes a baby born after a previous pregnancy loss does not appear to be given as much attention and commitment as he or she deserves. If the mother is still hurting emotionally from her previous trauma, her fears or state of depression may prevent her from effectively bonding with her new baby.

Although many women try to conceive as quickly as possible after a pregnancy loss, many authorities advise that allowing the grief and trauma to run its course before beginning another pregnancy may be healthier in the long run, especially for the well-being of the new child.

The Decision About Sterilization

Similarly, in most cases you should delay a decision about permanent sterilization (for either you or your husband or partner) for several months. Fear of another loss can cause some people to make a snap decision to be sterilized, which they may later regret. (Since I almost had a tubal ligation, but decided against it, and subsequently had Kevin the following year, and four years later gave birth to Melissa, I have especially strong feelings about this!) Only true life-threatening circumstances, or conditions which would almost certainly predispose one to more miscarriages or extreme complications should be reason to rush headlong into sterilization at a time like this. But even in seemingly impossible situations such as mine, miracles can happen.

Major Changes in Life

Frequently a loss such as this can be followed by hasty decisions about major changes in life. Church-going people sometimes leave their religions, perhaps feeling that “God has betrayed them.” Formerly non-religious people sometimes turn to churches or other spiritual pursuits for help. Sometimes people immerse themselves into new career pursuits or other interests. And not infrequently perinatal loss is the basis for a divorce. If possible, however, try to delay major drastic decisions about one’s life until things have settled down and have gotten back to normal. You are not in your normal state of mind and decisions made in the immediate aftermath of a pregnancy loss may not be rational ones for your entire life. Also, be aware that some seemingly “spiritual” pursuits, especially those that are less conventional or cultish, may be phony or even dangerous.

Different Grieving Patterns

Mothers and fathers grieve differently. The mother’s body is directly involved in the pregnancy. She experiences all the bodily changes and cannot help but begin to think “pregnant thoughts” and make plans for the baby from the minute she learns she is pregnant. Losing a baby, even if it is a very early miscarriage, is losing a part of herself. Experiencing death within one’s own body is having a part of oneself die. But for most fathers, even those who have already experienced the births of previous children, the baby is frequently not “real” to them. For some men the baby does not seem real until the mother is big and pregnant and he can feel the baby move. For others the baby is not a reality until it is born. Men are simply incapable of knowing or understanding what it is like to be pregnant. Therefore, following a perinatal loss, especially a miscarriage, the mother may be devastated and deeply grieved, but the father may feel hardy any sense of loss at all. Even if he sees the fetus, his only concern may be for the mother’s health, safety, and emotional well-being. A father’s lack of feeling over something that is an extremely devastating loss for the mother can be an additional source of deep distress, and can put a tremendous strain on a relationship.

The best thing to do is simply accept that he probably cannot feel or understand what you feel. Many women are not able to expect their husbands or partners to be their primary source of emotional comfort at this time.

Reactions of Others

Finally, other people may or may not be helpful. Many people will be sympathetic and will say the right things. Other people may say wrong, tactless, horrible things, or may not know what to say at all. Friends may even avoid you. No other person understands exactly what your feelings are, no matter how they try. Even professional counselors and therapists may prove ineffective and destructive. As difficult as it may be, it is important to come to a place of being able to forgive others for the hurtful things they may say or do.

Suggestions for Others

The following are suggestions for others who may counsel or otherwise deal with women who have experienced a perinatal loss:

a.) Remember that if the mother has another living child, or children, NO MATTER HOW MANY, this does not make her loss any less. This has been my own deepest personal grievance about other people’s reactions to my two losses (in 1983 and 1984.) Twice in a row I lost what would have been my fifth (living) child. During my grieving periods I heard seemingly hundreds of (well intended) variations of “Well, you have four children already!” to the point that I was about ready to scream!! That comment was made so often that I felt only deep resentment every time I heard it! The comment reflects a lack of sensitivity, and an implication that those babies’ lives would have been worth more if I did not have other children already or only had one or two. It’s a lot like saying to someone who has recently had their arm severed, “Oh well, you still have another arm and two legs!!”

(Michelle Duggar is the mother of 19 living children and is the matriarch of the famed Duggar family featured on TV. In 2011 she experienced a heartbreaking miscarriage. Her grief, and that of the rest of her family, was no less, nor was that baby any less valued because of the existence of their other children. Each child is loved and valued. The quantity of children in any given family does not diminish this.)

Some of the worst comments I heard were: “You’re just like an alcoholic! (Referring to my maternal feelings and enjoyment of babies. That comment came from a nutrition counselor.) “Another child would have been too much of a strain on you and your energies and finances anyway.” (So it’s better that my child is dead for the sake of our other children and our family budget?!) “You’re not capable of being intimate with anybody but a baby.” (That comment came from a psychiatrist whom I had gone to for help one week after my most recent miscarriage.) This may or may not be true about me, but the last thing I needed in that state of extreme devastation was to have my motives in wanting a baby questioned, put down, or analyzed! This seemed like nothing but “rubbing salt into my wounds!” Professional therapists seemed determined to label my great love and enjoyment for the pregnancy, birth, new baby experience as pathological. Another therapist kept insisting “I’m really worried about what’s going to become of you!” (i.e. once I was too old to have children. Hello, I also have talents as a writer and crafts-person as well as many other interests. I’m doing fine!) Comments like this have tempted me to wonder if professional therapists are determined to create additional problems for people rather than solve them just so they can stay in business!

One of the worst things someone can say is “Oh, come on, quit dwelling on it.” or “You should be getting over it by now.” People have a right to grieve for as long as they need to grieve. Everyone’s grieving patterns and needs are different.

Also, comments such as “Don’t you realize how common miscarriage is?!” are not welcome. Yes, miscarriage is not all that uncommon. Some estimates claim that roughly one out of four to one out of five pregnancies end in miscarriage. (The majority of these are undoubtedly extremely early miscarriages.) But statistical frequency of miscarriage does not make the individual loss any less for any woman. Even in situations where the rates of miscarriage have been extremely high (such as in towns near where above ground atomic testing has taken place), the personal tragedy of miscarriage is not any less simply because it takes place frequently.

b.) Other women who have also experienced a pregnancy loss are in the best position to offer comfort and understanding. But the experience of another type of loss, however valid or devastating in it’s own right, may not always be appropriate to compare with her loss. Some such attempts at comparison may he hurtful or offensive to her.

Following my own recent losses I found this to be true. One friend tried to offer sympathy because she had given birth by Cesarean. It is true that Cesarean mothers frequently do feel a profound sense of loss over not having given birth vaginally. But at the time I only found the comparison absurd! “So what if you had a Cesarean, you have a baby!! A vaginal birth is not what you take home and cuddle!! Don’t you realize how important a baby is?!”

Another friend tried to tell me that she understood “exactly how I felt” because years before she had had an abortion in her fourth month. I was unable to accept this. “I wanted my baby!! I would have given anything if my baby had gone to term!! I would never deliberately have an abortion!! If you had left your pregnancy alone you would have had your baby!!” (I do realize that that women who have abortions frequently do experience considerable grief and pain over their decision, similar to that felt by other mothers experiencing pregnancy losses. Their grief may be harder since they chose the abortion and society is even less sympathetic. I now know that I should have been more understanding and less self-righteous with that woman, but in my state of grief at that time I was unable to be.)

In yet another instance a male acquaintance tried to tell me that he “understood how I felt” because he had felt a lot of anger and grief when his own twin sons were circumcised against his orders years before. I have written a book on infant circumcision and am a nationwide resource person on the subject. Therefore, I very much oppose the cruel and unnecessary operation. But how can anyone even begin to compare the loss of skin to the loss of life?!!

c.) Don’t avoid the woman who has just experienced a loss. She needs friendship and companionship now more than ever, even though, like how I was, she may be cranky and emotionally fragile. There is an exception, however, to this rule. If you have a new baby yourself, or are presently successfully carrying a pregnancy to term, you may need to be cautious about being around her. If you are close friends with her, ask her how she feels about being around your baby or pregnancy. If she doesn’t want you around right now because of her loss, don’t take it personally. Your friendship can grow again later after her grief subsides.

d.) If you don’t know what to say, then simply tell her “I don’t know what to say to you.” She will understand and appreciate that far above and beyond all the well meant attempts that others come up with. Just an “I’m sorry, This is a truly terrible thing that has happened to you.” can mean more to her than all the other bits of advice that others may try to give.

e.) Concrete, medically sound, documented facts and suggestions for her situation, if you are in a position to give them, are usually welcome. But “quack” types of cures or trying to second guess “God’s wishes” are usually not appropriate or appreciated.

f.) Be aware that childbearing loss can profoundly affect a woman’s self-confidence and self-image. Feelings of failure – “My body has betrayed me!” or “My body isn’t good enough to have babies (at all or any more!)” The woman may feel angry at her body, at the doctor, the midwife, the hospital, her friends who have babies, her husband, the baby and even at God. She may feel cheated. “I paid my dues by going through morning sickness, etc., and I deserve a baby out of it!!”

Find Support from Other Bereaved Mothers

If possible, get in contact with other women who have been in the same position and have worked through their grief. Only other women who have also experienced a pregnancy loss can even begin to fully understand your feelings. Most men cannot truly understand. Women who have never been pregnant themselves cannot fully understand. Women who have experienced only successful pregnancies can partially understand, because every mother, no matter how normal and healthy her pregnancy, virtually always experiences some fears about losing her baby or having complications. If possible join a support group or get in touch with others who can be of help to you.

The Physical Aftermath

There are some physical things to expect following a miscarriage. Normally you should bleed for about two weeks after miscarrying The bleeding can be fairly heavy, especially if any clots or fragments of tissue still need to be expelled. Or the bleeding may be fairly slight if a thorough D&C was done. Just as following birth, the bleeding, should never be heavier than a normal heavy menstrual period. Also it should not have an unpleasant odor which could indicate an infection. Most health care providers recommend that sanitary pads rather than tampons be used while healing from a miscarriage, to help prevent infection. (Unlike during a menstrual period, after miscarriage or birth there is an open area inside the uterus where the placenta was attached which needs to heal.) If your bleeding seems excessive (if you are changing more than 2 or 3 soaked pads in an hour, it develops a foul odor, or if you run a fever, get medical attention.

Depending on how far along you were, your uterus should return to its normal, non-pregnant size, and should no longer be felt from the outside within 2-4 weeks following the miscarriage.

Normally in about 4 weeks after the bleeding stops, you should have a menstrual period. This period may be heavier than usual because the uterus is still healing. As a rule, ovulation does not take place until after the first period after a birth of miscarriage, (although there are exceptions!) Normally ovulation should occur about two weeks after the first period. If you wish to become pregnant again you should first consult with your health care provider about the cause of the miscarriage and your general, overall health as they might relate to a possible future miscarriage or other pregnancy complications. Even when all seems okay with no reason for a future pregnancy to be at risk, many doctors recommend allowing at least 3 or 4 menstrual cycles to occur before attempting another pregnancy. This will help your body get back into a healthier, more normal state, and will help you get past the peak of your grief before focusing on a new pregnancy. It is important that the much desired new baby be accepted for him or herself and not just as a “replacement.”

Finally, it is common to lose excessive amounts of blood during a miscarriage. Anemia (insufficient red blood cells) is characterized by fainting spells, feeling chilly when the temperature is normal, becoming tired or exhausted easily, muscular weakness, and greater susceptibility to colds and other illnesses. Red blood cells can only be built up again by taking in iron. Most common foods do not contain large amounts of iron. For most people simple anemia from blood loss can be easily corrected by taking iron pills and by eating iron rich foods such as liver. Cooking with iron pans also helps add iron to one’s diet. If you become anemic from blood loss, you should work at correcting this as quickly as possible, especially if you intend to become pregnant again.

Normally a blood sample will be taken while you are in the hospital, either during or shortly after the miscarriage. However, the results may show an inaccurately high blood count if it is taken while the miscarriage is in progress because it can take a while for the blood loss to show up in a blood sample. The results can also show an inaccurately low blood count if you have been on IV fluids for a while, as this tends to dilute one’s blood. For a more accurate indication of one’s true blood count, it should be done, if possible, about 2-3 days or more after the miscarriage or birth. You are considered anemic if you have a hemoglobin count below 11 to 12 grams (per 100 ml.) of blood), or a hematocrit below 30. If you are anemic, your health care provider should prescribe iron supplements which should soon bring your blood count back up to normal. This can also be achieved by eating an especially iron rich diet, but this may take longer than iron fortifying by supplements. You may wish to consult with a nutrition specialist about iron rich foods.

Once you begin on iron supplements and/or a nutrition regimen, have your blood count checked again in about 6 weeks. Once your blood count is back up to normal, you should quit taking any supplements. Too much iron, when it is not needed can also be dangerous.

Milk With No One To Give It To

Thankfully, I did not experience this following my miscarriages, but women who have been further along in pregnancy may experience their breasts filling up with milk. This is understandably an extremely devastating reminder that there is supposed to be a baby there to be drinking this milk! Taking hot showers and hand expressing small amounts of milk can help alleviate some of the pressure and discomfort. However, continued hand expressing will cause the milk to continue to be produced. Sage tea has been recommended to help suppress milk production. Your doctor or health care provider may be able to prescribe “dry up” medications or have other suggestions. Primarily time is what will get you through this immediate crisis. Milk production works on a supply and demand basis. With no baby there nursing, your body eventually receives the signal that the milk isn’t needed and will quit producing it.

Work is Good Therapy

Keep busy. Normally women recover physically from miscarriage or birth very quickly. But one’s emotional state after perinatal loss can take much longer to heal. For the first couple of weeks (longer if your health care provider advises or if the circumstances were unusual) you should simply concentrate on getting your rest and allowing your body to recuperate. After that, you should try to keep as busy as possible. Interesting, absorbing work can be extremely therapeutic. If you have an outside job, go back to work as soon as possible. If you don’t have a job or other small, dependent children, consider finding a job or doing volunteer work. Take a class or two – either with career plans in mind, or just to learn something interesting. Read. Sew. Write. Pursue a new hobby. Go to the movies. Visit friends. Take part in church or social activities. Plant a garden. Join a special interest group. Do whatever you can to fill your time. This does not mean that you should not take the time for crying spells and grieving. But the worst thing you can do is to sit at home and stare at the walls with nothing interesting to do.

Replacement of the Loss

If you cannot have another baby, or if you decide not to, get something else into your life of major importance that will fill that void. There are many homeless, needy children in this world. If possible, consider adopting a baby or child, or taking in foster children. If neither of these options are possible or what you want to do, then pursue a new career, write a book, or undertake some other major project of that nature.

Read

Read. Following my first miscarriage in 1973 there was virtually no information available for parents about miscarriage or perinatal loss. I did not know whether my feelings or experiences were normal. Following my second miscarriage in 1983 I was amazed at all the books, articles and resources that had become available over the previous ten years. I found the books an extremely helpful, vicarious way of sharing in the experiences of others. It helps to know that you are not alone. Other have gotten through this and survived. Some of this material I had read previously from the perspective of a childbirth educator wanting information. But in the midst of grief from my own recent loss, the same writings spoke to me from an entirely different perspective.

Many resources can now be found over the internet, through most bookstores, at your local public library, or through mail order. Information is also likely to be available from your childbirth instructor, hospital, birth center, or health care provider.

A Memorial or Funeral

Many parents find great comfort and resolution in doing something in the way of a memorial or funeral. Even if you were not very far along or never saw the baby, this still can be appropriate and healing. My own miscarried babies were too early in pregnancy to be given death certificates or funerals (at least in terms of what society recognizes.) They were disposed of, I assume without ceremony, by the hospital. However, I have known of others who have had their own informal burials and ceremonies for the miscarried babies. (Be sure to ask the hospital for your miscarried baby if you wish to do something like this. Otherwise, in most hospitals all miscarried or aborted babies are simply treated like all other body tissue that is removed during surgery. They are examined, usually briefly, in a lab and then are cremated.) I sometimes wish that I had had it together enough at the time of my miscarriages to have taken my babies home and buried them with a simple ceremony, rather than just allowing them to disappear in the hospital. At the time, however, I was only able to focus on getting through the experience.

Also, if you are a Christian, any miscarried baby, no matter how small, can be baptized. Anyone with Christian beliefs can perform a baptism if a clergy person is not available. Most Christian churches recognize the baptisms of other denominations. Therefore, if necessary, your baby can be baptized by a Christian of a denomination other than your own.

Or you can baptize it yourself if you wish. You simply sprinkle water on it and say I baptize you in the name of the Father, and the Son, and the Holy Spirit.” (If you choose to name the baby, you also include its name.) Also any ordinary water will do. You do not have to use “holy water” if none is available. (I was not yet a practicing Christian when my own miscarriages took place, so I did not do this. However, I still believe that my three miscarried babies are with the Lord. I do not believe that God’s acceptance of innocent beings is dependent on our ceremonies or actions. But baptism of a miscarried baby can always help the parents’ state of mind.)

Babies that die at term or past “viability” (generally this means those born at or after the 28th week of pregnancy) usually have funerals, or cremations and officially recognized ceremonies. Usually a baby’s funeral is simple and for family members only, depending of course on the parents’ desires. If you do not have a funeral (or even if you do), you may wish to do some kind of personal memorial that has meaning to you. I planted 3 white rose bushes in our front yard, along with five other brightly colored rose bushes for our (at that time) five living children. Other families have given money to charities in memory of the baby, or have purchased or made clothing and items for needy children.

Naming the Baby

Some sources suggest naming the baby, however small. (I never officially gave names to my miscarried babies. I do not even know the sex of the one I lost in 1973. The other two were both girls. I have kept some names for them in my own heart.)

Subsequent Pregnancy

Mother and baby The next pregnancy after a loss can be very difficult emotionally, even if everything seems fine physically. People forget that pregnancies involve time. Time can seem infinitely slow, endless, and precious when going through something like this. It takes time to get over one’s grief. It takes time to get back to having periods and ovulating again. It takes time to get from the miscarriage to the next pregnancy. It takes time to get through the next pregnancy especially when getting past the point that you lost the last one. And it takes time to get from there to full term and the birth of the baby. Even though years, in retrospect, seem to fly by rapidly, pregnancies when in progress, are made up of a special kind of slow motion time that seems to take forever. It can be very difficult just to get through it all one day at a time. It is helpful to try absorbing yourself in other interests not related to the pregnancy to help make time pass by more quickly. Realize that it is usually impossible to face your pregnancy as positively and nonchalantly as someone who has never experienced and has no reason to expect a pregnancy loss. It is all, understandably, extremely difficult when you must wait so long with so much uncertainty, when every cell of your being craves a successful pregnancy and a baby right now!!

A change of scenery, people, and possessions can help make the new pregnancy a more positive experience. People, places and things associated with the last pregnancy and loss can be painful reminders. Although usually impractical, some women have found it helpful to move to a new home following a loss. And however uneconomical, it may be worth it for your mental health to get rid of the maternity clothes that you wore during your last pregnancy, and give away or sell the baby clothes and furniture you had ready for that baby and start out fresh with new and different things this time. If you took childbirth classes with your last pregnancy and wish to take them again, you may wish to go to another instructor in a different setting. And however competent or well-liked, you may feel that going to a different doctor or midwife will help give this pregnancy a fresh start. Also you may wish to consider choosing a different setting for your baby’s birth, i.e. another hospital, birth center, or a home birth.

The “Silver Lining”

There is a “silver lining” in all this. Once you have run the course of your grief, you now have a greatly increased sense of insight, empathy, and sensitivity to the needs and feelings of others in this position. It’s a high price to pay, but you are now qualified to counsel any other woman in this position with full sympathy and understanding. You know from experience the right things to say and not to say. You can sincerely cry with her. She will appreciate your honest, sincere, and qualified efforts. It will be rare for her to turn you away.

The Long Term Effects

The grief and sense of loss will fade eventually. Depending on the circumstances, the positive outlook for a future pregnancy, and how far along the pregnancy was, it may take several months to get back to normal emotionally. For many women once the “due date” (that is the time that the baby would have been born had it gone to term) has passed, the grief may turn a corner and life will begin to get back to normal. However, everyone’s grieving pattern is different and has no set path. Attempts to deny or suppress grief may end up making the healing/grieving process take much longer, or the grief may express itself in strange ways. The inability to love or bond with a future child, or with other children you already have can happen as a result of unresolved grief.

The experience can permanently change one’s life, one’s personality, one’s beliefs – both spiritual and about life in general. (For example, I have been through a tremendous religious conversion. I have lost much confidence in purported ”wholistic” cures and “health food” claims for treatment of ailments.  I also chose a hospital birth when Kevin was born, although I was once a committed home birth mother with a certain amount of defiance for hospital procedures. I approached Kevin’s birth with some fears that I had never had before with my previous births. I would have still liked a home birth with qualified birth attendants, but none would accept me because of my age, number of pregnancies, and prior history. At one time I’m sure I would have considered giving birth by myself if faced with a situation with no qualified birth attendant available, but now I would be unable to do that. (Update – I later did give birth to my sixth child, Melissa, at home, in our bathtub. -R.R.)

Even years later, memories of the event may continue to inspire feelings of sadness and frustration. The residues of the experience may last throughout one’s entire lifetime. The pain may never entirely disappear, but life eventually does become livable again and it does go on.

by Rosemary Romberg

(Revised – 2013)


The Main Problem With Tragedy

Marion Cohen

(reprinted with permission from Mothering, No. 39, Spring 1986,
“When Things Go Wrong, What to do if Your Newborn Dies”, p. 28.)

When the hospital called to tell us the baby had died I thought it was just for that day so I went to bed early and slept well.

But the next morning I heard them talking downstairs; apparently the baby had still died (even though the hospital wasn’t calling to tell us today).

So it’s gonna be a few days, I figured; we might as well have a funeral. We drove 100 miles in two cars finding and losing the way, ’round and ’round standing ’round and around, crying, listening, crying, listening, standing and standing around.

But when it was over the baby had still died so there was nothing to do but drive back. It took two and a half hours and then the refrigerator had broken down. We soon fixed it but the baby had still died.

And every night after that I slept as long as I could to give the baby a chance to not have died.

But in the morning they were always talking downstairs and when I asked if the baby had still died the answer was always yes.

And so it went into a week and then it went into two weeks.

Eventually it went into months.

And it kept going.

It wouldn’t stop.

It kept on having happened.

No matter what I did, it refused to not have happened.

Even if I wrote in my diary about it.

Even if I wrote a poem about it.

Even if I forgot about it.

IT didn’t forget about it.

Not for a second was it caught off guard.

It was as stubborn as the music of the spheres.

It just wouldn’t let bygones be bygones.

To this day it has happened.

It insists on having happened.

It will never tire of having happened.

Nothing will distract it from having happened.

It was more than one day. It was more than one week.

It was more than months. It was more than years.

And it knew it — ALL the time.

Looking into the rain


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