Understanding Late Miscarriage and Stillbirth
What is a late miscarriage?
Doctors describe a late miscarriage as one that happens after 12 weeks and before 24 weeks of pregnancy. Late miscarriages are much rarer than early miscarriages. Just one or two per cent of all pregnancies end in a miscarriage in the second trimester of pregnancy. However, in reality, for many parents who have suffered a late miscarriage, the word “miscarriage” doesn’t properly capture the gravity and impact of their loss, as they may feel that they have suffered the loss of a baby, or a stillborn baby.
What is stillbirth?
A stillborn baby is one who is lost at or after 24 weeks of pregnancy. It results in a baby born without signs of life. About 1 in 160 pregnancies ends in stillbirth. Most stillbirths happen before labor begins, but a small number occur during labor and delivery
How do I know if my baby is in distress?
The most obvious and common signs of miscarriage / stillbirth are vaginal bleeding and strong, labour-like cramping pains. The bleeding may become heavy and have blood clots. Sometimes, your waters may break and your baby may be born very quickly.
Some women notice that their baby’s movements have slowed down or changed, or they haven’t felt any movements for a while.
What are the causes?
Sometimes, no reasons for a miscarriage can be found. However, most deaths, no matter when in pregnancy they take place, are due to a genetic or structural issue, such as a chromosomal abnormality or heart defect. Trauma can also cause a miscarriage, and sometimes more than one cause contributes to a baby’s death.
Common causes include:
Poor fetal growth. Babies who are growing too slowly have a significantly increased risk, especially those whose growth is severely affected.
Placental abruption. Placental abruption, when the placenta starts to separate from the uterus before a baby is delivered, is another common cause of stillbirth.
Birth defects. Chromosomal and genetic abnormalities, as well as structural defects, may result in a late miscarriage or stillbirth. Some babies have multiple birth defects. A baby may have had a heart defect or neural tube defect, such as spina bifida.
Medical conditions of the mother. Certain chronic conditions, such as Hypertension, lupus, diabetes or pre-eclampsia, that aren’t being managed well can also cause a foetal death
Infections. Infections involving the mother, baby, or placenta is another significant cause, particularly when they occur before 28 weeks of pregnancy. Infections known to contribute to stillbirth include fifth disease, cytomegalovirus, listeriosis, and syphilis.
Umbilical cord accidents. Accidents involving the umbilical cord may contribute to a small number of stillbirths. When there’s a knot in the cord or when the cord is not attached to the placenta properly, the baby may be deprived of oxygen. Cord abnormalities are common among healthy babies, however, and are rarely the primary cause of stillbirth.
What happens after the baby is delivered?
Depending on the stage of pregnancy and the circumstances, your midwife or doctor may ask if you’d like to see, touch or hold your baby. This is a very individual decision that you may find hard to make when you’re in emotional turmoil. You can’t know whether seeing your baby will help you in the long term.
Some parents want to see their baby but are worried about what he or she may look like. Your midwife or doctor can describe your baby to you to help you make the painful decision. You can ask for photos to be taken even if you are undecided whether or not you want to look at them. Some people know instinctively that they don’t want to see their baby, whereas others choose not to for faith or cultural reasons.
The medical team can do tests to try to determine the cause of the stillbirth. First they examine the placenta, membranes, and umbilical cord right after delivery. Then they ask permission to have these tissues thoroughly analyzed in the lab and to do genetic testing and an autopsy on the baby.
This may be difficult for parents who are grieving for their child. And even a thorough evaluation may not answer the question of why the baby died.
On the other hand, parents may learn valuable information. For example, if the stillbirth was the result of a genetic problem, the mother can be on the lookout for it in her next pregnancy. Or she may find out that the cause is something that’s unlikely to recur, such as an infection or a random birth defect, which may be reassuring if she wants to become pregnant again.
For parents who decide not to have a complete autopsy done, there are less invasive tests that may provide some useful information. These include X-rays, MRI, ultrasound, and tissue sampling.
Tests are also done on the mother, along with a thorough evaluation of her medical, obstetric, and family history for clues to the cause of the stillbirth.
Creating memories, such as photographs, handprints or footprints or a lock of hair from your baby may help to bring comfort, in time. Some parents find that it helps them to have a focus for their grief. However, these decisions are highly personal. There is no right or wrong approach, and you can take your time to think things through.
Recovery after a late miscarriage
Physical needs and care after a late miscarriage
Physically, your body may recover fairly quickly after a miscarriage. But it depends on how far along you were in your pregnancy and what type of miscarriage you experienced. For those who go through labor and delivery of the miscarriage, it can take several weeks to recover.
You’ll experience some bleeding and cramps similar to getting your period. Most of all, you’ll feel very tired as your body recovers.
Contact your doctor if your pain, bleeding, or exhaustion becomes worse or continues longer than several weeks. Another potentially upsetting part of your recovery may be that your body begins producing milk. If this causes pain or discomfort, be sure to talk to your doctor about taking some type of pain reliever or other ways to help.
You should also talk to your doctor about when you’ll physically be ready to return to work. Every situation is different, and your doctor can help determine when it’s safe and reasonable for you to return.
Emotional needs and care after a late miscarriage
The emotional needs after a late miscarriage shouldn’t be ignored. Losing a baby at any stage of pregnancy is difficult, but even more so in the second trimester.
Every woman will react differently and have different emotions. For some, talking about it helps. For others, moving on and not talking about it may help. It’s important to find what feels right for you and get the support you need. Your doctor can usually direct you to support groups or counselors that specialize in helping you work through all of your emotions after your miscarriage.
You’ll likely feel a wide range of emotions after your miscarriage.
These might include:
jealousy of others who or pregnant or have babies
It is also important to remember that people will not always know what to say. This can sometimes mean they say the wrong things. Being prepared for these times might help soften the emotional impact.
Consider seeking out others who have experienced miscarriages, particularly late miscarriages, who you can talk to or cry with. Knowing that someone else understands can help you tremendously as you recover.
You’ll also be offered a check-up after six weeks. The appointment with your consultant is a good opportunity to ask questions about the possible causes of your loss and what they may mean for a future pregnancy. It may also be a chance to discuss the post mortem results, if they are available. If results are not available, you should be offered another appointment.
You may feel tired and drained for quite a long time after your miscarriage. Your body needs time to recover from the difficult experience it has been through. Take things easy for a while and be kind to yourself.