Information about a miscarriage

What is a miscarriage?

The early stages of pregnancy are an exciting time. The fetus is developing and embedding in the uterine wall. Unfortunately, this doesn’t always proceed as expected. This is when a miscarriage can occur. A miscarriage is the loss of a non-viable fetus during the early stages of pregnancy. If a non-viable fetus has not been expelled naturally, it is referred to as a missed miscarriage. Approximately one in ten women experience a miscarriage.

Causes

In 95% of cases, a miscarriage is caused by a fetal disposition disorder. There is often a chromosomal abnormality that occurred at or even before fertilization. Nature seeks a “solution” and the pregnancy ends in miscarriage. This is usually not a hereditary factor, so there is no increased risk for a subsequent pregnancy. If you have had multiple miscarriages, you can be examined to see if a cause can be found. In 5% of the cases, the miscarriage may be caused by an infection, an abnormal uterine shape, a fibroid, or an unknown cause. You cannot cause a miscarriage yourself through physical exertion, sex, cycling, or falling, for example. However, these factors can act as triggers for a miscarriage that is already in progress.

What if the miscarriage is diagnosed?

After the miscarriage is diagnosed, you can choose between three ways the miscarriage can take place:

1. Waiting for miscarriage to occur spontaneously
2. Use of medication that triggers spontaneous miscarriage
3. Curettage: a procedure in which the amniotic sac is removed through the vagina

You may, of course, decide what you feel most comfortable with. If you choose medication or a curettage, we will refer you to the gynecologist. An intermediate solution is always possible. You can first wait to see if the miscarriage occurs spontaneously. If this does not happen, we can still refer you for treatment with the gynecologist.

The course of a spontaneous miscarriage

The course of a miscarriage can vary greatly from woman to woman. It usually begins with light bleeding and mild abdominal cramps. As the miscarriage progresses, you will gradually experience cramping pain in the uterus and increased blood loss, similar to a heavy menstrual period. You may also pass clots, sometimes the size of a fist. Over the course of a few hours, the amniotic sac detaches from the uterus and comes out through the vagina. Once the uterus is empty, the pain and bleeding will decrease. The bleeding typically continues for 1 to 2 weeks, similar to the last days of a period. The course can vary significantly between individuals. Some women experience only mild abdominal cramps, while others describe it as (light) contractions. How long you have been pregnant also plays a role in this. Whether the fetus is recognizable depends on how far along the pregnancy was when development stopped. From around 8 or 9 weeks, it may be recognizable as a miniature human being, roughly the size of a fingertip. Seeing and holding the baby can help with the grieving process and provide closure for the loss.

Our tips:

• During this time, make sure you have someone close to you for support. In our experience, it can be helpful not to be alone while going through a miscarriage.
• You may use pain medication during the miscarriage: start with 1000mg of Paracetamol and add 400mg of Ibuprofen if necessary. Warmth can also help. For example, use a shower or a hot water bottle.
• You can hang a colander or strainer in the toilet to prevent the amniotic sac and fetus from falling into the toilet.
• To see the baby properly, you can place it in a bowl of cold water. This will help it unfold and return to the shape and color it had in your womb. For more information, see: www.watermethode.nl

When should you call us?

Midwife on duty (available 24/7)
088-430 04 00

• You can always call us if you want to discuss something, have any questions, or need someone to talk to.
• If you continue to pass large clots or need more than two large pads within an hour to manage the blood loss, please contact us. This may happen in the short term, particularly when the fetus is being expelled.
• If you experience dizziness, fainting or starry vision.
• If you develop a fever during or after the miscarriage or curettage, a temperature of 38°C (100.4°F) or higher may indicate an infection.
• If prolonged and severe blood loss or abdominal pain persists after a spontaneous miscarriage or curettage, this may indicate an incomplete miscarriage. In such cases, treatment with a curettage may be necessary.

Physical recovery

Physical recovery after a spontaneous miscarriage or curettage is usually smooth. If you wish, you are welcome to have an ultrasound with us to check if the uterus is indeed empty.
During 1 to 2 weeks there may be some blood loss, first bright red, later brown. During this bleeding it is advisable to wait with sex, use tampons, take a bath and go swimming. You can expect your next period after about 4-6 weeks, but it may happen earlier or later. It is not more difficult to get pregnant after a miscarriage, and there is no medical need to wait to get pregnant again.

Emotional recovery

A miscarriage can be a very impactful event, and it may lead to a grieving process. The way individuals process a miscarriage is unique to each person, and the duration of this process can vary. It is important to acknowledge the loss and talk about it. Since the loss is often invisible to others, it can sometimes be helpful to speak with others who have gone through a similar experience. Don’t hesitate to share your grief with others; there is always someone who can offer support. It can be helpful for your emotional recovery to consciously say goodbye to the pregnancy and the baby. If desired, you can bury the baby in a place that feels right to you.

If you feel that you need more support to process the miscarriage…
There are several coaches who can support you with this. For example:
Coaching by Monique- IJsselstein > coachingbymonique.nl
Miriam van der Kreij- Utrecht > miskraambegeleiding.nl
Erlinde Weller-Utrecht> Erlindeweller.nl
Veronique van Norden > BeeVeer

The next pregnancy

After some time (which is different for everyone) the desire for another pregnancy often arises. Because the first months can be extra exciting and stressful, you may contact us early in the pregnancy. We may make an early ultrasound (from 6-8 weeks).