They were considered the ideal couple by their circle of friends. Everyone was convinced that they would also be great parents. Alex and Lisa also believed it themselves. And dreamed of their future family with two sweet children. But when Sarah was pregnant, she lost the baby at 10 weeks. The miscarriage plunged the couple into a deep sadness. 16 months later, Lisa and Alex finally became parents to a healthy baby girl. Now their happiness could have been perfect, had it not been for their desire for a second child. Little Ellie had already celebrated her second birthday when a sibling was announced. But Lisa suffered another miscarriage. And a few months later, another one.
Miscarriages are more common than expected
Lisa's case of multiple miscarriages is not entirely typical - but more women and parents share the sad fate of having to say goodbye to their unborn child at an early stage than you might expect. However, it may be of little consolation to those affected that an estimated one in four pregnancies (25%) ends in miscarriage within the first 12 weeks.
Miscarriages up to the 12th week of pregnancy account for the largest proportion of all miscarriages with around 85%. A further 15% of miscarriages occur between the 13th and 20th week. Up to the 12th week it is called a early abortion. From the so-called late abortion some speak after the 12th week of pregnancy, others only after the 16th week.
Among the "officially" recognised pregnancies from the 5th week onwards, the miscarriage rate is between 10 and 15%. Numerous pregnancies also end before the 5th week - but then usually unnoticed because the egg was fertilised but did not implant in the uterus. It is generally assumed that around half of the fertilised eggs do not even implant in women under the age of 30. And the older the woman is, the less often implantation takes place. So if a woman does not yet know that she is pregnant and the fertilised egg is released, she perceives this as supposed period bleeding. This was then simply "delayed" and possibly also "heavier than usual".
What does miscarriage mean?
One speaks of a Miscarriageif the pregnancy ends unplanned, before the child is viable. In legal terms, this means that the foetus shows no signs of life outside the womb, weighs less than 500 grams and leaves the womb before the 24th week of pregnancy. If, on the other hand, the deceased child weighs more than 500 grams and is born after the 24th week, it is referred to as a Stillbirth.
The legal consequences
Before I go into more detail about the causes and processes of a miscarriage, I would like to point this out to you: The distinction described between a miscarriage and stillbirth has legal consequences. These have an impact on maternity protection regulations or with regard to the burial of the baby, for example.
In the case of stillbirths, the law says
▶︎ Dead children born with more than 500 grams from the 24th week of pregnancy, must be buried.
▶︎ Parents can have the birth of their stillborn child documented by the registry office - with everything that goes with it: the child's first name and surname, gender, date and place of birth as well as details of the mother and father.
▶︎ The following applies to the mother General protection period after childbirth. She may not normally be employed during this period and is entitled to maternity pay and an employer's allowance. Nevertheless, the mother can at your own request already from the third week after the birth return to work, provided the medical certificate does not contradict this. If a mother feels overburdened by her employment during the protection period, she can revoke her declaration of willingness to work.
In the case of miscarriages, the law says:
▶︎ Also "star babies" who weigh 499 grams or less and are stillborn before the 24th week of pregnancy, can be reported to the registry office.
▶︎ And they too may be buried.
I am very pleased that, since a change in the law in 2013, affected parents have also been able to give these tiny babies an official and dignified existence in this way. Unfortunately, this was not possible until the amendment to the Civil Status Ordinance.
By the way: Parents can have such a "star child" documented at the registry office retrospectively even if their child was not born alive before the new regulation came into force.
The law says about midwifery assistance:
Whether after a miscarriage, a stillbirth or a termination of pregnancy in any case has the woman with her, but also afterwards Entitlement to midwife assistancewhich must be paid for by statutory or private health insurance. Especially in these special situations, counselling and support from a midwife are valuable. Unfortunately, however, we midwives often find that this legal entitlement is little known, even among doctors.
How does a miscarriage manifest itself?
The main signs of a (threatened) miscarriage are pain in the lower abdomen and, above all, vaginal bleeding. The more advanced the pregnancy, the heavier the bleeding usually becomes.
If you suddenly notice fresh bleeding during your pregnancy, this may be harmless - or it may indicate complications or a miscarriage. In the case of a miscarriage, the bleeding is often heavier than women are used to from their menstruation. On the other hand, the bleeding can also be light and still mean a miscarriage. The bleeding is often accompanied by pulling, cramp-like pain that can radiate to the back. In rare cases, fever and yellowish discharge are signs of an infection.
IMPORTANT: Put yourself in medical hands if you are bleeding! You can contact your midwife, your doctor or a hospital to clarify whether everything is OK or whether an abortion is imminent or taking place.
Sometimes a miscarriage barely announces itself or not at all. In this case, the pregnant woman has no symptoms, i.e. neither bleeding nor pain. And yet the embryo or foetus has died in the uterus. Depending on the duration of the pregnancy, this is referred to as a "non-viable pregnancy" or "intrauterine foetal death". Per Ultrasound no heartbeat or other signs of life can then be detected in the child. With this so-called miscarriage (Missed Abortion), the body has not yet expelled the dead fruit and other pregnancy-related tissue. Nevertheless, the typical side effects of an early pregnancy such as Nausea or tenderness in the breasts now diminish or disappear completely. This is due to the hormone levels dropping again.
What happens then?
With a early miscarriage the deceased embryo and pregnancy-related tissue are still in the uterus. In principle, there are now three options to change this:
Waiting for a spontaneous departure: It can take days or even two weeks for the body to realise that the pregnancy is over, and in rare cases even longer. In most cases, however, it will then ensure that the pregnancy ends spontaneously. The labour, which some also call "small birth", begins with bleeding, which can be heavy for a few days until it subsides and finally stops. During this time, the woman concerned should take her temperature regularly, drink plenty of fluids and rest as much as possible. This is good for the body and also helps the soul to say goodbye to this pregnancy. Once the bleeding has stopped, an ultrasound check should be carried out. This is because spontaneous discharge does not always ensure that all tissue is completely expelled. If necessary, a scraping (curettage) is performed.
However, some women find the time spent waiting for spontaneous miscarriage so stressful that they decide in favour of another (quicker) way: surgery or medication.
Performing a curettage: Up to the 14th or 16th week of pregnancy, doctors very often suggest a curettage to the woman. This is usually also performed if, despite spontaneous expulsion, tissue remains in the uterus that could cause infections.
This short surgical procedure is performed on an outpatient basis under general anaesthetic. The cervix is stretched (dilatation) and then the uterine lining or parts of it as well as remaining tissue from the embryo or foetus and the placenta are removed or suctioned out (curettage).
The risks of the surgical procedure: An anaesthetic is administered. The uterus or cervix can also be injured. The lining of the uterus also becomes scarred. These injuries can then delay a new pregnancy or even make it impossible. Despite these risks, the vast majority of women undergo a curettage without any problems.
Intervene with medication: Drug treatment can be an alternative to both surgery and waiting for spontaneous expulsion. It is intended to stimulate the body to expel the miscarriage or accelerate the onset of early miscarriage.
The woman is given a selected medication that she dissolves in her mouth, swallows or receives vaginally. This is intended to dissolve the fruit, open the cervix and initiate the miscarriage. Accordingly, some time after the administration of the medication (hours to days), bleeding and pain set in and the fruit is expelled.
It should also be noted that tissue may still remain in the uterus. In this case, a scraping must be performed.
What do affected women choose? In my experience, gynaecologists sometimes don't ask a lot of questions, but issue a referral for curettage straight away once they have determined the death of an embryo. Some women told me that they had no other choice than this or that they had to make a choice quickly.
That is why I would like to encourage you: You must nothing decide immediately. Take your time and discuss the next steps with your partner, your midwife and your doctor. Feel inside yourself to see which method might suit you. And be honest with yourself! It's completely okay if someone finds the idea of carrying the deceased fruit for a longer period of time unpleasant and wants to get the miscarriage over with quickly. It's also perfectly okay if someone needs more time to say goodbye to this pregnancy and decides to wait for a spontaneous abortion.
Sometimes a method is also ruled out for medical reasons. This would be the case, for example, if a woman cannot tolerate the medication used to induce/accelerate a miscarriage for health reasons.
Miscarriage after the 14th week of pregnancy
If the foetus that has died in the womb is already too large for a scraping, it must be born. Such a so-called "still birth" is often induced with medication. It can be as pain-free as possible, as different painkillers can be used than for the birth of a living child. Also a Peridural anaesthesia(epidural) is possible. However, some women would like to largely avoid painkillers and also experience labour as part of their farewell process.
As you can see, there is no "better" or "worse" way, but only what suits and feels right for each individual woman.
The idea of a woman giving birth to her stillborn child naturally may seem terrible at first. So you may wonder why this should not be done by Caesarean section so that the woman concerned can get it over with quickly. Of course, some women also decide in favour of this birth method. However, it remains a major abdominal operation and is not free of risks for the mother, even if the caesarean section has become very safe today. Nevertheless, it puts more strain on the mother's body than a natural birth. In addition, vaginal delivery helps many of those affected to cope better with the emotional pain and grief. Once the deceased child has been born, the parents can also look at it and hold it in their arms if they wish and are ready to do so. This allows them to say goodbye in peace. Many couples find these moments, which they share with their child, ultimately helpful and beautiful, despite all the grief.
Reasons for miscarriage
Sometimes there are specific causes that lead to an abortion. Sometimes no cause can be identified. It just happens. In most cases, however, the child would not have been viable. In this case, nature intended to terminate the pregnancy.
Possible causes of a miscarriage:
Genetic defects: At around 50 to 70%, chromosomal abnormalities in the embryo are the most common cause of miscarriages in the first trimester. This means that if the embryo cannot develop properly and is therefore not viable, an abortion occurs.
Very rarely, there are also genetic disorders in the parents (e.g. defective egg or sperm cells).
Hormone disorders: The mother's hormone balance can be disturbed by a thyroid disorder, for example. Once the exact cause has been found, it can usually be treated. A new pregnancy is possible.
Autoimmune diseases or disorders: The mother's immune system mistakenly works against her own body and therefore also against the pregnancy. This can result in the embryo/fetus being rejected. Autoimmune diseases include type 1 diabetes mellitus, for example, but this does not automatically lead to a miscarriage. It is important that the disease is well controlled with medication if a pregnancy is planned.
Abnormalities of the uterus: These can be, for example, an abnormal shape of the uterus, benign growths (fibroids), a disorder of the uterine cavity or even cervical weakness. The doctor will know what measures can be taken to enable a new pregnancy.
Infections: From bacteria or fungi in the vagina to measles and toxoplasmosis, various infections can trigger a miscarriage.
Blood clotting disorder: It can play a role in repeated miscarriages and is treatable.
Alcohol, cigarettes and drugs: Smoking, alcohol and drug consumption by pregnant women also increase the risk of abortion.
Stress: The risk of women suffering an early miscarriage increases by 42% if they are mentally stressed before or at the beginning of pregnancy.
If a woman suffers three or more consecutive miscarriages, this is known in gynaecology as a "habitual miscarriage". This means habitual or constant miscarriage. In this case, it may be advisable for an affected couple to seek medical advice and examinations to find the cause. It may be possible to treat the cause accordingly.
Not alone in the pain of parting
It is not possible to objectively measure the extent to which mothers and fathers grieve for a lost child. And it is also difficult to say how someone processes what they have experienced and suffered, as this also varies from person to person. In most cases, dreams, hopes and plans will have died along with the baby. In this sensitive phase, it is particularly important for the women affected, but also for the fathers, to receive support in every respect and not to remain alone.
What can help with a miscarriage?
For example, it helps many affected women:
- talk about it whenever you feel the need to do so. It is particularly important to talk to your partner about the loss you have suffered and the feelings associated with it. It may be that not all feelings and thoughts are reflected in the other person. After all, everyone is experiencing the situation in their own unique way. This is allowed and needs space. In any case, the miscarriage is now part of the couple's biography. The star child must and may find its place in the feelings and thoughts of the affected parents.
- Openness with friends and family. Confide in people close to you and tell them what has happened. They will notice how upset or sad those affected are anyway. If they know what has happened, they can offer much better support.
- Involve siblings in an age-appropriate manner if necessary: The deceased child is also a natural part of the family from then on, was a brother or sister, especially after a stillbirth. Siblings also grieve, need comfort - and must also understand their parents' grief.
- ritual farewell: for example, through a funeral that allows later visits to the burial site, or through a picture in the home on which the name of the deceased child is beautifully designed and framed.
- by sharing experiences with other sufferers. They share a similar fate and can be a great help. There are good opportunities on the internet to get in touch with other affected people, whether in your own town or online. Women and men affected by miscarriage can find support, information and contacts here, for example:
Initiative Regenbogen Glücklose Schwangerschaft e. V.:
Federal Association of Orphaned Parents and Grieving Siblings in Germany e. V.
And very importantly: The support of a midwife after a miscarriage! Support after a miscarriage is also one of the tasks of a midwife. If you need help, I look forward to seeing you in my Online midwife counselling.
By the way: Even after a miscarriage, it is important for every woman's body and psyche to take a postnatal course. Understandably, however, those affected usually don't want to meet happy new mums who may still have their babies with them. That's why there are Special postnatal courses for orphaned mothers. In addition to gymnastic exercises, the course programme also includes grief counselling and exchanges with other affected people. The Online postnatal course by midwife Katharina is good for regeneration after a miscarriage.
Getting pregnant again after a miscarriage
If the couple is ready for this, there is basically nothing to be said against a new pregnancy. However, it is not only the mother's body that needs sufficient time to recover beforehand - the parents' souls also need to come to terms with what they have experienced and be ready for a new pregnancy. Some mothers believe that they can cope better with the loss through a quick subsequent pregnancy. However, this is not the case. This is because the grieving process takes its own time. It cannot be shortened by a new pregnancy. If it is given too little time, the subsequent pregnancy and therefore the sibling is often more burdened by the fear of loss from the miscarriage.
It is true that the risk of losing another child through miscarriage is somewhat higher after a previous miscarriage. In many cases, however, the next pregnancy after a single miscarriage is unproblematic. The probability of this is 85%. After two miscarriages, the risk of a third miscarriage is between 19 and 35%. After three miscarriages, the risk of losing the child again increases to between 25 and 46%. It is important to rule out possible causes so that the risk of another miscarriage can be reduced.
It is generally advisable to discuss with your doctor and midwife how to proceed. Depending on the possible cause of the miscarriage, certain examinations may also be indicated in order to treat any risk factors accordingly. This may include, for example, an ultrasound scan of the uterus or a hormone balance check.
In any case, it is important to give the star child a good place in your heart so that a sibling can have their own place in the desired family constellation (as far as possible) unencumbered by this experience.
4 responses
My sister is having a nuchal translucency test to see if her child has a genetic disorder. It's sad that this is a common reason for miscarriages. But I didn't realise that genetic disorders are rarely present in the parents. I will tell my sister about this.