Losing a baby


Picture of an angel

Losing a baby is one of the most upsetting and stressful situations imaginable for any parent. If you are pregnant now, you might prefer not to read this section, although women who have experienced losing a baby often express regret that they were not as well prepared for this situation as they were for pregnancy and childbirth.

Firstly, it is important to define the term miscarriage, as opposed to stillbirth and neonatal death. Miscarriage (or spontaneous abortion) occurs in the first six months of the pregnancy. After that, once the foetus has reached twenty-four weeks* it is then called stillbirth rather than miscarriage. This is because at twenty-four weeks it is possible for the foetus to be able to survive outside the uterus.

Neonatal death is the term used when a baby dies within four weeks of birth.


Miscarriage - when does it occur?

It may be surprising to learn that in women who know they are pregnant, about one in four (or one in 6 depending on your information source) ends in miscarriage. Out of these, about 75% occur during the first trimester (up to fourteen weeks), often occurring when the woman would have normally expected a period if she wasn't pregnant. 3% of miscarriages take place during the second trimester (the next fourteen weeks) and once the foetus has reached twenty-eight weeks, it is then called stillbirth as explained earlier.


Why does miscarriage occur?

Except in a small number of cases, the exact cause of miscarriage will remain unknown. However, miscarriages during the first trimester are sometimes caused by the fertilised egg failing to undergo its first important chromosomal divisions properly. The germ plasm dies, causing your body to expel this matter in the second or third month. More than 50% of miscarriages are caused by a chromosomal abnormality. Maternal age also causes an increase in the risk of miscarriage. For women less than 35, the clinical miscarriage rate is 6.4%, for ages 35-40 it is 14.7% and over 40 it is 23.1%. Additionally, a study carried out in New York in August 2006 suggested that the age of the father of the baby may play a small part in miscarriage.

Miscarriages occurring after the first trimester are sometimes the result of the foetus' inability to maintain its attachment to the placenta, either because of some hormonal or mechanical reason, or because you have something called an 'incompetent cervix'. This is where the cervix is too weak to support the weight of the growing foetus and it dilates too early, expelling it. However, this can be corrected by putting a stitch in the cervix called a Shirodker Stitch. This needs to be taken out before labour. An incompetent cervix can also be the reason for repeated miscarriages too.


What are the signs?

For most women, the first sign of a miscarriage is vaginal bleeding, though this does not necessarily mean that miscarriage is imminent. However, it is still important that medical advice is sought immediately, but it is worth noting that only 50 per cent of women who bleed during pregnancy go on to miscarry. There are several reasons why bleeding might occur when you are pregnant:-

The bleeding might not be vaginal - you might have a bladder infection such as cystitis.
You may have cervical erosion - a rather common condition with a very frightening name! It simply means that the soft dark pinks cells from inside the cervix have grown outside it. The word erosion implies that the cervix is being eroded, but this is not the case, they are perfectly normal, but just turned outward. It occurs in response to oestrogen, so can be a normal development during pregnancy and in women who take the Pill and sometimes this area bleeds easily. 'Eversion' is now becoming the preferred term for this.

Little pieces of placenta might have come away from the uterine wall.

You may have polyps - non-cancerous growths on the cervix or in the vagina.

You might have experienced a partially-supressed period. This occurs where there is not enough oestrogen to stop the period completely. Physically, early miscarriage can often feel no worse than a heavy period, but with late first-trimester miscarriage there might be cramping and bleeding lasting a few days, sometimes starting and stopping erratically until the entire contents are expelled. Afterwards there is a period of bleeding until the uterine lining has healed.

Second-trimester miscarriage is more like a mini-labour, with strong and regular contractions. Miscarriages are characterised by stages, each with their own terminology:-

Threatened miscarriage:


This might be experienced as bleeding or spotting, possibly accompanied by minor cramping. Some doctors recommend bedrest and hormone treatment and the process might stop by itself, or it may continue. Usually you'll be advised to stay in bed for 24 hours to see what happens. This term tends to be used to cover virtually any bleeding in early pregnancy. If the bleeding stops and the pregnancy carries on normally, it is comforting to know that there is no increased risk of abnormality in the baby or problems as a result of the bleeding.

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