What is a late miscarriage?
Doctors refer to late birth if the pregnancy ends after week 12 but before SSW 24 with a loss of the baby (RCOG 2006a: 2). However, the word miscarriage does not nearly match the feelings of parents who lose a child in this way.
The orphaned parents understand the experience as the loss of a loved one or a silent birth. Legally, it is only a stillbirth or stillbirth if the baby is born dead and weighs more than 500 grams.
How common are late miscarriages and what are the reasons?
Only one out of a hundred miscarriages happens in late pregnancy (Symonds 2009: 314). All others are early miscarriages.
Late abortions are often associated with maternal health issues (NHS Choices 2009a). However, you should never forget that all the health problems rarely occur in pregnant women. This includes:
- Problems with the placenta, such as bleeding or placental insufficiency (the baby is not optimally supplied with oxygen and nutrients), a placental tear or a placental detachment (the placenta dissolves partially or completely too early from the uterus).
- Problems with the uterus such as cervical insufficiency, cysts or a uterine anomaly (Symonds 2009: 314)
- Bacterial infections of the mother can damage the baby through the placenta, e.g. Listeriosis and toxoplasmosis. Bacteria of the group streptococcus B can cause premature labor. (Symonds 2009: 314)
- other maternal health problems such as diabetes, epilepsy, hypertension, kidney damage or sickle cell anemia
Very, very rarely, developmental problems can be the cause of a late miscarriage. Perhaps a problem that has arisen during fertilization, such as chromosome damage (the Edwards syndrome, neural tube defect, hydrocephalus) or a Rhesus intolerance.
Women who are pregnant with twins or even more babies are at an increased risk of losing one child (or both) as miscarriages or stillbirths (RCOG 2008: 3).
Age also plays a role (Shiers 2003: 279). If the mother is older than 30 years, the miscarriage rate increases significantly, a further jump makes the statistic, if the mother is 35 years or older (Llewellyn-Jones 1999: 105). In older women, the risk of a genetic defect in the baby is higher, and it is precisely these pregnancies that very often end in miscarriage.
How do I know if a miscarriage is imminent?
The most obvious signs of a late onset are abdominal pain, bleeding (very severe and sometimes with blood clots) and loss of amniotic fluid (blistering) (NHS Choices 2009d). This is called spontaneous abortion or spontaneous abortion.
But sometimes there are no signs and the death of the baby is determined only at a check-up, if doctor or midwife no longer hear a heartbeat. This is called "silent abortion".
In such a case, wait a while to see if your contractions are natural (Schott et al 2007: 120). Your midwife can advise you what you can do in such a case. If contractions do not start, they have to be initiated artificially (Schott et al 2007: 120). Some parents want to do this as quickly as possible, others want to say goodbye to their child in peace. Take the time they need, do not let them push you. Unless there are special circumstances that your doctor has advised you about, there is no danger to your health.
What happens after the miscarriage?
Depending on your pregnancy week and the circumstances of your loss, you can see, touch, and hug your baby after birth. Studies show that many parents find this comforting (Radestad 2001, Geerinck-Vercammen 1999). You can also reminder photos. If you are afraid of seeing your baby, ask the midwife to describe it before you see it yourself.
Unfortunately, practice shows that miscarriage clinics often do not offer parents to see their child. But you can ask for it and insist. However, if you have a scraping or suction, this is not always recommended because your baby may have been defaced by this mechanical process.
If you can see your child, it can be a comfort to you and help with mourning as you create memories. But the decisions in such a situation are very personal, there is no right or wrong. You and your partner may have different ideas and desires, or you may need both time to think about them. Whatever you wish should be respected by the clinic staff.
Will I know the reason?
The cause of death can sometimes be detected by a blood test in the mother, a placental examination or a postmortem examination of the baby (autopsy).
An autopsy can:
- Find out the cause of death (s)
- Provide information about the stage of development of the baby
- Provide information about health problems that your doctor should pay more attention to when re-pregnant
- Confirm the gender of the baby
To help you make the decision, clinicians should give you as much information as possible. Without your consent, no examinations or tests will be made on your baby and your wishes and beliefs should be respected. Maybe you need time to think. But the earlier an autopsy is done, the greater the chances of obtaining useful information.
If you agree to an autopsy, you will be asked to sign a written consent form beforehand. Maybe you can see your baby again after the exam. Clinicians should tell you if this is possible and what your baby will look like. If advised against, then you should first take farewell to your baby before. You should also be informed when the autopsy results are available and you should make an appointment with the doctor to discuss it.
Your rights after a miscarriage
First things first: Even after a miscarriage you have the right to a follow-up care by your midwife. The costs are taken over as long as necessary by the health insurance. The midwife will advise you and pay attention to how your healing process is going.
In terms of employment, a miscarriage is not a birth, so you will not receive maternity protection. If you have already informed your employer about the pregnancy, you are now obliged to inform him that you have lost your baby. However, because of this, you do not have to return to work immediately - if you are mentally or physically unable to do so, your doctor will sign you up for some time.
The burial of a miscarriage child is a matter of country and regulated very differently. At the express request of the parents, however, the child can be legally buried. However, parents often encounter difficulties in practice: hospitals refuse to hand over the baby or cemeteries reject the funeral. Helpful is a medical certificate (proving that your baby has no infectious diseases) to apply for a funeral at the bureau or cemetery office. But if a graveyard denies a funeral, you can do nothing but seek another burial ground for your baby. There are also cemeteries and communities that have special burial grounds for children and babies.
In federal states where a child born without a child is not buried got to, some parents also build a small grave in their own garden for their child. Alternatively, you can put everything in the hands of a funeral home company that will take care of the paperwork. Check with your midwife or clinic to determine if there is a funeral home near you that specializes in the burial of babies and children.
The church baptism of a miscarriage child is not possible. Baptisms are reserved for live children. However, you can ask the pastor or priest to bless the child and hold a memorial service for their baby.
I can not get over the death of my baby. Where can I find help?
While some people want to return to their everyday lives as quickly as possible, others need time to process the trauma and grieve. In our link list you will find several clubs that offer self-help groups for orphaned parents. Many women have found after the death of their child especially the support on the Internet as very helpful. You may also want to look for moral support in our community grief group.
How will my body recover?
In the first few weeks you will bleed vaginally ("weekly flow") and have occasional pain as during the period (Miscarriage Association 2009). If the bleeding is severe, if the pain gets worse, or you have a foul-smelling discharge, go immediately to your doctor or doctor, tissue may still be left over from the pregnancy, and you may have an infection.
Depending on what pregnancy week you were in, your breast may produce breast milk. This can be uncomfortable and painfully remind you of your loss. It is not necessarily advisable to stop the flow of milk with medication (Oladapo and Fawole 2009). You can let nature take its course and wait for milk production to naturally fade away. But the medications are an option if you are feeling really bad.
After six weeks, your gynecologist will want to see you for a follow-up visit. This is a good opportunity to ask him or her about the causes of your baby's death and any possible re-pregnancy consequences.
It may take a while for your body to be in the same condition as before pregnancy. With a few gentle exercises, you can support regeneration and regain your strength. If your family or friends offer you emotional or practical help, accept them - but only if you feel that it really helps you.
Will I have a miscarriage again?
Whether you have an increased risk of miscarriage depends on the reason for your loss. If you know the reason for your baby's death, you can find out more about whether he is also at risk for future pregnancies. Discuss all medical factors with your doctor or a human geneticist.
Having a late miscarriage can be very traumatic. It may be difficult for you to decide for or against a new pregnancy. Some women want to get pregnant again immediately, others have no thought further.
Some women have an overwhelming urge to get pregnant again as soon as possible. Nevertheless, any follow-up pregnancy is of course fraught with enormous fears and worries. In our grief group in the community, you can talk to other parents about it and gain hope.
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