Carole and Ted Jones (names have been changed to protect their privacy) had been married for less than a year and were preparing to leave for a delayed but much anticipated honeymoon. Because Carole’s menstrual cycle had always been predictable and her period was late, she suspected she might be pregnant. Those suspicions were confirmed by her OB-GYN. The honeymoon was canceled, and the couple decided to stay close to home.
At five weeks, the pregnancy was still in its early stage and Carole and Ted were keeping the news mostly to themselves.
At 6.5 weeks, when an ultrasound was performed, Carole and Ted saw the baby and heard a strong heartbeat. The couple began to imagine everything — from who this child would be, to what kind of parents they would make. They caught an early glimpse of a changing and evolving relationship and a growing family.
At about nine weeks, Carole miscarried.
“When a woman has a miscarriage, she likely will feel a spectrum of reactions ranging from sadness, grief and guilt to self-blame and anxiety about future pregnancies, none of which are right or wrong,” says Dr. Miriam Schultz, a reproductive psychiatrist at Stanford Medicine Children’s Health. “And while there are no right or wrong ways to heal, there are ways to better help women and their partners cope with the experience.”
[Read: Early Signs of Miscarriage: Symptoms to Watch For]
What Is a Miscarriage?
A miscarriage is the unintentional termination or loss of a pregnancy before 20 weeks. Common in early pregnancy, 15% to 20% of all pregnancies end in miscarriage.
Most miscarriages are caused by genetic abnormalities that prevent the fetus from developing normally. They’re not caused by stress or by normal activities like exercising, working or having sex.
About 85% of women who have had a miscarriage go on to have healthy pregnancies, according to the American Pregnancy Foundation. For women who have had two or three miscarriages, 75% go on to have healthy pregnancies.
[READ: Pregnancy After Miscarriage.]
What Are the Symptoms of a Miscarriage?
Most miscarriages occur during the first trimester of pregnancy. Miscarriage symptoms can include the following:
— Vaginal bleeding. Bleeding from your vagina is the most common sign of a miscarriage. The appearance of blood can vary from light spotting to brownish discharge to a heavier flow of bright red blood. You may or may not have pain, but you should call your doctor right away.
— Cramping. You may feel pain in your lower abdomen that ranges in intensity from the sensation of period cramps to feelings akin to labor contractions.
— Fever. Some miscarriages are caused by an infection in the uterus, which can trigger fever. This is serious and requires immediate treatment to prevent shock or death.
— Vaginal discharge. During a miscarriage, you may pass larger clots than during a normal period and you may pass them more frequently. Usually, this is clear or pinkish fluid or discharge of tissue from your vagina.
— Loss of pregnancy symptoms. Sensations such as nausea, breast tenderness and a general sense of not feeling pregnant anymore may be signs of miscarriage.
[Rainbow Babies: Hope After Loss]
Treatment After Miscarriage
After a miscarriage, your uterus needs to be emptied so your normal menstrual cycle can resume. If your first sign of a miscarriage in a very early pregnancy is heavy bleeding, all the fetal tissue may have cleared on its own. Sometimes, though, fetal tissue remains and needs to be removed in other ways. Here are some of the ways in which that happens:
— Expectant Management. This method allows your body to expel the tissue on its own. It’s the most natural option, but it can be unpredictable. It can take anywhere from a few days to three or four weeks before the tissue is fully expelled. Your doctor may say that this is too long to wait for your body to resume its normal menstrual cycles and suggest another procedure.
— Medication. If it seems unlikely that your body will expel the embryo on its own or you or your health care provider need a faster and more predictable procedure, you may be prescribed an oral dose of mifepristone followed by misoprostol, the two pills that are together referred to as the abortion pill. Within a few hours of taking the medication or receiving a vaginal suppository, you should start to cramp and expel fetal and placental tissue. This usually takes 24 to 48 hours and can cause bleeding, nausea and diarrhea.
— Dilation and curettage, or D&C. This is the most predictable treatment. Your OB-GYN will pass a small tool through your cervix and into your uterus to surgically remove the fetal and placental tissue. Bleeding after the procedure usually lasts no more than a week and side effects are rare.
[READ: What Is Prolonged Grief Disorder?]
How to Prevent Infection After Miscarriage
Rarely, but sometimes, tissue that remains in the uterus after miscarriage can lead to a uterine infection, which is very serious and can be life-threatening. Here are ways to prevent infection:
— Use sanitary pads. Use pads instead of tampons until after your next period or until your doctor says you can use tampons again. While your cervix is open, you don’t want to introduce bacteria that might cause an infection.
— Do not douche. Although many do, it’s not advisable to douche under any circumstances as it can cause infection, but especially do not douche when your cervix is open.
— Do not swim or use a hot tub. Again, you do not want to introduce bacteria into your open cervix.
— Take a shower, not a bath. Avoid taking baths for a couple of weeks to prevent infection and until the bleeding stops.
— Do not have sexual intercourse. Abstain from sexual intercourse for about two to three weeks to allow the cervix time to close and reduce your risk of infection.
How Health Care Workers Handle Miscarriage
Miscarriage can be fraught with emotional distress, trauma and grief. In a studied review, women and their partners report that they were generally unhappy with how health care workers around them responded. But health care workers, too, report feeling unprepared to provide emotional support.
When Carole Jones, then a health educator at a hospital, began to sense that something was wrong, she immediately went to the hospital’s women’s center for help. An inexperienced ultrasound technician kept searching for a heartbeat and it was clear she wasn’t finding one. The technician abruptly left the room, leaving Carole feeling stranded, alone, distressed and abandoned.
A supervisor was sent in to confirm the absence of a heartbeat. She was quick and showed little emotion or empathy for how Carole was feeling. Neither of these health care workers, who were likely uncomfortable with the situation, knew how to respond while Carole was becoming more emotional.
Dr. Elizabeth Erickson, a psychiatrist at Family Care Center in Denver, says that health care workers and physicians often haven’t been properly trained to acknowledge the impact a miscarriage can have on a woman.
“We are beginning, though, to slowly see health care providers learning how to talk with patients in the face of what can be devastating loss,” she says, “and we are starting to see health care providers learn to support patients and allow themselves to be re-sensitized.”
Physical Healing After Miscarriage
As you wait for your regular menstrual cycles to return, and to ensure a healthy physical miscarriage recovery, follow these health measures while gradually returning to your regular activities:
— Hydrate. Keep your body well hydrated by drinking 6 to 8 glasses of fluid a day.
— Diet. Eat a healthy diet and cut down on foods and drinks with sugar.
— Exercise. Avoid strenuous exercise like running or aerobics until your doctor gives you the all-clear.
— Sleep. Naps may help you recover more quickly.
Miscarriage and Hormones
When you’ve had a miscarriage, your body goes through hormonal shifts as it readjusts to not being pregnant, intensifying your emotions. Here are some examples of changes you may notice due to your shifting hormones:
— Fatigue
— Trouble sleeping
— Appetite loss
— Crying episodes
— Profound grief
Emotions After Miscarriage
Erickson says grief is a natural response to loss, and after miscarriage it’s natural to grieve. “If your grief doesn’t abate over time, though, you could probably benefit from speaking with a therapist,” she says.
When Carole Jones miscarried during her first pregnancy, she was heartsick. She’d begun to dream about her baby and prepare for the future. When there no longer was a baby, she started to question herself and distrust her body, thinking perhaps she’d never be able to have a family. She blamed herself for the loss, thinking that maybe her body was broken.
While her husband was supportive, Jones had told so few people she’d been pregnant that once she miscarried, she had few friends with whom to talk and get support.
“I healed one day at a time,” says Jones. “It was hard because everyone around me was pregnant, but the miscarriage made us understand how much we wanted children, and now, years later, we have three healthy, active and happy children.”
Strategies for Healing After Miscarriage
Schultz believes it would be helpful if more women go into pregnancy knowing that there’s a possibility of miscarriage, especially in the first trimester. That said, she encourages women to be in touch with whatever feelings they are having after miscarriage.
Here are some suggestions and strategies for coping after a miscarriage.
— Reach out to your partner. If you have a partner, let them know how you feel and how they can help you. Men should also be encouraged to show emotions, because if they don’t, it could be mistaken as not caring. Men often revert to problem-solving mode, but if partners let each other know how they feel, it can prevent miscommunication.
— Share your experience. Don’t go through this alone. It’s important to talk with your partner, family and friends when you’re ready. Share with someone who understands how hard it is and how much it hurts. It can be helpful to talk with other women who have also had miscarriages.
— Engage in rituals. Miscarriage is often known as a “silent loss.” In our society, most other kinds of losses or death are publicly acknowledged. Miscarriages don’t come with funerals or rituals, so find ways to remember, acknowledge and honor the loss. Allow time and space to mourn the loss of hopes and dreams for a lost baby.
— Avoid numbing your emotions. In the aftermath of a miscarriage, avoid things like alcohol and internet scrolling in order to numb your emotions. Schultz says these feelings will rear their head at some point, so you ought to acknowledge them early and try to process them.
— Practice self-care. Treat yourself with kindness and compassion. When you’re able, try to exercise and do things like meditation and relaxation exercises to ease anxiety and boost resilience. Be aware of the tendency to beat yourself up and consciously counter those negative thoughts.
— Consider professional therapy. If your feelings are interfering with daily functioning or if sadness doesn’t lessen after a few months, you may want to talk with a mental health counselor or therapist to get help with sorting through emotions.
— Be patient with others. Often after miscarriage, people will say things they think are helpful but aren’t. They may downplay the emotional intensity of the experience at a time when you need them to validate how you feel. Be patient with those people — remember that they mean well.
— Take things day by day. You may feel that you will never again be able to experience joy. Do things that used to make you feel good even if you don’t want to. In time, you will likely find yourself enjoying them again.
— Seek resources and support for miscarriage. The grief of miscarriage is a unique kind of grief. It may be helpful to listen to podcasts on pregnancy loss and to connect with those who have had the same experience. Support groups meet in person or online. Check out your local area for in-person groups. Some online groups you might consider:
— Miscarriage and Early Pregnancy Loss Support Group
— Postpartum Support International
More from U.S. News
How to Fact-Check Health Information on Social Media
What Is Cognitive Behavioral Therapy?
How to Cope After Miscarriage originally appeared on usnews.com
