Miscarriage

Generally, pregnancy and childbirth are joyful events that people like to share with their surroundings. Just as happiness is celebrated, there is also a sad side that is unfortunately rarely discussed: many women experience one or more miscarriages in their lives. In this article, you will learn about the reasons why a pregnancy loss can occur, what happens afterward, and how you can find a way to cope with what you've experienced.

When is a miscarriage considered to have occurred?

From a miscarriage (medical Abort ) is the term used when a pregnancy ends prematurely before the baby is viable. According to medical definition, this occurs up to the 23rd week of pregnancy. More than half of fertilized eggs are lost before the sixth week of pregnancy, often even before the pregnancy is detected ( Early abortion ) and often unnoticed. A miscarriage before the 13th week of pregnancy is referred to as a Early breakfast , between the 14th and 23rd week of pregnancy then from a Late abortion . A birth after this time is called a preterm birth if the baby is born alive. If it has already died in the womb, it is a Stillbirth .

The risk of miscarriage decreases significantly during pregnancy; after the 16th week of pregnancy, it is less than five percent.

What are the causes and risk factors?

There are many possible causes that can lead to a miscarriage, including the following:

• Genetic chromosomal abnormalities of the fetus that prevent its development.

• Infections of the cervix or the uterine lining that can lead to premature opening of the cervix or contractions.

• Thrombophilia/Coagulation disorders of the mother. These can lead to blood clots in the placenta , which can result in insufficient blood supply to the fetus.

• Autoimmune diseases or immunological disorders between mother and father that cause increased antibody production and the body to reject the fetus.

• Disorders in the mother's hormonal balance, for example:

  • (Unrecognized) thyroid disorders that can cause early developmental issues and lead to miscarriage.

  • Diabetes: Not only gestational diabetes , but also a previously diagnosed Type I or II diabetes can impair fetal development.

  • Corpus luteum insufficiency: If the body does not produce enough luteal hormones in the first 12 weeks of pregnancy, it can lead to bleeding and pregnancy loss.

• Anatomical features of the uterus such as uterine weakness. The likelihood of uterine weakness increases with previous miscarriages or if a cervical operation has been performed. In rare cases, fibroids (benign tumors in the uterus) or a narrowed uterine cavity can also promote a miscarriage.

• Anemia, which can lead to the child's insufficient oxygen supply.

• Febrile infections that can stimulate labor-like contractions of the uterus.

• Genetic defects from mother or father.

• Smoking, alcohol, and drugs can cause fetal malformations and thus increase the risk of miscarriage.

• Certain medical examinations: radiation (for example, through computed tomography or X-ray), certain medications or vaccinations with live vaccines, maternal anesthesia, specific tests for detecting malformations (such as amniocentesis or placental examination, which in less than one percent of cases can lead to premature rupture of membranes).

• Severe or chronic stress, which causes the release of stress hormones and can, in the worst case, lead to a miscarriage. Short-term or minor stress, on the other hand, has no impact on the course of the pregnancy. So don't worry if you have one or two stressful days in between.

• Accidents or severe traumatic experiences that, in individual cases, cause miscarriages.

What are the signs and symptoms of a miscarriage?

The most common signs of a pregnancy loss are sudden, severe Bleeding from the vagina and contractions or menstrual cramps . Another accompanying phenomenon can be the Absence of typical pregnancy symptoms be. When the body stops producing pregnancy hormones, symptoms like breast tenderness or morning nausea quickly out. In early pregnancy, this can indicate a miscarriage. After the 12th week of pregnancy, however, these symptoms usually resolve on their own – their absence does not necessarily mean a miscarriage. Less common signs of a miscarriage include fever or purulent discharge. After the 20th week of pregnancy, the absence of previously noticeable fetal movements can also indicate a miscarriage.

If you notice any of these symptoms or suspect a miscarriage for other reasons, you should immediately contact your gynecologist or go to the emergency room. Some miscarriages also occur completely without bleeding or contractions. delayed abortion ) and are therefore not directly recognizable from the outside. Your doctor will then likely perform various examinations. With a vaginal examination of the cervix, they will try to determine whether the cervix is open. An ultrasound can also be useful. For example, hematomas on the placenta and a beginning shortening of the cervix can be detected, which may indicate a threatened preterm birth. From the sixth or seventh week, detecting the heartbeat via ultrasound also provides information about whether the baby is still alive in the womb. If the ultrasound also does not provide a clear result, a blood test to determine the pregnancy hormone ß-hCG can provide clarity. A lack of increase or even a decrease in the hormone level indicates a miscarriage.

What does the treatment look like after a miscarriage?

Different types of miscarriage are distinguished, which influence further treatment:

Incomplete or complete abort

The fetus, the amniotic membranes, and the placenta are partially or completely expelled. If tissue remnants remain in the uterus, a curettage is often performed ( Curettage ) performed under general or local anesthesia to prevent bleeding and infections.

Early miscarriage

This refers to cases where the impending miscarriage is detected early, but cannot be prevented anymore due to the open cervix. Usually, it is first waited to see if the body will expel the tissue on its own.

Delayed abortion ( missed abortion ) or Wind eye

In a missed miscarriage, there are initially no external symptoms such as bleeding or pain, no tissue is expelled, and the cervix remains closed, despite the absence of fetal heartbeat. This form of miscarriage is usually detected during ultrasound examination when the fetus shows no signs of life.

Of a Wind eye is spoken when a amniotic sac develops without a fetus inside. A blighted ovum is also only visible during an ultrasound examination. If the body does not expel the pregnancy tissue on its own, medications are usually administered to soften the cervix and stimulate the uterine muscles. If this does not happen, a uterine curettage ( Curettage ) may be necessary.

As long as there is no medical necessity, you have the option to choose between a D&C or waiting for a natural miscarriage in the event of a miscarriage. Some mothers find it helpful to have a few days to say goodbye by waiting, while others do not want that. Whatever you decide: After a miscarriage, you always have the right to care and follow-up from a midwife and to postpartum exercises. If the birth weight is over 500 grams, you are also entitled to a leave of absence from work for eight weeks and the statutory maternity protection of six weeks, if you have not already taken advantage of it.

Even if some affected individuals would like an answer to the question of "Why?", a clear reason for a miscarriage cannot always be identified. In principle, a subsequent pregnancy is possible after a miscarriage. Additionally, there is a wide range of medical options for therapy and diagnostics. Especially in cases of recurrent miscarriages, specific risk factors can be targeted through testing and treatment to reduce the likelihood of another miscarriage in a future pregnancy. Be sure to consult your gynecologist for advice on this.

What happens after a miscarriage and how can I learn to cope with the event?

Statistically, 15 to 20 percent of all women are affected by a miscarriage. Although pregnancy loss is quite common, it is rarely (publicly) discussed. Reasons for this can include the shame of the affected parents, the overwhelm of their environment, doctors who advise cautious communication, or the custom of announcing a pregnancy only after the 12th week.

Many women feel guilty or have the feeling that their body has failed. However, a miscarriage is very rarely due to any misconduct on the mother's part; she has only in the very fewest cases any influence on the continuation of the pregnancy. Be aware of this if you have experienced a miscarriage and such feelings burden you. An equally strong feeling is sadness that your child has gone. You should not deny yourself this grief under any circumstances; it is important and can even help you cope with the loss. If you wish, talk about it with your partner, family, or friends. Some affected mothers and fathers also find counseling or self-help groups (family counseling centers by proFamilia or donum vitae offer advice in every larger city) helpful in processing the experience and actively dealing with their feelings. Other parents find it comforting to hold a memorial service for their child or to give them an official name. Although miscarriages are not subject to reporting requirements in Germany, you can still register your child at the registry office and have their name entered if you wish.

LILLYDOO Midwife Sissi regularly cares for women who have experienced a miscarriage. In the video, she shares interesting information specifically about early miscarriages, a topic that is very close to her heart as a midwife.

Psychologist Jill on coping with a miscarriage

" Acceptance - no matter what it's about - can help to get out of an emotional negative situation. But above all, the situation does not worsen through acceptance. If you accept a miscarriage, you can consciously decide how you want to deal with it moving forward, instead of making it worse for yourself.

I know: It sounds simple, but of course it is not in practice. We achieve acceptance much more easily with things that are not so important to us than with emotional topics like a miscarriage. But it is especially worth it with these topics because you can save yourself a lot of suffering. When the mind starts to ruminate and worry, it usually doesn't stop so quickly.

With some distance, it is helpful to look closely and consider why you are still suffering so much. What stories do you tell yourself about this event? And how do you feel with this story? What does it cost you?

A first step to leaving these negative stories behind you is to accept that you had a miscarriage. Don't fight internally against reality anymore, but accept it. And then, at some point, you can also consider what positive things may have arisen from it. Maybe you've realized how much you can rely on your friends. Maybe your relationship with your partner has become even more intimate. Maybe you've become aware of how incredibly strong you are. Remember: your past has shaped you into the woman you are today.

If you change your way of thinking and can say that what happened is okay because you have grown from it, your perception of the miscarriage will change, and you will find a way to deal with it that no longer hurts you or makes you question your body. The first step to get there is to move into acceptance. After that, doors open for a new interpretation. And I sincerely wish you that the new stories you take away from your experience will strengthen you! In this sense: to a good gut feeling. I believe in you, and you should believe in yourself too. "