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Miscarriage

We would like to express our sincere sympathy to you and your family.

This booklet has been designed to include a range of information that may be of use to you and your family and friends. It is intended to guide you through some of the decisions and emotions you may be feeling at this time.

Why did I miscarry?

It is usually difficult to give a definite answer as to what caused a miscarriage. Women and their partners may blame themselves for a miscarriage, but it is very seldom anything they have done, or not done, that causes the loss. At least two-thirds of all miscarriages occur because of a random chromosome abnormality. This is usually a chance occurrence and does not necessarily mean that there are any problems with the ovum and sperm, or the chromosomes of the parents.

What happens now?

Following some miscarriages, all of the pregnancy tissue may have been passed and so nothing further needs to be done. Blood loss, like a period, may continue for up to two weeks, until the lining of the uterus is completely shed. Sometimes, following a miscarriage, pregnancy tissue may remain inside the uterus. Usually nature will take its course and all of the pregnancy will be passed; however, there are other options like using medicines or surgery to help empty the uterus. 

In many cases, a ‘missed miscarriage’ is diagnosed. This means that sadly the baby has died or perhaps the pregnancy stopped growing before a baby formed. The pregnancy hormone levels can continue to rise for some time and it can take several weeks before the body realises that the pregnancy is not viable and passes it. It is safe to wait for this to occur, however there are also options to empty the uterus if you do not wish to wait. For some women, the pregnancy will not pass naturally and treatment is required.

Your treating doctor, nurse or midwife will discuss all of the management options available to you so that you may make an informed choice about your treatment. This decision can be made in consultation with your partner and family.

Option A: Expectant (wait and see) management

In the past an operation was routinely performed for all miscarriages as there was no way to know how much pregnancy tissue, if any, still remained in the uterus. Using modern ultrasound techniques, it has become possible to adopt an expectant management (wait and see) approach. Not all miscarriages are suitable for this management option—the staff in the Pregnancy Assessment Centre (PAC) will advise you as to whether this choice is appropriate for you.

If I decide to wait, how long will it take for me to miscarry?

Although the length of time taken for a miscarriage to be complete can vary, in the majority of cases a pregnancy will miscarry within two to three weeks.

Do I need to come back to the hospital?

You only need to come back if the miscarriage does not occur within an appropriate time-frame. The nurse/ midwife/doctor will tell you how long it is safe to wait. Please phone 07 3163 5132 to book an appointment if you require treatment.

How do I know if the miscarriage is complete?

If you have a heavy bleed which gradually decreases and stops, then the miscarriage is most likely complete. Three weeks after the miscarriage occurs, do a home pregnancy test; if it is positive or you are still bleeding at this time, please see your GP to arrange an ultrasound scan to check whether your miscarriage is complete.

If you are bleeding heavily (soaking a pad in 30 to 60 minutes) or have severe period pain that does not go away with paracetamol (e.g. Panadol) /ibuprofen (e.g. Brufen, Nurofen), or are worried, please present to our Pregnancy Assessment Centre to be assessed by a doctor.

Important note: Do not use tampons or menstrual cups during the miscarriage as they can increase the risk of infection.

Is there any danger if I decide to wait?

All miscarriages can potentially be complicated by significant pain or heavy bleeding. Miscarriages managed with a wait and see approach carry a very small risk of infection but this approach is not always successful. If unsuccessful, you will be advised to consider surgical or medical management for your miscarriage. 

If, at any time, you change your mind about this management option, you are welcome to call us and discuss one of the other management options.

Option B: Medical Management

Medical management involves taking a medication called misoprostol to facilitate a complete miscarriage without the need for surgery. It has been proven to be an effective treatment for 80–85% of women whose miscarriage occurs before 13 weeks of pregnancy. You may be offered a second drug called mifepristone, which is given 1–2 days prior to the misoprostol. Mifepristone increases the success rate of treatment by 10–20%;the staff will discuss if this medication is suitable for you and explain the cost involved.

Is misoprostol a recognised treatment of miscarriage?

Yes, misoprostol has been demonstrated as an effective treatment of early pregnancy loss in clinical studies and compares favourably to both expectant and surgical management.

There is strong evidence for the use of misoprostol in the treatment of miscarriage, which is endorsed by both Queensland Health and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). However, the manufacturer of misoprostol has not registered it for use in pregnancy and therefore the Therapeutic Goods Administration cannot approve its use in pregnancy in Australia.

Is mifepristone a recognised treatment of miscarriage?

Mifepristone will not usually cause the miscarriage to occur. It is a ‘primer’ medicine that starts to loosen the pregnancy from the wall of the uterus, which then makes the misoprostol more likely to work. It is a single tablet which is swallowed whole with a glass of water.

What is involved for me if I have misoprostol?

Misoprostol will be administered either in the mouth (dissolved between cheek and gum), or in the vagina. You will be given the medication to take home and administer over two days. The treating doctor or nurse/midwife will explain to you how to do this and give you written instructions with a follow up plan. The second dose is very important as it helps to ensure that the uterus is emptied and the miscarriage completed. Not taking this second dose can result in pregnancy tissue being left in the uterus and the possible need for a curette (operation).

What is involved for me if i have mifepristone?

If the treating doctor or nurse/midwife decides that mifepristone is a suitable option for you and you are in agreement, you will be given a script to take to Mater Pharmacy (on site) where the medicine will be dispensed to you. A cost will be involved (the cost will vary depending on your individual circumstances; the doctor/ nurse/midwife will advise you about this). Again, we will provide you with verbal and written instruction on how to take both medications and a follow up plan.

What can I expect after being given misoprostol?

Bleeding and pain will start soon after the first dose of misoprostol is given (approximately two to four hours). This may last for up to 24–72 hours before the miscarriage is completed. Period-like bleeding will then occur over the next week or so. Approximately 10% of women may experience excessive pain or bleeding—a visit to your doctor or the hospital, and possibly surgery, may then be required. In a large recent study, hospitalisation for heavy bleeding or infection occurred in less than 1% of women. It is safe to use simple pain medicines such as paracetamol (e.g. Panadol) or non-steroidal antiinflammatory drugs ibuprofen (e.g. Brufen, Nurofen) for the treatment of this pain, according to the directions on the pack.

What are the risks and side effects of misoprostol and mifepristone?

Misoprostol and mifepristone are both usually well tolerated. Side effects may include nausea, vomiting, diarrhoea and fever. Allergy to either drug is uncommon; however, misoprostol should not be used by women with a history of severe asthma or porphyria (a metabolic disorder). Should you have any concerns, please do not hesitate to ask for further clarification from your doctor or nurse.

Your follow up appointments

A sample of your blood will be taken the day we give you the medication to assess your pregnancy hormone level (HCG). You will be given a request form to have a repeat blood test a week after commencing the misoprostol. A Mater Mothers’ nurse/midwife will telephone you the next day to check on your progress and review the blood tests. A drop in the hormone level by 85% or more indicates that the medication was successful and the pregnancy tissue has passed. If the hormone level does not drop enough or nothing has happened, you will be given an appointment to return to PAC to discuss further options. If the miscarriage has occurred then no further intervention is required.

For most women, the bleeding will stop within two weeks from the initial heavy bleeding. However, if you are still bleeding after three weeks, please see your GP to arrange to have a scan to make sure the miscarriage is complete.

If your miscarriage has not been completed, then your GP will refer you back to Mater. You will then have the option to either give it more time, have another two doses of misoprostol, or to have a surgical procedure called a curette. Our nurses will continue to follow up with you via telephone until the miscarriage is complete, regardless of which option you choose.

Option C: Surgical Management

The operation following a miscarriage is called a Dilatation and Curettage (D&C) and involves opening up the cervix (dilatation) and removing the uterine contents (curettage).

The procedure, performed as day surgery under general anaesthetic, usually takes less than 15 minutes and includes the following:

  • A catheter is inserted into your bladder to ensure it is completely empty.
  • A speculum is used to hold open the vagina (just like during a Pap smear examination) so that the cervix can be dilated using metal rods called dilators.
  • A suction catheter is passed into the uterus to remove any blood and clots.
  • A spoon shaped instrument called a curette is then passed into the uterus so the lining (endometrium) can be gently scraped.
  • The tissue that is removed (curettings) is sent to pathology to be examined under a microscope to make sure there are no abnormalities.

If you have a general anaesthetic, you will probably feel tired during the 24-hour period after your anaesthetic; It is important that you stay in the company of a responsible adult and do not travel for 24 hours and: 

  • do not drive or operate any heavy machinery
  • do not drive a car, motorbike or ride a bicycle
  • do not consume alcohol for the remainder of the day
  • do not sign any legal documents or make any important decisions
  • do not engage in sports or heavy lifting.

What are the risks or after-effects with this type of operation?

Dilatation and Curettage (D&C) is a common operation and there are few risks; some women may experience one or more of the following:
Short term risks:

  • Excessive bleeding soon after the operation.
  • Perforation of the uterus—a hole in the uterus.
  • Trauma to the cervix.
  • Infection—indicated by smelly discharge and/or fever and/or ongoing pelvic pain.

Long term risks:

  • Cervical incompetence—where the cervix does not function properly during pregnancy and this can result in preterm labour.
  • Chronic infection.
  • Adhesions (scarring) within the uterus, which may affect your future fertility.

If you are worried about any of these risks, please discuss them with your doctor or nurse.

How will I feel after the operation?

  • You may have period-like cramping pains; if so, please tell the nurse. It is safe to use simple pain medicines such as paracetamol (e.g. Panadol), or non-steroidal anti-inflammatory drugs ibuprofen (e.g. Brufen, Nurofen) according to directions on the pack.
  • You will have some bleeding in the days after the procedure; the amount and duration is different for each woman. However, many women describe having some bleeding for a day or two then stopping for a day or two and then having some light bleeding over the next few days. If you develop heavy bleeding (soaking a pad every 30–60 minutes) please present to our Pregnancy Assessment Centre.
  • It is important that you only wear sanitary pads while you are bleeding; the use of tampons can cause infection. You may have a bath or shower, as usual.
  • The general anaesthetic might make you feel drowsy and nauseated.
  • You may feel sad—please let the nurse know if you would like to see a pastoral care worker while you are in hospital. 
  • If you are feeling sad or depressed at home:
    • make an appointment to see your GP
    • contact Lifeline/Beyond Blue
    • contact Pastoral Care on telephone 07 3162 6729.

Sexual Intercourse

You should wait two weeks, or until any bleeding has stopped, after a Dilatation and Curettage (or any type of miscarriage) before resuming intercourse.

When to see your doctor

  • If you have a fever—a sign of infection; see your GP.
  • If you have vaginal discharge with an offensive odour—a sign of infection; see your GP.
  • If you have severe abdominal or pelvic pain—see your GP or present to PAC.
  • If you have heavy bleeding (soaking a pad in 30–60 mins) or are passing large clots—present to PAC.

Frequently asked questions

How long will I bleed for after a miscarriage?

Once the heavy bleeding has occurred and the pregnancy tissue has been passed, the bleeding gradually decreases then stops over the following week or two.

You should make an appointment to see your GP if:

  • you are still bleeding three weeks after the miscarriage
  • your bleeding settles then suddenly increases and doesn’t settle
  • your vaginal loss starts to smell offensive or you develop a temperature/fever
  • a home pregnancy test is still positive, three weeks after the miscarriage/ curette.

What else should I expect after having a miscarriage?

  • After a miscarriage you may have a dull ache in your lower abdomen—this is normal and may last for a few days.
  • Your breasts may be tender for several days and you may even leak milk. If this occurs, wear a firm fitting bra day and night, to provide adequate support until your breasts are comfortable. This may be necessary for a couple of weeks but will settle on its own. 

When can I go back to work?

One week’s absence is usually enough but the decision to go back to work is up to you. In all cases, a sick leavecertificate can be obtained on discharge from hospital.

Will the treatment I choose affect my chances of becoming pregnant again?

No. Generally your chances of having a successful pregnancy are just as good regardless of what treatment option you choose. However, the surgical option carries a slightly higher risk of fertility problems. 

How long should I wait before trying for another baby?

When the bleeding and pain has been finished for a week, it is usually safe to start having sexual intercourse again.

You may not feel like having intercourse for a while or your sex drive might decrease. Your feelings and those of your partner need to be respected.

You may try for another pregnancy again when you feel ready; however, we recommend you wait until after one period before trying for another pregnancy. Your period should return within four to six weeks of the miscarriage. If it does not, then please see your doctor for a check-up.

Will I miscarry again?

Fortunately, most couples go on to have normal, healthy, full term babies. The chance of another miscarriage following one miscarriage is not significantly changed. Even after several miscarriages, there is a good chance of a successful pregnancy.

What can I do to stop having a miscarriage?

There is no magic formula for success, but the emotional and physical well-being of both parents in the months before pregnancy will help to give your baby the best possible start. Please remember these are only suggestions—the most important thing is to decide how you both feel about being pregnant again, and to prepare in whatever way feels right for you.

Will I get a follow-up appointment after the miscarriage?

Only if there is a specific reason. We recommend you visit your GP in the weeks following the miscarriage if you have any concerns. It is natural to experience grief and feel low or depressed following a miscarriage. Give yourself time to recover. It may help to talk over things with your partner, friends and close family members or a visit to your GP to arrange professional counselling if you are struggling.

What other things should I consider before and during pregnancy?

Check up on your health

After a miscarriage, it is worthwhile asking your GP for a general health check. Your doctor may be able to identify or resolve any problems that may affect a future pregnancy. If you have a disability or long term condition such as diabetes, obesity, epilepsy or high blood pressure, talk to your doctor about your plans to fall pregnant. Ask how your condition will affect your pregnancy and what extra care may be needed to reduce any risk to the baby. If there is a genetic disorder in your own or your partner’s family, and you are worried that it may be passed on to your own children, ask your doctor about seeing a genetic counsellor who can advise you about the likely risk.

Drugs or medicines

Don’t take drugs or medicines unless you have checked with your doctor or pharmacist that they are safe to take during pregnancy. Common drugs such as alcohol, tobacco, caffeine (in tea, coffee and cola drinks) and tranquilisers can all affect your body’s chemistry. Illegal drugs such as cannabis, heroin and cocaine may affect fertility, increase the risk of premature or low birth weight babies or cause damage to the developing fetus. The safest course of action is to avoid using any of these drugs before and during pregnancy. Smoking can make a man less fertile and may result in the production of damaged sperm; a woman who smokes has an increased risk of miscarriage. Heavy drinking reduces the number of sperm a man produces and can also damage sperm. For women, heavy drinking reduces fertility and increases the risk of miscarriage. It can also affect the baby’s development during pregnancy. As the risk is highest in the earliest stages of pregnancy (including the time before a period is even missed) it is advisable that you both stop drinking if you are planning a pregnancy and during pregnancy.

Protecting against infection

Certain infections may increase the risk of miscarriage or abnormality to your baby during pregnancy. Rubella (German measles) can lead to serious disability for your baby if you have it in the first few months of pregnancy. Even if you think you are immune, ask your doctor for a blood test to check. You can be vaccinated against rubella, but it is best to wait three months after the injection before becoming pregnant.

Eat well

A well balanced diet is the basis of good health. A good diet will help to provide the best possible conditions for your baby to grow.

Folic acid supplements

Recent research has shown that folic acid (400 microgram tablet once a day) appears to reduce the risk of neural tube defects e.g. spina bifida when taken in the pre-conception period and during the first three months of pregnancy. High doses of certain vitamins and minerals can be harmful, so it is advisable to obtain advice from your doctor before taking any supplements.

Grieving for your baby

We are sorry that you have experienced the loss of your baby in early pregnancy.

You are likely to feel sad and you may need time to grieve. Don’t expect too much of yourself, some women recover quickly, others take a long time. You may experience a range of feelings such as sadness, anger, bitterness or guilt.

You may worry that some activities such as exercise, going to work, or sexual intercourse caused the miscarriage. This is a normal reaction, but it is very seldom that anything you have done, or not done, that has caused your loss.

The loss of a baby can be traumatic at any stage of pregnancy. Experiencing an early pregnancy loss can lead to feelings of isolation and loneliness, particularly when other people around you are having babies. Any resentment that you may feel is common and normal. It is important to acknowledge and accept your feelings and experience, as a part of the grieving process.

Partners

Partners are likely to feel upset because of your distress, as well as for the loss of your baby. You may be able to support each other and may even feel that this experience has brought you closer together. However, grief can put a strain on even the closest relationships. You and your partner may both be upset but in different ways or at different times. Your partner may also feel guilty because you are the one who has experienced the physical aspects of miscarriage.

Children

Children often notice when something is wrong, especially if a parent or someone close to them is upset. You may want to think about telling them what has happened, even very simply, especially if they knew you were pregnant. There are brochures and books available to assist you in understanding how children grieve and how to explain what has happened. Pastoral care is also available to provide you with support and guidance with how to approach the conversation.

What happens to your baby now?

All babies and pregnancy tissue will be treated with the reverence and dignity required by the philosophy and Mission of Mater and the Sisters of Mercy.

Cremation and burial

Many parents want to know what happens to their baby’s remains after a miscarriage. Mater arranges a group cremation for all babies who died in early pregnancy, unless otherwise notified by parents. These collective ashes are then placed in a reserved memorial garden located away from the hospital at Eco Memorial Park, 21 Quinns Hill Road West, Staplyton. Please be aware that we cannot give you any indication of the timing for cremation or internment of ashes. We invite you to visit the garden at any time.

However, if you choose to have your own private ceremony or burial (this is not a legal requirement if your baby is less than 20 weeks gestation) please contact the Early Pregnancy Nurse/Midwife at PAC within 28 days of your miscarriage to arrange collection of your baby.

Remembering your baby

Creating memories

Do not hesitate to ask the staff to see your baby, no matter how small they are. Many parents find this helpful in the monthsahead. However, sometimes, there may be no baby to see and you may find it difficult to grieve for your baby because you have no one to clearly remember. For this reason, you may like to create some memories of your baby such as planting a tree or shrubor creating your own personal memorial.

Service of remembrance

The service is held each year on the third Wednesday in March at 10 am in Mater Chapel, Level 3, Salmon Building, Raymond Terrace, South Brisbane 4101 QLD. For further information or to RSVP, please contact Mater’s Pastoral Care team.

Email: pastoralcare@mater.org.au
Ph.: 07 3163 6729`

International pregnancy loss day–service of remembrance

This service is held each year on 15 October at 7 pm, in the Corbett Room in the Whitty Building. For further information or to RSVP, please contact Mater’s Mothers’ Bereavement team.
Email: mmh.bereavement.support@mater.org.au
Ph.: 07 3163 3467

Ongoing support

Counselling services

It is likely that you will feel sad following your loss. For a small group of women, the sadness seems to grow deeper and deeper, and they are left with feelings that they find difficult to cope with and talk about. This is something which is more than grief and help is needed to get back on track. Please speak to your GP if you feel you may need counselling. You are entitled to Medicare funded counselling by a psychologist due to your pregnancy loss and your GP can arrange this for you.

Pastoral care

Mater’s Pastoral Care Department is available to provide spiritual and emotional support. The pastoral care workers are professionals trained in the skills of supportive and person-centred listening. Privacy, confidentiality and the rights of individual choices without discrimination are honoured and respected. Pastoral care can be contacted Monday to Friday between 7.30 am and 4 pm: 
Ph.: (Pastoral Care Department) 07 3163 6729 
Email: pastoralcare@mater.org.au

Perinatal Support Group—Circle of Hope 

We recognise that the need for support for parents after experiencing a loss is essential and ongoing. Therefore, we would like to invite our parents who are requiring further support after leaving the hospital to join us in our ‘Circle of Hope’ group. The group is open to all parents who have experienced a loss. We meet monthly over a cuppa to provide a safe space for parents to share their story. Our purpose is to encircle our parents with hope and encouragement. This is an opportunity for parents to meet in a secure environment to enable the group process of parents supporting each other to take place. Please contact Pastoral Care for further details and to RSVP.
Ph.: 07 3163 6729
Email: pastoralcare@mater.org.au

Community support

SANDS

Stillbirth and Neonatal Death Support Group (Qld) are a volunteer organisation that provides support for parents and families who have experienced miscarriage, stillbirth or neonatal death. You may be asked to leave a telephone message, so please leave your name and number and they will return your call as soon as possible. 

Ph.: 07 3254 3422 or 1800 228 655 (outside the Brisbane metropolitan area)
Email: sandsqld@powerup.com.au
Website: sands.org.au

Lifeline

Lifeline provides 24 hour access to crisis support services. 

Ph.: 13 11 14
Website: lifeline.org.au

Beyond Blue

Beyond Blue provides 24 hour access to support for people suffering from depression and anxiety. 

Ph.: 1300 224 636
Website: beyondblue.org.au

Further information, please contact:

Pregnancy Assessment Centre (PAC) Early Pregnancy Unit.
Ph.: 07 3163 5132

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430058
Last modified 03/4/2020.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 25/4/2017
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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