Still taboo because it is full of fear and obviously sadness, miscarriage (which, for our part, we prefer to call terminated pregnancy ) is nevertheless intrinsically linked to pregnancy. Because one in ten women - in the world (1) - have already been affected, it is time and necessary to speak out on this sensitive subject. To better cope with it if we are affected (ourselves or our loved ones), recognize it if it happens, know what the stages are for our head and our body if we have just experienced one, and above all, know how to bounce back, at your own pace, here are some keys.
What is a miscarriage?
A miscarriage defines a sudden and involuntary termination of pregnancy which occurs between 1 and 22 weeks of amenorrhea. However, there are differences in terminated pregnancies, depending on when or how they occur. It is important to clearly differentiate them, because the support is not the same, and will have to adapt.
> Spontaneous miscarriage (called FCS in medical abbreviation)
In the case of a spontaneous miscarriage, the embryo is expelled naturally through the uterus.
> Early miscarriage
We speak of early miscarriage when the pregnancy ends during the first trimester of pregnancy (before the 14th week of amenorrhea).
> Late miscarriage
Also sometimes called “late abortion”, miscarriage is said to be late if it occurs between the third and fifth months of pregnancy (after the 14th week of amenorrhea). Termination of pregnancy beyond five months (i.e. 22 weeks after the date of the last period) will be called fetal death.
> Isolated miscarriage
A miscarriage is considered isolated if the pregnant woman has only had one, as opposed to repeated miscarriages (a woman under 40 who has already had three consecutive early miscarriages). In the recent 2021 report (1), experts estimate that these recurrent miscarriages are, however, much less frequent: 1.9% of women have two, and this figure even drops to 0.7% for those who have had one. three. Remember that a miscarriage absolutely does not predict your ability to subsequently have a baby.
What are the causes and risks of miscarriage?
It is legitimate to want to understand what happened and to wonder if we “did something wrong”. But it is often a source of guilt among pregnant women, who feel responsible. Spontaneous termination of pregnancy affects approximately 15% of pregnancies, or 23 million worldwide, and 44 pregnancies lost every minute… (1). It is therefore a phenomenon that is unfortunately as sad as it is frequent, and the cause of which is generally not known. A mother can be in good health and still experience a terminated pregnancy.
The causes of miscarriage
> Chromosomal abnormalities of the fetus which then fails to develop correctly: this concerns the vast majority of cases. The chromosomes present a problem and/or are not well distributed, or embryonic development (nervous system, heart, etc.) presents dysfunctions. Terminated pregnancy in this case is an appropriate response from the body, which understands that the embryo will not be viable.
> A fall, an accident: a violent shock (or blows) can cause the placenta to separate.
> The presence of an infection in pregnant women: toxoplasmosis, rubella, listeriosis, etc.
> Health problems of the mother: coagulation problems, hormonal imbalances, uterine fibroids, malformations of the uterus, or even autoimmune diseases, chronic diseases, etc. In the case of repeated terminated pregnancies, further research is needed to find if there is a medical cause.
Risk factors
> Age: as with fertility , age unfortunately works to the disadvantage of women in the risk of terminated pregnancy; it would be 12% at the age of 25, and would increase to 50% at 42 (2).
> Consumption of alcohol or drugs during pregnancy ( especially heroin, cocaine and amphetamines) .
How do you know if you have had a miscarriage?
When you are pregnant, and perhaps even more so if it is your first pregnancy, it is not always easy to understand the signs of your body and the manifestations of pregnancy during the first weeks and to know if and when we have to “worry”, because everything is moving inside! To spot the symptoms of terminated pregnancy, carefully monitor:
> The sudden absence of the signs of pregnancy that you felt (nausea, breast pain, vomiting, etc.)
> Heavy bleeding (with the presence of blood clots, often bright red)
> Severe pelvic pain (tightness in the back or pelvic region is normal but if it intensifies or persists, this can raise the alarm)
> Contractions (regular and painful) or abdominal cramps
> Fever and chills: check with the help of a healthcare professional that this is not a sign that the egg sac is expelling the fetus
Some pregnancies can also end without any particular signs. In case of doubt or anxiety - if you feel that something is not going correctly - consult a doctor, gynecologist or midwife urgently. Sudden vaginal bleeding, intense pain (in the lower abdomen, abdomen or back) or loss of consciousness should be immediate warning signs.
What to do if you have a miscarriage
Several scenarios arise during a terminated pregnancy, but in all cases, if you think you have had one, you must urgently consult a health professional.
> Natural expulsion: when the fetus is expelled, cramps are felt and bleeding appears (see signs above). And in the case of a very early miscarriage, the woman discovers that she was pregnant by the time the pregnancy ends.
> Medications: taking a drug treatment (misoprostol) acts within 12 to 24 hours - taking a second dose is sometimes necessary - and causes contractions, followed by opening of the cervix and expulsion of the embryo. The risk of bleeding for the mother is rare, which allows her to stay at home and not be in the hospital during this painful moment. An ultrasound or blood test must follow to verify complete expulsion.
> Curettage: after 10 weeks of pregnancy, curettage is sometimes necessary to ensure that the fetus and the placenta are completely expelled. This is an endouterine aspiration using general or local anesthesia which allows the embryonic tissues to be evacuated from the uterus, carried out by a gynecologist. You will be kept in hospital for observation for a few hours, but this does not require any special monitoring.
Vaginal bleeding often continues after a miscarriage: avoid the use of sanitary tampons or menstrual cups during this period, more “intrusive” protections which could create pain and encourage infections. Prefer external protection: sanitary napkins and/or menstrual panties. It is also best to wait a few weeks before having sex again.
After miscarriage: what you need to know
We must not neglect the trauma that a terminated pregnancy can cause in pregnant women, regardless of the number of weeks at which it has arrived. The WHO definition speaks of perinatal bereavement when parents lose their baby between 22 weeks of gestation and the 7th day after birth, but in all cases it is a matter of mourning for both partners. , during which feelings are confused and mixed (emptiness, sadness, disappointment and sometimes even guilt). Even if the temptation is great to want to stay alone, it is important to confide in those around you, to be surrounded, and to talk about it with your companion, who also suffers and who often feels helpless.
However, if your grief lasts or paralyzes you for too long, do not hesitate to seek help from a therapist or even join support groups if you feel the need to feel understood. In France, there are an estimated 200,000 miscarriages per year (1) so you are not alone. Loved ones can be present but will not always be able to find the right words or have the necessary empathy if they have not gone through this difficult ordeal.
Good news (finally!): to allow you to take this time for yourself, the government has announced the introduction of sick leave in the event of miscarriage. This system should be implemented in 2024.
To recover, and be able to consider a new pregnancy as calmly as possible, we obviously believe in the healing power of time. It allows both the body and the heart to get back into shape, little by little, and removes the heavy feeling of guilt after an interruption of pregnancy. Even if you're the only one who knows when you're ready, it's recommended that you wait at least a few cycles before trying to get pregnant again. But have faith because a miscarriage in the past will not prevent you from having a normal future pregnancy. Remember to check with your gynecologist that the return of labor has taken place (some women can develop “ psychogenic amenorrhea”, a psychological blockage of periods) following your terminated pregnancy.
If you are considering a new pregnancy, you must prepare both your mind and your body to experience this joyful event again. If time ends up softening the trauma and removing the fear that it will happen again, you can act in the meantime, by giving your body as a mother-to-be a little boost. To boost your fertility - and at the same time reassure you by regaining confidence in your ability to carry out a pregnancy - we have created a food supplement based on plants and vitamins. By improving ovulation and the quality of oocytes, rebalancing the cycle and hormones, Baby Boost, our fertility vitamin product for women , is a favorite product, because our dearest wish is to support all mothers (those in the making, those who have been there recently, those who are at the end of their rope, those who think they cannot be, those who are anxious, those who are joyful…). Before, during, after, we want to be by your side, in good times and bad!
Finally, if you are pregnant again (congratulations!), do not hesitate to have early control ultrasounds (the first as soon as possible) to check that everything is going well. And to take care of yourself obviously!
Sources:
- https://www.thelancet.com/series/miscarriage
- Health Insurance Figures
