Still taboo because it is full of fear and obviously sadness, miscarriage (which, for our part, we prefer to call a missed pregnancy ) is nevertheless intrinsically linked to pregnancy. Because one in ten women - in the world (1) - has already been affected, it is time and necessary to speak out on this sensitive subject. To better cope with it if we are concerned (ourselves or our loved ones), to recognize it if it happens, to know what the stages are for our mind and our body if we have just experienced one, and above all, to know how to bounce back, at our own pace, here are some keys.
What is a miscarriage?
A miscarriage is a sudden and involuntary termination of pregnancy that occurs between 1 and 22 weeks of amenorrhea. However, there are differences in miscarriages, depending on when and how they occur. It is important to differentiate them, as the treatment options are not the same and will need to be adapted.
1. Spontaneous miscarriage (called FCS in medical abbreviation)
In the case of a spontaneous miscarriage, the embryo is expelled naturally from the uterus.
2. Early miscarriage
We speak of early miscarriage when the pregnancy ends during the first trimester of pregnancy (before the 14th week of amenorrhea).
3. Late miscarriage
Also sometimes called “late-term abortion,” a miscarriage is considered late if it occurs between the third and fifth month of pregnancy (after the 14th week of amenorrhea). A pregnancy that ends after five months (i.e., 22 weeks after the date of the last period) is called a fetal death.
4. Isolated miscarriage
A miscarriage is considered isolated if the pregnant woman has only experienced one, as opposed to recurrent 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 three. Remember that a miscarriage absolutely does not predict your ability to have a baby later.
What can be the causes and risks of a miscarriage?
It is legitimate to want to understand what happened and to wonder if we “did something wrong”. But this is often a source of guilt for pregnant women, who feel responsible. Spontaneous termination of pregnancy affects approximately 15% of pregnancies, or 23 million worldwide, and 44 pregnancies are lost every minute… (1) . It is therefore a phenomenon that is unfortunately as sad as it is common, and the cause of which is generally not known. A mother can be in good health and still experience a missed pregnancy.
Causes of miscarriage
> Chromosomal abnormalities in the fetus, which then fails to develop properly: this affects the vast majority of cases. The chromosomes are either defective and/or not properly distributed, or embryonic development (nervous system, heart, etc.) is malfunctioning. In this case, the pregnancy termination 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 detach.
> An ectopic pregnancy (in the majority of cases).
> Polycystic ovarian syndrome (PCOS) which can drastically increase the chances of miscarriage.
> The presence of an infection in the pregnant woman: toxoplasmosis, rubella, listeriosis, etc.
> Maternal health problems: coagulation problems, hormonal imbalances, uterine fibroids, uterine malformations (such as a septate uterus), or even autoimmune diseases, chronic diseases, etc. In the case of repeated missed pregnancies, further research is needed to find out if there is a medical cause.
Risk factors
> Age: as with fertility, age unfortunately plays a role against women in the risk of missed pregnancy; it is 12% at the age of 25, rising to 50% at 42 (2).
> Alcohol or drug use during pregnancy (especially heroin, cocaine and amphetamines).
How do you know if you've 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 you should “worry”, because everything is moving inside! To spot the symptoms of a missed pregnancy, carefully monitor:
> The sudden absence of signs of pregnancy that you were feeling (nausea, breast pain, vomiting, etc.)
> Heavy bleeding (with the presence of blood clots, often bright red)
> Severe pelvic pain (pulling in the back or pelvic area is normal, but if it intensifies or persists, this may be a warning sign)
> Contractions (regular and painful) or abdominal cramps
> Fever and chills: Check with 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. If you have any doubts or are anxious—if you feel that something is not going right—urgently consult a doctor, gynecologist, or midwife. Sudden vaginal bleeding, intense pain (in the lower abdomen, abdomen, or back), or loss of consciousness should be immediate warning signs.
What to do in case of miscarriage
There are several scenarios that arise during a missed pregnancy, but in all cases, if you think you have had one, you should 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 she was pregnant at the time the pregnancy ends.
> Medication: Taking medication (misoprostol) takes effect within 12 to 24 hours - a second dose is sometimes necessary - and causes contractions, followed by an opening of the cervix and the expulsion of the embryo. The risk of hemorrhage for the mother is rare, which allows her to stay at home and not be in the hospital during this painful time. A follow-up ultrasound or blood test will follow to verify complete expulsion.
> Curettage: After 10 weeks of pregnancy, a curettage is sometimes necessary to ensure that the fetus and placenta are completely expelled. This involves an endouterine aspiration under general or local anesthesia that allows embryonic tissue to be evacuated from the uterus, performed by a gynecologist. You will be kept in the hospital for a few hours for observation, but this does not require any special monitoring.
Vaginal bleeding often continues after a miscarriage: avoid using tampons or menstrual cups during this time, as these are more "intrusive" protections that can cause pain and promote infection. Instead, use external protection: sanitary towels and/or menstrual panties. It is also best to wait a few weeks before having sexual intercourse again.
After Miscarriage: What You Need to Know
Coping with your perinatal grief
We must not neglect the trauma that a missed pregnancy can cause in pregnant women, regardless of how many weeks along it is. The WHO definition speaks of perinatal bereavement when parents lose their baby between 22 weeks of amenorrhea and the 7th day after birth, but in all cases it is a bereavement to be done, 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 partner, who is also suffering and who often feels helpless. However, if your grief lasts or paralyzes you for too long, do not hesitate to seek support from a therapist or even to join support groups if you feel the need to feel understood. In France, it is estimated that 200,000 miscarriages occur per year (1) so you are not alone. Loved ones may be there 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.
Request sick leave for miscarriage if necessary
Good news! According to Amelie, since January 1, 2024, you can obtain sick leave without a waiting period for miscarriage . To benefit from this, it's simple: your doctor can prescribe you paid sick leave from the first day. Also note that if you prefer your employer not to know the medical reason for your absence, you can request a standard sick leave, with a waiting period.
Give yourself time to heal
We often wonder how long a miscarriage lasts . The truth is that there is no exact answer. Because every woman will experience this ordeal differently. But one thing is certain: to recover, and to be able to consider a new pregnancy as serenely as possible, we obviously believe in the healing power of time. It allows both the body and the heart to get back in shape, little by little, and makes the heavy feeling of guilt disappear after a termination of pregnancy. Even if you are the only one who knows when you will be ready, it is recommended to wait at least a few cycles before trying to get pregnant again. But keep faith because a miscarriage in the past will not prevent you from having a future normal pregnancy. Remember to check with your gynecologist that the return of menstruation has indeed occurred (some women can develop “psychogenic amenorrhea”, a psychological blockage of periods) following your missed pregnancy.
Prepare for another pregnancy when you feel ready
If you are considering another pregnancy, you need to prepare both your mind and your body to experience this joyful event again. While time may eventually soften the trauma and remove the fear that it will happen again, you can take action in the meantime by giving your future mother's body a little boost. To boost your fertility - and at the same time reassure you by regaining confidence in your ability to carry a pregnancy - we have created a dietary 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 who are about to become pregnant, those who have recently become one, 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 the good times as well as the bad!
You may also be interested in this article: Signs of Ovulation
Finally, if you're pregnant again (congratulations!), don't hesitate to have early follow-up ultrasounds (including the first one as soon as possible) to check that everything is going well. And take care of yourself, of course!
Sources:
- https://www.thelancet.com/series/miscarriage
- Health Insurance Figures
