A guide for women and families experiencing early pregnancy loss

Dear Grieving Family,

 

Pregnancy loss is a unique and often ‘alone’ event in a woman’s life. Healing occurs more readily when physical and emotional changes are understood. We hope that this pamphlet will help you with your recovery and assist you to care for yourself following your miscarriage.

 

 

First… A few words you may hear…

 

Miscarriage – “Plain English” term for the loss of a pregnancy, usually refers to early pregnancy loss (up to +/- 20 weeks)

 

Spontaneous Abortion – Medical term for naturally occurring pregnancy loss. Often written on your chart as “SAB”.

 

There are 3 types of Miscarriage/SAB:

 

“Complete” – The fetus, placenta and other tissue have been passed and the uterus is empty.

 

“Missed” – The fetus has died, but the process of naturally emptying the uterus has not yet begun. The woman may no longer “feel pregnant” but does not yet have miscarriage symptoms such as bleeding or cramping.

 

“Incomplete” – the process of miscarriage is in progress, but not yet complete. The woman will be experiencing symptoms such as bleeding and cramping. Depending on the individual situation, in consultation with her caregiver, the woman may choose to

  • await spontaneous completion
  • use medication to assist completion
  • complete the SAB surgically (D&C)

 

 

A few Resources:

 

We have spent a lot of time searching the internet for good information for parents experiencing pregnancy loss. These three websites stood out as useful, up to date and compassionate sources of information….

 

http://www.griefwatch.com/

 

A website with a special section for pregnancy loss. Good information and resources for parents.

http://www.aplacetoremember.com/Support from other families who have experienced pregnancy loss

 

http://www.parentbooks.ca/Pregnancy_&_Infant_Loss.html

Books for parents, children and professionals about pregnancy loss, grief and recovery

 

http://saanichlegacy.ca/spirits.html

 

“Little Spirits Garden” at Royal Oak Burial Park – a special memorial garden in Victoria that is designated for babies lost to miscarriage and stillbirth.

 

Taking Care of Yourself …

 

 

Physical Changes Following a Complete Miscarriage

 

Over the next few days you will experience many physical changes as your body returns to a non-pregnant state. You may experience vaginal bleeding similar to a heavy menstrual period. This will taper off over the next week. In a couple of days you may notice some breast tenderness and some leaking of fluid from your breasts. This is an expected part of your recovery and will also subside in about a week’s time. You may resume normal living and working activities as you feel up to it. Some changes in your body may require discussion with your caregiver.

 

Prevention of Infection

The entrance of the uterus (cervix) remains partially open for several days after pregnancy loss. During this time, bacteria can enter the uterus and cause an infection. It is important that you take the following precautions:

 

  • Use sanitary pads, rather than tampons, while you are bleeding
  • Refrain from having sexual intercourse for at least one week. This is usually when bleeding has stopped and the cervix is closed. Using a condom is recommended if you are still having vaginal
  • Do not douche until after you have discussed this with your caregiver
  • Refrain form using a Jacuzzi, jetted bath, or swimming until your flow has stopped

 

 

Call your caregiver if any of the following   occur:

 

  • Bleeding for more than two weeks
  • Bleeding heavier than a normal period for more than 24 hours (you can expect a light to moderate flow for 3-4 days)
  • Foul-smelling vaginal discharge
  • Severe abdominal pain
  • Nausea, breast tenderness, or bloating
  • An elevated temperature (over 38 degrees or 100 F) or a feverish feeling, chills, or fainting

 

 

Incomplete Miscarriage …

 

Your choices for care

If your miscarriage has not completed naturally and you have no signs of infection or heavy bleeding you and your caregiver may choose one of the following 3 options:

  • Wait for miscarriage to complete naturally
  • Use medication to complete the miscarriage
  • Schedule a “D&C” – a simple surgery to complete the miscarriage

 

Option A … waiting

If you choose to wait for natural completion of your miscarriage, it is important that you and your caregiver have a clear plan regarding signs of concerns to report, how long you are both comfortable waiting, plans for follow up care or ultrasound, and at what point you might need to change your plans to either option B or C

 

Option B … medical completion

Medical completion of a miscarriage for Missed or Incomplete SAB is becoming more common. Many women prefer this option as they can have some control over timing and prefer to miscarry in the privacy of their own home. The medications used to help your body to complete the miscarriage include: Misoprostol (cytotec) or Mifepristone (mifeprex)

It is important that you follow your caregiver’s instructions about the medication she has ordered to complete your miscarriage. The medication is meant to cause your uterus to cramp and expel the foetus, placenta and tissue. Bleeding may be quite heavy for a short period of time. Ask your caregiver for recommendations for oral pain medication, as it can be helpful to ease the pain of the procedure. Once you have passed all the contents of the uterus, the bleeding and pain will subside. Ask your caregiver for clear guidelines regarding what is normal to expect and what to do if there is excess pain or bleeding.

 

Option C … schedule a Dilation and Curettage (D & C)

 

In previous years, a surgical procedure called a D& C (Dilation and Curettage) was frequently performed after a miscarriage. This is less common practice today, but a D&C may be recommended if the miscarriage is incomplete or if there is excess bleeding or signs of infection. Whether you need a D&C is a decision that you and your caregiver can make based on your individual situation. This surgery does not involve any cutting. The cervix is gently stretched open and the tissue lining of the uterus is removed with a spoon-like instrument (curette) or suction. A D&C is usually preformed under general anesthetic or sedative medication. The medication may alter your mental and physical abilities for several hours. You may experience hoarseness, sore throat, or muscle aching in the first 24 hours after a general anesthetic. These symptoms usually disappear by themselves.

 

Post–Operative Recommendations:

The doctor who does your surgery will be responsible for your care and will give you specific instructions based on your individual situation. Here are a few general guidelines:

  • You should be accompanied home by a responsible adult
  • Rest at home the remainder of the day. Do not plan any other activities for 24 hours. Arrange for   someone stay with you
  • You should not drive an automobile or operate hazardous machinery for 24 hours following
  • You may feel some dull cramping in your lower abdomen for a few hours. You may take pain relieving medication as recommended by your caregiver
  • Do not drink alcohol for 24 hours since its effects will add to the effects of the

 

 

My Care plan    …..

 

 

My name                                                                               

 

Due date          /       /                Weeks pregnant                     

 

Care card number                                                                  

 

My Care plan (check applicable)

I have had a:           Complete miscarriage (date)              /     /     

 

     Incomplete miscarriage (date)           /     /     I am planning to:

     Wait for a spontaneous completion

     Complete medically

     Schedule a D&C

 

My follow up plans include:

Call                                                at #                        if excess bleeding, pain or signs of infection occur

 

D&C scheduled        /     /      at                       Hospital with Dr.                    _Tel #                      

 

Follow up office visit(s) to be scheduled with                                 Tel #                           date       /      /    

 

                             Tel #                           date       /     /      ]

 

          Ultrasound booked for        /     /      at                                         

 

          Medication has been ordered by Dr.                                     For:

     Pain

     Prevention/treatment of infection

     To complete the miscarriage

 

 

What to expect in the weeks following your   miscarriage…

 

Menstruation

You should have a menstrual period in 4 to 6 weeks. If this does not occur, consult your caregiver

 

Birth Control

Birth control must be used when you resume sexual intercourse. It is possible to become pregnant immediately after a pregnancy loss, even before menstruation has started. Ask your caregiver or contact Island Sexual Health Society (http://www.islandsexualhealth.org/) for more information.

Future Pregnancy

It may be advisable to wait a few months before considering another pregnancy to allow the mind and body to recover fully. Discuss this with your partner and your caregiver.

 

Emotions

Physical recovery occurs quite quickly while emotional recovery may take a little longer. This may be influenced by other events happening at the same time, for example, holidays. Some women may experience little or no emotional upheaval while others may experience feelings of sadness, depression, anger or guilt. All of these are feelings of grief and can diminish over time, if you can “reach in” and allow your grief to surface. Working through feelings of grief can extend from a short time to many months. Support from family and friends may not always be present or appropriate. Coping mechanisms are founded in family structure, as well as cultural and religious beliefs. If you feel you need someone to talk to, there are skilled persons in your community. Discuss a referral with your caregiver, or select a resource located at the back of this pamphlet. If you are in hospital you can ask your caregiver or nurse about resources that are available to help you in hospital and in the community once you go home.

 

You may experience many feelings

These feelings may include numbness, shock, confusion, exhaustion, disbelief, anger, fear, isolation/aloneness, pining/yearning, responsibility/guilt feelings, sadness, mood disorders, impaired memory or concentration, appetite, sleep changes and even depression. The intensity of these feelings can range from mildly bothersome   to quite overwhelming. Recent studies show that there is often no order or sequence to grief and that different feelings surface at different times throughout the bereavement period.

Children are unprepared for loss, and will require patience and love in helping them to understand. How much your children can understand depends on your child’s developmental readiness. Generally children deal best with loss if they are provided with “age – appropriate” information. There are booklets especially prepared for children. Family and Friends want to do the right thing but often are unsure how to help. Let them know what you are feeling and what you need at this time.

Your Partner also suffers the loss of this pregnancy and can experience many emotions and feelings. This can   be a very difficult time for partners since it appears there is little they can do to help. Each partner has sustained a different loss and has a unique mourning experience. Partners may experience feelings of being left out since the focus of attention is with the woman who has experienced the loss in a physical way. Traditionally, a man is expected to remain outwardly strong to support his partner. He may hide feelings of sadness and loss as he tries to support his grieving partner. Same sex partners may feel left out as caregivers may not recognize that they are also a grieving parent.

 

A couple experiencing grief over a pregnancy loss often discover that their grief responses can be different from one another. No two people grieve alike or at the same time. This is normal. However, it can place a strain on your relationship if not recognized. Talking about differences with each other can be helpful. Partners may also play an important role in telling the other family members (including children) what has happened and what will happen in the immediate future. It is important to discuss with your partner how you will handle questions from children, family and friends.

 

 

Facing The Future

 

In the past, early pregnancy losses were not well understood or honoured. It is now recognized that miscarriage is a profoundly sad event in many family’s lives as they grieve the loss of their child. Making future family planning decisions are difficult at this time. It may be easier to face these future decisions when your grief is less intense. While grieving, you may feel physically and emotionally drained. Take time out. Make arrangements for private time and rest. It is important to grieve the loss of this pregnancy before planning another.