29.OCT.2020 4 MIN READ | 4 MIN READ

A miscarriage is a painful and difficult experience. As a couple overcomes their grief and loss to try for a child again, here are some factors to consider.

A miscarriage is a very painful and difficult time for couples. A first trimester miscarriage is the most common type.

The incidence of an early pregnancy loss is as high as 31%. This decreases to 10% when considering clinically recognised pregnancies.

If you have recently suffered a miscarriage, you may be overwhelmed with emotions and questions on why it happened and how you can recover from the grief and loss. Although each of us deals with loss differently, this article will help provide answers to the common questions couples ask after a miscarriage.

What causes a miscarriage?

Miscarriage causes alcohol smoking
There are many possible causes of a miscarriage.

Most miscarriages happen during the first trimester, the period most critical to a baby’s development in the womb. In first trimester miscarriages, the most common cause is chromosomal abnormalities of the foetus. Chromosomes are structures that carry the genetic material, and most chromosomal abnormalities happen by chance.

Other possible causes of miscarriage include:

  • Abnormalities of the uterus or cervix
  • Exposure to toxic agents or radiation
  • Infections
  • Intake of certain medications that interfere with normal pregnancy
  • Maternal diseases, such as kidney disease, uncontrolled diabetes, and autoimmune diseases
  • Smoking, alcohol consumption, or use of illicit drugs

Are there different types of miscarriage?

There are different types of miscarriages, each present with different symptoms.

Threatened miscarriage

In a threatened miscarriage, a woman develops symptoms of miscarriage, such as abdominal pain and vaginal bleeding. However, the cervix remains closed. Some women can continue to have a healthy pregnancy, while others may progress to a complete miscarriage.

Inevitable miscarriage

In an inevitable miscarriage, the woman also has abdominal pain and bleeding, but the cervix is already open. The foetus will eventually be expelled from the uterus along with bleeding.

Complete miscarriage

A miscarriage is considered complete when all pregnancy tissue has left the uterus.

Incomplete miscarriage

In an incomplete miscarriage, some pregnancy tissue remains in the uterus. This causes continued bleeding and abdominal pain. Sometimes, a procedure called dilatation and curettage is needed to remove the remaining pregnancy tissue.

Missed miscarriage

This type of miscarriage is less common. The woman does not experience any symptoms, but the foetus stops growing inside the uterus.

Can I get pregnant again?

Women who experience pregnancy loss may try to get pregnant again as soon as they are medically recovered and psychologically ready. Studies do not report benefits for a delayed interval to conception.

It is best to avoid sexual intercourse while you still have bleeding to avoid infection. It may also be helpful to wait until a regular menstrual period so that you can better calculate the age of your baby in the next pregnancy.

It is also important for couples to be emotionally and mentally prepared for another pregnancy. Ultimately, the timing of when to try again for a baby is a very personal decision and should be carefully discussed by the couple.

How do I prepare myself to try for a baby again?

Baby after miscarriage doctor
After suffering a miscarriage, it is important to take care of your physical and emotional needs.

Try to get as much rest as you can and eat well-balanced meals so that your body can recover. The duration of recovery varies depending on how far along you were in the pregnancy. You may experience bleeding for few days and spotting for a few weeks after. You may also have mild abdominal cramps for a few days. Your doctor may advise you to monitor your temperature for the first few days to see if you develop a fever.

Allow yourself to experience, and express your emotions. Miscarriage can cause a wide range of emotions, including sadness, anger, disappointment, guilt and grief. Give yourself time to process these emotions.

There are different ways that couples grieve and work through these difficult emotions. You can ask help from family, friends, or other couples who also had a miscarriage. You may also find it helpful to join support groups for couples who experienced miscarriages. Other couples find it most helpful to lean on each other through these difficult times.

Accepting the loss is difficult, but it is an important step for you and your partner so that you can heal.

If you and your partner decide that you are ready to try again, it is recommended to take folic acid supplements to avoid birth defects of the foetus.

Will I miscarry again?

Most women are able to have a healthy pregnancy after experiencing a miscarriage. However, approximately 1% can have recurrent miscarriages, defined as having at least 2 consecutive miscarriages.

If you experience recurrent miscarriages, your doctor may request for tests to find out the underlying cause. These tests include ultrasound of the reproductive organs and certain blood tests.

When in doubt, consult your obstetrician for more information about how you can prepare yourself to try for a child after a miscarriage.

 

Article reviewed by Dr Clara Ong, obstetrician and gynaecologist at Gleneagles Hospital

References

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HTSP 101: Everything You Want to Know About Healthy Timing and Spacing of Pregnancy, retrieved on 28 September 2020 from https://www.who.int/pmnch/topics/maternal/htsp101.pdf. (n.d.)

Marcin A. Pregnancy After Miscarriage: Answers to Your Questions, retrieved on 28 September 2020 from https://www.healthline.com/health/pregnancy/pregnancy-after-miscarriage. (13 November 2019)

Pregnancy after miscarriage: What you need to know, retrieved on 28 September 2020 from https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134. (12 March 2019)

“No need to wait to conceive after miscarriage”, retrieved on 28 September 2020 from https://www.miscarriageassociation.org.uk/2016/11/no-need-wait-conceive-miscarriage/. (30 November 2016)

'No need to wait to try again after miscarriage' advice, retrieved on 28 September 2020 from https://www.nhs.uk/news/pregnancy-and-child/no-need-to-wait-to-try-again-after-miscarriage-advice/. (01 December 2016)

Types of Miscarriage, retrieved on 28 September 2020 from https://www.familyeducation.com/pregnancy/miscarriage/types-miscarriage. (n.d.)

Cherney K. Pregnancy Loss: Processing the Pain of Miscarriage, retrieved on 28 September 2020 from https://www.healthline.com/health/coping-with-miscarriage. (08 March 2019)

Miscarriage, retrieved on 28 September 2020 from https://my.clevelandclinic.org/health/diseases/9688-miscarriage. (22 July 2019)

Causes: Miscarriage retrieved on 28 September 2020 from https://www.nhs.uk/conditions/miscarriage/causes/. (01 June 2018)

29.OCT.2020
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Ong Aihui Clara
Obstetrician & Gynaecologist
Gleneagles Hospital

Dr Clara Ong is an obstetrician & gynaecologist at Gleneagles Hospital, Singapore.