What is a late miscarriage?
Doctors describe a late miscarriage as one that happens after 12 weeks and before 24 weeks of pregnancy.
What causes late miscarriage?
Late miscarriages are rare (of all miscarriages about 1 in 100 happen in late pregnancy) but they can just happen for no reason. However they are often linked to a medical issue – some of which include:
Problems with your uterus (womb). You may have a uterus that has an abnormal shape, fibroids or cervical weakenss.
A condition that affects your blood, such as sickle cell anaemia.
A condition that affects your hormones, such as diabetes or a thyroid disorder. These conditions may not cause a problem if they are properly managed while you’re pregnant.
A bacterial infection that can cross the placenta. Listeriosis is an infection you can get from food poisoning. Toxoplasmosis is an infection you can pick up from eating undercooked meat or from coming into contact with cat faeces. Both of these very rarely happen and are easy to avoid.
A viral infection, such as rubellla or an infection that can cause a high fever. You’ll be tested for rubella when you find out you’re pregnant. Most women are already immune, because they’ve already had the illness, or have been vaccinated.
A vaginal infection, such as bacterial vaginosis or, very rarely, group B Streptococcus. It’s possible, but unlikely, that these infections track up the vagina into your uterus.
Any serious illness involving your heart and blood circulation, or your liver or kidneys could cause a late miscarriage.
There are other factors that can lead to a late miscarriage. Sometimes, parents want to find out as much as possible about their baby. They may decide to have a diagnostic test, such as chorionic villus sampling (CVS). This test can tell you if your baby has a condition such as down’s syndrome.
Unfortunately, the way CVS is done means it can lead to miscarriage a few days later. CVS carries a 1 in 50 chance of causing pregnancy loss. The risks and benefits of taking a diagnostic test should always be clearly and carefully explained to you. This will help you make the important decision about what you want to do. (Private testing and certain consultants, can sometimes offer the test with a much smaller risk due to the equipment used.)
Very rarely, a late miscarriage will happen because there is a problem with the baby’s development. The problem will have arisen at fertilisation, when the wrong number of chromosomes passed from the mum and dad. Conditions such as Edwards’ syndrome and Patau’s syndrome are examples of chromosomal abnormalities that can lead to miscarriage.
There is a slightly higher chance of miscarriage with twin pregnancies, particularly if the babies are identical twins. Remember that the vast majority of twin pregnancies result in healthy babies. You’ll be looked after by a specialist team and will be offered extra scans to keep an eye on your babies.
How do I know if I’m having a late miscarriage?
The most obvious signs of late miscarriage are labour-like cramping pains and bleeding. The bleeding may be heavy and have blood clots. Other signs may be that your waters have broken or you can no longer feel any movement in your uterus.
Sometimes, there are no warning signs and the miscarriage is discovered during a routine antenatal appointment or ultrasound scan.The news will come as a great shock. It can be hard to understand or accept, because you had no idea what had been happening inside your body.
You may need treatment to help your body recover. Labour may have to be started artificially, or induced. This will mean you will have to go into hospital.
You may want to go ahead with the induction as soon as possible. If so, you will given medication, either by mouth, or pessaries via your vagina, to induce labour. Or you may prefer to wait for a few days, to give you time to take in what has happened and to see if labour starts naturally. Whatever you decide, doctors will take your feelings into account when discussing induction.
A late miscarriage can be painful, just like ordinary labour. You will be offered pain relief to ease you through this difficult stage. The pain relief will be very effective. It will be morphine-based, and you should be able to control it yourself.
What will happen after the miscarriage?
Depending on the stage of pregnancy, some parents are asked if they would like to see, touch or hold their baby. This is a very individual decision and you may find it hard to make “in the moment”. You can’t know whether seeing your baby will help you emotionally in the long term.
Some parents want to see their baby but are worried about what he or she might look like. Your midwife or doctor can describe your baby to you to help you make the painful decision. You can ask for photos to be taken even if you are undecided whether or not you want to look at them. Some people know instinctively that they don’t want to see their baby, whereas others choose not to for faith or cultural reasons.
Creating memories such as photographs, hand or footprints or a lock of hair from their babies provides comfort to some parents. It helps them to have a focus for their grief. However, these decisions are highly personal. There is no right or wrong approach, and you can take your time to think things through.
If you want spiritual support, hospitals have their own chaplains who can offer you comfort. Most maternity wards have a special room where parents and their families can be together after their loss. You may find solace in visiting the hospital chapel.
Whatever you decide to do in the hours or days after your loss, the hospital staff should support you in your decision and respect your wishes.
Will I be able to find out what went wrong?
There are tests that may help doctors find out what happened. Your blood will be tested for signs of an infection or clotting problems and the placenta can be checked for signs of infection too. You can consent to a doctor carrying out a post mortem examination (autopsy) of your baby. A post mortem examination may reveal:
- any health problems which may be important to take care of in a future pregnancy
- whether your baby’s development was normal
- a cause or causes of the miscarriage
- your baby’s sex
Unfortunately, though, the chances of finding any cause is very small.
Some parents decide against a post mortem for personal, religious or cultural reasons. To help you reach a decision, you should be given information about what will happen and time to absorb it. Do say if you’d rather not know the details.
If you decide to go ahead, you should be told when the post mortem results are likely to be available, and given an appointment to discuss them with the doctor. The wait for results is usually about six weeks.
What practical arrangements need to be made?
You do not legally register a baby lost before 24 weeks of pregnancy, if there were no signs of life (in the UK). However, it’s often important to parents to acknowledge their baby formally. Your hospital may provide a birth certificate for babies lost to late miscarriage.
There is also no legal requirement for a burial or cremation. However, most hospitals offer a simple funeral service. Some parents prefer to make their own arrangements for a private burial. In this case, the hospital provides a form or letter, saying that your baby was born without signs of life before 24 weeks.
Many parents decide to mark their loss with a formal or informal memorial ceremony. Of course the Saying Goodbye services are available to anyone who has lost a baby, whether you have previously had a private service or not.
How will my body recover?
In the first few weeks, you may have some vaginal bleeding and intermittent period-like pain. Usually, this bleeding slowly tails off. But if the bleeding or pain gets worse or you have a unpleasant-smelling vaginal discharge, call your GP straightaway. There may be some tissue from your pregnancy left behind or you may have an infection.
You may find the changes your body is going through are a distressing reminder of your loss. Your breasts may produce milk. This is normal but is upsetting as well as physically uncomfortable. In time, the milk will dry up naturally. The first week is usually the worst. Taking medication to stop the milk may not be better than letting nature take its course in the long run. But it is an option if you’re finding it really tough.
You can help yourself through this difficult time by:
- easing discomfort with painkillers, such as paracetamol or ibuprofen, cold compresses or warm showers
- wearing a good supportive bra and using breast pads to absorb the milk
- expressing a little milk to ease engorgement
In the first few weeks, you’ll be cared for in the community by midwives and then a health visitor may take over. You’ll also be offered a check-up after six weeks with your GP, and a later appointment with a hospital consultant.
This is a good opportunity to ask questions about the possible causes of your loss and what it may mean for a future pregnancy. It may also be a chance to discuss the post mortem results if they are available. If they are not, you should be offered another appointment. Your GP can also give you a sickness certificate for your employer if you and she feel that you need more time to recover.
All information on this website, and advice and support offered by the charity team is on a non-medical basis. The charity advises that anyone going through baby loss, medical treatment or health issues, should seek advice from their own GP, Consultant, Midwife or Healthcare Professional.Download the Saying Goodbye Support Leaflet (PDF)