Types of miscarriage, how do we ‘get through’ baby loss of any form?
Understanding the different types of miscarriage. The emotional journey of miscarriage, baby loss, early loss, miscarriage, missed misscrarrige, ectopic & stillbirth. What makes it easier and knowing you're not alone...
After a long battle with pregnancy loss surrounding our beautiful earth side girls, we've come to be very familiar with the heart ache this situation brings. We have 10 angel babies in total, all of which fall into many of the 'categories' below.
This is a blog that I've been asked to write so many times, I've actually tried to write it since September this year. If I'm honest, even with everything I have shared about our experiences, I have found it difficult, to know what to say. There's so much we keep private, we've only told part of our story publicly, because the truth is, I still find it painful, no matter how open I may be about many of our losses. But that's just it... no amount of time makes loss, go away. If you have experienced loss, there's a fair chance you will have felt society's pressure to 'just move on'. We as a group know, you don't 'move on' from loss, you find some way of coping, your own way and you move forward, a tiny step at a time, reluctantly, painfully. But somehow you find a way to live with the pain.
Its likely from strangers, family & friends, no doubt you've been accustomed to many insensitive comments too, the top ones always being; 'Everything happens for a reason''
'Atleast you know you can get pregnant'
'You can just try again'
'Just be thankful for what you have'.
These comments help NO ONE, so never feel bad for being offended or stepping back from someone for a while, whilst recovering from comments that you find hurtful, even if you know there may not have been any malicious intent. These comments and alike, can be damaging to mental health and devalue the pain of those people involved.
Miscarriage occurs in 1in4 pregnancies, 1IN4! That is an insane statistic for the 21st century, with so many left asking why us, why our baby? Sadly after one loss the nhs will not generally investigate, they wait until a woman falls into the 'reoccurring loss' bracket. Reoccurring loss, is a little less common, but still a fairly common occurrence, happening to 1in100 women. It often takes 3 losses for the nhs to start any sort of investigation, any less than 3 miscarriages, concluded 'not enough' and not 'reoccurring'. There is a heavy call for reoccurrence to be began from 2 losses, which makes perfect sense, but sadly there isn't enough funding in this area, to action this plan. Charities like 'Tommys' work tirelessly to have the investigations began earlier (from 2 losses) and prevent further heartache, and find answers sooner.
I think it's easier to understand loss by breaking down the different types. Loss is experienced in various ways, but netherless, all loss is VALID. Whether this helps you personally to accept or validate your own loss or helps you to understand better someone else's loss, pain and grieving, I really hope this helps in some way. There are many types of pregnancy loss, but some types are; Early loss (sometimes referred to as a chemical pregnancies- personally I do not like this term), Missed Miscarriage, Molar pregnancy, Ectopic pregnancy, TFMR (termination for medical reasoning), Embryo loss, Still birth.
(There are other types of loss too, this is just a selection of some of the most common)
Early loss (Chemical pregnancy)
One of the most common forms of loss, but also a very confusing type, that is often overlooked or downplayed because of the loss having happened so early on. Some people who experience this loss will not know they're pregnant, they may experience a heavier period and be none the wiser. Others will already have found out with a positive test, normally those who had been trying and testing early. Sometimes home pregnancy tests will be positive for short periods of time, followed by negative tests. As you probably know HCG, (the pregnancy hormone) should atleast double every 48hrs to signifiy a progressing pregnancy, so if tests were obviously positive one day and negative a few days/week later, there's a chance a chemical pregnancy may be the reasoning. This type of loss IS a miscarriage and therefore falls into the next category and in terms of reoccurring loss, this should be included as a loss by yourself and medical professionals. This type of loss usually occurs around the time a period was due, but is officially identified as a pregnancy that was 'too early' to be visualised on an ultrasound scan so a loss before around 6weeks gestation. No matter when anyone looses a baby, a loss is a loss, just as devastating and heartbreaking. The most common reason's identified for early loss (not the only reasons of course) are; chromosomal abnormalities, egg quaility, sperm quality, blood clotting disorders, vitamin D deficiency, Low progesterone. Many of the test's surrounding these causes will be performed under miscarriage clinic investigations as standard.
Miscarriage & Missed miscarriage
A miscarriage is defined as any pregnancy loss prior to 23 weeks of pregnancy (inc. early loss and most on this list). A missed miscarriage, sometimes called a 'silent miscarriage' is when the baby passes away but your body does not expel the pregnancy on its own. Over half of our own losses were this type, at various gestations. Sadly, for many this type of loss is when people will attend a scan, with no reason to suspect there is anything wrong and the baby(s) will have no heartbeat. Blited ovum's fall into this category too, this is when the pregnancy sac will grow and grow in line with gestation, or sometimes more rapidly, so the body believes it is still pregnant, but there will be no baby inside said sac. With a missed miscarriage, If the loss is identified early on, sometimes the hospital will ask couples to come back in a few weeks to 'be sure' before any treatment options are offered. Treatments for missed miscarriage are; 'watch and wait', this is often suggested if the loss was recent, to give the body a chance to refresh on its own. The second option is 'medical management' which requires the female to take, have an IV, and/or insert medication that induces the body to expel the pregnancy, it will lead to cramping and heavy bleeding. Often this works for many and is the preferred option but sometimes the medication doesn't work completely and 'surgical management' is required. For reference you can opt for surgical management from the get go if you so wish. Many prefer this, especially those who have had many losses, or those who just need the heartache over as soon as possible. Surgical management (also known as a D&C in some hospitals) is when the cervix is softened and opened and suction is used to remove the pregnancy, this is often done under sedation or general anaesthesia. Some find the surgical route less traumatic in terms of 'what they see' during the loss. But of course none of these options are nice, and any choice made is a heartbreaking one. There is no right or wrong decision here, whether you choose to wait, medical or surgery, do what is right for you, your physical and mental health.
(Personal story- With our first missed miscarriage, we found out the baby had died at 10 weeks, we waited and waited for it to happen naturally, bleeding heavily on and off. My body just didn't pass the pregnancy. I tried the medication, it didn't suit me and didn't work unfortunately. We got all the way to 16 and a half weeks before we opted for surgery. It felt like the heartache and physical pain had been dragged on for so long, and for me in hindsight, that particular pregnancy, I wish I had opted for surgery earlier on)
A molar pregnancy is when there's a problem with a fertilised egg, which means a baby and a placenta do not develop the way they should after conception. A molar pregnancy will not be able to survive either a partial molar or fully molar pregnancy. It happens by chance and is very rare. It is often identified by exceptionally high HCG (pregnancy hormone) in the woman's body for gestation. A molar pregnancy has to be removed, usually via a surgery, sometimes needing other areas of the womb removed too due to being imbedded deeply, this is generally performed under general anaesthesia.
An ectopic pregnancy (sometimes called tubular) is when the fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues. Sadly, though there's nothing we want more, it's not possible to save the pregnancy. Treatment options include high doses of medicine that aim to break down the pregnancy (often used at earlier gestations) or surgery. If caught early the surgeons may be able to remove the pregnancy with minimal damage to surrounding areas. Though it is common to loose the tube the pregnancy is in. If the tube had ruptured, which can happen when the pregnancy goes unidentified, is a medical emergency (symptoms CAN include; heavy bleeding, significant one sided pain, spotting, pain when bending, leaning & twisting BUT not always). If this happens you need emergency care and an immediate operation to stop the bleeding, if this happens the pregnancy and any damaged tissue would have to be removed, in a life saving capacity.
In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year (nhs) so it's always worth knowing the signs of this type of pregnancy. If you're newly pregnant and experience one sided pain, with or without bleeding, on & off or consistently, and haven't yet had a scan that has said your pregnancy is placed correctly, call your local EPU and express your concerns. Sometimes if scanned and they can't locate a pregnancy (maybe you're too early) they may identify it as a 'pregnancy of unknown location', this does not mean your pregnancy is ectopic, it could just be you're way to early to visualise the baby on a scan, BUT, it does mean there is a chance, so at this point make sure you're looking out for the symptoms of ectopic pregnancy just in case. Ruptures happen at various gestations, some people go a long way into their pregnancy unknowingly and others only a matter of weeks.
TFMR (termination for medical reasoning)
A form of loss, perhaps understood by only a very small group of people. TFMR is loss, a wanted baby that for medical reasoning, be that of the mother or child, it would not be safe or fair for them to be brought into this world. An example of why couples may be forced to make this devastating choice is something like, Edwards syndrome (Trisomy 18) a chromosomal abnormality which usually results in the child being stillborn or dying shortly after birth, often after a potential period of struggling. Many families (not all) may decide they feel it is fairer to end the pregnancy or they know they can not deal with the heartache of a full pregnancy, ultimately knowing the end result. TFMR applies to a broad range of situations and is often overlooked as a 'loss' but for sure should be considered as one. Parents would grieve this baby, just as any other parent of loss, potentially with an added layer of guilt, which is heartbreaking to imagine.
For ladies or couples undergoing ivf this is something you may have dealt with. Embryo loss can happen in many forms, that could be a embryo that fails to implant after it's transferred (remember most 'babies' are around 5 days old at transfer so already a forming pregnancy). The woman will find out the embryo has failed to implant when she takes a home pregnancy test, this can be devastating, the embryo was living, so is felt like any other loss. Other types of embryo loss include embryos that were previously frozen that do not survive the thawing process, that they undergo before transfer to the uterus. Many people, who themselves have encountered this or know people who have, disregard embryo loss. The individual or couples disregard their own loss of this form sometimes because society suggests embryo loss, isn't a loss. BUT, we know it is just as devastating to a couple as the other forms of loss. There is often an added layer of cycles having failed, which causes added pressure and strain.
Still birth is the loss of a baby, before or during delivery, 24 weeks onwards. It happens in around 1 in every 200 births in England. If the baby has passed, and the labour hasn't started on its own, there is sometimes an option to wait, but often labour will be induced. If there are other complications at play, like infection, the baby will usually be delivered promptly. It rarely happens where they deliver a stillborn baby, they know to have passed already, with no other complications, via C-section. There are many potential reason for a baby to be still born, but often they relate to the placenta (the connector between baby and mother). Stillbirth can happen with no sign or signal prior, and often with no real explanation. For those at risk of stillbirth, women are asked to be very hyper aware of their babies movements. Never feel silly to get checked out, trust your gut! Stillbirth is heartbreaking, and requires a legal registration of birth and death to be fulfilled in the U.K.
With the tragedy of still birth a funeral, burial / cremation is normally a 'must' legally in the U.K. But it is worth noting here that a loss at any gestation, you are able to request back your babies remains. It can be such a difficult time and something so many couples are scared to ask about. It's good to know that with some early losses the hospital has a procedure for 'mass cremation' where they cremate lots of babies together of similar situations, locally. You should be given info of where and when this is happening to be given the chance to attend, if they haven't mentioned this, definitely ask if you're able. You can also choose to take your babies remains home (pre 23weeks) and have a private burial or cremation, including on your own land if you so wish. Some couples find comfort in planting memorial trees and alike to mark their special little ones, they use these as a place of reflection.
Misscarriage and baby loss is an agonising experience in any form for all involved. It is made worse for many couples by the lack of answers. It is very difficult to move forward from an experience that you have no idea why it happened. But, sometimes answers make things even more heartbreaking and confusing, it's a real double ended sword.
For anyone who has experienced loss in any way, there is comfort in knowing, we are not alone. So many ladies will have been through this, even those who do not talk about it. Everyone has their own way of dealing with their pain. Some people close off and want to try and forget the trauma, whilst others are more vocal about their experience, they want their children to be spoken of. There is no right or wrong way 'to be'. There is no amount of time that can pass, when you should be 'over the loss'. Your baby, or babies, are special, they're yours, and no one knows the pain you've felt during this process.
So the answer to, how do we ‘get through’ baby loss of any form? Is... There really isn't an answer. We move through, we try our best. But it's okay to be angry, scared, upset. It's all part of this awful journey.
There's so many resources and charities out there working tirelessly to fund research into loss. During our own journey we have found various groups and charities very supportive, whether it be forever contact or just being apart if their social communities. See below links to the instagram pages for said groups;
I really hope this blog has given you a better understanding of the types of loss and you've found comfort in the knowledge, you're not alone! Feel free to follow us on instagram (@withtherobbins) where there is a community of so many likeminded ladies. Also always free as a caring ear for anyone who needs advice, always.
With The Robbins