Late miscarriage in the second trimester
Although most cases of miscarriages occur during the first trimester, there are some mothers-to-be who will be unfortunate enough to experience a miscarriage during weeks 14 to 24. Although much less common, a mother who miscarries at this stage of the pregnancy may feel confused, shocked and unclear about why her pregnancy ended at this stage.
It is a heartbreaking event to lose a baby and it will take time for you come to terms with what has happened.
Why a late miscarriage is not a stillbirth
It may make you feel some distress that a loss in the mid trimester of your pregnancy is referred to as a miscarriage rather than a stillbirth. The reason this happens is because 24 weeks is the legal gestational age, or point at which, a fetus is considered ‘viable’. It is considered that no baby born prior to this date would be able to survive.
Going through a miscarriage
When you experience a late miscarriage the event will happen in one of two ways.
It could be a spontaneous, natural event where your body will begin to go into labour with contractions. Your waters may also break. This episode will be quick and you won’t be able to stop the birth. You should call a hospital or your midwife to get help and treatment.
Alternatively, a problem may have been revealed at a scan, which identified that your baby has died. You will be offered help and advice on how you wish to manage your miscarriage, which is usually an induced labour conducted at the hospital. You will be given plenty of time to think about what you have been told and to decide when you feel ready to begin the labour.
Coming to terms with the news you have received will be a shock and you may find it difficult to think about and make decisions that you had not expected to make at this stage of your pregnancy. The hospital staff will help guide you through but it is always a good idea to have your partner, friend or adult family member with you for support.
Seeing your baby
When the miscarriage happens you may wish to see, hold or touch your baby. You do not have to do so if you are too worried or feel that you can’t. The hospital staff will describe your baby to you; you are free to change your mind if you want to see your baby at this point. You may also be offered a photograph if you wish to have a memory of your baby to keep.
You will be under no pressure and the hospital staff will be sensitive to your needs, the difficult choices you have to make and they will give you time to make your decisions.
Reasons why a late miscarriage may occur
Most miscarriages happen because of an abnormality in the baby:
- Chromosomal problems – Downs Syndrome, Edwards Syndrome or Turners Syndrome
- Genetic – abnormalities in the genes causing the baby to die during pregnancy
- Structural – problems affecting the baby’s body such as spina bifida or congenital heart defects
Other causes of late miscarriage may also be due to:
- Anatomical problems of the mother – an unusually shaped womb
- Infection – directly to the baby or of the amniotic fluid
- Antiphospholipid Syndrome (APS) – an increase in blood clotting
In most cases, you will be offered tests to try to help identify the problem and give you a reason why you miscarried. You will need to agree to this and, again, will be given time to make your choice.
In addition, you will also be offered the appropriate care, counselling and advice to help you understand what happened.
What an investigation (post mortem) involves
Most hospitals will offer you an investigation (post mortem) into your baby’s death, should you wish to find out the reasons behind your late miscarriage. This examination will hope to provide you with information about what happened to you, your baby, and your pregnancy. It will also help to inform your doctor regarding your care should you wish to try for another baby in the future.
You may not feel immediately able to make this decision, so will be given time to think it through. If you do not want go ahead with a post mortem it is possible to ask for an external examination and a placenta test, which could be helpful to you in the future should you get pregnant again.
Sometimes a reason for a late miscarriage is not found, which can leave you feeling confused but it may also mean that your baby was normal.
Marking the event of your baby being here
When you experience a late miscarriage, you won’t be required to have a burial or cremation for your baby but it is something you can arrange with the hospital if you wish. Some hospitals offer this for all miscarried babies, but the hospital staff will take time to talk through the options with you.
You might also find it helpful to speak with the hospital chaplain, who can provide some comfort and advice at what will be a difficult time.
The hospital may also be able to give you a certificate, which will note your baby’s name and the date of the miscarriage. This is not a death certificate, as your baby will have been miscarried before 24 weeks, and legally termed as viable.
Others who have experienced the same loss often choose to mark the loss of their baby in a more personal way, such as a special memento box, perhaps planting a tree or making a donation to a charity. These acts can provide some comfort and help with healing.
Looking after you and coming to terms with a late miscarriage
You will now be experiencing physical as well as emotional symptoms as a result of your late miscarriage. You are likely to have some bleeding and possibly some pain similar to a period. Your breasts will produce milk and some women find this particularly upsetting, it may also cause some discomfort.
Your feelings are very likely to be ranging massively from anger to sadness, fear to loneliness. You may not wish to talk about it yet or you may be overwhelmed with a need to cry a lot and openly. Each person will react differently. No reaction is right or wrong. If you require a medical certificate your doctor will give you one if you think you need time off work.
Mostly, it is important that you give yourself time to recover and grieve for your loss.