Miscarriage is an excruciatingly difficult ordeal for any individual to experience, both emotionally and physically. In our latest article, highly esteemed London-based consultant obstetrician and gynaecologist, Mr Christian Barnick, provides us with an in-depth, expert analysis of miscarriage.
What are the miscarriage rates for first and second pregnancy?
It’s very difficult to know what the exact rates are for miscarriage because so many women will have a miscarriage without coming to see their doctor. We think that as many as one in four pregnancies will miscarry in the first trimester. Most of these miscarriages will occur very early on.
When we scan women, we find that many of these early miscarriages are actually because of anembryonic pregnancies, which is a pregnancy where the embryo has never really started to form properly. This tends to occur due to abnormalities with the chromosomes in the pregnancy.
So, it is extremely common with first or second pregnancy, but of course it is so much more difficult for women when it’s their first pregnancy, because they will then likely remain convinced that they will not be able to have children, when of course this isn’t the case.
How does someone know if they’re having a miscarriage?
Unfortunately, it’s really difficult to tell. Many of our miscarriages these days will present on an ultrasound scan, where women have had a positive pregnancy test, they go along to the facility for a scan and unfortunately, at the time of the scan, it seems that the embryo is too small, or perhaps there’s no embryo present, or there is no heartbeat present.
So, many miscarriages will present in this rather cold sort of way. Then, there are also women who experience the more well-documented type of miscarriage, where they will notice that they start to experience bleeding, cramps, and then will pass large clots.
Having said that though, many women will bleed in early pregnancy, and they don’t miscarry. So, unfortunately, the signs and symptoms are not always that helpful, unless of course it is very obvious.
The important thing to do if you are worried that you are having a miscarriage is to go and have a scan. This really determines whether the pregnancy is going to be viable or not.
Is treatment required for a miscarriage?
When women have had a miscarriage, they will inevitably wonder if they can do something differently in their next pregnancy to try and prevent it from happening again. Many women will make adjustments to their behaviour thinking that they can somehow influence the outcome of the pregnancy.
However, a viable pregnancy is very hard to disrupt. We only need to look at the behaviour of some people to see that the behaviour of the mother really doesn’t influence whether or not they will have a successful pregnancy.
As far as treatment is concerned, a lot of women will be given progesterone, and they’ll be given this in the first trimester. However, when we look at the evidence for this treatment in preventing miscarriage, it isn’t quite as compelling as we would like it to be.
In women with very specific problems; perhaps some sort of clotting abnormalities or some kind of antibodies; then we would recommend that women take heparin injections in the early part of the pregnancy. However, this would only be something that we would recommend once we have performed specific tests for this.
How can people prevent miscarriages in the future?
Unfortunately, there isn’t much one can do to prevent a miscarriage. The chances of having a miscarriage are about one in four. The chances of it happening twice in a row are one in 16. So, actually, the chances of it happening again are relatively small.
Women need to take the time to recover from their miscarriage, both physically and mentally, and then try again. I always stress the fact that women must recover mentally, because, inevitably, they go into their next pregnancy in a very different state of mind.
When they have a positive pregnancy test, they won’t be thinking “oh, great, I’m going to have a baby”, but rather they will be thinking “oh, no, I hope I’m not going to have another miscarriage again” which inevitably makes the early part of pregnancy much more negative and difficult.
How would you describe the psychological impact of miscarriage?
The psychological impact of miscarriage is something that is quite often overlooked. Yet, many women will suffer very badly after they have had a miscarriage.
There are a number of complex issues here, the first of these being how important it is that women are looked after when they are having a miscarriage. Due to the fact that miscarriages are so common, it’s unfortunate that some healthcare professionals forget that, for this individual woman, this is a life-changing event.
Many women will so often experience treatment and care after miscarriage that is not quite so caring, kind, and compassionate. This makes a huge difference in relation to how they will recover psychologically.
The other problem and major psychological difficulty women face after having a miscarriage is the fact that they will have already imagined themselves in the future with their child. It is, of course, extremely distressing when this is suddenly taken away from them.
The longer women remain quiet about having had a miscarriage, the worse it will be for them. I think there is a real need in our society today that we open up about miscarriage and that we bring it out into the open and talk about it so that women can be more realistic about how often it can happen.
Mr Christian Barnick is a highly experienced, expert consultant obstetrician and gynaecologist who specialises in pregnancy and miscarriage, amongst other conditions that affect women. If you have recently suffered a miscarriage and are worried that it might happen again, you can contact Mr Barnick directly and consult with him by visiting his Top Doctors profile.