What and Why?
About 1 in 7 confirmed pregnancies end in miscarriage. This reflects the wide variety of pitfalls conception is now subject to, especially since non-nutrient chemicals began to intrude more intimately upon our lives. Your body devotes a great deal of attention and resourcefulness to overcoming these obstacles, and usually succeeds. Nevertheless there always were occasions then a pregnancy did not unfold ideally, and there may now be somewhat more. In these circumstances, miscarriage is your body’s healthiest way out of an impossible situation.
It is seldom your personal fault and could not safely have been prevented once the pregnancy had begun to take its course. The seeds of difficulty were probably sown between eight and four weeks before conception took place, at least a month before any routine test could demonstrate your pregnancy. Exposure at that stage to alcohol, smoke, toxic chemicals or nutritional hardship can have a devastating effect on the development of your egg and sperms. Most sex-cells that are badly affected are completely infertile, and no pregnancy ever results. But a few that are damaged only slightly may succeed in starting a pregnancy which is from the beginning unlikely to proceed far.
Your nurture of this pregnancy from then on may be entirely beyond reproach, though still subject to all the same disturbing influences that continually impinge on you, despite your best intentions otherwise. Their influence over so new a life runs dangerously deep, and further compounds a faulty start . If there is no major malformation in the formative folds of the developing egg, more subtle imbalances in the blueprint for development may prompt growth out of proportion to the power of the baby’s heart or liver, which at a later stage can still make survival impossible.
So a miscarriage during those first three months when such matters are decided, fully justifies your grief. Were our culture more civilized we should all feel your pain as our own; no wound in the tissue of life would leave us unmoved, let alone in so tender and innocent a part of it. We should all wonder in humble honesty by what collective folly such things can be, and comfort you with the sincere resolve to set it right.
Meanwhile you face the slow evolution of events. Bleeding is not a sure sign, since you may menstruate harmlessly at period time from the part of your womb your pregnancy has not yet filled. But it is usually the first, and does not settle properly with rest. Pain usually comes second, and intensifies until the pregnancy is lost. Clotted blood is seldom as hard and distinctly formed as a concepsus; if you doubt what you see, it is probably a clot.
Habitual miscarriage — two or more in succession — may not however be inevitable. If pain precedes bleeding, you may be physically unable to keep the neck of your womb closed firmly enough to keep your baby in. Or you may repeatedly make too little progesterone (pregnancy hormone) in those vital early weeks. Both of these can be prevented next time by suitable treatment.
What can I do?
1. Negotiate with your doctor where you should be. Home is safe for an early uncomplicated miscarriage, provided you and your medical attendants agree. Rutin and Vitamin C supplements help to control bleeding, reinforcing any medication you are offered.
2. If your miscarriage is incomplete or your baby has died but does not miscarry, do not submit to surgery if you really cannot face it — collect your thoughts first. In other cultures a disappointed mother usually waits until her body is ready to complete the process naturally. Her womb shrinks, salvaging its contents to replenish her reserves. Her body eventually rejects the much smaller residue in a brief inflammatory illness that may be feverish. This mechanism is available to you, and worked well in the several cases I have witnessed. Complications that require surgical treatment are rare, but can occur; if your obstetrician has specific fears based on the details of your own case, listen to him. If on the contrary his advice is based only on his standard general policy, and you are for the time being quite well, the dangers of surgery may be more real than those of biding your time. There is no automatic need for a ‘D and C’, which is in any case rather a crude operation.
3. Face your grief, and share it with your husband or confidant. Say all that is in you, even the things you know are unreasonable.
4. Then search rationally for something to do differently next time. Go over your family planning carefully for factors deserving more attention. Set about rebuilding the stores you lost with the miscarried pregnancy, giving yourself six months to accomplish this before you try again.
5. Any wholesome gesture that brightens your outlook is worthwhile, however irrational it may be: it needs only convince you, no-one else. Anything goes, from a new hat through a change of doctor to open defiance of what usually passes for good sense, provided it gives you the clean sweep you need.
6. If you have had two or more miscarriages, see your doctor well before you plan your next pregnancy. You may need to see a gynaecologist to investigate the cause, on which your treatment will depend; all this could take several months to arrange.
7. When you do conceive again, keep it to yourselves until you are clear of the first three months. It is very demoralizing to have to tell people if things go wrong.