SingaporeMotherhood | Pregnancy

March 2016

Dealing With Miscarriage

A miscarriage is defined as a pregnancy that fails to progress, resulting in the death and expulsion of the embroyo or foetus usually before 20 weeks of gestation. Miscarriage is probably one of the most painful experiences that a hopeful parent can experience. It is not just physically draining; the emotional consequences can be shattering as well.

Unfortunately, miscarriages are not uncommon. According to Dr Yeong  Cheng Toh, a consultant gynecologist and reproductive endocrinologist with Virtus Fertility Centre in Singapore, 15 to 20 per cent of pregnancies end in miscarriage.

And while it can happen to any pregnant woman, those over 35 years, women with uterine abnormalities, and women with poorly controlled medical conditions such as diabetes, renal disease or thyroid dysfunction are more at risk of having miscarriages.

Understand why it happens and find out how best to recover from it.


What Causes Miscarriage?

Contrary to hear-say, stress does not cause miscarriage. Dr Yeong believes that there isn’t sufficient evidence to support this: “Psychological well-being has long been claimed to be important to prevent foetal loss. But extensive studies have not proven that stress per se is a causative factor.”

“There are many possible causes of miscarriage, including genetic congenital or uterine abnormalities, infection (e.g. salmonella, malaria) in the mother, ingestion of certain teratogens or chronic medical conditions in the mother, such as uncontrolled diabetes, inherited thrombophilia or thyroid disorders,” says Dr Yeong.

Different Types of Miscarriage

He also explains that there are different types of miscarriages:

Complete miscarriage – the total expulsion of the foetus presenting with heavy bleeding and the ‘passage’ of products.

Incomplete miscarriage – where small bits of the pregnancy are left in utero, requiring a minor procedure (eg. dilation and curettage) to evacuate the uterus.

Missed miscarriage – asymptomatic, but an ultrasound has diagnosed the absence of a foetal heart.

While it is possible to have a miscarriage without actually feeling any symptoms, some common symptoms include heavy bleeding and cramps. “Generally, the patient also feels the ‘loss’ of all pregnancy symptoms, such as breast tenderness, nausea and vomitting,” says Dr Yeong.


Recovering After a Miscarriage

It’s important to fully recover from a miscarriage physically and mentally before trying for a baby again. “You need time to grieve and to come to terms with the loss,” says Dr Yeong. “Emotional stability is as important as medical fitness.”

“The majority of women recover one to three months after a miscarriage,” adds Dr Tan Chue Tin, a Consultant Psychiatrist at Mount Elizabeth Hospital. However, she cautions that “a woman’s body may recover physically long before she heals emotionally.”

During the process, Dr Tan explains, the woman may experience a range of emotions from grief, sadness, and guilt, to anger and self-blame. In some cases, the guilt and psychological pain can last for years.

Tanja Faessler-Moro, fertility counsellor at Virtus Fertility Centre, shares two factors that define the time frame for recovery that a woman goes through after a miscarriage. “One would be the duration of the pregnancy up to the miscarriage and the other would be the time it took to get pregnant. As a general rule, the longer it took to get pregnant, the longer it may take to recover emotionally from the loss.”

Their advice? To go through this loss as a couple and love and support each other through it. It goes without saying that your spouse has to be supportive too.

“Husbands should understand that during this painful period, most women can be irritable, needy and prone to anger outbursts,” says Dr Tan. “Be available and attentive; listen when she is expressing her grief, so she feels valued. A husband may be similarly affected and sharing the grief can be very cathartic.”


Trying For a Baby after a Miscarriage

When to conceive again? This decision should be made between husband and wife once they feel psychologically ready.

“The exact timing will depend on when the couple is ready,” says Dr Tan. “Some want to start trying straight away, while others need some time to get over their loss.”

When she does get pregnant again, it is perfectly normal for a woman who has gone through a miscarriage to carry extra fears.

“A pregnancy after a loss can be the longest nine months of a woman’s life,” says Dr Tan. The mum-to-be is anxious about whether there will be another miscarriage, especially around the time of the previous loss. Dr Tan recommends mums-to-be in this situation to “take it one day at a time”.

  • When feeling worried about the future, stop, and think only about today.
  • ‘Affirm each day’ and notice how this pregnancy is different from the pregnancy in which you suffered a loss. Take note especially of how things are going better.
  • Pay attention to what’s going well each day and how you and your baby are staying healthy.
  • Take care of yourself and focus on what you can do to make this pregnancy a healthy one.
  • Try relaxation exercises.
  • Remember that many women do go on to have normal babies after miscarriage.


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Dealing With Miscarriage