We are sorry that you are going through this traumatic experience. We know you are anxious, hopeful, fearful and confused and all of the emotions in between. There are no words that anyone can say, or anything anyone can do to make this easier for you. Rest assured of our prayers and know that there are others who share your grieving heart.
Your body will be going through dramatic changes. You have very little control over those changes. Every miscarriage is different so these are things to look out for and things to expect. At any time, if something does not feel right, seek medical help.
Loss with bleeding-
If you have started bleeding but are not sure whether you should be worried, you can go to a GP and ask for your HCG and Progesterone levels to be checked. In a normal pregnancy, the HCG levels should increase by two thirds in 48 hours. The GP will probably do this over a number of days. If your levels are continuing to rise, all may be well, keep monitoring them. If your levels are beginning to wane, then you may be experiencing a miscarriage.
As HCG and progesterone levels begin to wane, your body is receiving the message that you are not pregnant and therefore the mechanisms (hormones from the ovaries or placenta depending on the number of weeks gestation) which have been maintaining the lining of your uterus for the pregnancy are beginning to switch off and your body will be preparing to menstruate. Nothing can stop this natural process from happening. If the fetus and uterine lining are not sloughed, you will become very sick. Progesterone supplements can delay this process but not indefinitely. You may experience:
- Significant cramping which makes you double over or lose your breath
- Bleeding which soaks through pads in a hour or less
- Passing of tissue which resembles blood clots in early pregnancy and grey/pink material in later pregnancy
- Loss of pregnancy signs (nausea, breast tenderness)
Loss with no bleeding-
You may have been for a scan and heard the horrific news that there is no heart beat, this should be audible around 5-6 weeks and thereafter. If it is early in your pregnancy, your GP will probably test your HCG and progesterone levels and potentially send you for another scan in a few days time in case your dates are off. This will be a very anxious time for you and your spouse. If you are later in your pregnancy, and have previously heard a heartbeat, then we are very sorry for your loss.
Be gentle with yourself, talk to each other about how you are feeling, reach out to someone if you have no-one to talk to, ask questions of your GP.
Pray for God’s will to be done and for peace in your heart at this difficult time. Hold close to Mary, place yourself under her mantle. She too lost a child in horrific circumstances. Allow yourself time to grieve, you are suffering a traumatic and significant loss, even if noone else knows about it yet.
Expectant management of a miscarriage
When you choose to let nature take its course or ‘watch and wait’. You will know the miscarriage is imminent when you start experiencing one or more of the following symptoms: bleeding or cramping which make you double over or lose your breath or an upset stomach.
Things to have handy if you are choosing this path:
- Your phone in case of emergency
- A support person
- A bottle of water to keep yourself hydrated
- Heavy flow sanitary pads
- A strainer to collect the remains if on the toilet
- A container for the remains
- Scissors
- Towels
- Wash cloths
- Something to put down on the bed or floor if you feel more comfortable there
Possible positions to choose from: On the bed or floor, on the toilet or in a water bath.
You will pass blood (uterine lining), blood clots (when blood stands still it clots), the amniotic sac containing the remains, and the placenta which will vary in size depending on the number of weeks gestation. You can collect the amniotic sac and hold the remains of your baby by carefully opening the sac with wet fingers. Take all the time you need to hold and be close to your baby.
If the placenta is not delivered, you can massage the fundus (top) of your uterus for a number of minutes until it begins to cramp and then bear down to see if that will help deliver it. If you are able to, have a good look at the placenta once it is delivered and ensure that it is intact. If you are still bleeding a lot, it probably isn’t. You can always take it to a medical professional if you are unsure. If all of it is not delivered, you may require a D & C (Dilation and Curate).
After passing the remains and placenta, do a small tidy up and then rest. You have been through a lot- physically, emotionally and spiritually. If you start to feel faint or unwell at any time during the process, call emergency services immediately.
After any miscarriage, go to your health professional and have yourself checked out. You will bleed afterwards for roughly 2 weeks. If heavy bleeding persists, always see a doctor. The doctor may wish to do a follow-up scan to check that your uterus is clear. Use pads instead of tampons so that you can monitor any discharge and look for changes. Avoid strenuous exercise, get plenty of rest and drink lots of fluids, and look out for signs of depression. You have been through a significant ordeal, your hormones will be fluctuating significantly and you are grieving the loss of your child. If this becomes a problem, seek help. First of all, speak to your GP who can refer you to a local psychologist. They may know someone who has been trained specifically in perinatal care.
Medical Management of miscarriage
Chemical management
Involves the administration of drugs to encourage the uterus to contract and expel its contents. This is ethically acceptable for Catholics when it is determined that the fetus has died (ie. there is no heart beat). For your own piece of mind, have multiple scans over the course of a few days, just in case your dates are off. The most common drug used is Misoprostol. If you are past the first trimester, this will be administered in the hospital. If in the first trimester, expect a similar process to expectant miscarriage outlined above.
Surgical Management of miscarriage
D & C (Dilation and Curate)
A D & C is not the same as an abortion. A D & C after a miscarriage is to clear the uterine lining and content, including the amniotic sac and foetal remains.
This is an outpatient procedure. Before booking you in, the hospital will repeat the ultrasound to ensure there is no growth of the fetus and no heart beat. Like all procedures where you are under sedation, you will need to fast beforehand. The hospital will provide you with all the information that you require by way of medical preparation. You may be offered conscious sedation (you are awake) or complete sedation (you are asleep). Essentially, your cervix will be gently opened and the contents of your uterus will be suctioned or scraped out. It is rare, but there is a chance that not everything has been removed. The hospital will provide you with symptoms of this and you may require a follow-up procedure or management if this is the case. Complications are rare (less than 1 in 100) but include infection, excessive blood loss, perforation of the uterus and uterine adhesions (which may affect the ability to be pregnant again). You will need someone to pick you up from the hospital after you have been discharged. You will need rest after the procedure. Be prepared for the emotional tide which will ebb and flow throughout your preparation and recovery. While not meaning to be, the hospital staff can seem cold and methodical. This is something they do every day. Know that your loss means something and that you are not alone in your grief.
Depending on the hospital and the gestation of your baby, it may be difficult to obtain the remains of your little one. If you want to keep the remains and bury them, you will have to ask early and you may have to ask multiple times. Be prepared, it may not be easy and it may be very emotionally painful and draining. The advice from those who have experienced this is, stand your ground, keep insisting that this is your child and you have the right to bury him/her in a respectful way.
Link to burial/memorial resources:
Australian Resources
- St Agatha’s Catholic Church Cranbourne, Vic
Memorial Garden where families can have a plaque for their baby
Annual Memorial Mass of the Angels around November each year
- Geelong Cemeteries Trust
- Royal Brisbane Women’s Hospital Memorial Garden
Ectopic Pregnancy
An ectopic pregnancy is when a pregnancy occurs outside the uterus- including in the fallopian tubes, cervix, the cornua (area of the uterus where the tube enters), ovary, or the abdomen. This can be a medical emergency for the mother if not treated appropriately. The main way of distinguishing an ectopic pregnancy from a normal uterine pregnancy is that there is no evidence of conception within the uterus. The first course of action is to have an ultrasound and blood tests to observe your HCG and progesterone levels. This may be repeated over a number of days. In many cases, the pregnancy will progress in much the same way as a miscarriage. However, if an ectopic pregnancy bursts, this can be life threatening for the mother. Your health care provider will give you a list of symptoms to watch out for, do not ignore them and seek medical assistance straight away if you experience any of the symptoms.
There are 4 typical ways of treating an ectopic pregnancy
- Let nature take it’s course.
- Treatment with methotrexate which targets the rapidly dividing cells of the placenta and embryo and causes these cells to stop replicating.
- Laparoscopy- salpingectomy: This involves the removal of the affected fallopian tube. Note: you can still fall pregnant with 1 fallopian tube.
- Laparoscopy- salpingostomy: The removal of the embryonic sac.
For Catholics, ethical questions arise in the event of an ectopic pregnancy because usually at the time of its discovery, the foetus is still alive and developing. Treatment with methotrexate and Laparoscopy- salpingostomy can both be argued to be directly targeting the foetus and thereby intending its immediate death. On the other hand, the removal of the fallopian tube containing a foetus can be argued to be morally acceptable with the principle of double effect because the intended outcome is not the death of the foetus but saving the life of the mother. The death of the foetus is expected but not the direct intention of the procedure. There is much debate still among Catholic ethicists regarding what constitutes a direct action against the foetus and an action intended to save the life of the mother.. To inform your own conscience, you can read USCCB’s Ethical and Religious Directives for Catholic Health Care Services (5th ed., 2009), particularly numbers 45 – 47.
Dealing with grief
If you feel that things are not getting any better, the following organisations may be of support. Speak to your GP who may be able to refer you to a psychologist.
Specific infant or pregnancy loss organisations in Australia who may be able to assist you in your grief:
Australia Wide
Stillbirth Foundation Australia;
State by state: