Here we are in the midst of spring. We just celebrated International Midwives Day this week, and Mother's day is this weekend. I want to talk about some aspects of midwifery and motherhood that are more sensitive and painful. Now is the best time of year to talk about these aspects of motherhood, life, death, and the ability to let go and move on are so crucial for us to talk about right now because springtime is abundant with life, growth, and hope.
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As a midwife and herbalist, I used to lots of calls from women while they are experiencing a miscarriage. I'd also get calls from friends and family members who want to know how to support someone to heal after miscarriage. And recently, when I asked the Arkansas midwives group what topics they'd like me to talk about on Apothecary Wisdom, miscarriage was the primary topic mentioned. I'm planning on making a series about loss. We will cover miscarriage today, and the next episodes will be about abortion and stillbirth.
Finding out you are pregnant usually spurs a whole host of emotions, ranging from elation to sheer terror. Some pregnancies are planned and very much wanted, and others are a surprise, and the timing is way off. No matter where we find ourselves on the spectrum, it is often a very confusing and painful experience – both physically and emotionally – to miscarry.
Remember, you are not alone. Studies show that approximately 20-25% of all clinically recognized pregnancies will end in miscarriage, with 85% of spontaneous miscarriages occurring in the first trimester (weeks 1-12). That is 1 in 5 pregnancies that end in miscarriage. "Chemical pregnancies" may account for 50-75% of all miscarriages. Chemical pregnancies occur when a pregnancy is lost shortly after implantation, resulting in bleeding that around the time of your expected period. (1)
Today we are going to talk about the types of miscarriage and helpful ways to recover. I'm going to oscillate between medical terminology to educate professionally, and I'm going to use human words, women's words. Because it doesn't matter if it was a planned or unplanned pregnancy, it doesn't matter the cause, the statistics, the definitions or explanations. The psychological/ emotional/physical and spiritual impact on the woman who experiences a miscarriage is a feeling and a knowing that her baby has died. When a baby dies, it can be a devastating experience.
Why don't some pregnancies don't develop?
There are so many potential reasons why a pregnancy might not go to term. Many of which are very technical. Not that I don't want to explain it all. Most of it will go over our heads, and I want to keep it simple and straight forward and give you tools rather than to many definitions.
Here is my simple garden analogy to help explain what happens. Think of it like this, soil conditions and the condition of the seeds must be ideal for the seeds to grow well. If a seed is planted in a way that it cannot receive proper nourishment, it will not make it. If something goes wrong with its development, it will not grow healthy and strong. This simple explanation can be applied to early pregnancy conception, implantation, and fetal growth.
Types of Miscarriage
The medical terminology for a miscarriage is Spontaneous Abortion, and next week we will discuss Induced Abortion. Today we will focus on Spontaneous abortions (SAB) here we will refer to them as miscarriages. There are several types of miscarriage – threatened, inevitable, complete, incomplete, or missed.
When your body is showing signs that you might miscarry, that is called a 'threatened miscarriage.' It is common in early pregnancy to experience spotting or bleeding and cramping. The women who experience just bleeding or just cramping, over 80% the time, go on to carry a healthy baby. The condition becomes more serious when the woman experiences both cramping and bleeding at the same time. The cramping and bleeding can last several days or weeks until it's resolved. In a threatened miscarriage, the cervix is firm and closed.
At this point, you have a few options.
1- Wait and see what happens. Either everything will resolve, and you'll push your baby out in a few months, or the bleeding and cramping get progressively worse and lead to the passing of a baby that came too soon.
2- You can get a serial HCG and progesterone level test. These are indicators of what is happening. However, there is rarely anything a doctor, midwife, or you can do to change the inevitable course of events.
In the past bed rest was recommended, but there is no scientific proof that this helps to prevent the miscarriage. But, what bed rest does do, is help you feel like you are taking good care of your self and your baby. It allows you to slow down and come to terms with what is happening in your body and your life.
Now is a ripe time to ask yourself some tough questions, are you going to try to hold on to this baby or let it go? Getting clear about your intentions now will help you make plans about what to do next.
You can ask your midwife for an herbal tincture made with equal parts of cramp bark and wild yam to help stop the cramps. This tincture is a safe and gentle remedy that can support your body, not cramp so much and allow you to rest. While you're resting, visualize the baby in your womb surrounded by love and light, see the baby with a healthy placenta firmly embedded in the right place. Drink plenty of water and send your self and your body lots of love.
Inevitable miscarriages can follow from a threatened miscarriage or come unexpectedly. In this case, there is usually a lot more vaginal bleeding and stronger uterine contractions. During the inevitable miscarriage, your cervix opens, and the developing fetus will be born.
Many women experience intense labor pains and symptoms that last for several hours. Including rectal pressure, the urge to push, the immediate relief once the baby out followed by uterine bleeding. The cramping and bleeding may continue for several days after the miscarriage and needs to bee closely monitored.
A complete miscarriage is when all the contents of conception have left your uterus. Vaginal bleeding may continue for several days and begins to taper off.
If you miscarry alone, you should have a check-up with a midwife or doctor to make sure the miscarriage is complete, and the bleeding is within normal limits, and there are no signs of infection.
Sometimes, not everything comes out, and some pregnancy tissue remains in the uterus. You will usually experience more intense cramping and bleeding as your uterus tries to get everything out.
Sometimes, the baby has died, but labor didn't start right away, and the baby stays in your womb until you are ready to release it. If you have a missed miscarriage, you may have a brownish discharge. Some of the symptoms of pregnancy, such as nausea and tiredness, will fade. You might not notice anything unusual. And are shocked when you discover the baby died at your ultrasound appointment.
Missed miscarriages can last serval months. In my personal experience, my body held on my baby for two months before going into labor. According to my dates, I was 16 weeks, and when she was born, she looked developmentally to be 8-9 weeks gestation. I passed her safely at home with a midwife without any medical complications.
Other Types of Early Pregnancy Loss
An ectopic pregnancy occurs when the embryo implants outside the uterus, usually in one of the fallopian tubes. A fetus does not often survive an ectopic pregnancy.
If you have an ectopic pregnancy, you may not know it as first, until you start bleeding. Then you may get severe pain on one side of your lower abdomen, vaginal bleeding with white tissue, vomiting, and possibly pain in the tip of one shoulder. If you have these symptoms, seek urgent medical attention.
A molar pregnancy is a type of pregnancy that doesn't develop appropriately from conception. Molar pregnancies don't usually spontaneously resolve on their own, and they need to be surgically removed.
With a blighted ovum, the sac develops, but there is no baby inside. It is also known as an 'anembryonic pregnancy.' This condition is usually discovered during an ultrasound. In most cases, an embryo was conceived but did not develop and was reabsorbed into the uterus at a very early stage.
Seeing the Baby
Seeing the baby is important for the grief process. In any grieving process, dealing with the physical reality of the loss is an essential step in healing. Some women will want to see what came out of their bodies, while others are more hesitant to look. I want to gently encourage you if you are in this situation to look at what came out. This will be the only moment to see it. You won't' get another chance. And honestly, many women regret not looking and not seeing it. I also encourage partners to look at it and to photograph the baby, or the tissue that passed to share the images with the mother later.
Seeing what comes out is also serves as a medical necessity. It's essential to know if everything cleared out of the uterus. If you miscarry at home or out of the hospital, your midwife or doctor will need to examine you to confirm that you do not need any assistance emptying out your uterus. There are situations when women have retained fragments in her uterus that can lead to hemorrhage and infection. Both of which are major obstetrical emergencies. These women need to be monitored and take herbs or medications to help expel the contents of the uterus. Some women need a more invasive medical procedure called a D&C-‘dilatation of the cervix and curettage of the uterus to remove any remaining pregnancy tissue.
Signs and Symptoms of a Miscarriage
If you call your midwife with concerns about cramping and bleeding, she will have a long list of questions to help her understand your situation. I suggest you write down your symptoms. Write when they started, how long they lasted, the color the quantity of the bleeding along with any other pertinent information—writing down your experiences to help you remember and effectively communicate with your midwife.
Here are the common questions your midwife will ask.
- What symptoms are you having, and when did they start? How long have they been going on?
- Is there any bleeding or spotting? Describe the color and amount.
- Have you passed anything other than blood?
- Describe the abdominal sensations, cramps, pain, and location?
- When was the last time you had intercourse?
- How far along are you?
- What is your blood type?
Remember, just bleeding or just cramping is a normal and healthy part of pregnancy. Bleeding in early pregnancy might be implantation bleeding around (7-10 days after conception.) It could be cervical bleeding from polyps. Also, it is super common and normal to spot or bleed with intercourse during early pregnancy. It could be the menstrual breakthrough bleeding around the time you usually menstruate. Knowing your blood type is essential because if you are Rh-negative and you do miscarry, you will need a Rhogam shot.
Like I mentioned before, it is imperative to see and examine what passes through your body. If there are clots, or tissue, in the toilet, put a plastic bag on your hand and fish it out of the toilet. Store it in a glass jar and put it in the refrigerator for your midwife to examine. Please do not flush anything down the toilet! Also, save your soiled pads for the midwife to determine blood loss.
Bleeding is usually the first sign of a miscarriage. A little spotting or bleeding is normal. However, in early pregnancy, women have not gone through their process of blood volume expansion yet. Any amount of blood loss is more severe in early pregnancy miscarriage than it is at term birth. If you see bleeding, contact your midwife right away. I know from experience, there are women who have been bleeding at home for a while, denying the possibility of miscarriage. Those women need to be taken care of right away. The midwife should come over ASAP, or they should go straight to the hospital. Women who lose too much blood will become shocky very quickly. Prolonged bleeding over the course of several days may leave a woman weak and debilitated. Once she is stable, liquid Chlorophyll can help her recover from blood loss. As your midwife about a tincture made from equal parts of yarrow, bayberry, and shepherds purse to help stop the bleeding once the miscarriage is complete.
After a Miscarriage
Women should have at least one or two visits with their midwife to confirm that she is physically recovering and to support her emotionally. The physical body will heal up quickly. Women typically start having their menstrual cycle in a few weeks.
Seek Medical Attention:
- Any bleeding in pregnancy
- After the miscarriage, if you soak 2 full-sized pads in 30 minutes or less, or any continuous vaginal bleeding.
- Signs of excessive blood loss requiring immediate medical attention include: dizziness, light-headedness, weakness, fainting, hypotension, rapid heart rate, shortness of breath, and pallor all constitute a potential emergency—call 911.
- Signs and symptoms of uterine infection. Such as pain in the lower abdomen or pelvis, fever 100.4 (usually within 1 to 3 days after delivery), paleness, chills, a general feeling of illness or discomfort, and often headache and loss of appetite. Foul-smelling vaginal discharge. Rapid heart rate.
- Experiencing intense feelings of depression or anxiety that don't resolve with the suggestions below and last beyond a few days.
The Recovery Process
Physical Care and Comfort Measures
Like I mentioned earlier, the physical recovery process can be pretty quick. It's the psychological and emotional process that takes longer—knowing how to take care of your body, or how to take care of someone after a miscarriage exponentially speeds up the healing process. Many of the suggestion are for the mind and the body.
1. Rest. Getting the rest you need is paramount! Having help with household duties like cooking, chores, and childcare will get you off your feet so you can relax and recover more quickly.
2. Nourishment. Nourishment and hydration are foundational to your healing process! Eat healthy fruits, veggies, and whole foods. Especially in a time like this, you can enjoy comfort foods like chickpeas, coconut milk, and dark chocolate. It is time to be mindful of some things to avoid, such as sugar, alcohol, red meat, and dairy, because all of these can cause more inflammation. Your body is in a state of healing, and recuperation and inflammatory foods can cause more pain and discomfort.
3. Herbs. Let the herbs be a part of your support system. Cramp bark for the cramping. Yarrow for the blood loss. Red raspberry leaf tea is nourishing and tones your uterus. Red raspberry also helps with blood loss and maintains proper iron levels. Motherwort helps slow your bleeding and supports your mood. Cycle Relief has most of these herbs and is very effective at easing the pain of the cramps while still maintaining a good uterine tone, which is important while you heal.
Other herbs support your mood and hormones. Adaptogenic herbs such as ashwagandha are appropriate here. Woman's Balance Tea is filled with nourishing herbs, adaptogenic herbs, and immune-supporting herbs.
4. Compresses. Abdominal cramps and headaches are very common during a miscarriage. If you are cramping and are uncomfortable, you can place a hot compress on your abdomen and low back and a cold compress on your head for headaches.
5. Monitor. The two primary medical concerns with a miscarriage are blood loss and infection. At home, monitor your vital signs the best you can. Keep your visits with your care provider to get your iron levels checked. Anemic women are more depressed, depleted, and prone to infection. If you are concerned about anemia or would like to prevent it all together get Energizing Chlorophyll to help build your blood after a miscarriage.
6. Baths. Proper hygiene is essential to prevent blood loss and infection. One way to care for yourself is to prepare herb baths and Yoni steams. You can add yarrow, rosemary, lavender, sage, garlic, shepherd's purse, and sea salt to your baths and steams. The combination of these herbs makes a great antibacterial anti-hemorrhagic blend. We have videos about the therapeutic and ceremonial aspects of herb baths and steams on your youtube channel.
7. Abstain. Avoid sex until you stop bleeding to prevent infection. It is a good idea to give your body a few months to recover completely and have regular cycles before trying to conceive. Recommendations for getting pregnant afterward are all over the map. Many doctors tell women to wait until after a regular menstrual cycle, while others advise waiting up to 12 months. No matter how long you wait. I do think it is a good idea to allow significant time to pass so you can separate the two pregnancies as unique babies.
8. Partner. One important thing to remember is that your partner has experienced a loss, too. Connect with them. They may not express themselves as you do, yet they're grieving and are concerned about you. For your partner, the pregnancy may have only been a mental concept at this stage. And now he must cope with the loss of his baby and with a grieving woman. To avoid being overwhelmed by his partner's grief, a man may try to minimize the loss and encourage her to get over it and move on.
Both partners need to keep the lines of communication open and allow each other to feel their feelings through to completion. They both might really need physical connection and sexual intimacy to comfort them. Yet there might be mixed feelings due to the fear of getting pregnant again and the guilt of enjoying sex while grieving. The stages of grief include denial, anger, bargaining, depression, and acceptance. There is no right or wrong way to grieve; it is a natural and personal process that has to be experienced.
Mental and Spiritual Care
Like I mentioned earlier, your physical body can bounce back much quicker than our emotional and spiritual body does. After a miscarriage, there is no going back. There's only moving through, and moving forward to your new self. This experience has now shaped your mind and heart.
Women often feel intense guilt after the loss of a baby. Especially if they were ambivalent about the pregnancy in the first place. If the pregnancy was unwelcomed, a woman might feel relief as well, which might just heighten her feelings of guilt. Feelings of failure, shame, and loss of faith in her body are common and reflected in their relationships. Couples experience difficulties, such as poor communication and sexual disharmony.
I'd like to acknowledge here just how blind our culture is to the enormity of the experience of having a miscarriage. To be honest, before I had a miscarriage myself, I thought it was just like having a more challenging period. I did not /could not fully grasp that it was labor and birth and the death of your baby. In some ways, a miscarriage is even harder than labor and birth, because you go through all the work of labor and experience the emotional and physical pain without the prize of getting to breastfeed your baby. Instead, what happens is that you birth your dead baby, and it leaves a hole in your spirit and your heart. It takes a very long time before you feel Whole again. Hopefully, someday you can look back on the experience and see it as holy.
Miscarriage is intense for your body and can leave you feeling fragile physically and emotionally. From a mental health point of view, up to 1 in 5 women who experience miscarriage have anxiety levels similar to people attending psychiatric outpatient services, and up to one-third of women attending specialist clinics as a result of miscarriage are clinically depressed (2).
Here are some ways to help you restore your wholeness and recover:
8. Space. To facilitate healing, I recommend creating a container of safety for yourself and your partner. What I mean by this is that you must allow yourself to take the time to cry to grieve and express your deep feelings. Please don't try to jump right back to your regular life and pretend like it never happened or that it's all fine. At the same time, encourage yourself to move through your grief as a way of moving forward with your life. It can be draining to you and your loved ones if you stay in a perpetual cocoon of sadness. There will come a time when you feel like you made it to the other side.
9. Share. Talk about what you are experiencing and your what-ifs and your hope and your disappointments. Give yourself permission to "go there" with a person that you trust, who is a good listener, and has a healthy perspective. Call your midwife or doctor or counselor, or shaman, or pastor and process your experience with them.
One of the challenges women who miscarry face is that often their friends and family didn't even know they were pregnant. No one saw your baby bump or felt the baby move. They just started telling people there were going to have a baby. And their friends unknowingly come up cheerfully congratulating them, and the woman has to tell her friend about her loss. And she might feel like she has to comfort her friend who is just now finding out the sad news.
11. Honor. Find a soulful way to honor your pregnancy, your baby, and birth. Get creative, have a loving ceremony to release the baby, and say goodbye. Some ideas are naming your baby, lighting candles and floating them down the river, or releasing bubbles into the sky. Maybe make a fire, or plant seeds and make a butterfly garden to honor your experience.
12. Bless. Bless yourself, your body, and your womb. Anoint yourself with oils. Give yourself an abdominal massage. Give gratitude for all the beauty that is within you. You are not broken. Your body did not fail. For you to feel this and know this for yourself, I recorded a beautiful guided meditation called the pelvic bowl and body blessing for you to listen to and experience.
13. Move. Gentle movement is essential to help you move through your stages of grief. Stretch, breathe, journal, yoga, tai chi, qigong, walking alone or with friends, dance with yourself and your partner.
If you would like to join me for a Qigong class we meet every Friday Morning 10 am central time via Zoom. Go to www.pathwithharmony.com to sign up!
If you or someone you care about has had a miscarriage, my heart wraps you in love and support. Eventually, these intense feelings will integrate into your persona and not feel so severe. I hope you will feel safe and supported in our community, in your family, in your own skin. Please take your time to go all the way through to the grief process without any time frame restricting you. Reach out and receive support. Find the beauty and blessing in all of this. Even during life's hardest challenges, there are ways to stay grateful and express joy. I hope this supports your wholeness as a woman.
Until next time my friends, drink deep and always walk in beauty!
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(1) American Pregnancy Association - Miscarriage: Signs, Symptoms, Treatment, And Prevention, 2014.
(2) Tommy's - Miscarriage and Ectopic pregnancy statistics, 2015.
(3) Heath.com Anne Harding - Miscarriage? Try Again ASAP: Study Suggests 2010.