1 in 5 pregnancies will end in a miscarriage but even as common as this is, it’s not an easy topic to talk about it. This episode may be hard for some (or all) to hear. Please make sure you have your supports in place if you choose to listen. And we hope everyone listens.

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In this episode we have a poignant story from one of listeners, Mai, talking about her miscarriage, the process and the pain and the joy of becoming pregnant again. 

We cover:

• The types of miscarriage
• How miscarriages are diagnosed
• Ways we can support someone who has had a miscarriage
• Treatment of miscarriage
• When to start trying again

We talk about the following supports:

COPE

Pink elephants support network

Beyond Blue

Patrick [00:00:36] OK. Welcome, everybody, to Episode 27. Today we’re discussing miscarriage and pregnancy loss. So I’d just like to put out a warning, trigger warning for anybody who feels that today’s content may be triggering or upsetting for them and suggest that if you think that that’s you, that you make contact with your supports and make sure you have someone close by to turn to. If today’s content is likely to be very upsetting for you so you can have that support there. 

Brigid [00:01:09] Yeah, because we do think that it’s worth everybody listening to this. That way, you know, miscarriage is incredibly common. 

Patrick [00:01:17] Yeah, we’re talking about first trimester miscarriage here. Not second trimester loss or term stillbirth. And first trimester miscarriage is thought to affect at least at least one in five pregnancies. So it seems to us that it’s something that it is worth while knowing about it in case it happens to you. Or in case it happens to someone close to you so that you can give better support. 

Brigid [00:01:45] And the reason why we’re doing it is because over the weekend we put up post on our stories, sort of saying, what would we cover? What would you like to hear on our podcast next? And, you know, overwhelmingly people said about miscarriage. 

Patrick [00:01:58] Yeah, like lots. Lots.

Brigid [00:02:00] And, you know, there is quite a lot out there about miscarriage. I don’t know whether you seek it out if you haven’t had a miscarriage. So this is pre-emptive. I think everybody should be listening to this because we’re gonna be covering off not only if you have a miscarriage, but if you know someone that has had a miscarriage and how you can support that person through. 

Patrick [00:02:21] And we put out a call for personal experience. I know. Talk about being spontaneous. Sorry, people. This this is how we have the roll in our household. You know, busy household for boys, but also an obstetrician husband. Sometimes we don’t have things planned that well. I don’t know whether you’ve guessed that. But what we decided on Sunday afternoon was, wouldn’t it be great if we had women’s voices in this podcast? So we asked people to go to W W W dot speak pipe dot com slash, grow my baby just to record a five minute story about your miscarriage. And it was very short notice, but we did get a magnificent story. 

Brigid [00:03:03] So we’re going to hear from my Mai. 

Mai [00:03:07] Hi, I am Mai, I am 32 and I live in regional Victoria. Last year, shortly after our one year wedding anniversary, my husband and I decided that we would start to try for a baby, which was very exciting. 

Mai [00:03:22] And by then, we had been together for nearly a decade with our career well and truly cemented, building a house. We’re very excited being in our early thirties. And I went into planning mode. I  had bought those ovulation strips off Amazon. And I also bought the digital ones from chemist warehouse and I tracked my cycle. 

Mai [00:03:49] And after four months, I fell pregnant and I knew very, very early on. The pink line came up. I didn’t feel any symptoms. And I felt really good. 

Mai [00:04:07] And I was so happy and excited. And it was like this little secret between my husband and I was so exciting. I was so happy. And as soon as that little line came up, even though, you know, it was just a little pink line, I feel like the next 18 years of my life was mapped out. 

Mai [00:04:27] And I was so happy. 

Mai [00:04:28] To be mum finally, unfortunately, shortly after one day when I was at work, it was a friday  actually wanted to feel crampie and just generally really unwell. And I felt really emotional. 

Mai [00:04:44] When I went to the bathroom to check in, I saw a bit of pink my underwear and when I wiped and I started to panic straight away, I thought this must be either just normal discharge. You know, don’t think the worse and confusingly overnight I stopped bleeding until the next evening, afternoon, early evening. 

Mai [00:05:10] I started to bleed very heavily and I had like a horrible headache. I was nauseous, even had a fever. And I started passing clots and it was very distressing. 

Mai [00:05:22] And my husband didn’t know what was going on. I was just in a lot of pain and emotional, and upset. 

Mai [00:05:32] The bleeding continued over the weekend and when it came to Monday, I had bled so much and I was so dizzy I couldn’t even get myself out of bed to go to work. I was thinking about work. I called in sick and I got myself to the emergency room. My husband had to go away for work. Upsettingly. And at the emergency room, they confirmed that I’d lost our baby. 

Mai [00:06:05] And they explained, if I could, I could let my body carry it out naturally, because it looked like it was being very efficient of doing that. 

Mai [00:06:17] And the DNC was never explained to me as an option. And if I’d known, I probably wouldn’t have taken it. But yes, my body was very efficient and I was removing a lot of um, removing everything. And it was extremely upsetting. 

Mai [00:06:37] And I had a friend with me, like a mother figure, and she had gone through a miscarriage before. So that was good. 

Mai [00:06:46] And I feel really numb sitting in emergency. 

Mai [00:06:51] And they told me to go home and get some rest. And that was the main advice. And I went to see my GP the next day to see if there was anything I could do to help me feel better. I just felt so tired and dizzy and they told me to rest. And I read that it can take you months to get your period again and ovulate and conceive. And I didn’t want to accept that. And I asked my doctor if there was anything I could do, and he said I could try acupuncture. So I did. And I took all the smelly herbs and that acupuncture. And a month later, I was pregnant again. I feel so blessed. I’m now 10 weeks pregnant again with my rainbow baby. 

Mai [00:07:37] And even though I feel so blessed and grateful, I will never forget the baby we lost.

Mai [00:07:41] Because it will always be our baby. 

Patrick [00:07:45] Well, thank you more for sharing your story and being so brave to share it with all of our podcast listeners. And I think that firstly, we want to say how sorry we are that that happened to you. But also, thank you for sharing it because it beautifully illustrates so many of the aspects of miscarriage that we wanted to cover in today’s podcast. 

Brigid [00:08:11] It really did. So, you know, she talked a little bit about it. Was it early, wasn’t it? It was. It was, I would assume, probably like a six week miscarriage. I got that. Yeah. 

Patrick [00:08:23] And that’s when most of these first trimester miscarriages would come to light in the setting of, you know, unexpected bleeding. 

Brigid [00:08:32] Yeah. So are there any other symptoms around what someone would feel if they’re starting to miscarry. 

Patrick [00:08:39] So usually if someone a woman comes to see me in the setting a miscarriage, she’ll have noticed bleeding and cramping and sometimes, you know, pelvic pain. 

Brigid [00:08:52] And Mai mentioned fever. 

Patrick [00:08:54] Yeah, that was a little unusual. A fever would be an unusual thing to experience. Yeah. And they said there’s a bit of a difference between the patient feeling hot. More of them actually being hot. Yes. But if someone was in the process of miscarriage and had a proven fever from having their temperature taken, that would be of more concern. That would suggest a potential infection. But not everybody who feels hot actually will have an elevated temperature. Genuine fever yeah, right. So. So that’s the group that that they come in with bleeding and pain often to a hospital emergency department, this has a way of happening after hours. 

Brigid [00:09:34] And all they’ve started during the morning and they’ve gone a. Oh well I’ll just monitor it. I’ll see what I’ll say. What happens by the end of the day they think. “Oh no actually this is a serious” yeah. 

Patrick [00:09:45] And then and then of course there’s the group who miscarry but they don’t know they’ve miscarried. And that’s another very sad situation where people rock along for their first pregnancy scan only to find that that there’s evidence of miscarriage. 

Brigid [00:10:03] And that would be quite late, because what happens in our practise is people come in at 10 weeks for their first pregnancy visit, isn’t it? 

Patrick [00:10:10] What it is. But a good number of already had a scan referred from the GP. I just for other reasons, like to confirm that there’s an ongoing pregnancy if the woman is feeling anxious about that or to exclude twins or if there’s confusion about the dates. Yeah. If we can’t be a hundred percent clear about when the last period happened. So a good number. We’ve already had an early pregnancy scan. Somewhere around the six to eight week mark. Yeah. And but yeah, you know, several times a year I’ll see someone come in as late as 10 weeks for their first routine visit. And and tragically, we’ll find a, you know, an empty and empty pregnancy sack on scan or a or a sack with her fetus with no heartbeat. 

Brigid [00:11:02] So with bleeding, I know that we did cover this in an earlier episode in episode six. I think that episode is called a early bleeding in pregnancy. But and we talked about, does every bleed mean that there’s a miscarriage? 

Patrick [00:11:17] Well, absolutely. Absolutely not. So. So lots of bleeding can happen for benign reasons. You know, early pregnancy. And we did cover it in that other episode. But, you know, if all the people who present to the hospital emergency department with with bleeding in early pregnancy, most will have a reassuring scale. 

Brigid [00:11:38] Yeah, yeah, yeah. So tell me about well, what are the options? Is it only the emergency department that that woman can go to? 

Patrick [00:11:46] Well, well, no. But I’m sure people present to their GP. Some people who I already know from previous pregnancies will just ring me. Yes. And you know, they’re people. I’ve got my own ultrasound machine so that people who I can just see as an extra patient that day but, typically it would be someone going to their local doctor or after hours or in the setting of heavier bleeding or worse pain than they might might go to a hospital emergency department. 

Brigid [00:12:16] And I know it’s hard because, you know, I haven’t had a miscarriage. And you’re obviously a man. But what is a woman feeling? What’s the pain like? Well, what did they tell you? It’s like? 

Patrick [00:12:27] Well, the physical pain component can be somewhere between mild or nothing. Right up to right up to dreadful. Right. But the emotional pain is just awful. There’s a great deal of anxiety. And you won’t sort of settle that anxiety for people with bleeding in early pregnancy until they get their scan. Yeah. So simple as that. They want to see that that heartbeat. Yeah. And you know, who wouldn’t you know? So I think that delaying in that first trimester situation is all always unfortunate. You know, if they if there’s delays because people will not relax until they know what’s going on. And, you know, most of the small bleeds are not are not dangerous. And and the pregnancy is alive and well. And then for the people who who have miscarried, well, we want to move on to  discuss appropriate next steps. 

Brigid [00:13:24] So it’s is it only by ultrasound that a miscarriage can be diagnosed? I know we talk a little bit about the HcG blood tests. 

Patrick [00:13:33] Yeah. So ultrasound is the basis of the diagnosis. Pretty much every time. In the medical textbooks, there’s a lot of discussion about the various types of miscarriages and so forth. But most of that relates to the pre-ultrasound sound era when they really didn’t know what was going on. So. So if you come to a hospital emergency department, for example, with bleeding in early pregnancy, then an ultrasound will give the diagnosis most of the time. And there are some grey areas and in the grey areas, a quantitative beta HcG, that’s not just a yes, no pregnancy test, but the number. Yeah, 100, 100000, that can be used to sort out grey area cases. And then there’s sometimes where it’s still not sorted out despite an ultrasound and a quantitative hormone level. And those people need to have another scan next week. 

Brigid [00:14:32] And is why isn’t it sorted out? 

Patrick [00:14:34] Well, you can just be in a grey area. For example, if you’ve got bleeding at five weeks and the ultrasound shows a shows an empty sack and an empty uterus. Well, you might expect an empty uterus at five weeks. So the ultrasound can’t call it one way or the other. And then you’ll take a quantitative hormone level and it might be five hundred. And that doesn’t call it one way or the other. Five hundred would be a reasonable level. So in order to sort out whether it’s a miscarriage, an ongoing pregnancy, or even an ectopic, you have to scan again or do more blood tests. 

Brigid [00:15:12] Now ectopic we are going to cover in its own episode. Yeah. So, yeah. That’s coming up probably soon. But I just wanted to say about the HcG. Don’t go into the forums. Oh yes. If you don’t ask in in a Facebook group, you know I’ve got a beta HcG of X what does that mean? That will really mess with you calm. 

Patrick [00:15:38] Yeah, there’s a there’s a very widespread misunderstanding about beta HcG levels. How how useful they are in predicting outcomes. And they’re really only that useful in this in a few small grey area situations where we don’t know where the pregnancy is ongoing or not and they’re useful in the treatment of ectopics. 

Patrick [00:16:01] But there’s a wide normal range. So if you’re six weeks, it might be normal to be a thousand or six thousand. So so if your level’s 3000, is that better than two? No, no. It’s just that they’re both in the normal range. 

Brigid [00:16:16] Yes. That will mess with your brain. Yeah, yeah. Yeah. 

Patrick [00:16:19] We might use it to track so that if we do it two days later and it’s gone backwards. Well that’s a failing you know that’s. Yeah. That’s a non-progressive pregnancy. The first level by itself might modify normal. 

Brigid [00:16:33] Yeah, that’s right. And yours will not be the same as your friends. Now. That’s right. Yeah. So this is the big question Paddy. Why do miscarriages happen?

Patrick [00:16:43] Yeah. Well this is you know, this is the big question is that why in 2020 is this still happening? I guess roughly the same frequency as it did throughout human history. And we still don’t know what causes most of these. We don’t find out in individual cases. Put it that way. So you’re unlikely to get a definitive explanation for why your miscarriage happened. Most of them, we think, are due to major genetic errors that happened right back when the sperm and the egg first came together. Obviously, long before we can even know you’re pregnant, let alone let alone do anything about it. And there must be some genetic carers that are that when the big zipper of of sperm, DNA and egg DNA come together, there must be some errors in that process. Often say to people is a miracle it ever works out. How complicated is that? But there must be errors in that process that are so big that you can get a a an embryo that’s capable of going two to six weeks, but no further. 

Brigid [00:17:58] And it’s really important for a woman not to blame herself. We did a post in the early days of my baby on our Instagram, and I think it said something like, you didn’t cause your miscarriage by insert reason here. Yes. You know, it wasn’t because you exercised too hard at the gym, more because your colleague had some essential oil on or because you drank too much coffee or you know. 

Patrick [00:18:21] In fact, we know for a fact that those things don’t cause miscarriage only because they’re all really, really common activity. That’s right. And if they did, we would know. Yeah. Yeah. So there might be some healthy behaviours in early pregnancy, not smoking and so forth. But but we can’t usually put down a first trimester miscarriage to anything in particular. 

Brigid [00:18:41] What about women who have got like a different shaped uterus, like a bicornate uterus? Sure. 

Patrick [00:18:51] So there. That’s that’s one of the exceptions. So there is there are there is a group of women who are predisposed in some way towards a much higher chance of first trimester miscarriage. And sometimes these are the people who get recurrent first trimester miscarriage. One of the causes of that is an abnormal shape to the uterus. So a small number of women have a uterus. That’s an unusual shape. And some of those it’s difficult for the fertilized egg to implant in a good spot and they would be more susceptible to pregnancy loss. 

Brigid [00:19:34] Yeah, right. And what about non-rare things like adenomyosis or endometriosis or even PCOS? Like there’s a lot around infertility with some of those things. But does that cause miscarriages? 

Patrick [00:19:48] Yes. Some some of those conditions might predispose women to, you know, a higher risk of first trimester miscarriage. But most of our attention for those couples is focussed on helping them get pregnant, in the first place yeah. So, you know, I must say, I’m always much more concerned. For example, if a couple are experiencing some some miscarriages throughout their pregnancy life. I’m more concerned about those miscarriages. If each one of those conceptions took two or three years to bring about,. 

Brigid [00:20:28] You step up management in those cases? 

Patrick [00:20:29] Maybe. Yeah. Yeah. And so this is why the care has to be has to be nuanced and and expert, because, you know, of course, I’m going to perhaps throw the book more at a 40 year old who’s taking two years to conceive, then I might at a 21 year old who’s conceived quickly because if they both have a first trimester miscarriage, it’s much more potentially serious for one than the other. 

Brigid [00:20:59] Yeah, that’s right. And because it’s true, isn’t it, that most people that have a miscarriage only really have one in a row and then go on to conceive after that. 

Patrick [00:21:09] Yes, absolutely. So. So it just as statistically providing there’s nothing else wrong, then your chance of miscarrying, you know, twice or twice in a row is less than 2 percent and then only about 1 percent of people will then have three in a row. Yeah, right. And the three in a row group. I guess it’s progressively less likely due to chance alone. Yes. And there may actually be an underlying problem. And that’s why we tend not to throw the book at people until they’ve had three in a row. Yeah. Sometimes it might be twice in a row if they’re a special group. Sub fertility older. The younger couple with normal fertility who are getting pregnant quickly. It’s the most likely explanation is a run of bad luck. Yeah. And then only if that runs seems to be continuing do we think, “hang on a minute. What else is going on”. Yeah. And there are a a page full of investigations that we will do for a couple that we suspected had an underlying medical problem predisposing to a current miscarriage. 

Brigid [00:22:19] We might get onto recurrent because it’s not the norm. So but what I really wanted to ask, because I just I think about it a lot, probably more than I should, but I often wonder what it’s like for you. And what happens when you tell someone that there’s not a heartbeat. 

Patrick [00:22:37] Yeah, look, it’s one of the more challenging parts of the job. Right. And it’s challenging for me. I do it all the time. And I think it’s I think it really is challenging for people who who aren’t doing it all the time. Like, for example, a hospital emergency department doctors, you know who to save some time has done the scan himself rather than send the patient around the ultrasound department. A lot of emergency departments got their own scanner for various things and pop the scan on thinking you’ll be able to say to this patient, “you’re right, go home, you’ll be fine”. Yeah. And suddenly, you know, there’s a miscarriage. And I think that’s hard.  It takes a bit of time and I think experience and you’re training to deal with it. 

Brigid [00:23:18] Well, and what are most people’s reaction when you tell them? 

Patrick [00:23:22] Well, obviously, people are heartbroken. And there’s tears and disappointment. And and sometimes, you know, the woman might have come by herself. So then and then say, come and go. So then we need to bring the partner in from work and those sort of things. Yeah. And it’s it’s very, very normal to be just emotionally washed away by the experience at the very start. But I’m always amazed by people’s resilience. Yeah. You know, and so much so. And that’s that’s so common and so normal to be that resilient, to recover quickly and to keep going. That I actually say that to people in the in that first visit when the miscarriage is diagnosed, I say to them you you can expect to be honest, you can expect to recover quickly from this. And that’s not to diminish the pain they’re in right now. It’s just that I think it’s somewhat useful for people to know how long they’re going to feel so awful. And I think that sometimes I’ll say to people, you know, that the experience of miscarriage will be with you forever, but it won’t always hurt like it does today. 

Brigid [00:24:41] And it’s a real roller coaster of emotions, isn’t it. Absolutely. And we go back to what Mai said, and she said that she just felt like the whole next 18 years of a life all was planned out for her. And I think it’s that loss of what you expected and that ideal of what your life might be. 

Patrick [00:25:01] So, yes, because temporarily at least, you feel as if all of that’s been taken away. Because very quickly, people, very quickly, a couple start to feel that they just don’t want any baby. They want this one. Yes. Yeah. And why why wouldn’t you feel that way? Yeah. 

Patrick [00:25:21] So the loss of the loss of this baby needs to be acknowledged and respected. 

Brigid [00:25:28] And to have just gone to the COPE website now. That’s a fantastic resource for people.It’s www.cope.org.au  And they just talked about all the different types of emotions that you might have, such as numbness, disbelief, anger, guilt, sadness, depression, anxiety, confusion and even difficulty concentrating. Now that that’s the grief cycle, isn’t it? Absolutely. Yeah. Yeah. 

Patrick [00:25:57] And then and then, you know, surprisingly quickly that it gives way to hope. 

Brigid [00:26:04] Yes. The role of hope is enormous in all of this is now the role of hope in parenting is enormous. 

Patrick [00:26:12] Absolutely true. So, you know, in in in people who are emotionally and and and well, coming into the pregnancy, mental health is good and so forth. There is an amazing well of resilience that people seem to be able to draw upon. And of course, we want the people around us to be. Yeah. Supportive as well. 

Brigid [00:26:42] Yeah, that’s a really good point. So we we had a little think about, well what can you tell, what can you say to someone that had a miscarriage? Because often like our feet are totally in our mouth about really difficult issues like these. Like, for example, the other day I saw a good friend for the first time after she’d had chemo, you know, and she had a headscarf on. And and I went, oh, my God, how are you? Yeah. And then I saw the look in her face and I thought, well, what a stupid question to ask. I’ve got cancer. I really felt awful afterwards. 

Patrick [00:27:15] So the experts say to the person with if someone’s got a cancer, that can be more much more useful to say, how are you feeling today? Yeah, right. Cause overall they’ve got cancer. Surely they’ve been feeling highly troubled and potentially sad, depressed about that. But to ask how you’re feeling today seems to be a better question about, you know, how are you right now compared to the other pay and you had potentially what can I do to help? 

Brigid [00:27:45] Yeah. So we thought about things to say to women who have had a miscarriage. And obviously, you know, that’s the first thing that we all say, well, you and I say, Pat is, I’m so sorry for your loss. 

Patrick [00:27:55] Yeah, that that that one has actually got a high rating from the people who’ve been through the experience because it acknowledges the loss upfront. 

Brigid [00:28:06] Upfront. That’s right. Because often too often we say stay silent that way when people are in grief. Again, it’s this problem with putting your foot in the mouth. But I think it’s it’s much more important to acknowledge it and to do something, even if you don’t feel comfortable or feel like you will make things worse. It’s sending a text. I remember when my oldest boy’s dad died and we were inundated with texts. And that was just beautiful to receive. 

Patrick [00:28:39] That’s right. So I think that it’s better to say something than nothing or at all to take something than nothing. And something like, I’m sorry for your loss is something that acknowledges the loss is a good place to start. 

Brigid [00:28:53] And if you’re a good listener, then say, would you like to talk to me about it? Yeah, you know, because don’t. It allows them healing as well. 

Brigid [00:29:01] The person that’s actually had the miscarriage and other things during our grief that we found incredibly useful was useful. Practical people would bring us food. Yeah. Cakes, meals yeah. 

Patrick [00:29:14] Meals, any sort of follow up I think is really good too. So you think if if someone, you know, has had a miscarriage that you acknowledge the loss upfront and then a week or however however close you are to that person, what the appropriate time frame is, you say or do something again. 

Brigid [00:29:31] Yeah. And it might even be a month down the track or two months down the track or whatever it is. We also did a post about why don’t we tell people early on that we’re pregnant? You know, we’re worried that if we miscarry, we’ll have to untell people. But our point was that this is the community that we live in, like we have to have that support from our community. How would the community support us if they didn’t know were pregnant and gone through pregnancy loss? So I don’t know how everyone feels about that. I mean, I think if everyone knew. 

Brigid [00:30:05] That someone was going through a pregnancy loss, then, you know, we could support that person better. 

Patrick [00:30:09] I think that’s right. So that brings me just for a moment to things that we know we probably shouldn’t say. Yeah. So again, we’re not making this up. There’s been some research done on on what the women themselves will wanted to hear and didn’t want to hear. Yeah. At the time of a miscarriage. And I think the things that are probably the worst are the things that that seem to diminish or disregard the sense of loss. Yes. So in Mai story she said at the end, I’ll always miss that baby. Yeah. So. So it you know, it doesn’t really matter what somebody else thinks. Yeah. 

Patrick [00:30:52] That’s what she’s experienced. Absolutely. So don’t say it’s for the best. Oh my gosh. It’s for the best. Yeah. Yeah. Or it’s for the best because something was wrong. 

Patrick [00:31:02] Because something was wrong. That’s right. And so. So that that is not aligning at any point with what the person is actually feeling. And they might be worse, they might find that that completely unconcerned and consoling, but also put potentially offensive,. 

Brigid [00:31:19] Offensive and disrespectful of the process that they’re going through. Things such as at least it wasn’t it really wasn’t a fully formed baby yet again.

Patrick [00:31:28] Yet again. And oh, oh, you’re young and you can try again and have theme running through these. Is that it diminishes the pain. And the only thing that really will diminish the pain for that person is some time, some resilience and some recovery. Yeah, but not somebody telling them that they shouldn’t be in that pain. 

Brigid [00:31:45] That’s right. They should just get over it because, you know, it’s a natural it’s nature’s way of dealing with whatever. 

Patrick [00:31:52] Yeah. Probably best not to mention nature’s. No I as well as again that’s some that’s not not acknowledging the person, the woman’s pain. 

Brigid [00:32:03] Now we also need to acknowledge the partner. We with you. Somebody DM’d. Thank you for all your feedback. Like it’s just so gratifying.

Brigid [00:32:15] We are very grateful that people take the time to talk to us over our Instagram DM’s. She said, I just wanted the listeners to know that I was really angry at my husband because he looked like it didn’t impact him at all. Later he told me that he would cry in the shower, so I wouldn’t see because he thought he had to be strong for me. So we’ve just gotta give everybody time and and support and and love. That’s right. We’re gonna go back to medical. What happens next? Somebody has come in and they’ve had a heartbeat, missed heartbeat or they haven’t seen heartbeat on ultrasound. What happens next? 

Patrick [00:32:53] Yeah. So there’s a few different ways the situation can can be managed. Sometimes that is appropriate just to wait and observe and let the the process of miscarriage be completed naturally without intervention. And occasionally that is quite appropriate. Other times we might give medication, commonly something called misoprostol, which is a drug that will help the uterus contract and empty. 

Patrick [00:33:24] And that can be useful. And other times we would perform an operation called a curette to go in through the vagina. No cuts or stitches, but stretch the cervix open a little bit and put a suction tube inside the uterus to remove what’s left of the pregnancy. This is called a DNC. And there’s times when that’s appropriate as well. And working out which one of those is the appropriate advice to give people. You’ve got to we’ve got to weigh up a number of factors. What the woman wants, what the clinical situation calls for. And just for example, if someone’s having a huge amount of bleeding that’s really threatening their health, then to recommend further, further observation might be quite inappropriate. Maybe that woman needs a curette within a few hours. So if the bleeding won’t stop, they might be they’re not there might be another situation where we actually need to collect the material from the miscarriage and to send to pathology to see if there’s some sort of genetic recurrent genetic problem. So we might need to do a curete to actually collect them all the right material. 

Brigid [00:34:36] It’s so hard talking about I don’t know what the most compassionate term. I know that’s medical to say material, but is there a more compassionate way to say that. 

Patrick [00:34:44] In medical, we talk about products of conception. I think that’s not that much nicer. Yeah, but so sometimes, you know, sometimes there’s this there’s a sound medical reasoning behind the advice. Sometimes it’s very appropriate to wait and see if the uterus is empty or an ultrasound, then it might just be quite appropriate to let that bleeding run its course over the next couple of days. And and obviously the patient’s wishes come into it as well. Some people are very keen to start trying again immediately. And part of that is for the uterus to get empty as quickly as possible. So that might come into the decision as well. 

Brigid [00:35:26] And is there any that like is part of it also when you had that loss, like whether it was a six week loss or 12 week loss? 

Patrick [00:35:33] Yeah, absolutely. It can really depend on what’s on on what what can be seen in the uterus, on ultrasound. And if there’s a large amount of material, I always think that that’s potentially less likely to clear by itself. Yeah. 

Brigid [00:35:46] Okay. And what about, you know, we know it from the private system and we’re sort of talking about it from the private system. But what happens if someone’s public and to everybody overseas, I’m sorry, I’m talking about the private and public system within Australia. Sure. 

Patrick [00:36:02] I think that, you know, the options given shouldn’t be different. And I just think that potentially the situation might  be managed through family doctor, especially if it’s a very early miscarriage with an empty uterus on ultrasound. Yeah. Then then referral to a specialist or a or a hospital emergency might be not needed vs. a more complex situation which might be managed through a hospital, either public or private. 

Brigid [00:36:37] Yeah. And for someone who has miscarried and and then has either let the process happen naturally or has gone in had a DNC and saying what? What happens now? What’s her recovery. Yeah. 

Patrick [00:36:51] So there’s the the physical recovery tends to be quite fast. When the uterus is empty, most of the cramping pain goes away and the pelvic pain will settle in a matter of hours or days and and the bleeding stops. Emotionally, it’s a more complicated thing than that. We touched on before that that sort of experience of, you know, like I said to people, look, you know, if someone you know, you’re if your granddaughter has a miscarriage one day, you’ll say, oh, yes, I had a miscarriage, too. But it’s not like it will still be hurting. Yeah. When you’re a little old lady. So I think there’s a you know, the emotional recovery is highly variable and depends on a lot of things. But I’ve said before most people their resilience is such that they recover quickly. 

Brigid [00:37:43] And it is pretty normal again, going back to that grief cycle to feel sort of that you put a less of a loss of appetite or you’re feeling exhausted or drained or, you know, you might just need to have more time at home, sort of just having a sick day from work, or your week. Yeah. 

Patrick [00:38:02] And so it’s so. So that will vary for some people. And then and then really there’s a group that doesn’t recover emotionally quickly. And for those women to bring in some bigger supports. Yeah. Clinical psychologist trained in in pregnancy loss, you know, once a year or something, a psychiatrist. 

Patrick [00:38:26] If, you know, if people are experiencing a clinical depression triggered to or contributed to by a by pregnancy loss. 

Patrick [00:38:34] Yeah. And if that person is keen to get pregnant again, what what what is the timeframe? What what how long should they wait? 

Patrick [00:38:40] Yeah. So from when the uterus is is empty naturally or through curate, then you would expect the period to come back between four and six weeks ish. And people and obviously couples need to remember that ovulation comes before menstruation. So you might get pregnant again within the first cycle. Yeah. Like Mai did. So the the the relevance of that of course is that if your period hasn’t come back by eight weeks, first thing you induce a pregnancy test, you’re not already pregnant. You would experience you would expect that that period to come back between four and six weeks and then assuming you’re not already pregnant then that first date is the new day one. So we concentrate on conceiving again, if that’s what you want. So regular mid-cycle intercourse back on the folate and and working towards a new conception. 

Brigid [00:39:38] And in your experience, how how long do most people sort of white before they start trying?

Patrick [00:39:44] Yeah, it varies. It varies a bit. But a couple where the pregnancy was, um, was much wanted and they and they want to be pregnant again as soon as possible and they’re feeling up to it. People will commonly be trying and in the next cycle. Yeah, but I’m sure it’s also common for people to say we will give it three months and then you go again. 

Brigid [00:40:08] Yeah. Yeah. Okay. So we might need to talk about recurrent miscarriage. Now, you mentioned before that it’s 2 percent. 

Patrick [00:40:18] If you’ve had one miscarriage, then the chances of that being followed by two more are about 1 percent. 

Brigid [00:40:24] Right. Yeah. So it’s really quite small for recurrent miscarriage. Absolutely. Yeah. Yeah. And what what is the problem with recurrent miscarriages? Is that back to the abmormalities that you were talking about before? 

Patrick [00:40:37] Yes. So. So there are some couples where there’s a genetic difference in either the man or the woman. That means that they’re going to continually create embryos with a genetic problem. Yeah. And this is rare, but a real thing. And it’s one of the reasons why one of the investigations for recurrent miscarriage is what’s called a carrier type for for both the couple to make sure that neither are carriers of genetic variation. That’s going to make this happen time and time again. Yeah, right. And then sometimes things like pelvic ultrasound to look at the shape of the uterus. Yeah. And then occasionally we do all that and don’t find anything. Yeah. And there’s a role for some people with unexplained recurrent miscarriage for to be on some medications at the time of conceiving. 

Brigid [00:41:33] What are we talking there. 

Patrick [00:41:34] Aspirin helps a bit. Yeah. There are some people with some unusual blood clotting disorders where proper anticoagulation is needed. And it’s even been shown that, um, that there’s a that there’s an effect in some people with with unexplained recurrent miscarriage for just more surveillance. Right. Once you’re pregnant, which is an odd thing you wouldn’t think would make any difference. But it does seem to be a little bit of a difference if we do repeated first trimester ultrasounds with a lot of TLC. Yeah, that that may actually help affect outcomes. 

Brigid [00:42:18] Yeah, well, that is the mind? 

Patrick [00:42:22] Potentially. Yeah. Wow. 

Brigid [00:42:24] All right. So I think really that highlights that the DIY stage is over. Yes. P.O.W, as everybody knows, if you’ve got two miscarriages in a row, that that’s really you do need proper surveillance from a gynaecologist. 

Patrick [00:42:39] Well, I think if if you if you’ve had three in a row proven. Yes. You know, three in a row have already happened. Yeah. Then then absolutely. We’re getting up into specialist management territory and then even a couple perhaps if the woman was approaching 40 who had two in a row, I’d be I’d be watching that couple closely as well as well. And there is a role for so uncommon, but there is a role for some couples to use IVF technology to to get around some of these problems. Yeah. And that is you have an IVF cycle, make a number of embryos and the ones that you re-impant re-implement are the ones that seem to have the best, the best strength and quality so that you maximize the chance of picking a good one. 

Brigid [00:43:30] Yeah. And I just want to clarify about the One in five, number one in four. Some places say one in four pregnancies end in loss. However, that can be the one person can’t it. So you could have a miscarriage, but then a pregnancy, then a miscarriage, then a pregnancy. But that’s not a recurrent miscarriage. 

Patrick [00:43:52] That’s a good point. Yeah. So. So we’re probably least worried about the couples who’ve already got babies. Yeah. Because we know they can do it. And on just first meeting that couple, they’re less likely to have a major, major problem because they’ve they’ve done it before. Yeah. So yeah, we’re mostly talking about a couple with no live babies and multiple consecutive miscarriage miscarriages. 

Brigid [00:44:18] Okay, good. So we are lucky in a way that we have got some fabulous resources for women that have had miscarriage. And I would really recommend that you go to these resources rather than, you know, search on Instagram and the forums. Sorry. So one that I love is the pink elephant organisation. I’ve already mentioned cope with it. And another beyond blue have got some really good resources as well. Yeah. And I’ll put all of those into our show notes so you can go there to get the links if you can’t find them otherwise. And we’ll also keep up the speek pipe dot com slash grow my baby site because I reckon it would be really interesting to have a podcast which is like the voices of miscarriage, because we’ve got lots of birth stories out there. Yeah, we don’t tend to have too many about miscarriage. So if you feel like you want to add your voice, just go to that. I’ll have that also in the links in the show notes. Excellent. Yeah. Well, thanks for listening, everyone. We really hope that this has been useful. Hop over to our Instagram, which is at @grow_my_baby and join in on the conversation there. 

Brigid [00:45:33] And if you are loving our podcast and we hear it all the time that people love our podcasts. Could you please do us a favour and go in and give us a five star rating? And even if you have time, give us a little review because we love reading them. 

Patrick [00:45:49] Bye for now. Thanks for listening.