HEALTH

Miscarriage In Australia Is Far More Common Than You May Think

And we need to talk about it.

18/02/2017 2:55 AM AEDT | Updated 22/02/2017 11:09 AM AEDT

For 33-year-old Rosey, it happened quickly. Her first pregnancy, over in an instant.

"I lost it at nine weeks. I was young and thinking that nothing would go wrong. For me, I knew as soon as I started bleeding that it was all ending," Rosey told The Huffington Post Australia.

"That was ten years ago now. It was spontaneous and it was devastating."

Kirilly's story is different. A mother of three, she had never encountered problems during pregnancy. Until her fourth.

"When my littlest was ready for school, I knew I wanted another baby and, once again, I fell pregnant straight away. But I knew this time was different," Kirilly told Huffpost Australia.

I felt empty.

In Australia, up to one in four pregnancies end in miscarriage. 103,000 Australian families are impacted each year.

And yet, for many, it remains a silent trauma.

"I think that women still feel a sense of guilt and responsibility in relation to miscarriage," Associate Professor George Condous of Obstetrics and Gynaecology at Sydney Medical School and Gynaecologist at Nepean Hospital told Huffpost Australia.

Here's what you need to know.

What is miscarriage?

By definition, miscarriage refers to the loss of a baby before 20 weeks of pregnancy.

A still birth -- or the birth of a baby who has died in-utero or prior to delivery -- occurs after 24 weeks gestation.

"A miscarriage can occur when a developing pregnancy either has a baby that forms and the heartbeat stops, or when the pregnancy develops but the embryo doesn't. In this situation, you end up with a gestational sac inside the uterus with no developing embryo," Condous said.

"Both of these situations usually occur at less than 12 weeks' gestation."

This is nature's way of dealing with an abnormal embryo.

As a result, miscarriages are most common within the first trimester of pregnancy. But there are other cases.

"If a woman presents with some spotting, bleeding or lower abdominal pain, we would perform an ultrasound to determine the viability and the location of the pregnancy."

Common signs of miscarriage

Cramping stomach pain

Vaginal bleeding

If you are concerned about your symptoms, see your GP or go to your closest emergency department.

fotostorm via Getty Images
Spontaneous miscarriage in the first trimester accounts for 10-20 percent of pregnancies.

Why do miscarriages occur?

Most miscarriages are sporadic events with no treatable cause.

"Usually, this is the way miscarriages occur purely because of how the genetic material comes together -- in a way that is not compatible with life. Essentially, this is nature's way of dealing with an abnormal embryo," Condous said.

Such abnormalities are typically sporadic, and are not inherited.

Recurrent miscarriages, medically defined as three or more consecutive losses, are different -- and they affect approximately one percent of couples.

It is important to note that in almost every sense, there is nothing that a woman could actively have done to change the outcome of the pregnancy.

"In the recurrent group, there is potentially an underlying cause. This could be a chromosomal problem such as a genetic abnormality within one parent that is passed onto the pregnancy," Condous said.

Other causes can be related to thrombophilia -- a genetic condition affecting maternal blood and the process of placentation -- or the shape of a women's uterus.

"It is important to note that in almost every sense, there is nothing that a woman could actively have done to change the outcome of the pregnancy," Condous said.

"Not only do most people who have a miscarriage not fall under the recurrent group but most will also go on to have a healthy baby in their following pregnancy."

Types of miscarriages

Complete and incomplete miscarriages

"If a woman has had an earlier scan showing a pregnancy sac inside the uterus and then, following a re-scan, the uterus is empty, that is a complete miscarriage," Condous said.

"If there is no pregnancy sac, but there is some retained pregnancy tissue inside the uterus, that's an incomplete miscarriage."

Missed miscarriage

"When the embryo has stopped growing and there is no heartbeat, but the tissue has not passed, this is called a missed miscarriage."

Blighted ovum

"If a women has the same presentation and ultrasound shows there is a pregnancy sac but there is no embryonic part inside that sac, that is also known as an empty sac miscarriage."

What are my options?

Women seek medical care at different stages of a miscarriage. For some, it will have already happened. Other times, it will have only just begun.

Whilst Rosey's miscarriage passed naturally, Kirilly's experience required surgery.

Eight weeks into her pregnancy, after experiencing cramping and bleeding, Kirilly was sent for an ultrasound.

"I was told because I was a walk-in patient that I would have to wait. I was shocked when there was no sympathy at all," Kirilly said.

Sitting in the waiting room alone, cramping and bleeding, is a memory that will never leave me.

Back at home, Kirilly's cramps intensified.

"I miscarried while in emergency and needed to have surgery."

According to Condous, there are three options for treatment of miscarriage.

"If a woman is clinically stable and she understands her options, you can manage miscarriage expectantly, medically or surgically," he said.

Expectant management

This is a 'watch and wait' approach. "If a woman is going to miscarriage naturally, usually that would occur within the first 14 days after their first presentation. We call this the 'two-week wait rule'.

"We then perform a re-scan two weeks later."

Medical management

A woman who is clinically stable can be given medication to induce her miscarriage.

"This is either in the form of misoprostol, with or without mifepristone. This option usually applies up to nine weeks' gestation."

Surgical management

Dilation and curettage (D&C) is the most common approach in Australia.

"The surgery involves evacuating the womb of the pregnancy tissue. You can perform this for someone who has an incomplete, empty sac or missed miscarriage. And some women do need to have a second procedure," Condous said.

"If a woman presents with heavy bleeding and her condition is worrying -- she may have low blood pressure and a high pulse rate -- this becomes a potentially life-saving procedure to evacuate the uterus."

"When you look at rates of success, expectant management is around 60-75 percent, medical management is between 80-90 percent and surgical management is around 95 percent."

Umkehrer via Getty Images
How do you share your story when no one knew you were expecting?

What now?

"The most important thing that I talk to my patients about is that from a physical perspective, once a woman has her first period -- which occurs about four to six weeks later -- her body has recovered and she is okay to start trying again," Condous said.

After her first pregnancy miscarried, Rosey fell pregnant soon after. That pregnancy saw the birth of her daughter, and her son arrived two years later.

Kirilly too, gave birth to her fourth child -- but only after more heartbreak. Following her miscarriage, her subsequent pregnancy was ectopic.

And this is only one side of the story.

For every woman who endures a miscarriage, there is an often silent emotional toll.

Nobody knew I was pregnant with my fourth child, so nobody knew that I had lost it.

"When I got home from hospital after my surgery, I felt so alone. Nobody knew I was pregnant with my fourth child, so nobody knew that I had lost it," Kirilly said. "Returning to normal life was hard."

For Condous, supporting a couple -- in particular the women -- is the most important and underestimated aspect of miscarriage among clinicians.

"We absolutely need to ensure that they have support from a family and psychological perspective. It is vital to allow the couple to grieve," he said.

"The most stressful aspect in trying again is whether this will happen again. I think it is their call to try again -- when they feel the time is right.

Most people don't have recurrent miscarriages. Most people don't have an underlying cause to their miscarriage and have gone on to have healthy pregnancies.

"What I'd suggest is once you fall pregnant, go back to see your obstetrician at around 6 or 7 weeks to arrange an ultrasound. If you can demonstrate an embryo with heart activity, the risk of subsequent pregnancy loss falls to about six or seven percent."

Getty Images/iStockphoto
Most women who miscarry go on to have healthy subsequent pregnancies.

"My general feeling is until you do have that healthy baby, you really don't get over it. They help you to keep things in perspective. For me, having the healthy ones helped me to realise that something wasn't right the first time," Rosey said.

"But for some women, the cycle is enduring. This is a lot easier when you do get that healthy baby."

Moving forward

It has been ten years since Rosey's miscarriage. With two healthy kids in tow, her work in private medical practice is framed by her own experience.

I have two kids, but I have had three pregnancies and two births. I think that it really important.

"When I am dealing with a patient who is having a pregnancy, I always ask them how many pregnancies – not babies -- they have had. A woman may have a significant history, but she may have no baby," Rosey said.

"I have two kids, but I have had three pregnancies and two births. I think that it really important."

According to Condous, there have certainly been advancements.

"Over the last five or six years, a lot more research in terms of the diagnosis and the psychological effects has emerged. And as a conversation, I think it is becoming more acceptable to talk about it."

Despite this, he believes women are not expressing their experience openly.

"I think that women still feel a sense of guilt and responsibility in relation to miscarriage. If they were to explore that avenue, and often when they do, they find out that a lot of their friends, mothers, sisters and aunties have had a miscarriage themselves because it's such a common event," Condous said.

"My advice is to talk about it openly with your husband or partner and express your loss with your friends and relatives -- when the time is right."

If you or someone you know is showing symptoms of bleeding early into their pregnancy, see a doctor or visit your nearest emergency hospital.

If you are affected by the loss of a baby, SANDS Australia offers support through local support groups and a 24/7 phone line on 1300 072 367.

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