A note before I begin: the medical establishment refers to a miscarriage as an “abortion” and while the term means “ending” and is therefore accurate, it also carries other connotations which are painful for a mother who wanted to keep her baby, so I stick with the term “miscarriage.”
There are four kinds of miscarriage: spontaneous, threatened, incomplete, and missed. Here is what they mean:
Spontaneous miscarriage means that the baby has died, and the mother has begun to cramp, bleed, and expel the contents of her uterus (fetus, placenta, etc).
Threatened miscarriage means that the mother has begun to cramp and/or bleed, but the baby is still alive (verified via heartbeat or ultrasound). In these cases efforts are made to stop the miscarriage and save the baby—often bedrest or anti-labor medications are prescribed. If the same events happened after 20 weeks gestation, it would be called pre-term labor rather than a threatened miscarriage. The difference is that in the first half of pregnancy there is no way to save the baby if it comes out...in the second half of pregnancy (at least after 25 weeks) the baby has a fighting chance.
Incomplete miscarriage means just what it sounds like--the mother began to miscarry, but not everything came out. This is commonly diagnosed if she bleeds heavily for more than a few days, and can lead to anemia and other problems due to the severe and prolonged blood loss. A D&C is usually prescribed in these cases.
Missed miscarriage means that the baby has died (usually diagnosed via ultrasound when no heartbeat can be found via doppler), but that the mother have not yet actually lost the baby. In other words, her body is trying to stay pregnant, even though there is no longer a living fetus to support. In most missed miscarriages, once the mother finds out that her baby has died, she will begin to bleed within a matter of days—it’s an amazing proof of the power that the mind has over the body.
Now that you know what they mean, you should know what your options are.
With a spontaneous miscarriage, you typically don't need to worry unless you are in a lot of pain, or have excessive bleeding. You do not need to see a doctor or midwife unless you want to, although if you have begun seeing one then I'd recommend letting him/her know what is happening. Just take it easy (remember that your body is laboring and birthing, albeit in the wrong trimester, and that you cannot and should not try to carry on as normal during this time). Eat iron-rich foods to prevent anemia, drink lots of water to stay hydrated, and take a painkiller if you need or want one. There are a number of herbs that are recommended for helping with miscarriage, but that is another post.
If your bleeding is excessive or prolonged, or you may choose a D&C--I'll explain more about those in a minute.
With an incomplete miscarriage, there is usually a bit of placenta or something like that being retained inside the uterus. It prolongs the bleeding and can lead to hemmorage, anemia, or other complications if you don't get everything out. You should definitely see your doctor or midwife about this. You may be prescribed a medication which will cause your uterus to contract and hopefully get everything to move on out. Depending on the type and strength of the medication, your doctor may wish you to do this under supervision. Alternately, you may have a D&C. An incomplete miscarriage is the one time when I think a D&C is thoroughly warrented.
A D&C, or Dilation & Curettage, is which is where an OB will medically induce dilation of the cervix, and essentially vacuum everything out with a little tube. It is usually carried out with sedation or mild anesthesia--I had mine done under 'conscious sedation' and my mother had one done with just a spinal (ie, she was awake). A D&C is often followed with a little cramping and spotting, but in my experiences at least the after-effects were milder than an average period. Your OB will probably prescribe a painkiller and an antibiotic--I never needed the painkiller personally.
In the case of a missed miscarriage, you have two choices: have a D&C, or wait for the miscarriage to happen naturally. Most women seem to choose the D&C, but I personally advise against it, and here is why. While a D&C may feel easier on your body than days of bleeding, and may seem easier emotionally than having to see the products of your pregnancy, there are some things to consider.
Why I Don't Like Unnecessary D&Cs
- Seeing the blood (and yes, possibly a tiny fetus) is hard. Trust me it's really hard. In my own experience though, having a tiny someone to say goodbye to is better than having nothing at all.
- The forced dilation of the cervix can weaken it. If you have 2 or more D&Cs you will be at an increased risk for incompetent cervix, miscarriage, or preterm labor for future pregnancies. Your doctor most likely will not tell you this until you are in that subsequent pregnancy and he/she looks at your history and announces that you are high risk!
- There is potential for injury during the D&C (cutting or puncturing the uterine wall for example).
- Sometimes a missed miscarriage is mis-diagnosed. In other words, sometimes they miss seeing the baby, or the heartbeat...sometimes they tell you that the baby has died or that there is no baby and they are wrong. Sometimes there is a baby and it is just fine. Sometimes there were twins and only one has died. A D&C is what they call it if you wanted the baby, but if you didn't want the baby they'd have called it a 'suction abortion.' It's the same thing--and no, a living baby won't survive it. So again, I recommend waiting and letting nature take its course, because even the most advanced medical practitioners can make mistakes sometimes. (If you'd like to read a whole bunch of stories, visit The Misdiagnosed Miscarriage.)
Finally, a threatened miscarriage. With a threatened miscarriage your baby is still alive! This is key! Sometimes miscarriage is inevitable, but sometimes it is not! There is not really any way to know which way it will go, so (in my opinion) you have to move forward with the assumption that the baby can be saved. Personally, I would call my care provider. As I mentioned above, you may be prescribed labor-stopping drugs and/or bedrest. Bedrest is hotly debated: some people feel it doesn't make a difference, yet doctors continue to prescribe it. My own thought is that it might help, and it certainly won't hurt, and I'm willing to do whatever it takes to keep my baby. There are a couple of herbs which are considered to be 'smart' about miscarriage--they help things either stay in (if they should) or clear out (if they should). I don't really understand how they work, but midwives and herbalists have been prescribing them for miscarraiges and threatened miscarriages for centuries. More about those in the herb post.
Please, if you have questions about any of this, please leave a comment and I will try to get you answers. I learned all of this "in the trenches" so to speak, and wished I had known so much of it beforehand. We cannot be afraid to talk about these things--women deserve to know what their options are so that they can make the decicions that are right for them!