Miscarriage 101. What to do, what to expect
and how to recover.
There are few things in the world more isolating than a miscarriage. Often friends and family are at a loss for how to help or feel awkward bringing up the loss, leaving you with the internet and your healthcare provider as your only support (and sometimes, not even a healthcare provider)
Losses can be broken down into, chemical pregnancies which are losses before 5 weeks, miscarriages which are losses between 6-20weeks and stillbirths which are losses after 20 weeks.
Chemical pregnancies often happen on their own, but in the case of a miscarriage sometimes an ultrasound diagnoses a loss before you start bleeding. This is called a missed miscarriage. In the case of missed miscarriage or one that is not complete, you will likely be offered either medication that will help the process begin, or a medical procedure called a D&C. It is important to let your primary care physician or midwife know if you suspect you are having a miscarriage so that they can guide you through the process, outline your options and follow up to make sure you recovery has been complete.
When I am working with and caring for someone who has had a pregnancy loss, I always individualized my treatment plan to the unique circumstance of the loss, as well as the form of care they are receiving regarding the loss (medication, wait and see or medical procedure). Some patients get Chinese herbal formulas, some get acupuncture; some the focus is on recovery and others we review what we can do differently supplement and lifestyle wise moving forward.
There are however, basic guidelines I almost always suggest for during and after a miscarriage:
1. Rest: Being told to rest isn't ground-breaking advice, but how many of us actually take time off to rest and recover?
For an early and straight forward miscarriage, or if you feel strong and relatively unscathed. I would still suggest taking a day or two off just to allow your body a chance to reset.
For pregnancy losses that are more intense physically or emotionally, it would be ideal to request a week or more off from work (if you can afford it, or if you have a great workplace that understands...sadly we aren't all from New Zealand who just passed paid leave from work for after miscarriages). If requesting time off is proving complicated or is being met with resistance, ask your doctor for a note stating you need time off for 'medical reasons'. Most doctors will back up your request.
Note: Resting and taking time off is not a sign of weakness. You should not be sucking it up and moving on. Take some time if you can. Drink tea, watch some shows, read a little, colour, write, cry, whatever you need to allow your body and heart a moment to process what just occurred.
2. Stay warm: Take a note from the wisdom of 2000+ years of Chinese medical texts and keep your body warm. Make sure to wear socks, cover your lower back and mid-drift, and stay bundled up if you have to go outside in the cold. We are weaker and more susceptible to the elements after a miscarriage. Cold contracts and congeals, which can worsen cramping and clotting. Staying warm and eating warm foods helps support blood flow, which is key when that new fresh lining is being formed.
3. Comfort food: No...not that comfort food. Although I will not judge if you if you down a pint of ice cream or two. What I am referring to is old fashion food you would give someone who isn't feeling well. Things like soups, stews, slow cooked meals with quality meat and root vegetables. This is a gentle way of nourishing the body with the least amount of digestive energy. The nutrients are also more easily absorbed by the body this way.
4. Iron supplementation. Iron often takes a plunge in pregnancy. Iron can be further depleted if there is heavy bleeding during the loss as well. Having your ferritin checked or at least staying on your prenatal or full-heme iron supplement, will ensure your levels come back up to a healthy range. Iron is required for embryonic development and low iron stores are associated with a reduced ability to conceive. So, if you are planning to try again sooner rather than later, iron supplementation may be something to look into. I also suggest staying on your prenatal supplements.(More on prenatal supplements here)
5. Tuning in to your internal dialogue. Feelings and thoughts will come and go, and strong emotions may catch you by surprise. We often search for a reason for the loss, someone or something to blame...and we often point the finger at ourselves (something we did or should have done). Being mindful of what you are telling yourself can help steer you away from dark places. Let the thoughts come, acknowledge them, then let them pass. Be kind to yourself. You do not need tough love right now! Not from doctors, friends, family, or yourself. It is also worth seeking professional support from a counsellor. There are many different styles of counseling and finding a good fit can help you navigate all of the feelings and thoughts that come up. (Here is a link to some free resources)
Be aware of important dates. If you knew your estimated due date, or if you have a friend who got pregnant at the same time as you, be aware that those major milestones may surprise you with strong emotions, even if you thought you had processed and moved past the loss. Acknowledging the pregnancy and the loss in a way that feels right for you can feel healing and empowering.
6. When to start trying again.
This is not a straight-forward question, so I don't have a straight-forward answer.
With a chemical pregnancy or a loss before 5 weeks, often you don't have much a delay in physical recovery (emotional recovery is a whole other story and can vary greatly). The time you take off here is more based on how you feel physically and emotional and if you would like to change anything in your lifestyle or preconception care before trying again.
Losses 6-11 weeks: I suggest waiting 1-2 cycles for the uterine lining to reorganize, for your body to take a moment to process what happens, and possibly, to do selfcare to get you ready to try again (this may be supplements, regulating your menstrual cycle, working on egg/sperm quality to reduce chances of genetic reasons for the miscarriage, or looking deeper into if there is a reason to suspect immune or other factors that could be contributing)
Losses 12 onward: This varies too much to give a range. Loss recovery can be anywhere from 3 months to a year. I treat anything over 20 weeks like a birth and support the body in the same way. This often includes a more thorough investigation into what might be the cause of the loss, and various forms of emotional and physical support.
I can’t promise that time will heal everything. All I can say is that you deserve to be cared for, you deserve to be supported, and I want to see you strong and healthy. From there, healing will happen in its own time and its own way.
Dr. Emilie Salomons