Baby loss and miscarriage: your questions answered

What causes a miscarriage?

At the moment, it sadly isn’t always possible to give a reason why someone has a miscarriage. That’s why Tommy’s opened the UK’s only miscarriage research centre dedicated to understanding miscarriage and preventing it.

If a miscarriage happens during the first 3 months of pregnancy (known as early miscarriage), it’s usually caused by chromosomal abnormalities in the baby. These happen by chance. A problem with the development of the placenta can also lead to a miscarriage.

Tommy’s research shows that certain underlying health conditions can increase a person’s risk of miscarriage. These include blood-clotting disorders, and over-active or under-active thyroid and uterine anomalies.

You can find out more about what can cause a miscarriage on the Tommy’s website: https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/causes-miscarriage

What are the chances of a miscarriage?

An estimated 1 in 5 pregnancies end in miscarriage – but since miscarriages are currently not recorded, Tommy’s experts believe the actual number could be even higher.

Tommy’s research published in April identified certain people may be at a higher risk of miscarriage. They found that Black women have a 40% increased risk of miscarriage compared to White women, which is devastating, unacceptable and urgently needs to change.

It is not currently clear why Black people are at an increased risk of miscarriage, but it’s likely that the causes of these health inequalities in general are complex and may be due to a number of different reasons. Tommy’s researchers are now investigating whether it could be related to other health issues that more commonly affect Black women and can complicate pregnancy, such as fibroid conditions and autoimmune disorders. Until we know more about the reasons why, Tommy’s are calling for Black mothers and birthing people to receive personalised care in early pregnancy.

You can find more miscarriage statistics on this page of the Tommy’s website: https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/miscarriage-statistics

Can I choose how my miscarriage is managed?

In some miscarriages, all of the pregnancy comes away from the womb naturally and you won't need any treatment to help things along. This is called a complete miscarriage.

But if a miscarriage has started but does not come away from the womb completely, or if there were no symptoms and the miscarriage was found in an ultrasound scan, you may need to make some choices about what to do next.

If you have a missed miscarriage or incomplete miscarriage, you'll be offered 3 options:

waiting for the miscarriage to happen by itself naturally (expectant management) taking medicine to help the pregnancy come away from the womb (medical management) having surgery to remove the pregnancy from the womb (surgical management).

Your doctor should talk with you about what may be the best option for you. You should be given some time for the diagnosis to sink in and think about what you want to do.

How you are treated is your choice. However, you may be advised to have surgery immediately if:

• You are bleeding heavily or continuously

• There are signs of infection

• Previous treatment to remove the pregnancy has been unsuccessful.

You can find more about how your miscarriage may be managed on this page of the Tommy’s website: https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/miscarriage-management/how-your-miscarriage-will-be-managed-or-treated

How can I prepare for my next pregnancy/conceive after a miscarriage?

It’s best to ask your doctor whether there are any medical reasons why you should wait for a while before trying to get pregnant again. If there aren’t, it’s up to you when you want to start trying again. Some couples feel they need some time to prepare themselves emotionally and physically for a new pregnancy. You may need to allow yourself time to grieve for your lost baby before you think about the future.

If you do decide to try again, it’s a good idea to take care of yourself to ensure the best chance of a healthy pregnancy. This includes eating a healthy, balanced diet, managing your weight, avoiding drugs and alcohol and limiting your caffeine intake.

You can find advice for planning for pregnancy on the PregnancyHub section of the Tommy’s website: https://www.tommys.org/pregnancy-information/planning-a-pregnancy

Is there anything I can do to prevent a miscarriage

It’s important to remember that a miscarriage is very rarely a result of something you did or didn’t do, and there’s sadly no way to guarantee that you won’t have a miscarriage. However, certain things can help your chances of having a healthy pregnancy. These include:

• not smoking

• eating a healthy, balanced diet

• losing weight before pregnancy if you are overweight or obese

• managing your weight gain if you are overweight or obese in pregnancy

• trying to avoid certain infections during pregnancy, including rubella

• avoiding certain foods in pregnancy

• not drinking alcohol or using illegal drugs in pregnancy

• staying active

• limiting your caffeine intake before and during pregnancy.

https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/preventing-miscarriage

Does the risk of miscarriage become greater as I get older?

Tommy’s research shows that people over 40 are at a higher risk of miscarriage. Miscarriage rate is lowest among those aged 20-29 years, at 12%, increasingly to 65% in women aged 45 or over.

This is why Tommy’s are recommending that people over 40 be recognised as an at-risk group, so that they can receive personalised care from the start of pregnancy.

I really want to have another baby, but I keep having miscarriages. Where can I go for help?

If you’ve had 3 or more miscarriages, you qualify for investigations on the NHS, so you should speak to your GP about a getting a referral to a recurrent miscarriage clinic. At an RMC you will have tests done to see if you have a condition which might be causing your miscarriages. Doctors cannot always find a cause for your losses, but if they do identify an issue, such as a uterine anomaly or a blood-clotting disorder, you may be offered treatment that can reduce the risk of having another miscarriage.

Tommy’s believe that certain tests and treatment should be offered after 2 consecutive miscarriages, which is why they’re campaigning for changes to UK miscarriage care. In the meantime, certain clinics at the Tommy’s National Centre for Miscarriage Research will accept a referral after 2 miscarriages. Find out how to get a referral through your GP on their website: https://www.tommys.org/our-research/referrals-our-clinics/referrals-our-miscarriage-clinics

Is it possible for me to have another baby after a miscarriage? If so, after how long?

It’s important to remember that most people will go on to have a healthy pregnancy after having a miscarriage.

If you want to start trying for another baby, your doctors may advise you to have at least 1 period before you do so. This is because your first menstrual cycle after a miscarriage is often much longer or shorter than usual. If you get pregnant during that cycle, it may be difficult to work out when you conceived. This could make it difficult to work out when you’re due and cause you some unnecessary anxiety.

Most miscarriages are a one-off event and there is a good chance of having a successful pregnancy in the future, regardless of how soon you became pregnant again. There is even some evidence that conceiving in the first 6 months after a miscarriage lowers your risk of miscarriage next time.

If you’ve had an illness, infection or are trying to manage the symptoms of a long-term medical condition, you may be advised to wait for a while. You may also have to take medications that aren’t suitable in pregnancy.

Talk to your doctor if you’ve had a late miscarriage or recurrent losses. If you’re having tests or investigations, it can be helpful to wait until they’re finished before trying again.

https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/trying-again-after-miscarriage

Is having a miscarriage normal?

Miscarriage is the most common type of pregnancy loss. It’s estimated that it affects between 1 in 4 and 1 in 5 people, with 85% of losses happening in the first 12 weeks. A late miscarriage, between 13 to 24 weeks, is much less common.

It’s important to remember that many people who have a miscarriage will go on to have a healthy pregnancy. However, if you have a late miscarriage, or 3 or more miscarriages, you should speak to your GP. There might be an underlying issue which is causing your miscarriages, and your doctor will be able to refer you to a specialist clinic for investigations.

What is an ectopic pregnancy and what are the symptoms?

Ectopic pregnancy affects around 1 in 100 pregnancies. It happens when a fertilised egg starts to grow somewhere other than in the normal lining of the womb, usually in 1 of the fallopian tubes. Unfortunately, it is not possible to save the pregnancy if it is ectopic.

An ectopic pregnancy creates a potentially life-threatening situation for the mother, so it is very important that it is treated quickly.

Symptoms of an ectopic pregnancy usually develop between the 4th and 12th week of pregnancy. These include:

• Vaginal bleeding

• Stomach pain, typically low down on 1 side

• Shoulder tip pain (an unusual pain where your shoulder ends and your arm begins)

• Discomfort when going to the toilet

You should contact your GP or call NHS 111 if you have a combination of any of these symptoms and you think you might be pregnant, even if you haven't had a positive pregnancy test.

https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support

I had a previous ectopic pregnancy. Will I be able to conceive again?

For most women, an ectopic pregnancy is a ‘one off’ event and does not happen again. Even if you have only one fallopian tube, your chance of getting pregnant again is only slightly reduced.

You'll probably be advised to wait until you've had at least 2 periods after treatment before trying again. If you were treated with methotrexate, it's usually recommended that you wait at least 3 months because the medicine could harm your baby if you become pregnant during this time.

If you do get pregnant again, you may be offered an ultrasound scan at 6 to 8 weeks to confirm that the pregnancy is developing in the womb.

Talk to your GP if you do not want to become pregnant again. Some forms of contraception may be more suitable after an ectopic pregnancy.