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Module 2: Understanding the Labor Process at Different Gestational Ages
IN THIS LESSON
Early Miscarriage (1st trimester):
Overview
Early miscarriage happens within the first 13 weeks of a pregnancy. Approximately 10% of known pregnancies end in early pregnancy loss. 80% of these occur in the first trimester AND nearly 50% of EARLY pregnancy losses are from chromosomal abnormalities. (1) Miscarriage is, unfortunately, a common experience- this in no way makes the pain feel less. Sometimes, it helps families know that it may have been because the baby wasn’t developing properly. This coming from a scientific, bodily functioning way, it will never be okay losing our baby of course. Early miscarriages can often look like a period and some women and birthing people may not even realize they are having a miscarriage, especially if they are unaware that they are pregnant.
Early Miscarriage is often talked about as having the worst period of your life. We know bleeding during pregnancy is NOT a good sign, so if your client ever reaches out with this first symptom, it is time to go in, immediately. They can call their provider on the way to the ER.Some women may want to just stay home for the duration of their miscarriage. They are allowed to make that decision for themselves. But we need to make sure they still call their provider and schedule a follow-up appointment so that we can make sure they don’t have any tissue or remnants left in the uterus that can end up causing illness and infection.
Physical symptoms and emotional impacts.
Physical Symptoms your clients will experience can include:
Bleeding, which can be heavier in the first few days and can sometimes feel like quite alot. It can be heavier or equal to a period and this is the main sign they are miscarrying.
Pain- Cramping in the lower abdomen or severe pain on one side- caused by uterus contracting and cervix opening.
Breast tenderness, nausea, diarrhea, vomiting, etc.
If your client is experiencing any of these symptoms, have them call their providers right away.
Emotional Impacts
More often than not, parents blame themselves for the loss of their babies. They carry so much guilt and shame and may find it very difficult to reach out for help or to share this experience with anyone. They may experience anger at everyone around including hospital staff, their doula, their friends, and anyone with babies. They may feel grief, shock, confusion, numbness, and panic. The grief may cause emptiness and the feeling of physically being empty. They may feel physical reactions to their grief like chest pains, diarrhea, shaking, stomach knots, and exhaustion. Sleep may be difficult for a while and they may have nightmares or even insomnia. Some people may not experience this right away, some may not experience it. It is so individual to every parent or person.
Understanding the isolation often felt by Moms/Birthing Person during early miscarriage.
Our culture seems to look at miscarriage as so common that is shouldn’t be a “big deal”. Like get over it, you can do it again and it’ll be just fine.Telling a Mother she is fine after her baby dies is probably the absolute worst thing that has ever been done. There are some cultures that place such a high value on pregnancy that when a loss occurs it can feel too scary to tell anyone in fear you may be “cast out” or shamed. So sometimes these Moms sit in their grief and shame and never feel that they can share it or express the grief and sadness that it has caused. Our bodies can start showing and changing at the 4 week mark, some women/people have dreamed about being a parent since childhood, some people have had to utilize tools like IVF to support them in getting pregnant, there is SO much that goes into pregnancy and when we feel that no one understand us or what we are feeling or going through it can feel like we are completely alone. Especially in early miscarriage when we see messages that we were only pregnant for x amount of time, therefore we didn’t “bond” with the baby or form attachment so it shouldn’t be that hard.
How to provide gentle, compassionate support.
What can you do to support your clients in this experience? Early Miscarriage is a lot of supportive care. Preparing them for what miscarriage can look and feel like and preparing them for what will happen.
Here are some ways to make miscarriage at home just a bit more comfortable for your clients. And of course when your client thinks they are having a miscarriage the first step is contacting their provide or going into the ER. Before any over-the-counter meds are used always consult a doctor. *** I am NOT a doctor.
Pain medication. They can use over-the-counter pain meds to ease cramping and any pain they may experience. (Again have them talk to their doctor so they can direct them)
Comfort Tools: A heating pad or hot water bottle is a way to help ease pain and cramping.
Environment: Try to make things comfortable by lighting a candle, and using a diffuser. If the bleeding gets heavy they can sit on the toilet or use pads.
Fluids: Keep Mom hydrated, warm broths and teas may be comforting. Maybe offer snacks if they seem hungry.
Rest: Make sure your client is getting as much rest as possible.
Making sure that they have 1 or 2 other trusted people that know what is happening and are able to come support if they need it.
Support at the ER: If you are accompanying your clients to the ER they will more than likely need support in advocating for what they need. ERs are a hit or miss on whether they have their admin staff trained in compassionate care for pregnancy loss and have the ability to care and support them in the best way. They may only be allowed 1 support person- if that is the case and they have a spouse or someone else that will be with them, just make sure they can call or text you if they need you, if this is part of your contract or agreement or just how you want to do things.
Have your client call their doctor or go to the emergency room if they experience any of these...
Bleeding that soaks more than two maxi pads per hour for two hours in a row.
Fever greater than 102°F (a slight fever of 102°F or less is common with misoprostol use).
Feeling very ill, with lower abdominal pain after the heavy cramping and bleeding are over.
Info From https://www.aafp.org/pubs/afp/issues/2011/0701/p85.html
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