Geboortecentrum Amsterdam

A miscarriage, an intense and emotional event

This morning during the telephone consultation I received a call from Marije. She was 9 weeks pregnant and had had her first check-up last week. Next Thursday she would have her term ultrasound. This was Marije’s second time being pregnant. The previous pregnancy had ended early in a miscarriage, much to Marije and Sven’s distress. I was on duty when she called me over the weekend about 8 months ago. She had discovered some drops of blood in her underpants and asked what it could mean.

Blood loss

Blood loss, especially a few drops is very common. A lot of blood loss, and also if the color is bright red can indicate an upcoming miscarriage, but then there are usually other symptoms as well. There is usually a good explanation for some blood loss early in pregnancy. It certainly does not always have to be an announcement that things are going wrong. Your cervix is very well circulated in pregnancy so some bleeding can very easily occur if there is some pressure on the cervix. This can happen, for example, during lovemaking, if you have hard stools or have been busy and had to do a lot of lugging and lifting.

A miscarriage

As midwives, we are actually only really concerned about blood loss so early in pregnancy if it is accompanied by pain in your abdomen. That may indicate that the uterus is cramping to work the fetus out. That embryo, although there is usually only an empty amniotic sac which is also very irreverently called a “windei,” grew until about 6 weeks and then stopped developing for mostly unknown reasons. Because your body is ruled by hormones, it takes a while for all systems to understand that something has gone wrong and a miscarriage must be arranged. Hormones are strong but slow messengers, taking about 2 weeks to organize a miscarriage. An initial symptom of an approaching miscarriage may very well be some blood loss. So you cannot reassure someone if this occurs.

Fortunately, blood loss usually says nothing

During that first pregnancy, when I had her on the phone with some blood loss, I told Marije that blood loss at this stage is very common and that fortunately it usually says nothing. Of course, I also told her to wait and see if any other symptoms would appear. She asked what she could expect and I explained to her that a sweeping sign would be if it included abdominal pain. If it really becomes a miscarriage then she will have cramps and increasing blood loss. Right now it was still some dark brown, but that would then probably start to change to bright red blood loss. I asked her to call me back if that happens, but also if she gets a fever. I also told her to use pads and no tampons to avoid any infection.

At 1:00 that night she called me in a panic that she was having a menstrual-like feeling and more blood loss. I told her I would come to her and that if the bleeding got worse she should sit on the W.C. and not flush it away. That way I would be able to estimate the amount of blood loss a little easier, but also recognize a possible fetus.

Contractions in a miscarriage

Half an hour later I was with them and it was clear that Marije was having contractions. You also get contractions from a miscarriage. In fact, a miscarriage often goes like a birth and the whole process is very similar to that. It usually starts somewhat unclear; some loss of blood (signs of childbirth) then the cramps (contractions) start and increase in intensity. Because the cervix has to open up to work the foetus and placenta out, you have to open up a little. The blood loss but especially the cramps work towards a kind of climax (full dilation and urge to push in childbirth) and with a last violent cramp “the miscarriage” is worked out. Unlike in childbirth, in a miscarriage the fetus, placenta and amniotic sac are expelled all at once. The cramps then quickly decrease in intensity and the blood loss also quickly subsides.

An intense and emotional event

That a miscarriage is an intense, emotional event had also become clear to Marije and Sven. Even now, or rather now again, with their second pregnancy they were very wary and did not dare to tell their family and friends the good news. Even though Marije had all the pregnancy symptoms you could imagine, she still needed confirmation that she was fine. She called the telephone office to ask if it was normal that since yesterday she was suddenly much less nauseous. Her breasts were also less painful. She was very afraid it was not going well again.

I told her that that really happens often, that that is not a sign that something would be wrong. I also told her that I would be happy to arrange an ultrasound for her so she would have confirmation that everything was okay. Four hours later she was able to go to the ultrasound center and they saw a beating heart and a beautiful fetus. Of course, things can always go wrong, even at 40 weeks, but when you see a beating heart on the ultrasound and, according to the measurements taken at the ultrasound, the pregnancy is as big as you expected, that is a very good sign of a vital pregnancy.