* Author Topic: Guide to Late Miscarriage & Stillbirth  (Read 3258 times)

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Offline Dory10

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Guide to Late Miscarriage & Stillbirth
« on: 26/07/15, 12:16 »
Guide to Late Miscarriage & Stillbirth

Late miscarriage is used to describe a pregnancy loss between 13 Ė 24 weeks.  From 24 weeks onwards the baby is classed as stillborn.  Many parents however feel that the term late miscarriage really doesnít capture the gravity and impact of their loss, especially post 20 weeks.
A later loss can happen for many reasons and it may come as a complete shock where a routine scan shows that sadly your baby has died.  It may also be that youíve been carefully monitored for a health condition that has affected either you or the baby and that you had some warning that you could lose the baby.  Either way the news that your baby has died is completely heartbreaking.


Signs and Symptoms

There may be no obvious signs or symptoms that your baby has died thus adding to the disbelief and shock when it is discovered during a scan.  If you are later on in your pregnancy you may have noticed that you havenít felt your baby move for a while, it is vital to always seek medical advice from your midwife or antenatal clinic if you are experiencing reduced movements so that you can be monitored.
Sometimes you may experience heavy bleeding and strong abdominal cramps/labour pains and your waters may break.  You must seek urgent medical attention if you experience any of these symptoms.


What causes a late loss?

There are many causes of a later pregnancy loss.  Sometimes the mother has a condition that affects the pregnancy and sometimes there are major problems with the placenta or the umbilical cord.  It may be that the baby has a genetic or developmental  problem that is incompatible with life.  The Sands UK website has a page detailing more possible causes of later losses and can be accessed through this link http://uk-sands.org/why-babies-die/explaining-stillbirth/possible-causes  Ultimately the only way to find out why your baby has died would be to have a post mortem examination carried out.  The hospital staff will explain this process to you in full so that you can make an informed decision.  They will also test the placenta and umbilical cord and these can also be returned to you after testing if you wish.


What happens next?

Depending on your stage of pregnancy, there are different options.  Prior to around 14 Ė 15 weeks of pregnancy a d&e (dilation and evacuation) procedure can be offered, this is carried out under general anaesthetic.  Sometimes this is offered later in a pregnancy and is something you would need to discuss with your specialist.

There is an option to be medically induced with oral tablets and pessaries.  This will mean that you go into labour and deliver your baby.  The tablets will be given to you in hospital and an appointment made about 48 hours later for you to go in and have the pessaries that will induce labour.  It is important to contact your hospital straight away if you start to have abdominal cramps, bleeding or your waters break and you are at home.

A cesarean section would only be offered in cases where the motherís health is in danger.

Hospital arrangements differ from area to area but usually a delivery before 20 weeks takes place in a gynae ward or womenís health unit and after 20 weeks you will probably be in a birth centre or labour ward.  Speak to your hospital about where you are going to be and what arrangements they may have, some have special rooms for couples who are going to deliver a sleeping baby.  They may warn you that if you are going to be on a labour ward you might hear babies crying and see pregnant ladies and newborn babies.  In reality the rooms are heavily sound proofed and they will do their upmost to shield you from these things.

SANDS have a range of booklets available free to download and can be accessed through this link https://uk-sands.org/resources/parents-family-friends/support-booklets-leaflets


What should I take to hospital?

You will need to take a change of clothes, toiletries, a towel, slippers, dressing gown and some large pants or disposable maternity pants.  You will need to wear a sanitary towel/maternity pad afterwards.  It is also handy for your partner to have a change of clothes too.
Maternity pads/ super strength sanitary towels and if you were further along in your pregnancy, breast pads. 
There can be a lot of waiting and so some drinks and snacks will be useful as can electronic games, magazines and puzzle books for both yourself and partner.
Make sure you have change for the car park and any meals or snacks your partner may need to buy.   You will be given meals but he/she wonít.
A fully charged phone and charger in case you need to contact people whilst you are in hospital.
Depending on your stage of pregnancy you may want to take in a small outfit or blanket for your baby.  Speak to hospital staff about what is appropriate, your baby may be too small for even premature clothing but can be wrapped lovingly in a special blanket afterwards. 
You might want to take in a small teddy for your baby, sometimes it is nice to buy two the same, one to leave with your baby and one to take home with you.
This might sound strange and it isnít right for everyone but taking a camera, even if it remains tucked away in your bag, gives you the option of taking your own photos of your baby if you want to.


Afterwards

Please remember that it is completely a personal decision as to whether or not you wish to see or hold your baby afterwards.  You can change your mind at any time and the nurses or midwives will answer any questions and will be happy to describe your baby before you decide.  Usually the hospital will offer to take photos that are then kept in the motherís medical notes so that at any point in the future you can ask to see them. 

It is completely natural to be nervous about seeing and holding a sleeping baby, you may worry what he/she looks like, donít put pressure on yourself, see how you feel.  It might help to see a photo first.
With later losses you may be asked if youíd like to bath and dress your baby or the midwives are happy to do this for you, either with you there or not.
You will be given time to spend with your baby and in the case of later losses usually other family members are welcome to visit you if this is something you would like.
The hospital will be able to arrange for a Chaplain to visit you and bless your baby or equally they will welcome visits from any faith leaders.

The nurses or midwives will usually offer to take hand and footprints of your baby and where possible take little locks of hair too.
Sometimes you will be given a little memory box provided by charities such as SANDS.
Prior to 24 weeks gestation a baby doesnít receive a birth certificate but you can download one from SANDS or create your own, which the hospital staff will be happy to help you fill in.
Please donít be afraid to ask about any of these things and get ideas from support organisations such as SANDS https://www.uk-sands.org

You may decide that you wish for a post mortem to take place so that you can learn the full extent of your babyís condition or any implications for future pregnancies.  This will be fully explained to you by the hospital staff.  Usually your baby will be returned to the hospital with in 1- 2 weeks  but the results can take up to 12 weeks to return.
The hospital will discuss funeral arrangements with you, before 24 weeks gestation there is no legal requirement to have a funeral but many parents wish to have one.  The hospital can arrange this for you or you can organize this yourself through a local undertaker.  If the hospital arranges the funeral you can be asked to be informed when it is taking place, usually this will be a group funeral with other babies and their families. 

In cases of a later loss it may be that you have already prepared the babyís bedroom or nursery.  Coming home to face this room can seem unbearable, remember you donít have to think about what to do with anything right away.  It might be something you wish to leave for a while or pack away yourselves.  Some couples find it easier if friends or family do this for them so that they can look through things at a later stage.  There are no right and wrongs.

Most high street shops are also happy to accept returns of baby items in these sad circumstances even if the usual return periods have expired.

You can also sign up to a baby mail preference service so that you donít receive any baby related mail from companies even those that you may have previous signed up with such as Emmaís Diary or Bounty.  Here is a link to register your details  http://www.mpsonline.org.uk/bmps/


Support

You may feel that you need support at different times.  You may feel numb, sadness, anger, fear, confusion or a mixture of many different emotions. Please donít feel alone, sadly there are many women that have been in this position and it is important to seek help if you need it.  Organizations like SANDS have helplines, online support and meetings.  It may not be something you want to access but they are there at any point, days, weeks, months and years afterwards.  Here is a link to our coping after pregnancy loss thread https://www.fertilityfriends.co.uk/forum/index.php?topic=334678.70


Thinking of the future

Please see our Guide to Trying again after a loss https://www.fertilityfriends.co.uk/forum/index.php?topic=337963.0



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