What is a missed miscarriage? 5 women and a GP share the reality of pregnancy loss.

Content warning: This post contains mentions of miscarriage and pregnancy loss and may be triggering for some readers.

A tiny smear of blood, the feeling that something isn’t quite right, or blissful ignorance.

The feeling of making it to the 12-week ‘safe zone’ to only find that your baby had stopped growing weeks before.

And the shame, fear and cutting disappointment that comes afterwards.

Contrary to the dramatic, stabbing pains or visible bleeding that miscarriage is often portrayed in pop culture, a missed miscarriage is very different.

Mamamia founder, Mia Freedman talks about feeling lost after her miscarriage:

Speaking to Mamamia, GP and Chief Medical Officer at MedicalDirector, Dr Charlotte Middleton says this kind of pregnancy loss can be difficult to diagnose due to the lack of physical symptoms, with an ultrasound the only means as a definitive way of diagnosis.

“The definition of a missed miscarriage is when the baby has stopped growing, or has died, but there’s no actual physical signs of a miscarriage,” she explains.

“They don’t have that typical cramping, pain, or passing of blood, however I have quite a number of women who come to me and go ‘I just have a feeling,’ or say their nausea, or breast tenderness isn’t as bad as it was and this can sometimes be a subtle sign that something isn’t quite right.”

Despite this, the lack of forewarning can sometimes intensify the feelings of grief which come after a diagnosis. Just like with any kind of pregnancy loss, there is no one correct way to deal with the trauma. However, to better understand the relatively common condition – Dr Charlotte estimates that over one in four pregnancies result in miscarriage – we asked five women to share their experience with their own missed miscarriage.

What is it like to have a missed miscarriage?

While women may share similar physical symptoms of a missed miscarriage, how a woman emotionally and psychologically deals with her missed miscarriage will be different. Here, five women share their experience, however please note it could greatly differ to yours or someone else’s.

“I didn’t realise how emotional it would make me,” Jade, 35.

I was nine weeks when I found a tiny smear of blood and went to my GP. He sent me for a scan and no heartbeat was detected. Although the rational side of my brain totally understood what was happening, I didn’t realise how emotional it would make me.

I think the hardest thing with a missed miscarriage is not being prepared for that possibility. It’s never shown in our culture as an option. It’s usually the standard miscarriage imagery/explanation. What’s particular hard is that your body doesn’t recognise any change and keeps thinking you’re pregnant and won’t expel it naturally. So your only choice is a D&C, which is scary in itself, but you have to wait until the hospital can fit you in to do it. So you are walking around trying to be normal but with a terrible secret inside you until it’s done.

"I tried to buy an ultrasound machine from the US," Louise, 37.

My story starts on November 6, 2013, when I realised I was pregnant with my first child. It was the rush of joy that I've never experienced before. But there was a lot that happened between that point and when we discovered we had lost our baby. Things like flying to my mum's to tell her she was going to be a grandma and sharing the joy with husband's parents in the UK.

It was at the 11 week dating scan when we saw our jelly bean on the screen. My tears rolled. I thought my little person was right there, however they had stop growing weeks earlier and was gone. There were no words to describe the loss. You walk into a hospital pregnant and full of hope for the future and walk out devastated. The pain of this hangs with me to this day.

When it came to my recovery, the process was long. I needed support emotionally because I was doing irrational things like trying to buy an ultrasound machine from the US, but finding a good GP who I could trust and would see me whenever I needed was important. I did find that workplaces weren't really understanding, especially when it came to accommodating fathers who also experience the loss.

I never spoke about it to anyone outside of my circle and even then it was hard, but now I'm trying to talk about it. The positive I learnt was that support is out there. You have to ask and sometimes that is the hard part but if you have one medical person you can trust like your GP, they can help link you to further support. I found out more about my body and that helped me moving into my next pregnancies. I now have three children - a four-year-old son and twins.

My story is mine but so similar to other people's. I feel in so many ways that the little person I never got me to meet made be a better person and a better mum. They were so loved, I only wish I could have held that little person in my arms.

"Everything was good up until then," Brooke, 33.

I've had eight miscarriages and four of them were missed. When you fall pregnant, you think that when you get to 12 weeks you are ‘safe’ and that not too much can really go wrong and in some cases you think you can tell the world.

Nothing can describe that feeling when you're getting your 12 week scan and thinking that you might have made it to the “safe” zone, to find out you only made it to eight weeks and had no idea. Everything was good up until then every time. No cramping, no bleeding or anything, just a surprise at the first scan. It’s pretty heartbreaking. But, no matter how many times it’s happened, you’re still hopeful.

"I didn't know how common miscarriages were at that time," Michelle, 42.

I was nine weeks pregnant and having a dating scan, and despite my seven-week ultrasound showing a clear heartbeat, none was detected at this time. When I started to cry the technician coldly told me to stop being so emotional and that I can just get pregnant again. I was told to go home and wait for the miscarriage to actually start at home. It took a couple of days and you could see the embryo pass, I discovered it when I wiped away blood and held it in my hand. It was tiny and I could have mistaken it for a clot (of which there were many) but I could make out the budding limbs and facial features forming.

I became obsessed with becoming pregnant again before what would have been my due date because I didn't think I'd be able to cope with the emotional pain of reaching that without another bub on the way. I did go on to have two healthy boys, but the sadness of the missed miscarriage stays with me. Talking to friends and relatives after it first happened was a huge eye opener - so, so many had had miscarriages, missed or otherwise.

I did end up falling pregnant again before my original due date, but it was not an enjoyable experience. I didn’t trust my body anymore and kept expecting to lose the baby. I started to relax a bit after I got to 20 weeks but the lingering feeling that it could all go wrong did remain. It was 12 years ago so it’s an old wound and I’m glad it gets talked about so much more now.

"I was obsessed with getting pregnant again," Jessica, 31.

It was so unexpected to get pregnant so quickly and we were so excited! Better still, my younger sister was pregnant at the same time and I thought it was  amazing that we got to share this experience. The only difference was that she got to have her baby and I didn’t.

My husband and I had multiple scans and all was great. The heartbeat was there and all looked on track when I went to the 12 week scan at 13 weeks. I thought I was officially in the ‘safe zone’ and bounded in there so excited to see the jelly baby. I was so blissfully unaware and so stupidly naive.

When she said the words “no heartbeat” I was absolutely shocked. I literally felt like someone stepped on my lungs. A couple days and a D&C later I was numb. Very teary, very shocked and very angry at myself. Months and months later, I was still gutted, full of anger and definitely despair. I was so sick of people saying “if there was something wrong with the fetus it wasn’t meant to be... better now than later...” These comments were so unhelpful, just hug someone, listen and acknowledge their loss would be my advice.

I became obsessed with googling and listening to pregnancy podcasts. Obsessed with getting pregnant again. But as time went on I felt worse. My sister’s belly grew and so did my resentment towards her. As she would be battling morning sickness and complaining about pregnancy or her toddler I would dismiss her and silently think “you ungrateful b**ch, how lucky you are!” I avoided her. I avoided all excitement about her bub. At her gender reveal I couldn’t help it and bawled my eyes out in front of everyone, I struggled so much to feel any happiness for her. She was having a little boy (just what I had hoped for for myself) and for this I felt so guilty. Especially since becoming a mum a year or so after, I finally ‘got her’; it is the hardest most challenging thing ever and just because you complain doesn’t mean you aren’t grateful or love your child less.

Fast forward to my next pregnancy with my now daughter Tully. I could not enjoy it at all, and had the constant fear of waking up to it being a lie or a dream, fear of losing her throughout my pregnancy. Every twinge, every missed kick, every day I felt well meant something was wrong. Having a missed miscarriage messed with my psyche and in reflection I should have gotten help, but at the time I felt stupid for being upset over losing an underdeveloped fetus when actual women lost real children. But I think it wasn’t so much grieving the loss of a baby as it was the loss of the change in path and direction of my future, the excitement and hopes for my own family.

How can you manage a missed miscarriage?

While there are three primary ways women can manage a missed miscarriage, Dr Charlotte emphasises that withholding any medical implications, she prefers to let her patients select which option they'd like.

"In primary care as a GP, it's about confirming that they've had a missed miscarriage and then there's three different ways we can manage it," she says.

"I like to talk in depth with the patient, explain all three options in detail, before ultimately letting them make the decision."

Natural expectant management

This option is when women let "nature takes its course," says Dr Charlotte, explaining that the miscarriage passes in the form of bleeding, which can by mildly painful.

"What we need to explain to women is that it can sometimes take up to three to four weeks for the pregnancy to pass but some women do prefer it," she says.

"A lot of women describe that feeling as a lot more natural to them. They say it helps with the grieving process and often women say it offers them a better sense of control."

However, Dr Charlotte advises women to be aware of the possible complications which can arise during this period.

"While you can expect bleeding and (mild) pain, look out for signs of infection in terms of fever or chills, dizziness, fainting, or even very odorous vaginal discharge," she states.

"These are all signs that things aren't quite right and I can't emphasise this enough, but you should go and see your doctor or even present to emergency if you have concerns about these symptoms."

Medication management

"There are medications out there that can help to speed up the process," says Dr Charlotte.

Women can be given prescribed medication which aids the opening of the cervix in order to pass the pregnancy tissue. According to Healthy WA, this treatment is used in pregnancy loss within the first 28 weeks and has an 80 to 90 per cent success rate. Side effects can include some pain and heavy bleeding, with residual bleeding occurring in the four weeks after.

Surgical intervention

This is also sometimes referred to as a dilatation and curettage or a D&C, which is performed under a general anaesthetic and will surgically remove the pregnancy tissue from your uterus.

"Some women prefer this because it's obviously quicker and can allow them to move on quicker, but it also does involve a general anaesthetic, surgery and some of the possible complications that can come with that," Dr Charlotte says.

However, Dr Charlotte clarifies that the risk of infection and harm for any of the above methods is "very small" and neither option will impact a woman's chance of a "subsequent healthy pregnancy".

"It's absolutely equal for all three methods used," she says.

Psychological and emotional support

Second to the diagnosis, Dr Charlotte is adamant that there is no one way to grieve a missed miscarriage, just like there isn't one way to grieve pregnancy loss of any kind. However, a range of support options and resources are available, from online support groups, hospital programs, psychological therapy to clear, supportive and informative medical advice from your GP or obstetrician.

"We have to really understand that women react to miscarriage very, very differently. You have women who are utterly, utterly devastated and it's a really traumatic event for them and those women need support and they need to know we can offer that. Other women are quite matter-of-fact about it and can move on a lot quicker, however you would still make sure they have access to those resources," she says.

"Either way we need to know and understand that there's going to be a spectrum of emotions and responses to a miscarriage and from then we can decide how to best manage these reactions."

Will a missed miscarriage affect my chances of getting pregnant in the future?

Absolutely not and Dr Charlotte says this is a common misconception which is completely false.

"I emphasise to women who have gone through this kind of trauma, that the majority of women who have miscarriages go on to have normal, healthy pregnancies and babies. Even with multiple miscarriages, most women will end up having normal, healthy pregnancies," confirms Dr Charlotte.

Instead she says that while it's believed that one in four pregnancies end in a miscarriage, this number is probably a lot higher as some early miscarriages might just present themselves as a delayed or heavier period.

"A lot of miscarriages happen very early on and a woman might not even realise she's had one," she says.

"When we think of the number of pregnancies we have every year, the numbers just don't equate if there were issues having subsequent pregnancies. The misconception exists, but in fact it doesn't stop you from having a healthy subsequent pregnancy."

How long should you wait to try for pregnancy after a miscarriage?

While it won't affect your future chances of falling pregnant and having a healthy baby, Dr Charlotte does advise giving your body time to heal from the trauma before you try for another pregnancy.

"When you have passed it's very normal to have a light bleed for anywhere up to two or three weeks and most people will have a normal period about four to five weeks later," she says.

"We normally advise women to wait till after that period to start trying again. A lot of people are keen to jump straight in but you actually have a slight increased risk of miscarriage if you get pregnant too quickly.

"Your body has gone through a lot of trauma and it needs time to heal and that includes your uterus lining. It needs time to regenerate and that's why we allow for a normal period to occur first."

If this has raised any issues for you or if you would like to speak with someone, please contact the Sands Australia 24 hour support line on 1300 072 637.

Have you ever had a 'missed miscarriage'? You're definitely not alone. Share you experience in a comment below.