Why you need to know about the painful, silent phenomena of missed miscarriage
*Trigger warning: miscarriage and baby loss*
The profoundly emotional, distressing phenomena of missed miscarriage – in which the person expecting experiences no symptoms, only to find out, probably at a hospital scan, that their baby has been lost – is one which relatively few people are aware of.
If you need to speak to someone about miscarriage, you can call The Miscarriage Association's Helpline on 01924 200799
Miscarriage is both uniquely devastating and harrowingly ubiquitous. Among those who know that they have conceived, one in eight pregnancies end in the loss of a foetus before they would have been able to survive independently, outside of the womb, according to the NHS. If a baby dies after the 24 week point, this is known as a stillbirth. (More miscarriages occur before a woman knows she is pregnant.) When it comes to missed miscarriage, studies suggest between 1-5% of total pregnancies end in this way. Despite this, there is a lack of understanding about this deeply sad issue. NHS doctor of obstetrics and gynaecology Dr Anita Mitra, AKA The Gynae Geek, says that they are something that 'people are really not aware of'.
What is a missed miscarriage?
In this difficult scenario, a foetus or baby has died, or has not developed, but has not been physically miscarried. This is because the woman's body has not registered the loss and so has not begun the process of passing tissue out, which is what would cause symptoms such as intense cramps and bleeding. The body, as such, continues to pump out pregnancy hormones – meaning those affected might still 'feel' pregnant. The lack of information around this issue can mean, says Dr Mitra, that some women and pregnant people might find themselves hearing about it for the very first time when it is happening to them.
'A lot of people [that missed miscarriage happens to] will feel completely normal', Dr Mitra explains. 'Which is why it’s such a shock. They might go [to a 12 week scan] expecting to have a photo printed out, to hear the baby’s heartbeat, but it’s not there.'
A point on clarification: Dr Mitra says it’s important to demystify the 'really confusing' term ‘missed miscarriage’. 'People think "missed" means they've missed it, or that somebody [such as a doctor] who has seen them before [in a clinical setting] has missed it', she explains. 'But "missed" means that the body hasn't realised that the pregnancy isn't developing normally and so hasn’t started the miscarriage process – the heavy bleeding to expel the tissue that's there.'
How long can a missed miscarriage go undetected?
Usually, a missed miscarriage will be detected at the first 12 week scan. As such, it's possible for one to go undetected for between three to four weeks.
When this happens, 'It’s shocking for a lot of people because they're coming for their first scan,' Dr Mitra says. 'They're really excited. And so what will happen is we'll start the scan, and then we'll see that there is pregnancy tissue there, but it's not developed in the normal way.'
What causes a missed miscarriage?
It is unclear what exactly causes a missed miscarriage. But Dr Mitra emphasises that it is not the result of anything you have done, or could have prevented. While most miscarriage is related to genetic abnormalities, this: 'doesn’t mean what people think. Many think it means they’ve caused a problem to the baby, but that’s not the case.'
It's also possible that blood clotting may have prevented an embryo from implanting properly, or a ‘blighted ovum’ – where the gestational sack forms but no embryo develops in it – may have produced a positive pregnancy test.
'Miscarriages can be devastating, but it is so important to know that it is through no fault of your own,' says GP Dr Tosin Sotubo. '[They’re] unfortunately pretty much impossible to foresee and avoid. It can simply happen to anyone.'
What happens if I have a missed miscarriage?
Dr Sotubo says: 'This is a difficult time and these choices are understandably going to be extremely difficult. Your doctor should talk you through all your options and give you the information and time to take it all in and make a decision.'
In the event of a missed miscarriage, the three options offered are usually:
Expectant (also called 'Natural') management–this is the process of waiting for the body to naturally miscarry the pregnancy
Medical management–where medication speeds up the process of miscarriage
Surgical management–in which you would undergo a surgical procedure to remove the pregnancy
The process can be a traumatic one, Dr Mitra explains, especially for women whose native language isn’t English. 'Though there are translators, they're not really trained in how to explain a miscarriage to someone,' she says.
Regarding psychological support, Dr Mitra directs her clients to The Miscarriage Association, local support groups and their GP.
She's keen to stress that you shouldn't feel that you have to keep what has happened to you to yourself, and instead, find support, talk to people and realise that you are not alone. Experiencing the grief and devastation of miscarriage is not something that anyone should shoulder by themselves.
How does it feel to have a missed miscarriage?
In 2018, health journalist Amy Abrahams dealt with the pain of a missed miscarriage. A routine scan, before which she had experienced no symptoms, showed that her baby had tragically died. In the Instagram post below, shared with her permission, she details her experience.
A post shared by AMY ABRAHAMS (@amy_abrahams) on Jul 3, 2018 at 11:30pm PDT
How does the pandemic affect how missed miscarriage is dealt with?
Given the current reality of some people still having to attend pregnancy scans alone, you'd be forgiven for feeling extra anxious, at this time. (Dr Mitra notes that: 'Women are suffering disproportionately because of these kinds of restrictions.')
When it comes to aftercare and treatment: 'Do not worry,' says Dr Sotubo. 'You’ll still be able to get the necessary help and support you need during the pandemic. However, it may be that certain cases are managed differently to ensure you and those around you are safe. For example, you may be more likely to be offered natural or medical management so that the miscarriage can be managed at home, rather than surgical management in the hospital.'
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