If you are reading this because you have gone through a miscarriage, please accept my condolences. I have been through more than one miscarriage myself. The end of the precious hopes and sweet imaginings is heard to bear.

The official statistic is that ten to fifteen percent of pregnancies end in miscarriage. That means healthcare providers should have a solid plan for helping people through it, but like so many areas of women’s health, it has been a neglected aspect of care.

In this article, I will summarize the approach I take in my practice. It is my personal attempt at a ‘best practice’. First I will cover the physical considerations, and then the emotional. Please be forewarned that some of the information is graphic.

A miscarriage is simply the body expelling a pregnancy that stopped developing. Sometimes the miscarriage occurs without forewarning, other times an ultrasound reveals that the baby has died, or that there is no baby found within the gestational sac. Sometimes it is called spontaneous abortion, which can be confusing since we commonly use the word abortion to refer to having a pregnancy intentionally terminated.

Miscarriage can range from mildly painful to very painful with labour-like contractions. Expect to see blood, tissue, and clots. Some of the tissue may be recognizable: the fetus itself, the sac, the beginnings of the umbilical cord or placenta.

A missed miscarriage is when your baby has died but you have not yet passed the tissue. You will have three options: wait for your body to pass it, take a medication or have a surgery called dilation and curettage (D&C for short). Acupuncture can be used to encourage the tissue to pass. Misoprostol, one of the possible medications, is often associated with very heavy bleeding. It is best not leave home once you have taken it.

You may have heard of doulas who help with childbirth. Doulas are expanding their roles and some will help you through the process of miscarriage.

There are some important things to consider after a miscarriage is complete. Women who are Rh negative should receive Rh immunoglobulin after a miscarriage at twelve weeks or later to prevent a problem called hemolytic disease of the newborn in future pregnancies.

In women who have not had a baby before, a certain type of immune system reaction should be measured as soon as possible after miscarriage has occurred. It is called antithyroid peroxidase and it is related to the thyroid gland. Elevated levels can be associated with an increased risk of miscarriage and are very treatable with naturopathic medicine.

You may lose a lot of blood with a miscarriage. Initially, this will make you tired. Keep your hydration level up, allow yourself to rest and eat iron-rich foods. In those with a history of low iron levels, I recommend a supplement. I recommend having iron levels checked if fatigue lasts beyond eight weeks.

Sometimes the bleeding goes on for weeks. I recommend using a tincture containing astringent herbs. The astringent herbs close off the blood vessel of the uterus, which allows small pieces of remaining tissue to detach and decreases the loss of blood. Sometimes, prolonged bleeding indicates that larger pieces of tissue remain in the uterus. If you have a sense of fulness in the pelvis or normal menstrual cycles have not resumed, ask your doctor for a pelvic exam or ultrasound. Retained tissue is usually not dangerous, even if it goes on for many months. However, if you experience pelvic pain, fever or foul-smelling discharge, seek care right away because you may have a uterine infection.

Normal menstrual cycles typically resume within weeks and potentially right away. The usual advice is to hold off on trying to conceive until after your next period. This is to improve the accuracy of the estimated due date should you become pregnant right away. In my practice, I like women to keep track of their basal body temperatures to detect when ovulation occurs again, which provides an even greater level of accuracy in predicting due dates and also provides me with information if menstrual cycles do not resume normally. Some women find it either too tedious or too emotionally painful to keep track of their basal body temperatures, and that is okay.

Beyond the physical considerations after a miscarriage, we also have to care for and nurture our emotions too.

I want to stress that any emotional reaction you have to a miscarriage is okay, whether it be mild sadness or full-blown grief or a sense of relief. Whatever your emotions are, they are acceptable and normal and you can guarantee that other women have felt exactly as you do. It is common to experience greater levels of anxiety or depression for around six months after a miscarriage. I will often recommend herbs or supplements to help manage moods.

Sometimes you may actually experience intense fluctuations of emotion. Similarly to after a pregnancy, your hormone levels are changing rapidly. This re-calibration can dramatically impact your moods.

If you are able, taking time for self-care is a good idea. Check in with yourself about what would be most nourishing for you; self-care practices that work well for someone else may not work well for you. For example, some people will excuse themselves from attending baby showers after a miscarriage. I did that for a shower that was happening very shortly after I suffered a loss. After a period of time, though, I found that I received a lot of nourishment from being around pregnant friends and newborn babies even though I felt a little sad at the same time. It helped dispel my bitterness.

I like to recommend massage therapy for people going through difficult times. The physical touch is reassuring and increases levels of oxytocin, which combats feelings of isolation. Sometimes physical therapies can allow a release of emotions. Don’t worry, massage therapists are accustomed to people crying during their appointments. I confirmed this with one of the RMT’s I work with, Morgan Young, who told me, “It’s a very natural and common situation that we are prepared and trained for.”

One of the burning questions people have after a miscarriage is ‘Why did this happen?’ The frustrating answer is that we will never know why any particular miscarriage took place. Fight the tendency to blame yourself. Many factors, maybe even most factors, affecting fertility are beyond the control of the individual. That being said, in my practice, I try to seek out factors affecting the risk of miscarriage that can be modified before a patient starts to try to conceive. If you wish to try to conceive again, you may wish to review these factors and see if there are any steps you can take to reduce the chance of another miscarriage, once you feel up to it.

No one ever wants to be tested in this way, but negotiating strong emotions is a testament to your resilience.

Miscarriage is a common experience, and my hope is that we will move towards managing it with more medical skill and greater compassion.

Dr. Andrea Hilborn is a naturopathic doctor in Kingston, Ontario

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