Interview by Hilary Quigley

with Denah Smith, B.Sc.N., Registered Nurse

Q. What is a miscarriage?

A. A miscarriage is the loss of a pregnancy in its early stages. The medical term for it is "spontaneous abortion," meaning that the pregnancy ends on its own.

Q. How do you know you're having a miscarriage?

A. Often the first thing a woman might notice is some bleeding. That can be normal during pregnancy and may go away on its own, but sometimes it can be a sign that a miscarriage is starting. If it is a miscarriage, the bleeding will get heavier and there will be cramping that will get more and more severe. There will be clots and then some tissue in the blood. If it is very early in the pregnancy, there may be nothing you can recognize.

Sometimes a miscarriage can take a few days to complete. It is important that you see a doctor if you are pregnant and have any of these symptoms.

Q. Why would a pregnancy miscarry?

A. We really don't know all the reasons why. Probably it happens because something in the development of the pregnancy didn't happen quite right. Everything has to work really beautifully in the pregnancy. If one little step doesn't work right, then a miscarriage happens. It's sort of nature's way of saying,"Well, this one didn't work out."

Q. What are some statistics on miscarriages?

A. From 15% to 20% of pregnancies will end in a miscarriage — that's one out of six. Most miscarriages occur by the time the woman reaches 12 to 13 weeks of pregnancy — that's during the first three months. Later than that is rare.

Q. Why is it called a miscarriage?

A. 'Mis' means "to do improperly", like mistake. So it means that there is a problem with the carrying of the pregnancy.

Q. Are there different kinds of miscarriages?

A. Yes, and there are different terms for different kinds of miscarriages. Some women have a "spontaneous abortion." That means everything comes out all at once. Sometimes, the process goes on for quite a while. That's called an "incomplete sponta- neous abortion."

There is a third kind, called a "missed abortion." It's a mis- carriage that's happened but hasn't fully come away from the uterus yet — the woman has only bled a little. Sometimes, the miscarriage will continue on its own, but sometimes the woman may need to be treated. The woman will have a "D and C," other- wise known as dilation and curettage, which is a medical procedure where the pregnancy tissue is removed. Alternatively, she will receive a drug called "misoprostol" to help the miscarriage continue.

These miscarriages are different from the kind of abortion that is done by choice. That is called a "therapeutic" or "induced" abortion.

Q. Can you make yourself have a miscarriage?

A. That would be an abortion. There have been a lot of folk remedies over the years, but it's very unsafe to do it on your own. It would be my hope that, if anybody thought they wanted to bring a miscarriage on, they would go to an abortion clinic to have it done safely.

Q. Can a miscarriage be fatal or a health risk?

A. People have bled to death or developed infections as a result of miscarriage, but in Canada and the US we have good health care so that is very, very rare. If you have a miscarriage, it's impor- tant to see a doctor.

Q. What do you do if you're having a miscarriage?

A. It depends on how far along and how bad your symptoms are. If the bleeding is really heavy or the cramping is really severe, go to the hospital emergency room so that a health professional can check you over. You can also be given some- thing for pain if needed. Some women who know that they are going to miscarry will stay at home because they are more comfortable there. They keep in contact with their doctor and watch that their bleeding doesn't get too bad.

Q. Are there any long-term effects of miscarriages? A. No. Miscarriages are very common. The rare woman may have miscarriages over and over. There are some medical reasons for that happening. Most women who have one miscarriage won't have another one.