Loss

The loss of a baby, either during pregnancy or at birth, is perhaps one of the worst tragedies for any family. We are so very sorry for your loss.

If your baby died during pregnancy or in the first days of life, you and your family may need help to understand what happened. And you may need support to find ways to deal with your grief and ease your pain. Miscarriage, stillbirth and other conditions can cause a pregnancy to end before or during birth. Newborn death can be caused by premature birth, birth defects and other health conditions.

If you’ve had any of these experiences, you may be overwhelmed by your feelings of loss. Learning how people grieve and thinking about ways to remember your baby can help ease your pain and get you ready to think about the future. Visit our online community where families who have lost a baby can talk to and comfort each other. Sharing your family’s story may ease your pain and help you heal.

In this section you will find information about:

• Miscarriage
• Stillbirth
• Newborn death
• Ways in which you might deal with grief

Miscarriage

Unless otherwise noted, material is courtesy of March of Dimes (adapted for Kosovo)

KEY POINTS

• It’s sadly very common in the first trimester, with an estimated one in five pregnancies, or more, ending in miscarriage.
• It’s not your fault. Most first trimester miscarriages are caused by chromosome problems with the baby. In some cases, there there might be ways to reduce your risk of miscarriage.
• It’s normal to worry that you will miscarry again, but most miscarriages are a one-off event, with only 1 in 100 women having multiple miscarriages.

What is miscarriage?

Miscarriage is when a baby dies in the womb before 20 weeks of pregnancy. Among women who know they are pregnant, about 10-15% end in miscarriage. As many as half of all pregnancies may end in miscarriage—we don’t know the exact number because many may happen before a woman knows she’s pregnant. Most miscarriages happen in the first trimester (13 weeks) of pregnancy.

What are the signs of miscarriage?

Signs and symptoms include:

• Vaginal bleeding or spotting
• Cramps like you feel with your period
• Severe belly pain

Many women have these signs and symptoms in early pregnancy and don’t miscarry. If you have any of the signs or symptoms, call your doctor or go to the hospital. Your doctor may want to do some tests to make sure everything’s OK. These tests can include blood tests, a pelvic exam and an ultrasound. An ultrasound is a test that uses sound waves and a computer screen to show a picture of your baby inside the womb.

What happens and how long does it take?

(various sources, including NHS (UK), CDC (USA), BabyCenter and New Kids-Center)

Unfortunately, if you have started to miscarry, there is nothing you can do to prevent it from continuing. The average time it takes is two weeks but some women experience bleeding and cramping for over three weeks. An ‘early miscarriage’ (first trimester) can start like a period, with spotting or bleeding and cramping, and progress in intensity, including heavy bleeding, with blood clots. Some women notice passing the pregnancy sac (also called pregnancy tissue or fetal sac) while others do not. After this occurs, the pain and bleeding usually start to subside, but you will likely bleed for another 7-14 days. Most women get their period again, oftentimes heavier than normal, 4 to 6 weeks after a miscarriage. Keep in mind you can be fertile during this period so it is best to take precautions to avoid getting pregnant right away. If you do not get your period within six weeks of the end of your miscarriage, visit your doctor.

If you are worried you might be having a miscarriage, call your doctor or visit the hospital. If you are bleeding very heavily (soaking a maxi pad in one hour), have excessive pain or have signs of an infection (foul smell from your vagina), go to the hospital immediately. It's very important to know that vaginal bleeding, spotting, or pain in early pregnancy can also be a sign of an ectopic or molar pregnancy. These are serious conditions and you should confirm with your doctor that you are not at risk.

There are three ways a miscarriage can be treated, depending on the situation. The doctor should discuss each option with you and explain their recommendation:  

1. Watching and waiting (also called a ‘natural miscarriage’) – you wait 7-14 days for the pregnancy tissue to be passed naturally. This is normally recommended for early miscarriage as it is the safest option. The doctor should give you instructions on what to do during this time, and may recommend a follow-up visit. To manage the pain, take paracetamol.
2. Pills to empty the womb – you take special tablets prescribed by the doctor to speed up the process, after which the pregnancy is passed vaginally. Possible side effects include nausea, vomiting, and diarrhea. This is not guaranteed to work and you might still need surgery to remove the pregnancy tissue.
3. Surgery (D&C) to empty the womb - this involves emptying the womb by an operation known as a Dilation and Curettage (D&C). This is usually done if there is a medical threat to the mother (excessive bleeding), if the pregnancy has not passed either naturally or via pills, or if the mother finds it is too emotionally or physically painful to wait for the pregnancy tissue to pass.

Some experiences by women who had an early miscarriage are given below:

(courtesy of New Kids-Center)

Case 1: Miscarriage at 6 Weeks but Found Out at 10 Weeks

On the 5th of June, I noticed a spot of blood on my underwear, when I went for a shower. I was carrying for 10 weeks by this time, so my husband took me to the ER. I experienced light spotting for 30 minutes in the hospital. I was told that my baby had died at 6 weeks and 9 days, and the doctor told me to come back to the hospital if the bleeding increased. The next day I could barely stand due to the cramping and bleeding, the pain was worse than labor pain. I underwent a D&C the next day and I was bleeding for a week, like periods.

Case 2: Miscarriage at 5 Weeks Without Severe Symptoms

My miscarriage occurred when I had completed 5 weeks and 5 days of pregnancy. 2 days of light spotting were followed by another 2 days of light bleeding and period like cramps. I was bleeding for the next 5 days.

Case 3: Miscarriage at 6 Weeks with Heavy Bleeding

I completed 6 weeks of pregnancy on Wednesday, when I lost my baby. It started off with mild cramps and spotting. I got upset and went on saying “oh no, oh no, oh no”. The bleeding became quite heavy in sometime and I realized I had lost my baby. The pain was so bad, as if someone was stabbing my abdomen with a knife. I was emotionally spent and the physical pain was very bad too. This is the most hopeless I have ever felt in my life.

Dos and don'ts during and after a miscarriage

(adapted from New Kids-Center, http://www.newkidscenter.com/How-Long-Does-a-Miscarriage-Last.html)

• Do not use tampons. Use pads as this will reduce the risk of infection as compared to the tampons and also tend to give a fair idea on the amount of blood loss. If the pad has to be changed per hour, it is necessary that you go to the emergency room or your doctor, since you are at the risk of developing a hemorrhage.
• Avoid Infection. Take precautions like using the shower instead of bath, and avoid swimming pools and hot tubs. It would also be advised to avoid intercourse when you are suffering from bleeding caused by miscarriage.
• Use a well-supporting bra. If the miscarriage happens in the later stages of pregnancy, the breasts can remain large and even leak milk for several days. It can be painful and distressing. A well supporting bra can relieve the pain. Paracetamol can be taken as a painkiller or the doctor should be consulted.

How long does it take to recover from a miscarriage?

It can take a few weeks to a month or more to physically recover from a miscarriage. It may take longer to recover emotionally. You may have strong feelings of grief about the death of your baby. Grief is all the feelings you have when someone close to you dies. You may feel sad, angry, confused or alone. At times, your feelings may seem more than you can handle. You may have trouble concentrating. You may feel guilty about things that happened in your pregnancy. It’s OK for you to take time to grieve, ask your family and friends for support, visit our online community for support, and find your own way to remember your baby.

If you miscarry, when can you try to get pregnant again?

This is a decision for you to make with your partner and your doctor. You’re most likely medically OK to get pregnant again after you’ve had at least one normal period. But you may not be emotionally ready to try again so soon. Miscarriage can be hard to handle. You may need to take time to grieve the loss of your baby. You may want to wait a while before trying to get pregnant again. Your doctor may want you to have some medical tests to try to find out more about why you miscarried. If so, you may need to wait until after you’ve had these tests to try to get pregnant again.

Many women who have a miscarriage worry they'll have another if they get pregnant again. But most miscarriages are a one-off event. According to the NHS (UK), only 1% of women experience recurrent miscarriages (three or more in a row) and more than 60% of these women go on to have a successful pregnancy.

What causes miscarriage?

Many women will ask themselves, ‘did I do anything to cause the miscarriage’ and in 99% of cases the answer is “NO”. It is natural to want to understand why this has happened, but most times the cause cannot be identified. Possible causes include:

• Chromosome problems. This is the cause of more than half of miscarriages that happen in the first trimester. Chromosomes are tiny, thread-like structures in cells that carry our genes, with half coming from the mother and the other half from the father.
• Blighted ovum. This is when a fertilized egg implants in the uterus but doesn’t develop into a baby. This is sometimes caused by chromosome problems.
• Smoking, alcohol and drugs. If you smoke, drink alcohol, use street drugs or abuse prescription drugs, you may increase your chances of having a miscarriage.
• Mother’s health. Some health conditions may increase a woman’s chances for having a miscarriage. Treatment of these conditions before and during pregnancy can sometimes help prevent miscarriage. If you have any of these health conditions, tell your doctor before or as soon as you know you’re pregnant. These include:
  • Hormone problems. Hormones are chemicals made by the body.
  • Infections
  • Diabetes. This is having too much sugar in your blood. This can damage organs in your body, including blood vessels, nerves, eyes and kidneys.
  • Thyroid disease. The thyroid is a gland in your neck that makes hormones that help your body store and use energy from food.
  • Lupus and other autoimmune disorders. Immune disorders mean your immune system doesn’t work correctly and can’t protect your body from infection.
• You may have heard that getting too much caffeine during pregnancy can cause miscarriage. Caffeine is a drug found in foods, drinks, chocolate and some medicine. It’s a stimulant, which means it can keep you awake. Some studies say caffeine may cause miscarriage, and some say it doesn’t. Until we know more about how caffeine can affect pregnancy, it’s best to limit the amount you get to 200 milligrams each day (about one cup of coffee).

There are a lot of misconceptions about miscarriage. Medical evidence states that an increased risk of miscarriage is not linked to:

• a mother's emotional state during pregnancy, such as being stressed or depressed
• having a shock or fright during pregnancy
• exercise during pregnancy – but discuss with your doctor what type and amount of exercise is suitable for you during pregnancy
• lifting or straining during pregnancy
• working during pregnancy – or work that involves sitting or standing for long periods
• having sex during pregnancy
• travelling by air
• eating spicy food

(source: NHS, http://www.nhs.uk/Conditions/Miscarriage/Pages/Causes.aspx)

Repeated miscarriages

Usually, miscarriage is a one-time thing. Most women who miscarry don’t have the same problem in another pregnancy. But about 1 percent of couples have repeat miscarriages. This means the woman has two, three or more miscarriages in a row.

There may be some specific problem that causes repeat miscarriages. But these causes are known in only half of all cases. Even without treatment, about 60 to 70 percent of women with repeat miscarriages go on to have a successful pregnancy.

Known causes of repeat miscarriages include:

• Problems with the uterus or cervix. The uterus (womb) is where your baby grows inside you. The cervix is the opening to the uterus that sits at the top of the vagina. Problems with the uterus and cervix cause 10 to 15 percent of repeat miscarriages.
• Chromosome problems. Chromosome problems usually happen just once. But in about 2 to 4 percent of couples with repeat miscarriages, one parent has a chromosome problem that doesn't affect his own health but can cause problems in the baby. Both parents should have a test called a karyotype to check for chromosome problems.
• Antiphospholipid syndrome. This is a condition of the immune system that increases the risk of blood clots in the placenta. Your immune system is what protects your body from infection. Antiphospholipid syndrome causes 5 to 10 percent of repeat miscarriages. Your provider can test you for this condition with a blood test. Treatment is with low doses of aspirin and a medicine that helps thin the blood.
• Hormone problems. Hormones are chemicals made by the body. If you have too
• Infections. Some infections of your reproductive organs, like the ovaries, uterus and cervix, may play a role in repeat miscarriages.
• Harmful chemicals. If you or your partner work with certain harmful chemicals, you may be more likely to have repeat miscarriage. These chemicals include solvents, like paint thinner. If you’re worried about being around harmful chemicals, tell your doctor.

Further information and help

You might still have lots of questions or feel like you need more support. Don’t be afraid to ask for help. Here are some places to turn:

1. Contact your local Beba-ks Center for advice and support.
2. Share your story on our online community and read the experiences of others.
3. Visit the following websites (only in English unfortunately) for more information

• http://www.miscarriagesupport.org.nz
• http://www.nhs.uk/Conditions/Miscarriage/Pages/Introduction.aspx
• https://www.babycenter.com/0_miscarriage-signs-causes-and-treatment_252.bc

Stillbirth

Material courtesy of March of Dimes (adapted for Kosovo)

KEY POINTS

• We know that certain infections and pregnancy complications can cause stillbirth, but we don’t know all the causes. 
• Some women are more likely than others to have a stillborn baby. You may be able to help reduce your risk to help you have a healthy baby. 
• Most women who have a stillbirth and get pregnant again later can have a healthy pregnancy and a healthy baby.   

What is stillbirth?

Stillbirth is when a baby dies in the womb after 20 weeks of pregnancy. 

Most stillbirths happen before a woman goes into labor, but a small number happen during labor and birth.

What makes a woman more likely than others to have a stillbirth?

Things that make you more likely than others to have a stillbirth are called risk factors. Having a risk factor doesn’t mean for sure that you will have stillbirth, but it may increase your chances. Talk to your doctor about what you can do to help reduce your risk for stillbirth. You may be more likely than other women to have a stillbirth if you: 

• Are obese. If you’re obese, you have an excess amount of body fat and your body mass index (also called BMI) is 30 or higher. To find out your BMI, go to www.cdc.gov/bmi.
• Are pregnant with multiples (twins, triplets or more)
• Are 35 or older
• Have a medical condition like diabetes or low or high blood. Diabetes is a condition in which your body has too much sugar (called glucose) in the blood. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body. 
• Have never given birth before
• Had a miscarriage or stillbirth in a past pregnancy, or you had a baby who died in the first 28 days of life (called neonatal death) 
• Had complications in a past pregnancy, like premature birth, preeclampsia or fetal growth restriction. Premature birth is birth that happens before 37 weeks of pregnancy. Preeclampsia is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Fetal growth restriction is when a baby doesn’t gain enough weight in the womb before birth. 
• Smoke, use street drugs, take prescription painkillers or drink alcohol during pregnancy.

How do you know if your baby is stillborn?

The most common symptom of stillbirth is when you stop feeling your baby moving and kicking. Other signs and symptoms include cramps, pain or bleeding from the vagina. Call your doctor right away or go to the hospital if you have any of these conditions. 

Your doctor uses an ultrasound to see if your baby’s heart has stopped beating. An ultrasound uses sound waves and a computer screen to show a picture of your baby inside the womb.

If you’ve had a stillbirth before, can you have a healthy baby in another pregnancy? 

Yes. The chances of having another stillbirth are very low for most women. If you had a stillbirth and are thinking about having another baby, give yourself time to heal physically and emotionally. Talk to your doctor about what’s right for you. She may want you to have medical tests to try to find out more about what caused your stillbirth. You may need to wait until after you’ve had these tests to try to get pregnant again.

Here are some things you can do help to lower your risk of having a stillbirth in another pregnancy: 

• Get a preconception check-up. This is a medical checkup you get before pregnancy. It helps make sure you’re healthy when you get pregnant. 
• Get to a healthy weight before getting pregnant. Your provider can recommend ways to get to a weight that’s right for you. 
• Don’t smoke, drink alcohol, use street drugs or abuse prescription drugs. 
• If you have any pain or bleeding from the vagina during pregnancy, call your doctor right away.  

If you get pregnant again, your doctor monitors you and your baby closely. At around 32 weeks of pregnancy, she may ask you to do kick counts to help you keep track of how often your baby moves. Your doctor may also do medical tests to check your baby’s heart rate and movements.

What causes stillbirth? 

We don’t know what causes many stillbirths, but common causes include:

• Infections in the mother, baby or placenta. Some infections may not cause symptoms in the mother and may not be diagnosed until they cause serious complications, like premature birth or stillbirth. Infections that can cause stillbirth include Cytomegolovirus (a kind of herpesvirus), Fifth disease (caused by a virus called parvovirus B19), genital and urinary tract infections, Listeriosis (a type of food poisoning), Syphillis (a sexually transmitted disease) and Toxoplasmosis (an infection caused by a parasite). 

• Complications during pregnancy, including being pregnant longer than 42 weeks, diabetes, high blood pressure, lupus (an autoimmune disorder), obesity, preeclampsia, preterm labor (labor that begins before 37 weeks of pregnancy), preterm premature rupture of the membranes (also called PPROM), trauma or injuries (like a car accident), thrombophillias (increases your chances of making abnormal blood clots), and thyroid disorders.
• Conditions in the baby, including birth defects and genetic conditions like Down Syndrome (occurs in about 14% of stillborn babies), fetal growth restriction, insufficient oxygen during labor and birth, Rh disease (when a woman who is Rh-negative is pregnant with a baby who is Rh-positive).  
• Problems with the placenta. These can include blood clots, inflammation (redness, pain and swelling), problems with blood vessels in the placenta and other conditions, like placental abruption. Placental abruption is a serious condition in which the placenta separates from the wall of the uterus before birth. Women who smoke cigarettes or use cocaine during pregnancy are more likely to have placental abruption than other women. Placental problems cause about 24% of stillbirths.
• Problems with the umbilical cord, like having a knot in the umbilical cord. Accidents involving the umbilical cord may lead to about 10% of stillbirths.

How can you deal with feelings of grief after a stillbirth?

Grief is all the feelings you have when someone close to you dies. Having a stillborn baby is a painful loss for a family. But there are things you can do to help you grieve, heal and remember your baby. 

After birth, do what feels right for you and your family, and what the hospital will allow. You may want to spend time alone with your baby and other family members. You can name your baby, hold your baby and possibly take part in cultural or religious traditions. Some families take photos of their baby, or retain other keepsakes to help them remember their baby. 

Parents who have a stillbirth need time to grieve. You and your husband may cope with grief in different ways. This may cause problems for the two of you. You also may need help dealing with others as you grieve. Ask your doctor or get in touch with your local Beba-ks Center to discuss ways of how to cope with your baby’s death. 

Having a stillbirth may make you more likely to have postpartum depression (PPD). PPD is a kind of depression that some women get after having a baby. Click here to learn about the signs and symptoms of PPD and ways you can cope. You can always talk to someone at your local Beba-ks Center about PPD and ways to cope and overcome this difficult time.

Talking about your feelings may help you deal with your grief. Visit our online community where families who have lost a baby can talk to and comfort each other. Sharing your story may ease your pain and help you heal. March of Dimes has developed a booklet, “From Hurt to Healing” which you might find helpful in dealing with your loss. Contact us to request a copy.

Further information and help

You might still have lots of questions or feel like you need more support. Don’t be afraid to ask for help. Here are some places to turn:

1. Contact your local Beba-ks Center for advice and support.
2. Share your story on our online community and read the experiences of others.
3. Visit the following websites (only in English unfortunately) for more information

• http://www.firstcandle.org/grieving-families/stillbirth/
• http://stillbirthalliance.org
• http://starlegacyfoundation.org

Death in the first month after birth

Material courtesy of March of Dimes (adapted for Kosovo)

KEY POINTS

• The most common causes of neonatal death are premature birth, low birthweight and birth defects.
• An autopsy may help you find out why your baby died. Check with the hospital about whether or not to have an autopsy on your baby.
• Your doctor may help you learn about why your baby died and if you may have the same problems in another pregnancy.
• Getting counseling and support can help you cope with your baby’s death.

What is neonatal death?

Neonatal death is when a baby dies in the first 28 days of life. If your baby dies this soon after birth, you may have many questions about how and why it happened. Your baby’s doctor can help you learn as much as possible about your baby’s death.

Talking about your feelings may help you deal with the grief you feel about your baby’s death. Grief is all the feelings you have when a loved one dies. Visit our online community where families who have lost a baby can talk to and comfort each other. Sharing your baby’s story may ease your pain and help you heal.

What are common causes of neonatal death?

The most common causes of neonatal death are:

• Premature birth. This is when a baby is born too early, before 37 weeks of pregnancy. Babies born too early may have more health problems than babies born on time.

• Low birthweight. This is when a baby is born weighing less than 2.5kg. Babies born too small may have more health problems than babies born at a healthy weight.
• Birth defects. Birth defects are health conditions that are present at birth. Birth defects change the shape or function of one or more parts of the body. They can cause problems in overall health, how the body develops or in how the body works.

Premature birth and low birthweight cause about 1 in 4 neonatal deaths (25%). Birth defects cause about 1 in 5 neonatal deaths (20%).

Other causes of neonatal death include:

• Problems in pregnancy, like preeclampsia. This is a condition that can happen after the 20th week of pregnancy or right after pregnancy. It’s when a pregnant woman has high blood pressure and signs that some of her organs, like her kidneys and liver, may not be working properly. Signs of preeclampsia include having protein in the urine, changes in vision and severe headaches.
• Problems with the placenta, umbilical cord and amniotic sac (bag of waters). The placenta grows in your uterus (womb) and supplies the baby with food and oxygen through the umbilical cord. The amniotic sac contains the fluid that surrounds the baby in the womb.
• Infections like sepsis. Sepsis is a serious blood infection.
• Asphyxia. This is when a baby doesn’t get enough oxygen before or during birth.

Why are premature babies more likely to die shortly after birth than babies born on time?

Some premature babies may develop serious complications that can sometimes cause death. These complications include:

• Respiratory distress syndrome (also called RDS). This is a breathing problem most common in babies born before 34 weeks of pregnancy. Babies with RDS don’t have a protein called surfactant that keeps small air sacs in the lungs from collapsing. Since 2009 Action for Mothers and Children (AMC) has delivered surfactant medication to UCCK hospital in Pristina and saved an estimated 1,800 babies over that time. AMC has also provided UCCK an oxygen supply system which helps around 2,000 babies annually who cannot breathe on their own. AMC also arranged the donation of two CPAP machines which has saved over 1,500 babies since 2012.
• Intraventricular hemorrhage (also called IVH). This is bleeding in the brain. Most brain bleeds are mild and resolve themselves with no or few lasting problems. More severe bleeds can cause serious problems for a baby.
• Necrotizing enterocolitis (also called NEC). This is a problem with a baby’s intestines. It can cause feeding problems, a swollen belly and diarrhea. It sometimes happens 2 to 3 weeks after a premature birth. It can be treated with medicine and sometimes surgery. But in serious cases, it can cause death.
• Infections. Premature babies often have trouble fighting off germs because their immune systems aren’t fully formed. Infections that may cause death in a premature baby include pneumonia (a lung infection), sepsis (a blood infection) and meningitis (an infection in the fluid around the brain and spinal cord).

 

 

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Category: Loss