​Losing your baby early in pregnancy, later on during delivery or after birth is an event which has potential immense psychological impact on you and your partner's life.

Early Pregnancy Loss​

About 20% of women suffer from a miscarriage early in pregnancy (usually up to 12 weeks gestation​), and in the majority of women, the cause is not known. A miscarriage often brings about despair, depression​ and shock to the parents. 

This effect is more pronounced, especially if there had been a history of infertility or previous pregnancy losses. Other causes of early pregnancy loss include chromosomal or genetic defects in the fetus, which by natural selection, will not be sustained. 

In most pregnancies, the event is only a sporadic one and therefore, will not affect the chance of success in subsequent pregnancies. It is only when miscarriages happen for three or more times (recurrent miscar​riages), that we would be concerned about underlying defects in the parents. 

Under these circumstances, a more thorough assessment and investigation of the couple is warranted.

Late Pregnancy Loss/Intrauterine Death

Stillbirth is an unforeseen event and is defined by the death of a baby when it is born after 24 weeks of pregnancy. Fortunately this occurs only in 1:100 – 200 pregnancies, but when it happens, it is devastating. ​

In many cases the cause of death of the baby cannot be established and there is no way of reliably​ predicting its occurrence during the antenatal period. Other known causes include placental problems, growth restriction of the baby, infections, birth defects, umbilical cord accidents, chronic maternal diseases (such as diabetes, high blood pressure), post term pregnancy ( > 42 weeks of pregnancy) and Rhesus incompatibility.

​Will Induction of Labour be Necessary?

Some women will find it very difficult to come to terms with the fact that they are still carrying a fetus that is no longer alive in their womb. Studies have shown that a woman is much more likely to suffer from depressive symptoms after delayed delivery of a stillborn of more than three days. 

Most women will opt for an induction of labour to avoid this. The doctor​ may take into account the mental state, physical conditions and advise on when is the best time to induce delivery. The aim ultimately is to allow for a vaginal delivery. This avoids having to put the mum through the risks associated with a cesarean section. 

On the other hand, it is generally safe to delay delivery and await spontaneous labour provided there are no other conditions such as:​ ​​​​

  • ​A rupture of membranes predisposing to infection in the womb.​ 

  • Severe medical conditions like uncontrolled diabetes or hypertension. 

  • Abruptio placenta which is a life-threatening condition resulting from the placental separation from the womb.

There is also a theoretical concern that clotting problems may develop in the body as delivery is delayed for a long period of time ( > 4 weeks). As such, periodic blood tests to screen for such clotting problems may be necessary if delivery is still delayed after a few weeks.​

Is There Help Available?​

​It is p​erfectly normal to grieve over your pregnancy loss. The grief process goes through the different phases of denial, bargaining, anger, sadness and then finally acceptance of the situation. 

In fact, you should start to feel gradually better as time passes. Seek professional help if you find great difficulty in overcoming the grief​ and you are not able to cope with everyday life. 

Most people who suffer loss of loved ones go through a process of grief reaction which eventually leads them to emotional healing. The feelings you may experience may include shock and denial, guilt and anger, depression and despair, and finally acceptance. 

Finding a way to manage your grief may aid in your recovery process. You might consider holding a small memorial service, or a symbolic ceremony to​ share your thoughts about your baby. 

You may also want to share your thoughts through a support group with others who have experienced pregnancy losses. 

Your doctor may encourage you and your family members to see, hold and touch your baby, although this may be a very difficult and painful moment. Even if there is some malformation of the baby, seeing is better as what is often imagined by the woman is often worse than reality. 

Holding and giving your baby a name may aid in your recovery process. You may want to save a photo or other mementos which you can cherish when you think about your lost baby. 

In KK Women's and Children's Hospital (KKH), our psychiatrists, psychologists and medical social workers are at hand to help grieving mothers cope with their pregnancy loss better. Women who have difficulties coping with a pregnancy loss can contact KKH Central Appointment at 6294 4050 to obtain an appointment with the Department of Psychological Medicine.

In addition to the above-mentioned emotional aspects, some other medical issues need to be addressed as well. They include:

  • ​ Suppression of lactation to avoid breast engorgement and discomfort. This can be achieved by cold cabbage treatment, a good supportive bra and pain-killers. If necessary, specific medicines may be prescribed (Dostinex or Cabergoline). 

  • Contraceptive methods must be discussed as it is still possible to get pregnant before the first period. Pregnancy that occurs too soon may be detrimental and you should try to conceive again after the grieving process is over. 

​​​Why Did It Happen? 

The painful question of “why” this has happened may or may not be answered. Often no specific cause is recognized as the baby looks normal. 

The only way to uncover reasons for the demise is to examine the pregnancy history, perform a series of blood investigations on the mother and to perform a detailed and complete examination of the fetus (postmortem). 

Postmortem examination may provide the reason for the baby’s demise. Contrary to what most people think, a postmortem examination is conducted with utmost respect to the baby by a fully trained and qualified doctor. This procedure does not mutilate the body which can then be returned intact to the parents. 

​Knowing what happened need not tell why it had happened in the first place, but it puts a closure to the event. In instances that a cause is found, possible interventions or treatment may be administered in subsequent pregnancies to help manage it better.

Acknowledgement

Source: Dr TAN Thiam Chye, Dr TAN Kim Teng, Dr TAN Heng Hao, Dr TEE Chee Seng John, The New Art and Science of Pregnancy and Childbirth, World Scientific 2008.

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