Often pregnant mothers feel sense of relief when progressing to second trimester. Chances of miscarriage this stage of pregnancy is rare. Losing a baby in second trimester is bewildering. Mothers often share experiences of pregnancy and miscarriage. Sharing experiences gives mothers understanding of what to expect incase miscarriage happens to them. Many women haven’t heard of silent (missed) miscarriage, spontaneous abortion or fetal demise because it’s likely they haven’t known anyone that’s been through it. What can mothers of late term pregnancy loss expect when given unfortunate news of fetal death in second trimester? I found little information during loss of my baby at 20 weeks gestation. I hope my experience might be helpful to other women in need of answers.
Silent miscarriage: Some women don’t experience obvious symptoms of miscarriage. Silent miscarriage becomes evident after discovering absence of fetal heartbeat, mother’s uterus hasn’t grown and ultrasound confirms the fetus has stopped growing.
Spontaneous abortion: Medical term used when miscarriage occurs prior to 20 weeks gestation. This term might not be used in attempt to respect patient’s sensitivity.
Intrauterine fetal demise (IUFD): Fetal death within pregnant mother’s womb that occurs after 20 weeks of gestation.
Medical Treatment for Miscarriage
It’s possible to misdiagnose fetal death. Make sure diagnoses of fetal death is correct by requesting another ultrasound before any further medical procedures.
Calculating gestational age of the fetus helps determine diagnosis of miscarriage, spontaneous abortion, fetal demise or stillborn. Immediate conclusion of when the fetus died can be difficult. Ultrasound technicians take measurements by ultrasound to estimate gestational age. Pathology can later confirm precisely how many gestational weeks the fetus was along. Gestational age will help determine proper medical procedures. Women that haven’t miscarried naturally will have the following choices:
Going into labor naturally is preferred by some women. Patient will need to follow doctor’s orders by monitoring for signs of intrauterine infection. Doctors and staff would like to keep you as comfortable as possible. Make your preferences known of how you would like your labor and delivery managed.
Inducing labor can get the process moving at a quicker pace. Some patients will try Laminaria. This herb is inserted into the cervix the day before labor is expected. Laminaria is used to soften the cervix. It feels scratchy and I couldn’t complete insertion. The following day I was given Cytotec for induction. It takes 1-3 days for the induction process. Doctors like to keep patients comfortable as possible during labor. If you don’t want heavy drugs make sure to let them know before induction. Toradol was given later to manage my discomfort. I found it wasn’t too heavy, but took the edge off.
Dilation and curettage is a surgical procedure offered in the early months of miscarried pregnancies.
Dilation and evacuation is offered by some doctors. Some hospitals may not perform this surgical procedure. I was told by a doctor that some woman choose this method to avoid emotional trauma that might come with giving birth to a deceased fetus. Referral can be given to perform this procedure at another hospital if preferred. Postnatal diagnosis of fetal demise can be more difficult because the fetus wouldn’t necessarily be intact.
Make Wishes Known
Time is short and we will never get these days back. It’s hard to plan this unexpected day. Even under the circumstances it’s possible to make the day special. Many women don’t know what opportunities she may be able to have with her baby after delivery. Here are some ideas that some mothers choose if they are able to deliver the baby:
Special baby blanket and outfit
Bring family photo to help bring comfort
Talk with chaplain or minister
You may find answers to some questions. Be prepared that it’s likely you won’t find answers to all of them. Write down your questions as you think of them and bring them at your next doctor visit. It’s hard to remember all those important questions when you’re giving your attention to the doctor.
Why did this happen? Unfortunately it’s often hard to determine why the baby died in second trimester. In most cases this answer remains unknown. You might decide to send the baby to pathology to get more answers. Be prepared though that you may only hear what was ruled out.
Will I get a birth certificate or death certificate for baby? This answer will depend on the state. Babies 20 weeks gestation will often be given a birth certificate. Certificates of fetal death are most common for babies under 20 weeks of gestation.
Postpartum of Fetal Demise
Breasts will still lactate. Engorgement can be managed by wearing a tight sports bra. In addition, cabbage leaves can be placed in the bra or icepacks can be held to breast area to help relieve discomfort. Further, Ibuprofen can be taken to help with the breast inflammatory process. Women should expect to heal physically much like every other labor and delivery. For many women the emotional process is most difficult. Be sure to keep your doctor informed on how you are doing emotionally.
Losing a baby is a troublesome time for grieving mothers. You may have a hard time sleeping. Don’t feel ashamed to tell your doctor if you need help. This is common and your doctor may prescribe you a sleep aid. If Ambien is too strong, Benadryl can be a good alternative. Take comfort in family and friends. Let them help you as you recover. Don’t be afraid to ask them for anything. Get as much rest as you can during this time. You need time to heal physically and emotionally. Grieve the way you need to. Allow yourself to take each day one at time.
Coping and Support of Loss
Parents need to grieve to help make peace with the loss in their lives. Emotional stress can create friction between two parents. Keep in mind every parent will grieve differently.
If siblings are involved they will be affected by this loss too. It’s possible in some cases for siblings to view and hold the baby. Some parents might share pictures. I decided in our case to draw a picture of the baby. My daughter wanted to know what the baby looked like. She took great comfort in the drawing. Kids might ask a lot of questions. My kids needed to talk about our loss to find peace. This might be the first death experience for a child. Some children will need a lot of comforting during this time. Answer your child’s questions as you see appropriate for your child.
Mothers can feel very alone after devastating loss. Many women find comfort in online support forums. Mothers can feel a sense of togetherness when hearing other stories of loss. Talking about our experiences allows us to gain some understanding and hopefully we will find more answers in years to come.
Some mothers may find doing things in baby’s memory a healing experience. Some things mothers might choose:
Asking for medical records of pregnancy
Making a scrapbook
Finishing baby projects
Writing a journal to baby
Lighting a candle
Sending messages by balloons
I hope this information will help in days ahead as you progress through this journey. Feel free to comment below to add your experience, advice and suggestions for other mothers who are experiencing late term pregnancy loss.
Ketchikan General Hospital