Signs, symptoms and the physical process
Many people who have had a second trimester loss have told us that not knowing what to expect made their experience even more distressing.
We hope that the information we have here and on the next few pages may prepare you a little or perhaps explain more about what you have already been through.
We talk below about
- symptoms and signs that something is wrong
- the process of labour and birth
Signs and symptoms…
The main symptoms of second trimester loss are vaginal bleeding, painful cramps in your abdomen (stomach), or the waters breaking or leaking out from around the baby.
For some people these symptoms may go on a long time, with repeated visits or stays in hospital.
For others it may be a very quick process, and they gave birth to their baby within a few hours of their first symptoms.
Some people notice that their baby’s movements have slowed down or changed, or they haven’t felt any movements for a while. Often there is no set pattern to movements before 24 weeks of pregnancy, so it can be difficult to know if this is normal or not.
… or none
Sometimes there are no obvious signs at all. Some people may have no idea that anything is wrong with the pregnancy and only find out that the baby has died during a routine scan or appointment. This can come as a considerable shock and it may take time before you can take this information in.
When they told me they couldn’t find a heartbeat, I think my heart stopped, too. I was full of the joys of being pregnant only to feel I had been hit by a train head on.
Labour and birth
How things might start
Your loss may start spontaneously, perhaps with some light bleeding that gets heavier and mild cramps that gradually become much stronger. Once the process starts, there sadly isn’t any way of stopping it. Things might happen very quickly and you might have your baby at home or perhaps somewhere else, and then be transferred to hospital.
My labour with our first twin was 2 hours. I didn’t require any pain relief, I didn’t have any contractions.
If your loss doesn’t begin spontaneously, you may have to have medication to start off the process of labour (induction) or you might be able to choose to wait for labour to start on its own.
The staff caring for you should discuss all your choices to prepare you for what might happen. If you have time, you may want to go home and think about it for a few days. These are usually very difficult and upsetting decisions to make.
You may wonder why you have to go through the process of labour and birth rather than having a caesarean section. This is because surgery is a potential risk to you and would normally only be offered if there were a higher risk to your health by going through labour.
Even in these extremely difficult circumstances, however, many people find that the experience of labour and birth can be special and meaningful.
Induction is usually a two-stage process. First you will be a given a tablet called mifepristone to make the uterus more sensitive to the tablets used in the second stage. After taking this medication, and a short period of observation, you will usually be encouraged to go home and will be asked to return 36-48 hours later to start the labour.
When you return, you will be given prostaglandin tablets every few hours until you have regular contractions and your baby is born. Depending on your previous history, your health professional may recommend a slightly different regime and will be able to explain the reason for this with you.
What happens next
You may be cared for in a gynaecology or maternity setting and sometimes it is possible for you to choose. This varies a great deal from one hospital to another. Some hospitals have a special bereavement room.
It was so hard walking through the labour ward. The walls were covered in photos of newborns, but I knew I wouldn’t be leaving with my own baby.
In most cases you will have one particular member of staff to care and support you throughout labour and birth, or perhaps more than one if there is a change of shift during that time. Staff will discuss your care so that you understand what will happen at each stage of the process.
All the staff were kind and caring. In a strange way, this made the experience of delivering my baby calm and peaceful and I’ll be forever grateful to those who cared for us.
Pain and pain relief
Everyone’s experience of pain is very different. Some people may have very little pain especially if their loss is very swift. Others have period-like cramps to begin with and these may progress gradually or quite swiftly to strong labour pains – contractions in your abdomen and/or pain in your back. You might be aware of your waters breaking, or they might stay intact until your baby is born.
The staff caring for you will be able to talk to you about the options for pain relief as and when you need it, so it’s important to let them know when you do.
I started with no pain relief, then progressed to paracetamol and codeine, a tens machine and then diamorphine and gas and air for the actual delivery.
The birth of your baby
For many people experiencing a second trimester loss, the birth itself is a time of contrasting emotions. Sadness is often the strongest feeling, but people have also described the birth of their baby as being a special and significant moment in their lives.
You might be very worried about what your baby will look like. You might be unsure whether you want to see them and you may choose not to look.
Hospital staff may offer to take a photo of your baby and save it for you in case you want to look later.
It may be that someone else, a midwife or a family member, will describe your baby to you and that will help you decide.
There is no right or wrong thing to do – it depends how you feel.
I initially declined to hold my baby. I was scared about how he might look. But a few hours later, I changed my mind and a very kind midwife brought him back into the room. I was pleased I’d seen my baby, who was tiny but perfectly formed.
Depending on the size and condition of your baby, you may be able to hold and cuddle them. You may feel worried about this because they are so small and fragile. Hospital staff will support you in whatever feels right for you. It may be that you need time to think about this.
You may prefer to see your baby once they have been washed and gently wrapped or dressed or you may choose to wash and dress your baby yourself, if that’s possible.
As well as photographs, staff may be able to take handprints and footprints if you would like them to. Some people like to keep these in a memory box along with any scan pictures or other items connected with their baby or pregnancy.
You should always be able to spend time with your baby while you are in hospital and there may be opportunities to return to hospital to see them; or you may decide to take them home, with advice and support from staff.
On the next page, we talk about tests and investigations and follow-up.