Unfortunately, not all pregnancies end well. For a few, pregnancy ends with a miscarriage or with the death of the baby. This chapter describes some of the things that can go wrong. If your pregnancy ends in this way, then you will need both information and support. Talk to the people close to you about how you feel and to your doctor, midwife or health visitor about what has happened and why. Sometimes it is easier to talk to someone outside your immediate circle. Organisations offering information and support are listed here

Ectopic Pregnancy

After fertilisation the egg should move down into the womb to develop. Sometimes it gets stuck in the fallopian tube and begins to grow there. This is called an 'ectopic' or 'tubal' pregnancy. The fertilised egg can't develop properly and often has to be removed in an operation.

A common cause of an ectopic pregnancy is some sort of blockage in the fallopian tube, possibly as a result of an infection. Warning signs start soon after a missed period. They are a severe pain on one side, low down in the abdomen, vaginal bleeding or brown discharge, and sometimes feeling faint, and women should see their doctor immediately.

Talk to your doctor to find out why it happened and whether your chances of conceiving a baby have been affected. One organisation which can offer support is called Child. You may also like to contact the Miscarriage Association who can offer support during the aftermath of an ectopic pregnancy. Expect to feel a sense of loss and give yourself time to grieve.

Miscarriage

If a pregnancy ends in the first six months it is known as a miscarriage. Miscarriages are quite common in the first three months of pregnancy. Probably at least one in six clinically recognised pregnancies ends this way. At this stage a miscarriage usually happens because there is something wrong with the baby. A later miscarriage may be due to the placenta not developing or working properly, or the cervix being weak and opening too early in the pregnancy.

An early miscarriage can be rather like a period, with bleeding and a similar sort of aching pain, maybe occurring on and off, happening at the time when a period would have been due. With a later miscarriage, bleeding is likely to be accompanied by pains that feel more like the pains that come with labour.

If you bleed or begin to have pains, you should contact the person who is giving you antenatal care, either at the hospital or your GP's surgery. You may be told to lie down quietly or to come into hospital immediately. Sometimes the bleeding stops by itself and your pregnancy will carry on quite normally. But if a miscarriage is going to happen, there is very little that anyone can do to stop it.

After a miscarriage, you may have a 'D and C' (that is, dilatation and curettage) to empty the womb. This is done under anaesthetic. The cervix is gently widened and the lining of the womb scraped or sucked away. The cervix narrows again afterwards.

Afterwards

One miscarriage will not affect your chances of having a baby in the future. Even after three miscarriages you still stand a good chance of carrying a baby to term. If you have three or more miscarriages, you should be referred for further investigations. In some cases, all investigations will be normal and no precise cause found.

A miscarriage can be very difficult to come to terms with. You may feel disappointed, angry, or even guilty, wondering what you did wrong. Some people fear that the miscarriage may have been caused by making love, though this is extremely unlikely. In fact, whatever the cause, it is very rarely anyone's fault.

You will almost certainly feel a sense of loss. You need time to grieve over the lost baby just as you would over the death of anyone close to you, especially if the miscarriage has happened later in pregnancy. Many people find it helps to have something to remember their baby by. In early pregnancy you might be able to have a picture of a scan. After about four months you could ask for a photograph of the baby. If your miscarriage is very late you may be able to see and hold your baby, if you wish, as well as having a photograph. Talking also helps. Talk about your feelings with your partner and those close to you. The Miscarriage Association can give you information and put you in touch with other women who have experienced a miscarriage.

Termination

If tests show that your baby has a serious abnormality you may consider whether or not to end your pregnancy. It is important to find out as much information as you can from the doctor about the particular condition and how it may affect your baby, so that you can make a decision that is right for you and your family.

You will probably be very shocked when you are first told the diagnosis by the consultant and may not be able to take very much in. You may need to go back and talk again, preferably accompanied by your partner or someone close to you. You will also need to spend time talking things through with your partner or with others close to you.

An early termination, before 12 to 14 weeks, will usually be done under a general anaesthetic. For a later termination you will probably go through labour as this is usually the safest way for you. You may wish to think beforehand about whether you want to see and perhaps even hold your baby and give your baby a name. It can make the baby more real for you and your family and help you to grieve. If you don't wish to see your baby, it's still a good idea to ask hospital staff to take a photograph for you. You may find this comforting at a later date. It can be kept in your notes in case you wish to see it.

You may find your feelings quite hard to cope with after a termination, whether it has been in early or late pregnancy. It will help to talk about them. If you would like to talk to people who have undergone a similar experience you can contact ARC (Antenatal Results and Choices)

Losing a baby

In the UK about 4000 babies every year are stillborn - the baby is already dead when it is born. About the same number die soon after birth. Often the causes of these deaths are not known.

If you lose a baby like this, you are likely to feel very shocked. But you and your partner may find it comforting to see and hold your baby and give your baby a name. You may also like to have a photograph of your baby and to keep some mementos such as a lock of hair or the shawl the baby was wrapped in. All this can help you and your family to remember your baby as a real person and can, in time, help in coming to terms with your loss. Many hospitals have a bereavement counsellor (or voluntary support from someone whose baby has also died) who will help you to find the best way for you and your partner to cope with your loss.

One of the first questions you are likely to ask is why your baby died. The doctors and midwives may not know. A post-mortem examination is usually advised and this may help to find out, although it doesn't always provide the answer. Most hospitals will offer you an appointment with the consultant who can explain to you what is known. If you are not offered an appointment, you can ask for one.

It may also help to talk about your feelings with other parents who have lost a baby in a similar way. SANDS (the Stillbirth and Neonatal Death Society) is an organisation that can put you in touch with other parents who can offer friendly help

You may well want to arrange a cremation, funeral or service. You should be able to do so. If the baby was lost after 24 weeks, the loss will need to be officially registered as either a death or a stillbirth. If you want to arrange a funeral or cremation and your baby was lost before 24 weeks, you will need a certificate from the hospital. Talk to your midwife or doctor about what you want to do and to find out what arrangements are available locally. You could also consult the hospital chaplain or rabbi or your own religious adviser.

Saying goodbye to your baby

A funeral or some other way of saying goodbye may be a very important part of coming to terms with your loss, however early it happens. If your baby dies after 24 weeks of pregnancy the hospital must provide a death certificate and arrange a burial or cremation. If you would like to arrange it yourself or organise a service you can do that. Just speak to the ward staff and they will tell you what the arrangements are in your hospital.