The main difference between a miscarriage and a stillbirth is when the pregnancy loss occurs:

- Miscarriage: The loss of a baby before the 20th week of pregnancy, or if the baby weighs less than 350 grams if the gestational age is not known.

- Stillbirth: The loss of a baby during or after 20 weeks of pregnancy.

Stillbirths are further classified as early, late, or term:

• Early: Between 20 and 27 weeks of pregnancy

• Late: Between 28 and 36 weeks of pregnancy

• Term: At 37 or more weeks of pregnancy

Both miscarriages and stillbirths are traumatic events that can have long-lasting

impacts on the family.

Symptoms of a stillbirth may include:

• Fetal movement or kicking stops

• Bleeding or spotting

• No fetal heartbeat heard with a stethoscope or Doppler

• No fetal movement or heartbeat seen on ultrasound

The decision for management is a choice for you and your healthcare provider, and is either medical or surgical and is dependent on gestational age.

Medical management: This involves taking medication to induce uterine contractions and ultimately pass the pregnancy. Depending on the state you live in, this could start with mifepristone, followed by misoprostol 24 hours later, or be solely misoprostol. If you are early on in your pregnancy, doing this at home is an option with the guidelines to come into the hospital if you have severe pain or are soaking through more than 1-2 pads per hour. If this is the right option for you, pain control with strong ibuprofen and tylenol is often adequate.

If you are further along in your pregnancy, you may need to be supervised in the hospital until the baby and placenta are delivered. After delivery, you may be able to go home that day, or may need to stay in the hospital overnight to watch for bleeding and make sure that your pain is controlled. Pain control options include ibuprofen, tylenol, IV pain medicine, and epidural if you desire one.

Surgical management: This is when the pregnancy is removed from the uterus manually by a doctor. Depending on gestational age, you may have the option for a procedure in the office, or may need a short hospital stay. The procedures used are:

• Manual vacuum aspiration: This is usually done in the office setting with local anesthetic, and is used for pregnancies 10 weeks or under. You would be put into stirrups, a speculum inserted, a thin tube inserted into the uterus and vacuum suction turned on to empty the uterus.

• Suction dilation and curettage: This is a procedure similar to a manual vacuum aspiration, but the suction is generated from a machine. This may be done in the office or in a hospital setting. If you are in the hospital, after receiving general anesthesia, a speculum is inserted and the cervix gently dilated. A suction tube is inserted into the uterus and the pregnancy is removed. This is usually done up to about 13 weeks gestation, and you will likely go home the same day.

• Dilation and evacuation: This is a slightly more involved procedure that is used for pregnancies from about 14 weeks on, and involves specialized instruments and training to complete. You may need to have your cervix dilated slowly the previous day in preparation. This is completed under general anesthesia, and you may go home that day or need to be observed in the hospital overnight.

After a stillbirth, the baby's body must be buried or cremated by law if the baby was born after 24 weeks of pregnancy. The hospital and funeral home will work together to coordinate the transfer of the baby. Many funeral homes will provide a free coffin and either burial or cremation. Here are some other things that happen after a stillbirth:

Immediately after delivery

Health care providers will examine the baby, placenta, and other tissues to help determine the cause of the stillbirth. The baby is then wrapped in a blanket and brought to you to hold if you desire to. If you do not desire to hold baby, they can be kept in the bassinet or taken to the hospital mortuary.

Spending time with the baby

Parents can choose to spend time with the baby, such as reading to them, singing to them, or sleeping with them. They can also take photos, create keepsakes, or observe religious rituals, and many hospitals have trained nursing or other staff to do this service for you.

Funeral arrangements

A social worker, chaplain, or nurse at the hospital can help with funeral arrangements. The family can decide whether to have a service before the burial or cremation.

Visiting the baby

Parents can visit the baby at the funeral home until the burial or cremation.

Recovering from a miscarriage or stillbirth can take time, both physically and emotionally:

Physical recovery can take a few days to a couple of months.

Some physical effects include:

• Vaginal bleeding that lasts up to several weeks

• Lower abdominal pain that lasts up to two days

• Breast discomfort, engorgement, or leaking milk

• Your period may start within 4 to 6 weeks

To help with physical recovery, the first few days you should rest as much as possible. Ibuprofen and heating pads can help with cramping. Postpartum ice packs and witch hazel pads can help with vulvar pain and swelling.

You should contact your healthcare provider if you experience any of the following:

• Bleeding that continues beyond 3-4 weeks

• Fever

• Abnormal smelling vaginal discharge

• Severe breast tenderness or redness of your breasts.

Emotional recovery can take longer than physical recovery, and is not dependent on how far along you were when you lost the pregnancy. You might feel a range of emotions, including anger, sadness, guilt, or shock. It's common to feel tired, lose your appetite, or have difficulty sleeping.

To help with emotional recovery, you can:

• Talk to a therapist, grief counselor, or support group

• Lean on friends and family

• Talking with someone who has also experienced a pregnancy loss

• Practice self-care, such as getting a massage, taking a walk, or doing gentle exercise

• Find a way to safely experience your emotions, such as writing a letter or recording a message

Trying for another baby after a loss is a very personal decision. Your doctor will likely recommend to track your pregnancy hormone level (beta HCG) down to zero before you try again, and may recommend waiting for 2 or 3 menstrual cycles. Many people may choose to start birth control to give themselves more time before a future pregnancy.

People who experience a miscarriage can usually go on to have a healthy pregnancy in the future. The chance of losing a pregnancy is higher than people think, up to 1 in 4.

However, losing two or more pregnancies in a row is uncommon, affecting about 1 in 100 women.

The most common cause of a miscarriage is a chromosomal abnormality, which causes the pregnancy to develop abnormally. These events occur randomly, and unfortunately there is nothing for you to do to prevent them from happening.

The majority of miscarriages cannot be prevented, but there are some things you can do to reduce the risk of a miscarriage.

• Avoid smoking, drinking alcohol and using drugs while pregnant.

• Being a healthy weight before getting pregnant, eating a healthy diet and reducing your risk of infection can also help.

• Attend your scheduled prenatal visits with your OBGYN.

You may feel pressure to let everyone know what happened immediately, but it’s ok to tell people on your own timeline and in whatever way feels right to you.

Some strategies for telling people include:

• Outsource some of the emotional burden: Having a designated person reach out to friends and family that you choose so you do not have to tell each person separately.

• Make a post: Making a social media post about your experience can be a cathartic way to tell a lot of people at once, and can put you in contact with friends or family who have had a similar experience.

• Be upfront: When telling someone you had a miscarriage, be direct and honest, saying something like "I recently experienced a miscarriage" or "I lost the baby I was pregnant with," and then explain further if you feel comfortable, acknowledging that it's a difficult topic and you might need time to process it yourself. You can let them know you appreciate their support and understanding.

• Choose a private moment: If telling someone in person, find a time when you can have a private conversation without distractions.

• Express your feelings: If you feel comfortable, share how you're feeling emotionally, whether it's sadness, grief, or confusion.

• Set boundaries: If you don't want to discuss details, it's okay to say you need some time or just want to acknowledge the loss.

Firstly, there is nothing wrong with keeping items that you have purchased or have been given to you. Particularly if you are wanting to try to conceive again quickly, or if you are emotionally attached to certain items.

New items can be returned to the store for a refund or credit. Having a friend or family member do returns can be a good way to lighten your load when people are asking ways they can help.

For items you do not wish to keep or return, donating to a charity or giving them to someone in need is a great option. Your local hospital may take donations, as well as domestic violence organizations, or a thrift store if you’d like to simply drop items off.

Lactating after a loss may be a confusing feeling. You desire to encourage the process, or to stop it entirely.

Key steps to manage lactation after a miscarriage:

• Consult your healthcare provider: Discuss your situation with your doctor to get personalized advice based on your specific circumstances.

• If you would like to pump your breasts, milk donation can be comforting to those who have experienced loss. Your local hospital may take donations, or you can donate to a milk bank.

The advice below is for women who would like to decrease their milk output:

• Wear a supportive bra: A well-fitting bra can help reduce discomfort and provide compression.

• Discuss medication with your doctor:

  • Cabergoline is a prescription medication given as a one time dose after delivery that can suppress milk production. Your doctor may want to avoid this medication if you have high blood pressure.

  • Pseudoephedrine is an over the counter decongestant that may suppress milk supply. While over the counter, taking this medication is still best under the supervision of your doctor. Symptoms of this medication include insomnia and irritability.

• Use cold compresses: Apply cold packs to your breasts for 15-20 minutes at a time to alleviate swelling and pain.

• Express minimally: If your breasts feel full, hand express or pump just enough milk to relieve pressure, but avoid fully emptying them.

• Gradually reduce pumping sessions: Over a few days or weeks, slowly decrease the number of times you pump each day and the duration of each pumping session.

• Pain relief medication:If needed, take over-the-counter pain relievers like acetaminophen or ibuprofen to manage discomfort.

Postpartum depression is a serious mood disorder that can affect up to 1 in 7 people postpartum, regardless if you experienced a loss or live birth. Symptoms can range from mild to severe and may appear within a week of delivery or gradually, even up to a year later. If you think you might be depressed, it's important to get help as soon as possible. With the right support, most people make a full recovery.

Symptoms include:

• Mood: Feeling sad, hopeless, overwhelmed, or tearful

• Sleep: Oversleeping or having trouble sleeping

• Appetite: changes in appetite including no desire to eat, or eating more than it takes to feel full

• Concentration: Having trouble concentrating, remembering details, or making decisions

• Negative thoughts: negative thoughts that you can’t seem to shake

• Physical: Experiencing physical aches and pains, including frequent headaches, stomach problems, frequent fatigue, and muscle pain

• Behavior: Withdrawing from or avoiding friends and family

• Psychotic: Rarely, postpartum depression can evolve into psychosis, which includes experiencing delusions, visual hallucinations, or hearing voices.