Miscarriage is never a piece of happy news, but it is a common pregnancy outcome that can be caused by many factors. Though it is not a good situation for a woman to go through, it is important to understand that a miscarriage does not signify the end of your life as a parent. Dr Ashley Chung Soo Bee, a Fertility Specialist and Consultant Obstetrician and Gynaecologist from Sunway Medical Centre Velocity shares about what you should expect after a miscarriage and other important information that you need to know. Q1: What is an early miscarriage? What are the risks of miscarriages? Dr Ashley: Early miscarriage is defined as losing your baby in the first 3 months of pregnancy. Unfortunately, early miscarriages are very common, as 1 in 5 women will have a miscarriage with no apparent reason after a positive pregnancy test. The risk of miscarriages increases by age, as at the age of 30, the risk of miscarriage is 1 in 5 (20%); and for those over the age of 40, the risk of miscarriage is 1 in 2 (50%). The risk of miscarriages is also increased due to medical problems (such as poorly controlled diabetes) and unhealthy lifestyle factors such as smoking, being overweight or heavy drinking. Q2. What is going to happen if I am diagnosed with a miscarriage? Dr Ashley: After your doctor has confirmed that you have miscarried and if your ultrasound scan shows that you have no further remains in your womb, it is considered a complete miscarriage - meaning that all the pregnancy tissue has left the uterus and you do not require further treatment. If the miscarriage is confirmed but some or all the pregnancy tissue is still inside your womb, your doctor will talk to you about the best options for you. You may either choose to wait and let nature take its course, use medication or undergo surgery to remove the pregnancy tissue. Q3. What do I expect after a miscarriage? Dr Ashley: You can expect to have some vaginal bleeding for 1\u20132 weeks after your miscarriage. This is similar to a heavy period for the first day or so. This should lessen in time and may become brown in colour as well. You should use sanitary towels rather than tampons, as using tampons can increase the risk of infection. If you have regular periods, you can expect to have your period in 4-6 weeks\u2019 time. Q4. Is it necessary to go through confinement after a miscarriage? Dr Ashley: Confinement is a traditional practice after giving birth among the Asian population. The aim of confinement is to help a mother to recover following the delivery of a baby. Asian households will also practice confinement after a miscarriage, but these practices are generally to ensure a better recovery for the individual. There are no hard and fast rules, just make sure that you have enough rest for your body to recuperate and eat nutritious food so that it can replenish the nutrients lost. Q5. When can I go back to work after a miscarriage? Dr Ashley: Returning to work depends on you and how you feel. It is advisable to rest for a few days before starting your routine and daily activities but returning to work within a day or two will not cause you to harm if you feel well enough. Most women will return to work in a week, but you may need a longer time to recover emotionally. You can speak to your doctor if you feel the need to do so. Q6. What can she eat or avoid after a miscarriage? Dr Ashley: You should ensure that your body has all the nutrients it needs by eating a healthy balanced diet. A healthy diet involves high-fibre intake (fruit, vegetables, wholegrain bread, and cereal) with up to two litres per day of fluid intake, mainly water. It is important to remember to eat at least five portions of fruit and vegetables each day as well. Q7. Can I have a massage after a miscarriage? Dr Ashley: Miscarriage may lead to a high level of stress on the body. Common physical issues include back pain and increased muscle tension. Massages can help relieve muscles stiffness, reduce pain symptoms and can stimulate relaxation of the mind to improve your energy levels. Q8. Can I use feminine wash after I went through a miscarriage? Dr Ashley: Maintaining proper hygiene is important after a miscarriage. It is more important to use sanitary towels instead of tampons, as mentioned before. Additionally, it is also ideal for individuals to shower or bath as normal twice a day. Q9. Sex after miscarriage - how long can I wait before I can be with my husband? Will it be risky for me? Dr Ashley: It is advisable to avoid having sex in the first two weeks after the miscarriage as the body is in a recovery phase. If you are feeling well and the pain and bleeding have stopped, you can consult your doctor if you and your partner can have sexual intercourse. Overall, it is important to feel comfortable with the idea of being intimate with your partner again. If you are finding it difficult to cope with the miscarriage loss do remember to talk to your partner and communicate how you are feeling. Being open about your experience and any difficulties you may have may make it easier to be physically intimate again. Q10. Is it possible to get an infection after miscarriage? If yes, what to look for? Dr Ashley: Yes, there is a possibility of getting an infection after a miscarriage. As mentioned earlier, it is expected to have some vaginal bleeding for 1\u20132 weeks after your miscarriage which is like a heavy period and we advise you to use sanitary towels rather than tampons, as using tampons could increase the risk of infection. You can expect some cramps (like strong period pains) in your lower abdomen on the day of your miscarriage and you may get milder cramps or an ache for a day or so afterwards. However, do be aware of fever, heavy or prolonged bleeding from vagina, smelly vaginal discharge or increasing or persistent tummy pain. These could be signs of infection of the lining of the womb after a miscarriage. Infection of the womb happens to 2-3 out of 100 patients and can also indicate that there are some remaining pregnancy tissues in the uterus. \tTreatment This can be treated by antibiotics or may require a procedure to remove the remaining tissues if there are any. Do seek consultation from your gynaecologist if you recognise these signs and symptoms after a miscarriage. Q11. How to deal with mental health after miscarriage since we usually heard that postpartum depression is always being diagnosed in those who encountered a miscarriage? Dr Ashley: A miscarriage affects every woman differently and can be devastating for her partner too. Some women come to terms with what has happened within weeks; for others, it may take longer. Many women feel overwhelmed and emotional for some time afterwards and others can experience intense periods of grief over a longer time. Hence, it is important to have strong support from family and friends as having a company gives you a chance to communicate how you are feeling after your miscarriage. Additionally, having a company can help lift your mood as well as bring comfort. If you feel that you are struggling to handle the grief of going through a miscarriage, it is important to seek help from your doctors as they are there to provide professional support for you during this challenging time. Q12. Is there any medication or supplement that one should take after a miscarriage? Dr Ashley: Individuals should eat a balanced diet to replenish the nutrients that may have been depleted after a miscarriage. This can be further supplemented with vitamins such as multivitamins, vitamin D, essential fatty acids, and B vitamins. If you are preparing to get pregnant again after the miscarriage, it is ideal to take 400 micrograms of folic acid every day from when you start trying for a baby, to reduce the risk of your baby being born with a neural tube defect (spina bifida). Overall, it is important to be as healthy as you can by eating a balanced diet and to stop smoking if you smoke. It is advisable to not drink alcohol as this may increase your chance of miscarriage. If you ever experience this before, keep in mind that having a miscarriage once does not raise your odds of having a miscarriage again. Many couples who have been through a miscarriage go on to experience healthy and happy pregnancies. Accept your grief but DO NOT blame yourself! Give your time to heal. We believe you can go through this. Stay tuned with Motherhood Story to get more information about pregnancy, after birth and many more.