Hesperian Health Guides
Chapit 22: Ede yon fi apre avòtman oswa foskouch
Sometimes a pregnancy ends early. With miscarriage the woman simply starts bleeding or having contractions until the pregnancy comes out. When a pregnancy is ended on purpose, it is called an abortion.
Most miscarriages do not cause problems, but some do. Most abortions done by people who are experienced and skilled, and with tools that have been sterilized or the correct medicines, are not dangerous. But many abortions are not done safely.
- 1 Pwoblèm ki rive lè yon gwosès pran fen anvan lè
- 1.1 Finding care after a pregnancy ends
- 1.2 Emotional support after a pregnancy ends
- 1.3 Physical care after a pregnancy ends
Pwoblèm ki rive lè yon gwosès pran fen anvan lè
A woman can have serious health problems when a pregnancy ends early. Part of the pregnancy may be left in the womb. She may have heavy bleeding or infection. Without treatment, she could die. This chapter will explain how to:
- watch for warning signs.
- give emergency care to a woman who has a problem from a pregnancy that ended early.
Finding care after a pregnancy ends
Women who have bleeding or infection after miscarriages or abortions need medical help fast. But often they do not get this help. There may be no money to pay for care if something has gone wrong. For women in isolated villages, a trip to the hospital in the city can be too far, too frightening, or too expensive. Many women, especially unmarried women, feel they must hide their condition because of attitudes against sex, family planning, or abortion. Fear, lack of money, and distance from medical care should not be reasons for women to suffer — but they often are.
Midwives can help save many women’s lives, because midwives are usually the closest and most trusted health workers in their communities. When a woman who is sick or injured knows there is someone kind and skilled nearby who does not charge a lot of money for services, she is more likely to get the care she needs to prevent her death.
Decide to help
Do not be afraid to care for women who have had unsafe abortions. Even in places where abortion is not legal, it is legal to save the life of a woman who is suffering after unsafe abortion.
Some midwives do not want to care for women after unsafe abortions because they believe that abortion is wrong. But caring for a woman who is in danger after an unsafe abortion is not the same as doing an abortion. After an unsafe abortion, a woman may die if she does not get help. When women are sick, for any reason, midwives must help them.
Emotional support after a pregnancy ends
When a woman has a miscarriage, she may be very disappointed that her pregnancy ended. She may feel afraid, sad, upset, or guilty — and wrongly think that the miscarriage was her own fault. This emotional pain is just as important as the pain women have in their bodies. You can help a woman with her emotional pain before, during, and after caring for her medical problems. See more information on what can cause miscarriages and how to care for and support a woman after a miscarriage.
After an abortion, a woman may have strong feelings even if she knows she made the right decision for herself and her family. While most women are relieved the pregnancy ended, some women feel a mixture of relief, sadness, grief, guilt, shame, anger, and even love. These feelings may be stronger if she is having health problems from an unsafe abortion or if the abortion provider was disrespectful or unkind. And where abortion is illegal, a woman may be afraid of being punished.
Midwives can help a woman with emotional pain
- Explain what is causing the illness or bleeding.
- Explain what you are doing to help.
- If she does not want to become pregnant again, help her choose a family planning method that is right for her.
Listen and give support
- Ask her if she wants to talk about how she feels. She may not tell you unless you ask.
- Listen to her if she wants to talk or cry.
- Reassure her the way you would reassure a loved one or friend.
It does not help to blame a woman for her illness or injury
If abortion is illegal or not a choice you would ever make, and you think women are wrong to use it to end a pregnancy, you may think any illness that follows is the woman’s fault or simply a fitting punishment. But no matter how a woman is injured or becomes ill, your first goal should be to save her life or her health. Shaming, threatening, and mistreating women weakens them when they most need strength to fight for their health.
Blaming women for their own sickness does not help them become healthy.
Physical care after a pregnancy ends
Check the woman’s physical signs — like her temperature, pulse, and the amount she is bleeding. This will tell you what kinds of medical help she needs.
- Mild pains or cramps in the lower belly for a few days.
- Light bleeding (up to the same amount as normal monthly bleeding) for a few days or very light spotting for up to 2 weeks.
- Strong cramping in the lower belly.
- Swollen or hard lower belly.
- Heavy bleeding, large clots of blood, or bleeding for more than 2 weeks.
- Bad smell from the vagina. Healthy signs Warning signs
- High temperature, 38°C (100.4°F) or above.
- Fast pulse, over 100 beats a minute.
- Feeling very nauseated.
- Feeling faint or dizzy.
You should also ask her about this pregnancy.
Find out how long she was pregnant. A woman whose miscarriage or abortion happened early in her pregnancy is easier to help than a woman whose miscarriage or abortion happened later. If a woman was pregnant for more than 3 months and is now having problems, get medical help.
Ask how the pregnancy ended. If the woman had a miscarriage or if her abortion was provided by a trained health worker who used sterile tools, she is less likely to have serious infection or injury than a woman whose abortion was done by someone who used unsafe tools. For example, if the woman tells you that someone used a sharp wire to give her an abortion, you will know to look for signs of injury inside the body.
The rest of this chapter describes how to help a woman who is having problems after a miscarriage or abortion.
Talk with women about how to care for themselves
A woman should take good care of herself for a few days after any miscarriage or abortion. This can prevent her from getting an infection, and will help her body heal faster. Women should:
- drink plenty of liquids and eat nutritious food.
- rest often.
- avoid heavy work for a week.
- bathe regularly, but should not douche or sit in a bath or tub of water until a few days after the bleeding stops.
- use clean cloths or pads to catch any blood, and change the pads often.
Also, the woman should not put anything inside her vagina, and should not have vaginal sex for at least 2 weeks, and not until a few days after she stops bleeding.