Pregnancy loss

Dr Richard Murphy

Pregnancy loss

If you have experienced pregnancy loss or you have had a difficult or traumatising birth experience before, then I recommend seeing me before you conceive again. Part of my role as your obstetrician is to help you prepare for your next pregnancy in the best possible way. Stillbirth, a near-miss situation, or the fear of another miscarriage can cause massive anxiety.
My role is to inform and support you so you and your partner are not alone.

Obstetrics and gynaecology consultations at my private practice in Subiaco.

Fertility consultations at Genea Hollywood Fertility

Delivering at the Labour Ward of SJOG Subiaco Hospital


Unfortunately, miscarriage is very common. Most pregnancy losses happen early in pregnancy, in the first 12 weeks.

Studies show that up to one in five women, will have a miscarriage before 20 weeks of pregnancy.

Your body goes through some extremely complex processes when a new human being is conceived and starts developing. In this process, things can go wrong, and most miscarriages are a ‘random event’, meaning it is unlikely to happen again. If you have had 2 or more confirmed miscarriages without a live birth I would like to see you to talk and do some simple tests.

If you have any pregnancy loss in the second or third trimester you should see me for careful investigation. We do not want the same thing to happen again.

“As a woman you are born with all the eggs you will ever have. As you grow older, your egg quality reduces and there is more chance that your pregnancy has an abnormal chromosomal arrangement. Age related changes do occur for men too but are more subtle.”

Dr Richard MurphyPrivate Obstetrician Perth
Pregnancy Loss - Dr Richard Murphy
When we talk about conceiving a baby, there is a whole spectrum of possible outcomes. If there is a delay in falling pregnant or a history of pregnancy complications, then that usually increases your risk in future pregnancies.

Blood loss in pregnancy: am I miscarrying?

Bleeding at any time in your pregnancy is scary. My golden rule is this – if you are bleeding, I will see you as soon as possible. A meta-analysis was recently published showing a reduction in miscarriage if oral progesterone was used for threatened miscarriage (where you have pain, bleeding and an ongoing live pregnancy). If you have blood loss in the second half of your pregnancy, then the assessment will take place on the labour ward at St John of God Hospital in Subiaco.
Bleeding does not necessarily mean that you are miscarrying and the blood loss will usually settle. If your pregnancy continues, it is important that we organise a careful assessment of why you are bleeding and monitor your baby’s wellbeing.
Blood loss can be even more scary if you have had a close call in a previous pregnancy. It could be anything from pre-eclampsia, an abruption, intrauterine growth restriction, preterm delivery or a particularly difficult delivery or birth experience. I understand that your past experiences can influence your reaction to complications in your current pregnancy.

Multiple miscarriages

“Multiple miscarriage” has traditionally been defined as 3 or more consecutive miscarriages. Nowadays, it is common to investigate earlier, simply because the information helps us explore and plan treatment with the intention to reduce your risk of further miscarriages.

“I know very well how devastating an experience of loss can be. The journey to completing your family can bring grief, a massive sense of loss, and even self-blame. For you as a woman, for your partner, and your entire family.”

I consider it my role to listen to your history and to look at the bigger picture of your journey towards conceiving. If your age is a factor, or if you have a history of fertility or medical problems, then I will always help you obtain the highest level of clarity so you can make well-informed choices and decisions.

Previous miscarriage and anxiety

The loss of a wanted pregnancy can be devastating and I believe that you deserve personalised and individualised care. I want you to hold a healthy, full term, perfect little human being.

I still remember the devastation of one particular first-time mother when she had a miscarriage at 8 weeks. With investigation we were able to diagnose a balanced Robertsonian translocation in her partner, something that is associated with recurrent miscarriages. With the help of Preimplantation Genetic Testing (PGT) of IVF embryos, her next 2 pregnancies resulted in beautiful healthy babies. Just as importantly, she had no further miscarriages and her family was complete!

A second trimester miscarriage, between weeks 14 and 27, is much less common than first trimester pregnancy loss. There are many causes, a lot of which can affect subsequent pregnancies.

“I understand your journey. I have had well over 10 years experience working at the Perinatal Loss Clinic at King Edward Memorial Hospital, a statewide service to support women and their families who have lost pregnancies in the second and third trimester and help plan for their future.”

Dr Richard MurphyObstetrician Perth
Any second-trimester pregnancy loss will require a lot of emotional support for you and your partner. At the same time it should be thoroughly investigated. This will enable a diagnosis to be made, along with an accurate prognosis about what can happen in subsequent pregnancies and most importantly what can be done to prevent further pregnancy losses.
My work always consists of two components: science, medical expertise and information on one end, as well as being by your side as a person to guide and help you on your journey.

Cervical weakness and miscarriage

“Cervical incompetence” occurs when the cervix opens for no apparent reason at the wrong time in your pregnancy. It can be associated with previous surgery or procedures to the uterus or cervix. It can also be associated with weaker connective tissues. If your cervix opens extremely prematurely there is a high chance you will lose your baby, often as a result of infection developing through the open cervix.

When can cervical weakness occur?

  • If you have had a second trimester pregnancy interruption
  • If you have had more than one LLETZ* or LEEP* surgery or a cone biopsy for precancerous cervical changes,
  • If you have a connective tissue disease such as Ehlers-Danlos Syndrome

A Cervical Cerclage or stitch is the treatment for cervical incompetence. I regularly perform this surgery.

*LLETZ: Large loop excision of the transformation zone

*LEEP: Loop electrosurgical excision procedure

A procedure to remove abnormal cervical tissue of the cervix using a thin wire loop that is heated electrically.

Support after stillbirth

You are not alone; tragically seven babies per 1,000 were stillborn in Australia in 2018, one per 142 babies.

“My wife and I lost our first baby, a boy, in our first pregnancy at 25 weeks. This was the single worst event in our lives. Thankfully we managed to complete our family after this but these tragedies do alter how subsequent pregnancies are managed.”

If you have lost a baby through stillbirth or in the neonatal period I can help you to get through it. With a team-based approach, providing physical and emotional support, you will slowly recover.
We will thoroughly investigate what has happened and map out a pathway to getting you to the safe delivery of a baby. There is almost never a situation where you and your partner should not be able to safely try again. If this is you, please make a time to see me.

If you had a close call...or a near miss

If you have had a close call with a previous pregnancy, you will probably be more anxious this time. Whether you had preeclampsia, an abruption, intrauterine growth restriction, a preterm or a difficult delivery, it is perfectly normal to be more anxious and worried when you fall pregnant again.

My recommendation – if you have had a difficult pregnancy before – is to come and see me before you conceive again. My work as your obstetrician then starts with looking at how we can improve your next pregnancy, for the benefit of your future baby but also you as a parent.

I’ve got your back

The discovery that you are pregnant should be a time of such joy, as it is for most women and their partners. If this joy has been taken away by two, three or more miscarriages, the prospect of another pregnancy can be terrifying and stressful. Please do not walk this journey alone. There are a number of options available if you are in this situation. What I have learned is that the assessment and any choices or steps need to be 100% personalised. So please, make a time to come and see me, with your partner if possible.

For more information about pregnancy loss, visit Pregnancy Loss Australia