•     Cervical problems can almost all be prevented. Gynecologists should be very cautious and gentle when dilating the cervix to do an abortion or a D&C, using only the smallest dilator they need to. Better management of labour, with the woman in an upright position (sitting, squatting, kneeling or standing) will greatly help reduce cervical trauma during birth.

•     Perhaps the greatest single preventive for cervical problems is the use of a special stitch put in by a gynecologist at about 14 weeks. This holds the cervical canal closed and keeps the baby safely inside. The stitch is removed at about 38 weeks, or earlier if the woman goes into labour before this.

•     Hormone treatments can be given to prevent hormone-deficiency states that cause miscarriages.

•     The surgical correction of uterine abnormalities and the removal of fibroids can prevent miscarriages in some of the women in whom these are a problem.

•     Supportive psychotherapy should be more widely offered to any woman who has had more than one miscarriage because it works in a significant proportion of women.

•     We look in some detail at how to prevent congenital abnormalities in babies on page 294.

•     If any woman has a history of miscarriage or premature labour it makes sense not to have intercourse (or even, probably, orgasms) around the time at which she previously had the miscarriage. If you are worried about a miscarriage, don’t have sex or an orgasm in weeks 10-14 of the pregnancy. There is no evidence that using a vibrator inside the vagina causes miscarriages, but it is probably sensible to steer clear of them around this vulnerable time.

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