Miscarriage: You Are Not Alone

Miscarriage can be devastating and because it is seldom discussed, or only spoken in hush hush, there are so many taboos on the subject. The truth is, around 30% of pregnancies end with miscarriage [1]. If you’re reading this and in need of support, we want you to know that you are not alone.

You may be struggling with grief, anxiety and shock, as well as mood swings and tiredness as your body and hormones adjust.

You’ll probably have a lot of questions about what has happened. The outline below aims to answer some of these questions and hopefully alleviate any worries you have about what this means for you and your future. Take what you need, skip over or leave behind anything that you don’t.

  1. What is a miscarriage?
  2. What are the first signs of a miscarriage?
  3. What causes a miscarriage?
  4. How to prevent a miscarriage?
  5. How to cope with a miscarriage?
  6. When will I feel ready to try again?

What is a miscarriage?

Miscarriage is the spontaneous loss of a pregnancy before the 20th week. In medical articles, you may see the term "spontaneous abortion" used in place of miscarriage.

Miscarriage does not include situations in which you lose a fertilized egg before a pregnancy becomes established. Studies have found that 30 to 50 percent of fertilized eggs are lost before or during the process of implantation [2] – often so early that a woman goes on to get her period at about the expected time.

Most miscarriages occur before 13 weeks and are called early miscarriages. Many women won’t even realize they were pregnant, as is the case of chemical pregnancies, which may account for up to 75 percent of all miscarriages. These chemical pregnancies happen when the embryo hasn’t properly attached to the uterine wall, and it’s lost so early after implantation that the bleeding can be mistaken for your period.

What are the first signs of a miscarriage?

Miscarriage signs and symptoms can vary, and it’s important to know that many of these can also occur in a perfectly healthy pregnancy.

Bleeding or spotting.  Vaginal bleeding or spotting is usually the first sign of miscarriage. Keep in mind, though, that up to 1 in 4 pregnant women have some bleeding or spotting (finding spots of blood on your underpants or toilet tissue) in early pregnancy, and go on to have successful pregnancies.

Abdominal pain. Abdominal pain usually begins after you first have some bleeding. It may feel crampy or persistent, mild or sharp, or may feel more like low back pain or pelvic pressure. Benign cramping could be caused by gas or your expanding uterus.

When cramping and bleeding happen simultaneously, it’s a good idea to talk to your doctor.

Other potential indicators of miscarriage can include:

  • Painful true contractions
  • Backache or back pain
  • Passing clots or other tissue from the vagina
  • A white-pink mucous discharge
  • A sudden loss of pregnancy symptoms or a feeling of no longer being pregnant (though remember, these symptoms fluctuate a lot in completely healthy pregnancies, and differ from person to person)

Up to 50% of miscarriages are missed miscarriages, which may not produce any symptoms. This is where the embryo stops developing, but the placenta is still producing the pregnancy hormone hCG, meaning that you may still experience pregnancy symptoms such as morning sickness and fatigue.

What causes a miscarriage?

The majority of first-trimester miscarriages are thought to be random events caused by chromosomal abnormalities in the fertilized egg. Most often, this means that the egg or sperm had quality issues and as a result, the fertilized egg can't develop normally. Placental problems can also result in miscarriage. 

Maternal age, health, lifestyle choices, and trauma can affect the likelihood of a pregnancy ending in miscarriage.

Sometimes a miscarriage is caused by problems that occur during the delicate process of early development. This would include an egg that doesn't implant properly in the uterus or an embryo with structural defects that prevent it from developing.

Since most healthcare practitioners won't do a full-scale workup of a healthy woman after a single miscarriage, it's usually impossible to tell why the pregnancy was lost. And even when a detailed evaluation is performed – after you've had two or three consecutive miscarriages, for instance – the cause still remains unknown half the time.

When the fertilized egg has chromosomal problems, you may end up with what's sometimes called a blighted ovum (now usually referred to in medical circles as an early pregnancy failure). In this case, the fertilized egg implants in the uterus and the placenta and gestational sac begin to develop, but the resulting embryo either stops developing very early or doesn't form at all.

Because the placenta begins to secrete hormones, you'll get a positive pregnancy test and may have early pregnancy symptoms, but an ultrasound will show an empty gestational sac. In other cases, the embryo does develop for a little while but has abnormalities that make survival impossible, and development stops before the heart starts beating.

If your baby has a normal heartbeat – usually first visible on ultrasound at around 6 weeks – and you have no symptoms like bleeding or cramping, your odds of having a miscarriage drop significantly and continue to decrease with each passing week.

How can you prevent a miscarriage?

First and foremost, you can’t do anything to stop or prevent miscarriages caused by chromosomal abnormalities. These miscarriages can happen to anyone, and they account for the highest number of pregnancy losses.

In addition to preparing your body for pregnancy, it’s important to get as healthy as you can before conceiving. This means eating well, exercising regularly, managing your stress, keeping your weight within healthy limits and. Take a prenatal vitamin daily. Adequate folate can prevent serious birth defects that typically form before you even know you’re pregnant. 

Drug and alcohol use, smoking or being around smoke, and drinking excessive caffeine can increase the risk of poor pregnancy outcomes.

The silver lining: Sex doesn’t cause miscarriages, and neither does working—unless you work in a hazardous environment where you’re exposed to radiation or chemicals, or where you’re at increased risk for getting physically hurt. Moderate exercise doesn’t cause miscarriages either. In most cases, continuing to exercise throughout pregnancy is recommended, as it can lead to better health outcomes for both mama and baby.

How to cope with a miscarriage.

Losing a baby can be heart breaking. Bereavement, grief and loss can cause many different symptoms and they affect people in different ways. There's no right or wrong way to feel.

Like many women who have gone through it, you may feel like a failure or be disappointed in your own body in some way. But it’s important to keep in mind that while some lifestyle can raise your risk, in most cases, miscarriages can’t be prevented and is largely out of your control.

Miscarriage can take an emotional toll on you. You’re mourning the loss of a person whom you’ve already created a space for in your life, so it’s incredibly important to acknowledge the feelings you’re dealing with before you try to move on. Recognizing your loss will allow you the ability to heal much better.

One way to do that is by finding a way to honor the loss. Consider planting a remembrance tree or flowers that bloom year after year. You can mark the anniversary by observing it in a small but meaningful way, whether it’s lighting a candle or releasing a sky lantern. Or you can create a pregnancy keepsake box where you gather everything in one place: the pregnancy scan and a pregnancy journal, if you kept one. Pulling these items out from time to time can be a part of your healing process.

Some women and couples come to terms with what happened within a few weeks. For others, it takes longer. You may also find that you and your partner grieve in different ways. If you’re having trouble coping with a miscarriage or it’s causing a rift in your relationship with your partner, ask your doctor for a referral to a therapist for counseling services.

When will I feel ready to try again?

It’s impossible to say when you will feel ready again. Some people worry about getting pregnant again and need to take some time to come to terms with what happened. Other couples see a new pregnancy as the best way for them to heal and trying again becomes part of their recovery.

Some people get pregnant immediately after a miscarriage. Other couples take a bit longer. Try not to worry if you’ve conceived quickly in the past and it’s taking longer this time, it may just be your hormones and body need time to readjust.

When you’re ready, we’re here for you.

 

 

Research Support:

[1] https://www.ncbi.nlm.nih.gov/pubmed/3393170

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5443340/

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