Miscarriage: what it is and how to cope
Often accompanied by severe bleeding and pain, miscarriage is the most common form of pregnancy loss. It occurs before the 20th week and affects 10–20% of all pregnancies. The real number is even higher as many miscarriages occur so early that a woman hasn’t yet realized she’s pregnant. Depending on the case, medical or surgical treatment is sometimes necessary. Most often, a miscarriage will not influence future pregnancies.
Although miscarriage is a common occurrence, it can be difficult to process emotionally, especially if the pregnancy was difficult to achieve and is happily anticipated. If it happens to you, seeking support for yourself and your partner is an important part of self-care.
Miscarriages can be early or late
There are two types:
- early miscarriages affect between 10 and 15% of pregnancies and occur during the first trimester of pregnancy
- late miscarriages affect less than 1% of pregnancies and occur during the second trimester
Early miscarriages are very common. It is common for a woman to miscarry before she even realizes she’s pregnant.
Between 10 and 20 % of confirmed pregnancies end in miscarriage within the first 12 weeks of pregnancy.
Late miscarriage, also called second-trimester or mid-trimester loss, refers to a miscarriage that happens when a fetus is lost between 14 and 20 weeks of pregnancy. They are much less common than early miscarriages and often feel more devastating, both emotionally and physically.
Symptoms
Bleeding and vaginal spotting at the start of gestation is common and in at least half of all cases there is nothing to worry about: the pregnancy will progress normally. Pain and cramping in the abdomen or lower back can also be normal signs of pregnancy. However, these can also indicate a potential miscarriage so please consult your doctor to be sure.
Pink discharge (fluid or tissue passing from the vagina) is another possible sign of a miscarriage.
In the case of pink discharge, it is imperative to consult your doctor to rule out an ectopic pregnancy, which can put the life of the mother at risk. This condition is rare, but much more dangerous than miscarriage. Early detection saves lives.
An ultrasound test can rule out ectopic pregnancy. If all is well, the same test can allow expectant parents to hear the fetal heartbeat from around the seventh week of pregnancy.
What causes miscarriages?
Early miscarriages usually happen because the embryo is not developing as it should. Chromosome problems are thought to be the most common cause. These problems usually happen for no reason and are unlikely to happen again.
Chromosomal abnormalities might lead to:
- blighted ovum (or anembryonic pregnancy)—a fertilized egg implants in the uterus but doesn’t develop into an embryo. This is considered to be the cause of approximately one in two miscarriages during the first trimester of the pregnancy; the body halts the development of the egg into an embryo because it recognizes a problem
- intrauterine fetal demise—an embryo forms but stops developing and dies before any symptoms of pregnancy loss occur
- molar pregnancy (or hydatidiform mole)—both sets of the fetus’s chromosomes come from the father, or partial molar pregnancy—the father provides two sets of chromosomes, but the mother’s chromosomes remain. Both cases are associated with abnormal placental growth and lack of fetal development. This condition can have serious complications, including a rare form of cancer, and requires early treatment.
In some cases, the poor health of the mother can lead to miscarriage. If an expectant mother has uncontrolled diabetes, thyroid disease, hormonal problems, a serious infection, or cervix problems, these can lead to miscarriage.
Late miscarriages are often due to a morphological abnormality of the uterus—a malformation that prevents the embryo from developing in good condition. For example, the uterus may have an unusual shape that makes pregnancy more difficult. Such morphological anomalies can be corrected surgically, although this is not always necessary, and the pros and cons should be considered.
Risk of miscarriage at age 35 is about a 20%; at age 40 the risk is about 40%; and at age 45 and above there is an 80 % risk.
Late miscarriage can also be provoked by some lifestyle factors, such as smoking, second-hand smoke, alcohol and drug use, excessive caffeine consumption, or obesity. Lifestyle factors can be addressed to minimize risks.
Environmental factors that influence the risk of miscarriage include exposure to hazardous chemicals such as heavy metals, mercury, solvents, paint thinners, or pesticides. Determine if any of these substances are present in your home or at your place of work so that you can avoid contact with them.
What doesn’t cause miscarriage
Routine activities such as these don’t provoke miscarriage:
- exercise, including high-intensity activities such as running or cycling
- sexual intercourse
- working, provided you aren’t exposed to harmful chemicals or other dangerous environmental factors
What happens next
In most cases, a woman’s body will carry out the miscarriage naturally. Bleeding will normally continue for 7–10 days and will have stopped completely in two to three weeks. During this time, stay home and take it easy, use prescribed painkillers if necessary, and spend time with supportive friends who are willing to take care of you until you have recovered.
Your doctor may ask you to take a home pregnancy test to confirm that the pregnancy has ended. Be sure to make a follow-up visit to your doctor to make sure that your body is recovering as it should.
An incomplete miscarriage can be addressed through minor surgical intervention or drug treatment. Neither method has an impact on future fertility.
Some sources cite a third possibility—expectant management, which means waiting for the body to clean itself. However, this method can increase the risk of future hemorrhagic miscarriage and is not currently recommended.
Getting pregnant again
Most women resume menstruating within four to six weeks following a miscarriage. Day 1 of the new cycle should be counted from the first day of bleeding from the miscarriage.
It may take a few cycles for a woman’s period to stabilize, as the body’s hormones need to rebalance following pregnancy loss. If menstruation was unpredictable prior to the pregnancy, they will likely continue to be unpredictable.
An unpredictable cycle can make tracking ovulation more difficult, but it is possible to get pregnant again within the first few cycles following a miscarriage—or as soon as the couple is ready.
However, in the case of repeated miscarriages (three or more in a row), it is advisable to identify possible risk factors and manage or avoid them.
Often nothing can be done to prevent miscarriage. Focus on taking good care of yourself:
- avoid risk factors (smoking, drinking alcohol, drug use)
- limit your caffeine intake
- eat a nutrient-rich diet
- consult your doctor about the best nutritional supplements for pregnant women
- if you have a chronic condition, work with your health care professional to manage it
How to get over a pregnancy loss
Regardless how early or late a miscarriage is, it can cause severe distress. Women may feel unjustified guilt and experience feelings of loss and grief. Men also suffer and often blame themselves. Talk to each other.
Those who experience pregnancy loss commonly pass through the various stages of grieving:
- shock and denial
- guilt and anger
- depression and despair
- acceptance
It can be very difficult to talk openly about miscarriage as it is often associated with unfulfilled dreams and feelings of failure. Sharing these heavy emotions with your partner or close friends/family can help you overcome the grief and regain your enthusiasm for life.
As so many women suffer a miscarriage at least once during their reproductive years, it can be very helpful to share your experience with someone who has been there.
But each of us has a different history, different circumstances, and different needs. Sometimes friends seem to be offering superficial compassion and comfort. When even the most well-meaning friends are at a loss for how to help you cope, an experienced professional therapist will have the tools to examine your grief safely so you can let it go when it is time.
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