What is a Miscarriage?
A miscarriage is the spontaneous loss of a pregnancy before 20 weeks gestation. The majority of miscarriages occur within the first 13 weeks of pregnancy. Miscarriage is the most common form of pregnancy loss with as many as 15-25% of all clinically recognized pregnancies ending in miscarriage. After 20 weeks, a fetus is technically viable outside the womb; a pregnancy loss at this point is considered a stillbirth.
Contrary to popular belief, sex and exercise will not cause a miscarriage.
If you have suffered a miscarriage, YOU ARE NOT TO BLAME. Please remember that.
Symptoms Of Miscarriage:
If any of the following symptoms occur during pregnancy, it is important to call your doctor as soon as possible. Possible symptoms of miscarriage may include:
- Lower back pain, or abdominal pain that is dull, sharp, or cramping.
- Tissue or clots passing through the vagina.
- Brown or bright red vaginal bleeding (with or without cramps)
- A sudden decrease in signs of pregnancy.
- White-to-pink mucus from the vagina.
Types Of Miscarriage:
Threatened Miscarriage – any vaginal bleeding during early pregnancy without cervical dilation or changes in cervical consistency. Mild cramping may occur; however, usually, no pain exists. No tissue or fetal membranes have passed through the vagina. Threatened miscarriages are very common – about 25-30% of pregnancies have some amount of bleeding; less than half of all threatened miscarriages lead to a true miscarriage.
Inevitable Miscarriage – an early pregnancy that has vaginal bleeding and dilation of the cervix. Generally speaking, the vaginal bleeding is heavier than with a threatened miscarriage and the pain is greater.
Incomplete Miscarriage – a pregnancy that has vaginal bleeding, dilation of the cervix and passage of the fetus and other products of conception. Often the cramps are extremely painful and the bleeding from the vagina is heavy. While a complete miscarriage may not have occurred, the miscarriage is inevitable.
Complete Miscarriage – a full miscarriage; all products of conception have been passed through the vagina, and the mother notes that the amount of bleeding and pain have diminished. The cervix is closed and high. Ultrasound examination reveals an empty uterus.
Missed Miscarriage – the presence of a nonviable intrauterine pregnancy that remains in the uterus without bleeding, abdominal pain, passage of tissue or cervical changes. A missed miscarriage is generally diagnosed by the absence of fetal heart tones or by an ultrasound.
Chemical Pregnancy – a pregnancy lost shortly after implantation. May occur so close to normal menstruation that many women do not realize they are pregnant.
Molar Pregnancy – a genetic error during fertilization leads to growth and proliferation of abnormal tissue within the uterus. Molar pregnancies don’t usually contain an embryo, but will often have more severe pregnancy symptoms. A molar pregnancy is diagnosed via ultrasound.
Blighted Ovum (also called anembryonic pregnancy)- a fertilized egg implants into the uterine wall, but fetal development does not occur. Often ultrasonography will reveal a gestational sac (with or without a yolk sac) without fetal growth.
Chances Of Having A Miscarriage:
Most women of childbearing age have between 10-25% chance of having a miscarriage.
Women under 35 = 15% chance of miscarriage.
Women between 35-45 = 20-35% chance of miscarriage.
Women over 45 = up to 50% chance of miscarriage.
Why Do Miscarriages Occur?
Typically, the cause for miscarriages is idiopathic, meaning that no cause can be easily identified. In the first trimester of pregnancy, chromosomal abnormalities of the embryo are the most common cause of miscarriage.
Other causes of miscarriages include:
- Hormone imbalances
- Improper implantation of the fertilized ova into the lining of the uterus
- Maternal infections such as the German measles, CMV (cytomegalovirus), mycoplasma pneumonia, etc.
- Structural abnormalities of the uterus including fibroids, endometriosis, abnormal growth of the placenta, and poor muscle tone in the mouth of the uterus
- Cervical incompetence
- Chronic maternal infections, including polycystic ovarian syndrome, poorly controlled diabetes, renal disease, Lupus, untreated thyroid disease, maternal hypertension, and antiphospholipid syndrome.
- Drinking, smoking or recreational drug use (especially cocaine)
- Advanced maternal age
- Trauma to the mother
Treatment For Miscarriages:
The number one goal of medical professionals is to prevent and/or treat complications of the mother while allowing the body to do what it needs to do. Common complications include loss of blood (hemorrhage) and infection. If the body passes all of the fetal tissue, generally no medical intervention is necessary, although medications may be given to prevent excessive blood loss or assist the body during the process.
If the body does not manage to pass the fetal tissue properly, medical intervention may be required. The medical procedure practitioners use when fetal tissue is improperly passed is called a D&C, which stands for “dilation and curettage.” This is a relatively minor surgery during which a doctor enlarges the cervix (dilation) and removes (curettage) any residual fetal tissue from the uterus. A D&C is generally performed in an outpatient surgery center or hospital and under sedation. A D&C is also performed for other medical issues besides miscarriages, such as to remove uterine fibroids or polyps, to control irregular menstrual bleeding, and to rule out endometrial cancer.
Bleeding and pain should be monitored. Any changes or signs of infection (chills, nausea, vomiting, and fever) should be reported to the doctor immediately.
A miscarriage should always be reported to the doctor so that potential complications can be ruled out.
Following a miscarriage, do not use a douche, have sex, or insert anything into your vagina until your doctor says it is okay. The waiting period is typically about 6 weeks.
Prevention Of Miscarriages:
Unfortunately most miscarriages occur for reasons we can’t identify, which makes prevention and prediction of miscarriage very difficult; however, there are things that can be done to give any pregnancy the very best chance:
- Get adequate prenatal care.
- Follow the advice of your doctor or midwife.
- Take steps to control high blood pressure (called “preeclampsia” in pregnancy).
- Avoid alcohol, nicotine, and recreational drugs.
- Discuss all prescription drugs with your doctor or midwife.
- Avoid or cut down on caffeine intake.
Emotions Following A Miscarriage
Emotional responses of individuals who have experienced a miscarriage vary. Many grieve the loss of pregnancy just as they would grieve the death of a living person, which means that they may experience shock and denial followed by feelings of guilt, depression, and anger before finally feeling acceptance. If you have experienced a miscarriage, give yourself time to grieve your loss. Seek support from friends, family, bereavement groups, and/or a therapist to aid you in healing emotionally.
It is important to note that men and women may react differently to the loss of a pregnancy, which can further complicate a relationship. Men do not consider themselves to be a father until they hold their baby for the first time; because of this, it is not uncommon for a man to feel confused about how to react to pregnancy loss or to experience the loss to a lesser degree than a woman.
In addition, men tend to grieve more privately, and their grief may be funneled into projects or the examination of facts and information surrounding the pregnancy. Women, on the other hand, feel a connection to the pregnancy earlier and tend to be more outwardly emotive regarding the loss. No matter how your partner reacts, it’s important to stay communicative and be respectful of their feelings and any differences in how they grieve.
Women who have suffered miscarriage are susceptible to postpartum depression. It can be difficult to differentiate between grief and depression, but typically if the symptoms are severe and impinge upon one’s ability to function for a prolonged period of time, professional help should be sought.
How To Help A Loved One Who Has Miscarried:
As with any loss, a miscarriage can be hard for friends and family to navigate. Knowing what to do or say can be hard. Here are some tips:
- Take cues from your loved one: because everyone grieves differently, try to take your lead from her to determine how she’s taking the loss and what she needs.
- Listen: she may want to talk about thoughts and emotions, or she may need to talk about the pregnancy and baby. Listen carefully, focusing on what she’s saying (not on what you’re going to say) and showing you’re paying attention by making eye contact, nodding, gestures, etc.
- Choose your words carefully: don’t tell her she can try again or that it was “meant to be” – these cliches, while common, aren’t always comforting. Don’t criticize or offer advice; listen to how she talks about the miscarriage and go from there.
- Be genuine: don’t tell her you know how it feels or what she’s going through unless you actually do – even though you mean well, this can come off as very offensive. As well, it’s okay to be honest and say, “I don’t know what to say. I’m so sorry for your loss.”
- Consider sending a card: this can be a good way to reach out and let a loved one know you’re thinking about her and sorry for her loss.
- Don’t be afraid to check in: continue asking her how she’s doing and give her the opportunity to talk about her thoughts and feelings. As well, don’t leave out Dad: he’s grieving, too, so make sure to ask how he is doing.
Additional Miscarriage Resources:
Parents or other family members who have experienced the loss of a baby between conception and the first month of life can receive a free March of Dimes bereavement kit by contacting the Fulfillment Center at 1-800-367-6630 or using this link.
Grief Issues Special to Miscarriage – Miscarriage Support Auckland, Inc. is based in New Zealand and provides information about miscarriage issues.
Share – This organization provides mutual support for bereaved parents and families who have suffered a loss due to miscarriage, stillbirth, or neonatal death. SHARE provides newsletters, pen pals, and information regarding professionals, caregivers, and pastoral care.
HopeXchange – Information, support, and hope after pregnancy loss.
Unspoken Grief – A site dedicated to being open, honest and raw about healing after miscarriage, stillbirth or early infant loss.
Still Standing Magazine – an online magazine focusing on encouraging women, men, and even children to embrace life, connecting hearts around the world who have similar life experiences and becoming a resource for friends, family, and even medical professionals, to know how to support someone enduring child loss and/or infertility.
Still Birthday – Wonderful resource page full of love, support, and information about all things related to miscarriage and baby loss. In addition to information about the loss, there is information about how to care for yourself during this incredibly difficult time. It also contains information about how to start the process again after a loss
Page last audited 7/2019