Miscarriage (also called early pregnancy loss) is when there is pregnancy loss before 20 weeks. For women who know they’re pregnant, about 10 to 20 in 100 pregnancies (10 to 20 percent) end in miscarriage. Most miscarriages – 8 out of 10 (80 percent) – happen in the first trimester before the 12th week of pregnancy. Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1 to 5 in 100 (1 to 5 percent) pregnancies. Pregnancy loss that happens after 20 weeks is called a stillbirth.
Miscarriage is very common. Some research suggests that more than 30 percent of pregnancies end in miscarriage, and many ends before a person even knows they’re pregnant. Most people who miscarry go on to have a healthy pregnancy later.
What is a threatened miscarriage?
This is when a pregnant person has bleeding, little or no pain, a closed (undilated) cervix and the baby may have a heartbeat. The cervix is the opening to the uterus that sits at the top of the vagina. Most of the time, threatened miscarriages turn out fine.
Is Miscarriage Very Common?
If you haven’t experienced a miscarriage yourself, I guarantee you know someone who has. It’s incredibly common. For women in their 20s and 30s, 1 in 5 pregnancies ends during the first trimester, and that ratio climbs to 1 in 4 for women 35 and older, and to 1 in 3 for women over 40. The experience can range from disappointing to traumatic, and yet few women ever talk about it.
“We completely ignore miscarriage in this country,” says Alice Domar, PhD, author of Conquering Infertility and executive director of the Domar Center for Mind-Body Health at Boston IVF. “It’s swept under the rug—because it’s abnormal, it’s nature gone wrong. It feels like failure and so it’s a source of shame.” But women should tell people they’ve had a miscarriage, Domar says. “That’s how you’re going to get the love and support you need—and to hear stories of other women’s healing after such an intense loss.”
Why It Happens?
Although doctors don’t fully understand why miscarriage happens, the most common known cause is problems with baby’s chromosomes, the thread-like structures in each cell that carry our genes. Studies show that up to 70 percent of first-trimester miscarriages are caused by too many or too few chromosomes, which can come from a faulty egg or sperm. The risk of trisomy (having too many chromosomes, a fault of the egg), rises as we age: In women under 25, chromosomal error accounts for 20 percent of miscarriages; in women over 40, it accounts for 70 percent of miscarriages.
Factors leading to miscarriage
Other factors leading to miscarriage include hormonal problems, such as low progesterone; infections, such as listeria, Chlamydia and bacterial vaginosis; and a mother’s chronic health problems such as polycystic ovary syndrome, lupus, high or low thyroid function and poorly controlled diabetes. “If you have any of these illnesses, make sure you’re in remission before getting pregnant,” advises obstetrician-gynecologist Mary Stephenson, MD, director of the Recurrent Pregnancy Loss Program at University of Chicago Medical Center.
Lifestyle factors play a role, too. Alcohol can quadruple your risk of losing a pregnancy. Smoking—and even second-hand smoke—can more than double it. Even too much caffeine (more than 375 mg or about 2 cups a day), doubles the danger. “I advocate zero tolerance of smoking and alcohol,” Stephenson says. “To put your best food forward, make sure you have a balanced lifestyle: Get regular, moderate exercise, eat properly, keep stress to a minimum and have a positive attitude going forward.”
Telltale Signs
How do you know a miscarriage is happening? The number-one symptom is vaginal bleeding, sometimes accompanied by period-like cramps (although many women who spot go on to have normal pregnancies). You may also simply stop feeling pregnant. I know I my tiredness, food cravings, breast tenderness and emotional see-sawing seemed to subside a few weeks into the pregnancy. I thought it was odd but I believed the friends who assured me it was because every pregnancy is different! If you experience any suspicious symptoms, call your health care provider right away.
Coping with the Loss
While the physical healing after a miscarriage can be speedy (hours or days), the emotional wound may be deep. “You have to treat it like a death,” Domar says. “You can’t expect yourself to bounce back the next day.” Try using the following coping mechanisms to ease the grief.
1. Banish guilt.
Even if you drank a margarita, soaked in a hot tub, dyed your hair. Took a 9-hour plane ride or busted your bum on the ice in your driveway, the miscarriage is most likely not your fault and could not have been prevented. “There’s nothing you did or didn’t do that caused your miscarriage,” Domar says. Don’t stress yourself out examining with a microscope every little thing you might have done to cause the miscarriage. But do talk to your healthcare provider to rule out medical problems.
2. State your needs.
Don’t expect that you and your husband will cope with the loss the same way, especially if you miscarried during the first trimester. “You may have felt tired and nauseous and had swollen boobs, but the only change in his life is that his wife went to be earlier,” Domar says. “He’s mourning the theory, but you’re mourning the actual physical loss of pregnancy.” So while your husband certainly wants to support you, he may also want to watch the football game. Instead of being offended, tell him what you need from him. Whether it’s to watch the kids and run errands while you have alone-time, give you a massage, or join you on the sofa for a chick-flick marathon.
3. Honor the experience.
The Japanese have a Buddhist temple where women who’ve lost a pregnancy place a small statue of an infant (called a mizuko jizo) and wish it well on its journey, believing it will live at another time. In recent years, rabbis have begun developing Jewish ceremonies to acknowledge the lost life and ease the family’s sorrow. In an article in the journal Women and Therapy, Albuquerque, New Mexico Rabbi Deborah J. Brin, confirms, “Creation and participation in a grief ritual can bring the grieving parents to a healing resolution.” Whether you hold a symbolic funeral with poems and prayers, compose a letter, make a charitable donation, plant a tree, release a balloon, or simply light a candle, ritual can help you make peace with the loss.
4. Share the news.
Don’t hide your grief from family and friends. “The more people you tell, the more likely you are to find women who’ve also had miscarriages,” Domar says. “They can provide support, hear you out, and share with you how long it took for them to recover.” What’s more, going public with your experience can normalize it—helping remove any stigma or shame you may unconsciously be attaching to it. After all, you wouldn’t hesitate to tell friends you’d had a house-fire, that your relationship ended, or that you were called back after a mammogram. Treat a miscarriage the same way and get the support you need.
5. Get Tested
After a miscarriage, you may want to be screened for medical conditions that could jeopardize future pregnancies. Dr. Mary Stephenson recommends:
- TSH blood test to screen for thyroid disease
- Fasting blood-sugar test for diabetes
- Pelvic exam and cervical culture to look for an infection, such as Chlamydia or bacterial vaginosis (BV). One study found that women with BV were nine times more likely to miscarry than their uninfected peers.
- Chromosomal analysis. Have the doctor send your miscarriage materials—the blood clots and tissue you passed, also called “products of conception”—to a lab for chromosomal testing. “If there’s an abnormal number of chromosomes then we know why the pregnancy stopped, and the risk of another miscarriage is not increased.” Stephenson says. “If we find that the chromosomes are normal, then we need to look for other factors, and there’s a greater risk of subsequent miscarriage.” If you’ve already had two or more miscarriages, talk to your healthcare provider about getting a complete medical evaluation to determine the cause.
