Understanding Miscarriage: It's Not Your Fault

All About Women physicians talk about how to get through the physical and emotional effects of a pregnancy loss

A miscarriage is a tragic loss that can cause a mother to experience tremendous grief and sadness. During such times, it's important to know you're not alone.

Miscarriages are rarely talked about, but they occur more often than you might expect. Many women are surprised to learn that at least 15-20% of all pregnancies end in miscarriage. This number is likely much higher because many more pregnancies end before a woman even knows she is pregnant.

Suffering a miscarriage can be a devastating and confusing time for a woman.

Learning more about miscarriages — such as their causes, symptoms, and treatment — can help you prepare for what's to come and perhaps give you a measure of comfort in knowing that most women who miscarry go on to have successful and happy pregnancies.

Gainesville pregnancy care physicians; All About Women

Definition

A miscarriage is any pregnancy loss that occurs during the first 20 weeks of pregnancy, or up to the 5th month. A miscarriage is the most common cause of pregnancy loss. The medical term for miscarriage is “spontaneous abortion,” although doctors don't frequently use this terminology because it may be confused with intentional pregnancy termination.

5 Surprising Statistics About Miscarriage in America

As many as 75% of fertilized eggs don't go on to result in a full-term pregnancy.


Nearly 1 in 5 women with a verified pregnancy will end up having a miscarriage.


About 900,000 - 1 million confirmed pregnancies in the U.S. end in miscarriage every year.


About 1 in 100 women (1%) have repeat miscarriages. The vast majority of women suffering 1 miscarriage can expect to have a normal pregnancy next time.


Over 80% of miscarriages occur before 12 weeks.

Sources:
https://www.uptodate.com/contents/miscarriage-beyond-the-basics
https://www.marchofdimes.org/complications/stillbirth.aspx
https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Bulletins/Committee-on-Practice-Bulletins-Gynecology/Early-Pregnancy-Loss

Risk Factors & Causes of Miscarriage

Miscarriages can occur any time before the 20th week of pregnancy, though most occur before the end of the first trimester. Once a heartbeat is detected (usually around the 12th week of pregnancy), the chance of a miscarriage significantly decreases.

Women have a greater risk of miscarrying as they age. While approximately 15% of women under the age of 34 miscarry, 25% of women between the age of 35 and 39 will miscarry. Women over the age of forty have a 40% chance of miscarriage, with the risk increasing further after the age of 45.

Over half of all miscarriages are caused by chromosomal anomalies in the egg or sperm. While it sounds serious, a chromosomal anomaly simply means the egg or sperm had a defect. Miscarriages caused by chromosomal anomalies do not indicate a future risk of miscarriage.

Chart courtesy of the American Journal of Epidemiology (source)


Besides the age of the mother and chromosomal anomalies, other risk factors for miscarriage include:

  • Lifestyle factors (smoking, stress, substance abuse, etc.)
  • Problems in previous pregnancies
  • The mother being overweight or underweight
  • Untreated STDs (chlamydia, gonorrhea, etc.)
  • Viral or bacterial infections during pregnancy
  • Conceiving after being infertile
  • Abnormalities of the uterus or cervix
  • Chronic illness (poorly controlled diabetes, autoimmune processes, kidney disease, etc.)

It's worth noting that having sex while you're pregnant, moderate exercise, and using birth control pills during pregnancy are NOT medically associated with pregnancy loss. At All About Women, we think it's important to address these myths and misconceptions about miscarriage.

If you miscarry, particularly more than once, your doctor may want you to collect some of the passed tissue for lab testing. These tests will help determine if there are any genetic or other health factors, such as hormonal imbalances, that can be controlled or monitored to help prevent a future miscarriage.

Again, most women who miscarry proceed to have healthy, successful pregnancies.

Symptoms and Treatment of Miscarriage

Women who miscarry report a wide range of symptoms.

For instance, bleeding and cramping may be a sign of a miscarriage. It is possible to bleed during the first trimester without miscarrying, but — about 50% of women who bleed will lose their pregnancy to a miscarriage. Many women who miscarry also notice that they're no longer experiencing the normal signs of early pregnancy such as nausea, tiredness, or breast tenderness.

Other common signs and symptoms of miscarriage include:

  • Mild to severe back pain
  • Unexplained weight loss
  • Tissue material passing through vagina
  • Painful contractions
  • White-pink mucus

If you experience any or all of these common miscarriage symptoms, you should contact your midwife or OB/GYN. While there's usually no way to prevent a miscarriage, you will need to be in close contact with your healthcare provider in case you do miscarry.

Some women have no signs of a miscarriage and don't know their pregnancy has ended until a heartbeat cannot be detected during a sonogram. If this occurs, your doctor will tell you to expect to miscarry within the next several weeks. Sometimes, it can take up to six weeks before an ended pregnancy miscarries naturally.

What to Expect During & After a Pregnancy Loss

The height of a miscarriage involves heavy bleeding for several hours. It may begin with light spotting and cramping, or heavy bleeding may begin suddenly. You will pass large clots of blood and may have mild to heavy cramping. You may want to begin taking an over-the-counter painkiller or one that your doctor has prescribed early in the miscarriage to prevent cramping from escalating.

Most miscarriages can happen at home, though you should stay in contact with your OB/GYN or midwife. They may want you to go to the hospital if bleeding becomes heavy. You should also go to the hospital if you experience any foul odors or fevers that could indicate an infection requiring immediate treatment.

Following the period of heavy bleeding, lighter bleeding and spotting will continue over the course of a week or two, similar to your period.

If you learn of an impending miscarriage at your appointment, it may take several weeks before a miscarriage begins naturally. If your pregnancy was in the early stages, your doctor may be able to prescribe you a medication such as Misoprostol to cause uterine contractions and expulsion.

Or, if you don't miscarry naturally after several weeks, your doctor may schedule you for a D&C procedure, or dilation and curettage, in order to complete the miscarriage.

You will have a follow up appointment several weeks after your miscarriage to make sure everything has passed. A blood test will ensure that your hormone levels have normalized. Some miscarriages are incomplete and require a surgical procedure, usually a D&C, to remove remaining tissues.

If you're Rh negative, you may need a Rh immune globulin shot within 72 hours of your miscarriage to ensure you don't have problems in your next pregnancy.

You can usually start having sex about four weeks after a miscarriage and your period will likely come back after six weeks. Though it's possible to get pregnant immediately following a miscarriage, your healthcare provider may recommend you wait a full menstrual cycle before you try to get pregnant again to allow time for physical healing.

Emotional Healing from a Miscarriage

Emotionally, it may take longer before you're prepared for pregnancy again.

Grief, guilt, depression, anger, or relief are all feelings that are common when women experience a miscarriage. If you miscarried before 12 weeks, you may feel alone or isolated if no one knew you were pregnant. If you share that you've miscarried, you may feel like people dismiss it because you weren't far along in your pregnancy.

The truth is that regardless of how far along you were, you've probably already thought out your whole pregnancy and imagined holding your baby in your arms. It's okay to grieve. By sharing your miscarriage story with friends, family members, and healthcare providers, you may learn of women in your life who've had miscarriages that you never even knew about.

The pregnancy care physicians at All About Women are here to help you through the painful course of miscarriage with both competent medical care and sincere compassion. If you're concerned about miscarriage or have other pregnancy concerns, contact our office in Gainesville or Lake City to schedule an appointment today.

Miscarriage & Pregnancy Loss Support

Did you or someone you love recently have a miscarriage? Find a pregnancy loss support group near you to connect with doctors and women who understand what you're going through. Here's a list of local, national, and international organizations and resources: