What Is Miscarriage?
The topic of miscarriage is still sort of a taboo topic in our society. Our mothers, grandmothers, and their mothers before them didn’t talk about miscarriage at all. It was something that was considered ‘just one of those things that comes with being a woman’, and better left unsaid. Today it is becoming more socially acceptable to talk about and grieve openly. We are even beginning to hear and see stories about miscarriage and couples sharing their grief publicly in mainstream media. However, unless personally affected by miscarriage most people are still fairly unaware of how common miscarriage is, its effects on emotional and mental health, and what to say (or not say) to a friend or loved one experiencing miscarriage.
Miscarriage is defined as the spontaneous loss of a fetus before the 20th week of pregnancy (pregnancy losses after the 20th week are called stillbirths). Miscarriage is a naturally occurring event. Miscarriage is very common, occurring in every 1 in 4 pregnancies.
Most miscarriages are caused by chromosome problems that make it impossible for the baby to develop. In rare cases, these problems are related to the mother’s or father’s genes.
Other possible causes of miscarriage may include:
- Drug and alcohol abuse
- Exposure to environmental toxins
- Hormone problems
- Physical problems with the mother’s reproductive organs
- Problem with the body’s immune response
- Serious body-wide (systemic) diseases in the mother (such as uncontrolled diabetes)
Around half of all fertilized eggs die and are lost spontaneously, usually before the woman knows she is pregnant. Among women who know they are pregnant, few women will have a miscarriage. Most miscarriages occur during the first 7 weeks of pregnancy. The rate of miscarriage drops after the baby’s heartbeat is detected.
A number of things can lead to isolated or recurrent miscarriage. The most common being a chromosomal abnormality where the genetic material from the sperm and egg do not fuse together appropriately. This is the reason for about half of all miscarriages and is usually a random occurrence. A variation of this type of miscarriage is called a “blighted ovum”, where the water bag and placenta develop but not the fetus. However, in about 9 out of 10 of cases the next pregnancy after these types of miscarriage is to term. This is why most doctors will not order a complex evaluation after a single, first-trimester miscarriage. Further investigation into reasons for miscarriage usually occur once a woman has had 2 or 3 recurrent miscarriages without a live birth in between. Doctors can find a cause of recurrent miscarriage in about half of all cases.
- Medical condition in the mother such as diabetes or thyroid disease
- Hormone imbalances
- Immune system responses
- Uterine abnormalities
An abnormality of the uterus (womb) is the reason for about 10-15% of recurrent miscarriages. When the uterine muscle is slightly malformed the pregnancy cannot grow appropriately and as a result recurrent miscarriage may occur. This problem is diagnosed with a special x-ray or ultrasound of the uterus and surgery to correct the defective area is usually successful in curing the problem.
There are different kinds of miscarriages that can occur at different stages of pregnancy. Symptoms will vary depending on the type of miscarriage.
- Threatened miscarriage
- Missed miscarriage
- Blighted ovum
- Ectopic pregnancy
- Molar pregnancy
- Chemical pregnancy
- Incompetent cervix
It is important that couples realize it is not their fault the miscarriage occurred.
Miscarriage is a devastating situation, and something that will forever affect you and shape your outlook on child bearing. The physical recovery from miscarriage may occur much sooner than the emotional and mental affects on a couple. This process will only take longer and be more painful when unnecessary guilt is added. It is important to surround yourself with people who can support you through your process, and allow you the time and space you need to grieve. There is no “right” way to process your grief from a miscarriage. The way a person navigates their grief and the length of time it takes an individual to recover mentally and emotionally from miscarriage is as unique as the person going through it. Don’t compare yourself to others, and don’t put a time limit on yourself.
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The Miscarriage Process
Most miscarriages begin away from the hospital. Like all births, miscarrying can take anywhere from under an hour to days or even weeks to complete (see ‘Types of Miscarriage’).
Miscarrying is a natural process and happens when a baby hasn’t formed completely. Except for the timing, the miscarriage process usually happens in the same way. A fast miscarriage can be really shocking and frightening once the process begins to happen. If it is your first pregnancy and you don’t know what to expect it can be especially frightening. Contact your doctor or midwife if you begin to have miscarriage symptoms. Though there is seldom anything that can stop the process of miscarriage once it has begun, it can be reassuring to speak to your doctor or midwife. They can walk you through what to expect and help you navigate the physical process of the miscarriage. They can help you decide whether you want to complete the process at home or at the hospital.
If you refer to your doctor or midwife and decide to miscarry at home, here are a few suggestions to help in the process.
- Sit over the toilet with a pillow behind your back or a warm compress over your abdomen while you dispel the tissue.
- Choose to dispel the tissue over a large bowl if you wish to bury the remains in a memorial service or have the remains examined by your doctor or midwife.
- Once the miscarriage is over, call your doctor or midwife to schedule a visit. Although miscarriage is a natural occurrence it is important you are examined to be sure the miscarriage is complete and there is no risk of infection.
A D&C also known as dilation and curettage, is a surgical procedure often performed after a first trimester miscarriage.
About 50% of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is more likely to be incomplete, requiring a D&C procedure. Choosing whether to miscarry naturally or to have a D&C procedure is a personal choice to be made with the assistance of your doctor or midwife.
A D&C may be recommended for women who miscarry later than 10-12 weeks, have had any complications, or have medical conditions in which emergency care could be needed.
Recurrent miscarriage, also referred to as habitual pregnancy loss is commonly defined as two or more consecutive miscarriages. About 5 percent of women will have two or more consecutive miscarriages and 1 percent will have 3 or more.
Possible causes for recurrent miscarriage:
- Genetic Abnormalities
- Anatomic Abnormalities
- Medical Conditions
Because recurrent miscarriage is not common, your doctor may recommend testing to determine the cause of the recurrent loss and help you determine a possible treatment plan.