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Dealing With Miscarriage

woman A miscarriage is the loss of a baby before the 20th week of pregnancy
According to the March of Dimes, as many as 15% of all recognized pregnancies, and as many as 40% of all pregnancies end in miscarriage. The reason for the large difference between these two numbers is that many miscarried pregnancies go unnoticed because they occur before a woman realizes she was pregnant.

What Does (and Doesn’t) Cause Miscarriage

There are many old wives tales about the possible causes of miscarriage, including sex, excessive exercise, bad karma, and even misalignment of the astrological signs. Unfortunately, the truth is that the causes of many miscarriages are not known.
Most miscarriages occur in the first trimester (12 weeks) of pregnancy and are the result of chromosomal abnormalities in the developing embryo. These chromosomal abnormalities prevent the embryo from developing normally and the body spontaneously terminates the pregnancy. Other potential causes of miscarriages are infections, hormonal problems, reproductive tract abnormalities such as fibroids, or other health issues and illnesses affecting the mother.

What Can You Do to Reduce Your Risk of Miscarriage?

The bad news is that there is nothing either a woman or her doctor can do to prevent an impending miscarriage. The good news is that most women who lose a child to miscarriage go on to have a healthy pregnancy in the future.
There are, however, certain risk factors.

Risk factors that can be modified with behavioral change:

Risk factors that can be modified with medical or surgical treatment:

  • A cervix that is too weak to stay closed during a pregnancy
  • Chronic disease
  • Hormonal disorders
  • Some medications
  • Infection
  • Structural abnormalities of the uterus

Risk factors that cannot be modified:

  • Older age
  • Genetics
If you have some of these risk factors, eliminating and modifying as many of them as possible may help reduce your risk of miscarriage. Before your next pregnancy, you may want to consider genetic testing and/or counseling.

What Are the Signs and Symptoms of a Miscarriage?

The signs and symptoms of a miscarriage include:
  • Vaginal bleeding or spotting
  • Abdominal pain or cramping
  • Passage of tissue from the vagina
  • Fluid draining from the vagina (without pain)
If you are pregnant and experience any of these symptoms, contact your doctor immediately.

Why Do Some Women Have Repeated Miscarriages?

Certain medical problems may increase your risk for miscarriage. Testing of the mother, the father, or the fetus can reveal the cause of the miscarriages in up to 70% of couples. However, even if you have had repeated miscarriages, you may still be able to complete a healthy pregnancy.
If the reason for your repeated miscarriages is a weak cervix, you may be able to undergo a cerclage. This is a procedure in which a stitch is made around the cervix to help keep it closed throughout the pregnancy.
If you have a chronic disease, such as diabetes, keeping the condition under control will also increase your chances of having a healthy pregnancy.
If you have thrombophilia, taking a blood thinner may help reduce the risk of miscarriages.
Progestin may be another therapy that can help reduce the risk of miscarriage in women with a history of recurrent miscarriages.
If you have repeated miscarriages, ask your doctor for a complete medical evaluation to determine the cause.

How Can You Recover Emotionally From a Miscarriage?

If you have experienced a miscarriage or the loss of a child for any reason, it is important for you to understand that grief is a very individual experience. There is no right or wrong way to grieve. However, it is also a process made up of several stages, and while you may skip or repeat certain phases, it is helpful to understand what they are.
The phases of grief:
  • Avoidance and disbelief: When faced with such an overwhelming loss, you may find yourself avoiding your feelings or having trouble accepting what has happened. Avoidance and disbelief allow you to break your grief down into more manageable pieces until you are more ready to accept the loss of your child.
  • Pain: When dealing with the loss of the child, keep in mind that your pain may manifest itself in any number of ways, either as a physical illness, forgetfulness or difficulty concentrating, depression, anger, or guilt. Try to remember that this pain is part of your grieving process and that eventually you will move through it.
  • Acceptance and adaptation: While you will never “get over” the death of your child, eventually you will reach a place of acceptance and adaptation, and your pain will ease. This doesn’t mean you will forget your child, but it does mean that you will find a way to incorporate your baby’s memory into your life in a meaningful way and move on toward a different future and a new dream.
The loss of a child, at any age, for any reason, is likely the most tragic and difficult loss any family can face. In addition to the physical loss, there is an emotional loss, and the loss of all the promise that life contained. Recovering from the loss is a slow process. But with support and time, you can heal.

RESOURCES

The American Congress of Obstetricians and Gynecologists http://www.acog.org

US Office on Women's Health http://www.womenshealth.gov

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

Women's Health Matters http://www.womenshealthmatters.ca

References

Christiansen OB, Nybo Anderson AM, Bosch E, et al. Evidence-based investigations and treatments of recurrent pregnancy loss. Fertil Steril. 2005;83(4):821-839.

Early pregnancy loss: Miscarriage and molar pregnancy. American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq090.pdf?dmc=1&ts=20130725T1029548132. Accessed July 25, 2013.

Miscarriage. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated April 29, 2013. Accessed July 25, 2013.

Miscarriage. March of Dimes website. Available at: http://www.marchofdimes.com/baby/loss%5Fmiscarriage.html. Updated October 2008. Accessed July 25, 2013.

Recurrent pregnancy loss.EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated October 10, 2012. Accessed July 25, 2013.

Repeated miscarriage. American Congress of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq100.pdf?dmc=1&ts=20130725T0945500212. Accessed July 25, 2013.

2/9/2012 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Lund M, Kamper-Jørgensen M, Nielsen HS, et al. Prognosis for live birth in women with recurrent miscarriage: what is the best measure of success? Obstet Gynecol. 2012;119(1):37-43.

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