For most women, a positive pregnancy test is a time for celebration and joy. But for the 15 to 20 percent of documented pregnancies that end in miscarriage, that time of celebration can turn into a whirlwind of confusion, loss and the fear of trying to conceive again.
“I experienced two miscarriages before giving birth to our twin sons,” says Linda Olson, a mom from Pennsylvania. “The loss of a fetus is a devastating experience emotionally. To the mother, it is a death to be mourned just like the person who had been born.”
An early miscarriage is nature’s way of preventing a very abnormal pregnancy from continuing.
So what exactly causes a woman to miscarry? Are there any ways to prevent it? Read on as experts discuss the physical signs of miscarriage and what to expect from the body afterward, while women share advice on how to move forward from the experience.
Causes of Miscarriage
According to experts, it is often difficult to determine the causes of first trimester miscarriages. Placental and uterine abnormalities and increased maternal age can all play a role, as do chromosomal abnormalities.
“There are so many things that need to meet up perfectly to form a healthy embryo,” says Leslie Ludka, a certified nurse-midwife in Boston, Mass., and member of the American College of Nurse-Midwives. “We never get a solid answer, which is very difficult for many women, but there is nothing they did that caused it to happen.”
To that effect, if you are steering clear of drugs and alcohol during your pregnancy and making regular visits to your provider, there is nothing else you can do to prevent a miscarriage, says Dr. Kathryn Landherr, an OB/GYN with La Dea Women’s Health in Tucson, Ariz., and co-author of Hands Off My Belly: The Pregnant Woman’s Survival Guide to Myths, Mothers and Moods (Prometheus Books, 2009).
Dr. Kenneth Johnson, vice chair of the Department of Obstetrics and Gynecology at Nova Southeastern University College of Osteopathic Medicine in Florida, believes that although it may not seem like it at the time, a miscarriage can actually prove to be beneficial for a family, as the fetus most likely was not developing normally. “The cause of early miscarriage (and the benefit) is in the fact that these early miscarriages are almost always (greater than 95 percent) very genetically abnormal pregnancies,” says Dr. Johnson. “Another way of looking at it is that these pregnancies would have never been normal. Thus, when a couple has an early miscarriage we inform them that this is nature’s way of preventing a very abnormal pregnancy from continuing.”
While second-trimester miscarriages don’t occur as often, they are often caused by different reasons from first trimester miscarriages, such as cervical incompetence, placental attachment, and infection to the pregnancy or uterus, says Ludka. Or the miscarriage could have occurred during the first trimester but the mother had no indication because of delayed symptoms or a follow-up visit that wasn’t scheduled until a few weeks later. In that case, there are tests that can be performed to help determine the cause of a second-trimester miscarriage.
Symptoms of Miscarriage
“There are two major symptoms of a miscarriage,” says Dr. Landherr. “Bleeding or abdominal cramping signal there may be a miscarriage and once an ultrasound is done, this can usually be determined.”
She also says about 30 percent of pregnancies can experience some bleeding and go on to develop normally, so it is best to consult with a provider anytime you experience any bleeding during the pregnancy.
“The physical aftermath varies from person to person, and includes the patient’s choice,” says Ludka. “Some women just want their body to take the natural course. Other people cannot bear the idea of waiting, so they choose to have a D&C; (dilation and curettage). If there is any sign of hemorrhaging or fever, doctors will recommend a D&C; immediately.” (A D&C; involves dilation of the cervix and scraping of the lining of the uterus).
“What happens is that the body many times experiences the miscarriage naturally, on its own, by bleeding and cramping,” says Dr. Landherr. “These symptoms can be very extreme but are, most of the time, self-limited and this can be handled at home with strict precautions for bleeding and pain and under a physician’s care and follow up.”
“A very important piece of good news is that early miscarriage does not affect the couple’s ability to have a normal pregnancy in the future and is not in any way serious unless it recurs two or more consecutive times,” says Dr. Johnson. “In the event of three consecutive miscarriages the term ‘habitual aborter’ is used and this condition does require a detailed work-up by the doctor.”
Once the miscarriage is complete, by a D&C; or naturally, a woman can experience spotting or off-and-on bleeding for one to four weeks, says Dr. Landherr. “The pain, however, usually decreases and almost resolves once the miscarriage has been complete, so there is not usually any residual pain. It will take several weeks for her hormone levels to adjust in her body, so she may not feel completely back to normal hormonally for about that long.”
Trying to Conceive After Miscarriage
Deciding when or if to conceive again after experiencing a miscarriage involves several different factors. Most physicians advise waiting two to three normal menstrual cycles to allow the lining of the uterus to become normal again. “Your body is the best barometer,” says Ludka. “It will get back into its own rhythm. A woman and her family need to grieve over the loss of that pregnancy. They also have to get over the fear that it will happen again.”
Families choose to heal from the loss of a pregnancy in different ways. For Tracey Segarra, a mom from New York, holding a small ceremony including prayers and poems with her husband and a local rabbi helped the couple find closure. She also appreciated the friends and family who simply took the time to say, “We’re sorry for your loss.”
But what is the best way to deal with well-meaning family members, friends and colleagues who often make well meaning but hurtful comments regarding the failed pregnancy, or expect a woman to bounce back from the experience within a few weeks?
“My advice to others is, it’s OK to mourn and you need to do this,” says Olson. “Don’t let other people brush off your deep feelings. They do not understand because they are very uncomfortable dealing with this situation. It’s far more common than most of us know. But take care of yourself, find someone you can confide in and allow yourself time to heal.”
“Soak up the heartwarming stories, the stories of the woman with five losses who went on to have two children later in life, completely naturally,” says Tina McAllister, an Arizona mom who has experienced four different miscarriages. “These stories happen to real women. And they are uplifting … something to hold onto when you feel down in the dumps about your own situation.”