Understanding Miscarriage

Jun 15, 21 ● 6 min

By Leslie Schrock, author of Bumpin’

No matter when a miscarriage happens, it can be devastating. Because so many happen before a woman even knows she’s pregnant, and not all are reported, it’s nearly impossible to quantify what percentage of pregnancies end in miscarriage. Our best guess is that it happens in 10-20% of all pregnancies, but it could be as high as one in three. More than a million American women report a miscarriage each year, and 80% of these happen in the first trimester.

So what causes a miscarriage? As many as 75% are due to chromosomal problems, errors that occur randomly as the embryo divides, not issues inherited from either parent. Chromosomal issues are more common with age, so the risk of miscarriage goes up when women hit 35, and when men are over 40.

How can I tell if I’m having a miscarriage?

Bleeding, especially around the time of implantation, is pretty common, making it hard to know the difference between that and a miscarriage. If you experience bleeding and any of the below miscarriage symptoms, it’s time to call your physician:

Severe abdominal pain
Cramps
Progression of vaginal bleeding from light to heavy
Discharge of tissue with clots
Fever
Back pain
Unexplained weakness

What do I do if I’m having a miscarriage?

Call your provider. They will ask for the start date of your last period to understand how far along you are, as well as symptoms and any history of fertility issues. Pending your circumstances, they may suggest waiting to see if it resolves, ask you to come into the office, or direct you to a nearby emergency room to get checked out.

If you do go in, a doctor or nurse will do a pelvic exam to see if your cervix is dilated, and an ultrasound to check for a fetal heartbeat and other developmental indications. If it looks like a miscarriage is occurring, a sequence of two blood tests set twenty-four hours apart to see if HCG levels are going up or down is one way they can confirm. If you are passing tissue, that may also be sent to a lab for analysis.

If it is a miscarriage, there are several ways it can resolve. The first is known as expectant management, which means letting it take a natural course. A first-trimester miscarriage usually feels and looks like a period. Heavy bleeding or passage of tissue should stop in a few hours, and light bleeding will conclude after several days.

If the miscarriage doesn’t or can’t clear on its own and it’s before nine weeks, your doctor will suggest medication to help things along. Mifepristone combined with misoprostol is the most common and safest way to manage a miscarriage at home. The medications cause bleeding and cramping and in some cases nausea, vomiting, fever, chills, diarrhea, and headaches. Be prepared to take it easy for a few days, and have high-absorbency pads on hand, especially overnight.

If you are nine weeks or more into your pregnancy, you may need a dilation and curettage (D&C) to remove any remaining tissue. Done in an office or as an outpatient procedure, it is not considered an elective procedure as it is time-dependent, so even with more limited healthcare resources, you will have access to care. It takes under thirty minutes and does not require a long recovery period. Your doctor may start the process of dilating your cervix a few hours or the day before the procedure with medication.

After your cervix is dilated, the remaining tissue will be removed from your uterus with a long instrument called a curette. You’ll spend an hour or two in recovery to check for bleeding or other complications, and for the effects of anesthesia to wear off before you leave. Complications from a D&C are rare, but expect to feel drowsy and have mild cramping and light bleeding. Sex is off-limits for one to two weeks afterward to reduce your infection odds. Your uterus has to build a brand-new lining after a D&C, so your period can take longer than one cycle to come back.

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Is it my fault if I have a miscarriage?

Though it’s very hard not to feel this way if it happens, miscarriage is rarely “your fault.”

The majority are caused by chromosomal abnormalities— not by something you ate, stress from your job or partner, or by working out too hard. Miscarriages can happen no matter how healthy and diligent you are because the embryo is simply not viable. Other known miscarriage causes are related to uncontrolled health conditions like diabetes, hormonal and thyroid issues, infections, or uterine or cervical abnormalities, and lifestyle-related factors like being overweight or underweight, smoking, using drugs, and aggressive alcohol consumption.

When can I try to get pregnant again?

Opinions range from as soon as you are medically cleared to have sex again to six months. Exactly how many cycles you should wait generally depends on how far along you were when the miscarriage happened, how it resolved, and your overall health.

Most doctors suggest waiting 2-3 months to let your uterus go back to normal and, if the miscarriage required intervention or your pregnancy was more advanced, monitoring your hormone levels. If it happened early and did not require any medical intervention, there is no evidence that shows that waiting even one month contributes to the health of future pregnancies. Ovulation can happen as soon as two weeks after a miscarriage, which means you can get pregnant before your period arrives. Letting yourself heal physically is only half the process, and you should not feel pressured to get pregnant again until you feel ready.

If I have one miscarriage, will I keep having miscarriages?

No. Fewer than 5% of women have two consecutive miscarriages, and only 1% experience three or more. Recurrent pregnancy loss is poorly understood but, as the stats indicate, is relatively rare.

How do I heal after a miscarriage?

There is no right or wrong way to deal with the aftermath of a miscarriage. Whether you choose to lean on friends and family, work with a therapist, or process the experience privately with your partner, the only strategy to avoid is doing it alone. People may not know what to say or do, so be as open as you can and tell them what you need. You may be surprised to find out how many of your friends and family have gone through it, too.

The grief can be much deeper for you, as the pregnancy and loss happened in your body. Because it wasn’t as real to them in that way, your partner might process it differently. Try not to judge if they don’t seem to feel it as intensely.

Telemedicine is a flexible, affordable way to access a therapist who specializes in processing grief or trauma, or there are also online support groups that allow you to connect with others who have gone through the same loss. Hearing and reading other people’s experiences can be healing, but it can also trigger feelings of grief, so try to manage your consumption if it’s causing heartache.

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