Women and their partners have so many different choices and opinions in deciding how to build their families; start childbearing young or wait until you’re older?, one child or many or none at all?, learn the gender or wait for the surprise?, natural childbirth or pain management? Similarly, women vary greatly in how they respond to pregnancy; some are very anxious, some take it all in stride, some adore pregnancy and others suffer through it. Pregnancy is a blank slate upon which we begin to form the picture of our family and each picture is as different as the woman in whose body the process begins.
But miscarriage, the darker side of pregnancy, brings out the same reactions in almost all of us; sorrow and fear. The sorrow may be enormous and deeply, lastingly painful for some and a quiet peaceful resignation for others. Even for women struggling with an unintended or unwanted pregnancy, miscarriage can still hurt. It also causes fear in women; fear that they somehow caused the miscarriage with their actions or thoughts, fear that their body will not be able to carry a healthy pregnancy, fear that the emotional pain will be too much for their relationship to survive, even fear of judgment from others.
If you’ve suffered a pregnancy loss, please know that these emotions are normal and are yours to have and to hold until they pass in their own time. Many women find that time alone heals the pain and others find that discussing their pain with a therapist, a clergy member or in a group with others is most helpful. With this grief, you are likely to also have many questions. Why did this happen to me? How common is this? How likely am I to have another miscarriage? Is there anything I can do to prevent this?
The answers may surprise you. For, though this is a difficult process, it is an extremely common one and, in most cases, it is an integral part of healthy and normal reproduction. If we consider the utter miracle that occurs when, literally, billions of cells work together in a woman’s body to form the perfect infants and children we see all around us, we must also value that a mother’s body (in communication with the embryo or fetus) knows when there are problems occurring in the development and terminates the pregnancy. Problems occur frequently. Estimates vary but at least 30% and, perhaps, up to 50% of all conceptions end in miscarriage. That translates into more than 1 in every 4 women in the world suffering at least one pregnancy loss.
There are several causes of pregnancy loss and most are out of your control. Chromosomal abnormalities are the most common factor. There are some situations in which children can survive – and even flourish – with chromosomal abnormalities such as in Down Syndrome. But for the most part, chromosomal abnormalities are not compatible with life and so the body must end the pregnancy when this occurs. Abnormal development of the placenta, poorly managed or undiagnosed chronic illness, a recent infection or an uncommon shape to the uterus can also cause miscarriage. A difficult aspect of miscarriage is that most women will never learn the exact cause of their own pregnancy loss.
Many miscarriages occur before women even learn of their pregnancy; the embryo passes with some bleeding at the time of the expected period. For the others, development usually ceases at 5-6 weeks after the last menstrual period but it may take several more weeks before the mother’s body is able to slow down the surge of pregnancy hormones. In these cases, women have typically gotten a positive pregnancy test, perhaps experienced some symptoms of pregnancy and are looking forward to hearing a heartbeat by the time the miscarriage is detected. If a heartbeat is detected, the likelihood of miscarriage drops significantly with only a very small percentage of pregnancy losses occurring after the first trimester. A loss after 20 weeks is, officially, considered a stillbirth or preterm delivery.
If a heartbeat is not detected and you go on to receive the sad news of miscarriage, your provider will discuss with you the options you have for care. Some women choose to let the body move at it’s own pace to expel the pregnancy and others choose to have a procedure called dilation and curettage (D&C) to remove the tissue from the womb. There is no “right” choice, only the choice that suits you best.
The doctors and midwives at P&M will work with you through all phases of your pregnancy and if your pregnancy ends in miscarriage, we will be there for you to get you through this difficult time. If and when you decide you would like to try again for pregnancy (we recommend waiting for at least three normal periods before attempting conception again), we will carefully review your medical history to determine whether additional testing is recommended. In general, a single miscarriage does not warrant extensive testing. We hope, and typically see that the next pregnancy is healthy and normal. If you have suffered more than two miscarriages, if you are over the age of 35 or if you have a known family history of certain disorders that can increase the risk for miscarriage, we will discuss with you some testing and recommendations for helping you to experience pregnancy and childbirth.
Like many things in life the joy and beauty of pregnancy has a flip side that is less celebratory. Miscarriage, in most circumstances, is common, normal and an important part of the complex system that allows us to produce our beautiful children. That doesn’t mean it doesn’t hurt, though, and mourning is a natural reaction. Everyone here is deeply committed to walking with you through this process and offering whatever support we can to assure your emotional well-being.