Estimated reading time: 10 minutes
Miscarriage. It may be the most feared word for many women early in pregnancy. While you may prefer not to give it any thought., some women find that educating themselves about it actually eases their worries. It is especially helpful to know what symptoms may point to an early pregnancy loss and when to call your doctor. Let’s take a look at the facts, risks, when to call the doctor, and more.
What Exactly is Miscarriage?
A miscarriage is the loss of a pregnancy in the first twenty weeks. The medical term for a miscarriage is spontaneous abortion. The word abortion may make some women feel uncomfortable, because they associate it with an elective abortion, but don’t feel upset or surprised if you see the term spontaneous abortion on your records. It simply means that a pregnancy ended on its own.
Most miscarriages fall into the category of early pregnancy loss, in the first thirteen weeks of pregnancy. Late miscarriage occurs between the fourteenth and twentieth weeks. A loss after the twentieth week is considered a stillbirth rather than a miscarriage.
How Common Is Miscarriage?
Overall, about 10 to 15% of known pregnancies end in miscarriage (1, 2). That number doesn’t include losses very early in pregnancy when women didn’t even recognize yet that they were pregnant. You may see differing estimates from different sources about how many pregnancies actually end in miscarriage, but a common estimate seems to be around 20 to 25%. Other numbers that are helpful to know:
- The vast majority of miscarriages occur before the thirteenth week of pregnancy.
- Late miscarriages, those occurring in weeks thirteen to nineteen of pregnancy, happen in just 1 to 5% of pregnancies (2).
- Recurrent or habitual miscarriage is when a woman experiences three miscarriages in a row. This happens in only 1 to 2% of women.
- Even in women who have recurrent miscarriages, studies show that 60 to 70% still go on to have successful pregnancies (3).
What Causes Miscarriage?
The causes of pregnancy loss vary, and they’re often unknown. Though, it is believed that about half of miscarriages are caused by genetic abnormalities. For example, chromosomes are what carry a person’s genes and determine their traits. Sometimes an embryo, or fertilized egg, may get the wrong number of chromosomes (2) or develop an abnormal structure. This can cause an embryo to not develop properly and result in miscarriage.
The good news is that most chromosome problems are not inherited. They’re just happenstance and are unlikely to happen again in subsequent pregnancies. If a person experiences multiple early pregnancy losses — usually three in a row — genetic counseling can be done to try to find the cause.
Factors That Increase Risk
While the cause of a miscarriage often isn’t known, there are some things that are connected with an increases risk of pregnancy loss. These factors include:
- Chronic health conditions (like autoimmune disorders)
- Hormone problems (such as polycystic ovary syndrome or PCOS)
- Diabetes, especially if not well managed
- Problems with the uterus
- A high fever in early pregnancy
- An infection somewhere in the body (especially be sure to tell your doctor if you think you may have a sexually transmitted infection)
- Incompetent cervix (this means that the cervix starts to open sooner than it should)
- Obesity, especially if BMI is over 35
- Drinking alcohol
- Using illegal drugs
- Exposure to environmental contaminants like arsenic, lead, and some solvents (1, 3, 4)
- Older age of mother and/or father (3)
What Are the Signs of Miscarriage?
The most common sign of miscarriage is bleeding. In the majority of cases, bleeding is the first thing that alerts mom and her care team that something may be wrong. Fortunately, not all bleeding and cramping during early pregnancy means that there’s a problem. However, if you experience any bleeding after you’ve gotten a positive pregnancy test, you should call your doctor or midwife.
There are other signs to watch for as well. Here are the symptoms to pay attention to:
- Vaginal spotting or bleeding without pain
- Bleeding that is heavy or persists, with abdominal pain or cramping
- Pain that comes and goes
- Pain that begins in the small of the back and moves to the lower abdomen
- A gush of fluid from your vagina without bleeding or pain
- Fetal tissue passed from your vagina (1, 3)
If you experience any of these symptoms, you should call your healthcare provider right away.
How Do I Know If I’m Having a Miscarriage?
If you have the above symptoms, your doctor or midwife will talk you through how to proceed. For spotting or light bleeding, your provider might ask you to just take it easy and be watchful for a few days.
If bleeding is heavy or persistent or comes with other symptoms, he or she may do some testing. You may have blood tests. (Unfortunately, one common test doesn’t give instant answers. Rather, it needs to be repeated over a few days because your provider is watching to see if hCG levels in your blood are rising or falling.)
You may have an ultrasound to check if your baby has a heartbeat, look at the uterus and placenta, look for an ectopic pregnancy, etc. Your provider may also do a pelvic exam to check whether your cervix has dilated.
Sadly, there is no way to stop a miscarriage. If you have lost a pregnancy, the focus moves to making sure that all byproducts of the pregnancy leave your body so that you can heal properly. If you pass everything naturally, nothing else needs to be done.
Sometimes, though, tissue remains in the uterus. You may be given the option of either a medication that helps your body expel the tissue that remains or a procedure called dilation and curettage (D&C). In a D&C, your doctor dilates your cervix and removes any remaining tissue with either suction or an instrument called a curette (2). This procedure doesn’t require hospitalization and can be done in your doctor’s office.
Treatment for Missed Miscarriage
In a missed miscarriage, the baby is no longer alive but the mother’s body has not started bleeding or making attempts to expel the tissue. This discovery may happen when a doctor is listening for a heartbeat or performing an ultrasound. When this happens, the woman is usually given a choice of whether to wait and let the miscarriage happen naturally (expectant management) or speed up the process with medication or a D&C (medical management.) Unless a woman is at an increased risk of hemorrhage, it’s usually safe to wait if that’s what mom desires.
Treatment for Late-Stage Miscarriage
If a miscarriage happens after the first trimester, the baby may need to be delivered vaginally. Labor and delivery of a baby who is no longer living may sound terribly overwhelming. And without a doubt, it would be incredibly difficult both physically and emotionally. Doctors and nurses are sensitive to these situations and strive to be gentle and supportive as they work with a grieving mother.
After a Miscarriage
For most women, a miscarriage ends with the passage of the tissue and nothing else needs to be done. However, some women may need further intervention. For example, if you have Rh-negative blood, you may need an injection of Rh immunoglobulin (RhIg), which prevents you from developing antibodies that could harm a future Rh-positive baby (1). And if you’ve had three miscarriages in a row, you may want to do some testing before becoming pregnant again. This can help you can try to understand why the miscarriages may be happening.
Just remember that your fertility will likely return soon, and take steps to support your desires in moving forward. If you don’t want to become pregnant again right now, be sure you’re using birth control. If you are hoping to conceive again soon, take this pause to address any possible health concerns so that you go into the next pregnancy as healthy as possible. Be sure to continue taking your prenatal vitamin.
There’s a wide range of “normal” when it comes to how you may feel after a miscarriage. A very early pregnancy loss may not physically feel that different from a menstrual period. A later term miscarriage may require a month or more before you start feeling physically better. Either way, you will still have pregnancy hormones in your blood for a month or two, which can affect both your mood and body.
Most women’s periods return within 4 to 6 months. However, you could ovulate again early as 2 weeks after an early miscarriage. This is why you should be careful to use birth control if you don’t want to become pregnant again yet. If you do hope to conceive again soon, ask your doctor for guidance on whether you should give it some time or can start trying again right away. There’s no one-size-fits-all advice on this as doctors’ opinions vary and the details of your loss and health make your situation unique.
Emotional healing and regulation may take much longer than the physical healing. You may feel shock, sadness, anger, numbness, or any number of emotions. Even if your pregnancy was brief, you are mourning a very real loss. Don’t feel like you need to minimize that fact. Your grief may feel intense, and that’s normal. Or you may feel like you never got a chance to connect with the idea of the pregnancy and find that you’re not as sad as you feel like you should be. This is also normal. There is no right way to feel about a miscarriage, and no one right way to grieve.
Even if you hadn’t announced your pregnancy yet, you may find great comfort in leaning on your friends and family after a miscarriage. Don’t hesitate to work with a therapist or grief counselor, either alone or with your partner, to help navigate your feelings. You may also want to seek out connection with others who have suffered losses; there are many online and local support groups for pregnancy and infant loss.
Pregnancy After Miscarriage
A vast majority of women are able to become pregnant again after a miscarriage, if they choose to do so. While there can be great excitement in pregnancy, some women who are experiencing pregnancy after loss also feel a range of other emotions. They may feel a heightened sense of fear that they will suffer another miscarriage. They may have trouble getting excited because of that fear. They may find that they’re unable to really feel attached to the baby until he or she is born. All of these feelings are normal.
Talk to your doctor or midwife about how you’re feeling. He or she has walked this road with many others, and won’t be surprised or put off by anything you’re feeling. A conversation with your provider may also leave you feeling more confident or less worried about another loss. Lean on your partner and other loved ones. Connect with others who are in your position. Hopefully, you’ll find that the days pass quickly and that your little one is in your arms before you know it!
How different women feel about their pregnancy loss is as individual as the women themselves. Some feel that a miscarriage is the loss of potential, but not what feels in their hearts like a baby. Others feel very much like they lost a child, and spend their lives counting that little one right along with their living children. For some women, the pain fades quickly, while other carry a dull ache, and some other find that they wrestle with intense grief for some time. Each of these reactions is as normal as the others.
Remembering Your Baby
Some women find that memories of their pregnancy are enough for them, while others like to have a physical reminder of the little one they lost. It may be comforting to plant a tree, put a special stone or figure in your yard or garden, place a figurine in your home that represents the child, or buy a special piece of jewelry. Some parents find that giving their child a name helps them to feel more real and will choose a name, even if the pregnancy was lost too early to know for sure what the gender was. Just as there is no right way to grieve, there is no right way to remember or memorialize.
If you ever find yourself facing a miscarriage, we hope you can find a small amount of comfort in knowing how many of us have been there. There is strength in shared experiences; may you find solace in the knowledge that one in four women, including many of us here at Kopa Birth, have experienced the loss of a pregnancy. Our hearts are with you.
Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!
- The American College of Obstetricians and Gynecologists. (2010). Your Pregnancy and Childbirth Month to Month, 5th edition.
- Miscarriage. (n.d.). March of Dimes. https://www.marchofdimes.org/complications/miscarriage.aspx
- Glade, B.C., Schuler, J. (2011). Your Pregnancy Week by Week, 7th edition. First Da Capo Press.
- Alves C, Rapp A. Spontaneous Abortion. [Updated 2020 Jul 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560521/