Miscarriage: What is it and How to Cope

comforting mom

Even though it hadn’t even been a week, it was still difficult to accept the fact that the pregnancy was already over and I experienced an emotional roller coaster for a few weeks as I went through the process of grieving.

How common is miscarriage?

It doesn’t matter when you experience miscarriage – it’s heart breaking. Unfortunately, miscarriages are very common. On average, one out of every five pregnancies end in miscarriage and most happen during the first trimester, sometimes even before a woman knows she is pregnant. A small number of miscarriages – less than 1 percent – are called stillbirths because they happen after 20 weeks gestation.

Are miscarriages preventable and what causes them?

It's important for women who miscarry to understand miscarriage can't be prevented and are usually due to a developmental problem or a chromosomal abnormality. Things like the mother’s age, history of miscarriage, certain medical conditions, and fever increase the risk of miscarriage. These are factors outside of a woman’s control. 

However, there are things you can do to decrease your risk of complication such as:

  • Making and keeping all prenatal appointments
  • Limiting caffeine intake
  • Getting immunized against communicable diseases
  • Taking a prenatal vitamin daily (one with at least 400 mg folic acid) while trying to conceive and throughout the pregnancy
  • Starting out at and maintaining a healthy weight during pregnancy
  • Following your doctor’s advice given to you based on their knowledge of your situation
  • Avoiding all alcohol, tobacco products, illicit street drugs, and over-the-counter, prescription, and herbal remedies that haven’t been recommended by your OB provider as being safe during pregnancy

What are the symptoms of a miscarriage?

Bleeding and spotting are the most common signs of miscarriage, but they don’t accompany all miscarriages and bleeding and cramping don’t always mean miscarriage. In fact, 20-40 percent of women experience vaginal bleeding during the first trimester and of these, many go on to have healthy pregnancies. If a woman ever has vaginal bleeding or cramping though, she should call her doctor who can determine if further investigation or medical attention is warranted. Other causes of these symptoms include ectopic pregnancy, pelvic organ problems, and implantation spotting, all of which your doctor would consider in addition to miscarriage if you go in with cramping and bleeding. Many women have questions about implantation bleeding. It's not threatening to the pregnancy, but is only given as the diagnosis for the bleeding after all other serious complications have been ruled out.

What are the different types of miscarriage?

If you have a miscarriage, your doctor may use a few different terms to explain what happened. These might include blighted ovum, threatened miscarriage, inevitable miscarriage, incomplete miscarriage, complete miscarriage, and missed miscarriage. Here is a brief explanation of each:

  • Blighted ovum: a miscarriage happens very early on because no fetal issue has formed.
  • Threatened miscarriage: a woman is cramping and bleeding but the cervix is closed. The fetus has a heart beat and the uterus is the correct size for gestational age. In many of these cases, the bleeding subsides and the pregnancy continues to term. In other cases, the bleeding gets heavier and it progresses to an inevitable miscarriage. 
  • Inevitable miscarriage: bleeding and cramping have occurred and your cervix is opened, allowing the contents of the pregnancy to pass through.
  • Incomplete miscarriage: a miscarriage has occurred but the woman’s body is not spontaneously expelling all the pregnancy contents from her body.
  • Complete miscarriage: all the contents of the pregnancy have passed spontaneously.
  • Missed miscarriage: the fetus has died or has not developed, but the body doesn’t initiate the discharge of the fetus or pregnancy contents from the body. An example of this is what happens when a woman experiences no symptoms and then finds out at the doctor’s office that there isn’t a heartbeat.

What happens after a miscarriage is diagnosed?

A pelvic exam is performed by a doctor and an ultrasound done to confirm the miscarriage. If the woman’s body has completely cleared all the contents of the pregnancy or it happens very early on, further treatment is rarely needed. If the uterus still contains pregnancy contents, they need to be removed. Medication can be given to help this happen and in some cases, surgery is necessary. This procedure is called dilation and curettage (also known as D&C) and is where the doctor scrapes the uterine lining to clear the uterus. It is done under general anesthesia and bleeding and cramping are common afterwards.

As mentioned before, most miscarriages happen in the first trimester, but if they happen later, labor and delivery is necessary. In those situations, the doctor will recommend induction of labor at a hospital, under close monitoring and care.

How do I cope with the loss of a pregnancy?

Recovery after a miscarriage includes physical and emotional healing. There's no right or wrong way to feel afterward. If you've had a miscarriage, it's very important to allow yourself to go through the grieving process. You'll be in denial, feel anger, attempt to bargain in an effort to compensate for the loss of control, experience depression, and then finally accept it. It takes time though and you and your loved ones need to be allowed to go through each of these stages. If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help.

Talk with family and friends about what happened and about what you’re feeling. Attend support groups for women who have experienced pregnancy loss. Seek encouragement from women who have successfully overcome the heartache and grief that comes with loss. Be proactive and talk with your doctor about what happened so you're informed and able to determine if the issues you had this time might have implications in future pregnancies. If so, request early and frequent prenatal care. Try not to compare pregnancies from your past and in the future and try not to think that all pregnancies will end in miscarriage. Stay positive and focus on the future. Talk with your doctor about how soon they feel like you should start trying to get pregnant again. Most doctors recommend letting 2 to 3 cycles pass before trying again to make sure that your body is physically capable of pregnancy and that enough time has passed for you to have healed emotionally.