Miscarriage

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Disclaimer: Throughout this article we will be using the term “expectant mother” to refer to a pregnant female, although we acknowledge that not all pregnant females will become mothers. Some may choose to serve as surrogates, or to give their babies up for adoption by couples who wish to become parents. Further, we will be using feminine pronouns to describe the female who is experiencing miscarriage.

A miscarriage, or spontaneous abortion, is a pregnancy that is involuntarily terminated during the first 20 weeks that follow conception. Most miscarriages occur within the first trimester of pregnancy. Many women may not realize that they have experienced a miscarriage as it occurs early in the pregnancy, before the conceptus can survive independently outside of the womb.1

As miscarriages can be devastating and isolating events, there tends to be limited discussion about them, causing many to not be aware that miscarriages are the most common reason for pregnancy loss. Approximately 10-25% of known pregnancies end in miscarriage.2 This number is most likely significantly higher when including undetected and/or unreported miscarriages. In some cases, the female is not aware that they are pregnant, and thus remain unaware that they experienced a miscarriage.3 In the following sections we seek to bring attention to the risks and causes of miscarriage, its most common symptoms, the emotional and psychological pain it espouses, and how couples can move past the grief of such tremendous loss. 

 

Causes and Risk Factors for Miscarriage

cmp3.10.3.3Lq4 0x532a0207There are various genetic, hormonal, and medical explanations for the unexpected loss of a fetus. Often a miscarriage is due to the defective nature of the conceptus. Abnormalities in a developing fetus’ chromosomes are the most common causes of first-trimester miscarriage. Sperm or eggs that are damaged or contain an incorrect number of chromosomes can contribute to these abnormalities and make it impossible for the baby to survive.2,3 The mother’s age and health also contribute to the possibility of miscarriage. Risk of miscarriage increases with age, and females in their 40’s or older have a five times greater risk of miscarriage than those aged 31-35.4 Where the standard rate of miscarriage is 10-25%, females who are younger than 35 have about a 15% chance of miscarriage. This percentage increases to 20-35% for females between 35 and 45 years of age, and reaches 50% for women age 45 and above.2 Women who struggle with hormonal issues, thyroid disease, diabetes, infections, and autoimmune disorders may experience spontaneous abortion, as well as those who are severely over or underweight.1,3 Females who are obese may experience difficulties becoming or remaining pregnant, and it is often recommended that some weight is lost prior to becoming pregnant or beginning treatment with assisted reproductive technology (ART).

Unhealthy lifestyle choices, such as smoking, alcohol and drug abuse can further complicate a pregnancy, and often lead to miscarriage. In a study conducted among females aged 14-39, researchers found that 34.6% of the participants who experienced a miscarriage were smokers. The chemicals found in cigarettes can damage the placenta and inhibit fetal development, causing them to die in the womb. Other studies conducted on the how alcohol consumption may influence miscarriage have established a somewhat indirect connection between the two. Studies show that miscarriage due to alcohol has a stronger basis in how much or often an expectant mother drinks, as opposed to consumption alone. In other words, alcohol abuse can be seen as a risk factor for miscarriage, while occasional alcohol consumption may not be a factor. Findings of these studies revealed that expectant mothers who drank alcohol daily were twice as likely to miscarry as those who did not drink.4 While these studies do not directly tie alcohol consumption or the act of smoking to miscarriage, it is not recommended for the health and development of the fetus to partake in either activity during pregnancy.

In addition to age, illness, and lifestyle, some reproductive disorders can contribute to higher risk of miscarriage. Conditions such as Polycystic Ovarian Syndrome (PCOS), endometriosis, and complications thereof have been linked to greater risk of spontaneous abortion. Anatomical defects of the reproductive system also influence a fetus’ ability to live to term. Uterine septum—a congenital deformity in which a cavity of tissue divides the uterus—is the most prevalent of these, and research reveals that miscarriage has occurred in 79% of the expectant mothers with this deformity. Becoming aware of the possible causes of miscarriage can help expectant mothers take steps to prevent them. Although miscarriages are unintentional and most often unexpected, treating pre-existing medical conditions that can influence pregnancy loss and adopting healthier habits can help to manage the probability that they will occur.4

Signs and Symptoms of Miscarriage

Although some females do not realize that they are pregnant and therefore do not realize they are experiencing a miscarriage, some females can recognize obvious signs. Notable symptoms commonly include vaginal spotting or bleeding, cramps akin to period cramps, painful contractions occurring every 5 to 20 minutes, and lower back pain. Miscarriages that take place later in the pregnancy can result in more uncomfortable cramping and intense vaginal bleeding. Expectant mothers may also experience a sudden change in their vaginal discharge, or pass tissue with clot-like matter from the vagina.1,2 For those who are aware that they are pregnant, it is possible to notice a sudden decline in the normal signs of pregnancy or unexpected weight loss.2 If experiencing any of these symptoms during pregnancy, it is imperative to contact a health professional and seek further medical assistance. While some symptoms may appear as a result of less severe and threatening conditions than miscarriage, a doctor’s attention ensures safety nonetheless.1

 

Types of Miscarriage

Although miscarriage is often referred to as a singular event (the loss of the fetus during pregnancy), it is actually a process with multiple stages, each of which affects the fetus differently and can be accompanied by specific symptoms. There are five types of miscarriage. The first is a threatened miscarriage, where a woman may experience some vaginal bleeding, cramps, and/or pain in the lower back. However, the cervix remains closed, preventing the fetus from being expelled from the body . The fetus is lost in approximately half of all threatened miscarriages. In the other half, the baby may survive the full length of the pregnancy once the bleeding stops. The second type is an incomplete or inevitable miscarriage, in which the cervix begins to open with symptoms similar to that of a threatened miscarriage. In this case, however, the pregnancy is unable to continue because of cervical dilation, and the mother may continue to endure bleeding and cramping if not all of the pregnancy tissue is discharged from the uterus. The discharge of pregnancy tissue from the uterus also occurs in complete or missed miscarriages, yet the fact that not all of the tissue is expelled is a defining characteristic of incomplete miscarriages. Medical care is usually necessary to remove the tissues left inside. Unlike an incomplete miscarriage, a complete miscarriage involves the full expulsion of the embryo or products of conception from the uterus. Pain and bleeding normally dissipate soon after the miscarriage has completed.2 A fourth type of miscarriage is the missed miscarriage. A pregnant female may not be aware that she has experienced a miscarriage, in that the common signs of bleeding and cramping may not be present. The embryo dies inside the uterus without being expelled. Therefore, signs of pregnancy such as ultrasound-detected heartbeat may be absent, and medical treatment may be necessary if pregnancy tissues are not passed automatically. The final type of miscarriage is recurrent, meaning that a woman has experienced three or more first trimester miscarriages. This type is uncommon, and has only been found to affect about 1% of people attempting to conceive children.1,2

In addition to the five main types of miscarriage, there are several notable pregnancy anomalies that can lead to spontaneous abortion, and possibly threaten the health of the mother. A blighted ovum, or embryonic pregnancy, occurs when a fetus does not begin to grow and develop upon the implantation of a fertilized egg. In this case a pregnancy is not necessarily lost, but simply fails to begin. Another condition is ectopic pregnancy, where a fertilized egg implants and begins development in a location other than the uterine wall (such as the fallopian tube). This situation can be quite painful and must be treated quickly to avoid severe health risks for the mother. Further, a molar pregnancy is caused by a genetic mistake in the process of conception, causing the uterus to begin growing abnormal tissues that can mimic the signs of pregnancy. A woman may miss her period or experience morning sickness, or even receive a false positive result from a home pregnancy test. While the above health conditions may not directly affect the miscarriage process, they do pose risks to women trying to conceive.2 It is important to pay attention to the body and its changes during pregnancy, and consult a doctor about possible symptoms of both the miscarriage process and the above conditions.

 

Coping After a Miscarriage

After a miscarriage, it is understandable for the expectant mother to feel overwhelming sadness and grief for her lost child. However, miscarriage can affect more people than just the pregnant female—her partner is also likely to feel the loss of their unborn fetus, and the relationship between partners may shift in its nature as recovery takes place.  Both partners may need time to grieve separately, yet also support and uplift one another during this time. The following sections outline the influence of miscarriage on the expectant mother, her partner, and the couple together and detail how family and friends may help them through their period of grief.  

For the Expecting Mother

A spontaneous abortion can be a significant loss for the expectant mother. A strongly desired pregnancy that ends in a miscarriage can cause a great deal of grief and emotional suffering, and it is normal and encouraged for those involved to take time for emotional and psychological healing. It may take several weeks or months for the female body to completely recover from a spontaneous abortion, as pregnancy hormones can remain in the blood for this length of time. However, the process of emotional healing for all involved may take longer.3 Miscarriage is an especially difficult loss to accept and process due to the connection formed between an expectant mother and her developing baby. Even within the first 20 weeks of gestation, it is possible for a mother to develop a meaningful bond with her emergent child and to feel its existence as part of her own. During this time, expecting mothers also begin to develop their own maternal identity, which includes breaking from their identity as their mother’s child and embracing a new one as their child’s mother.5 If these processes of bonding and identity formation are arrested by miscarriage, the effects can be psychologically and emotionally damaging to the female. It is normal to feel a wide range of emotions, including grief, guilt, hopelessness, anger, confusion, shock, relief, or isolation.1,3 Females who have experienced multiple miscarriages, as well as those struggling with infertility or are receiving treatment, may feel an even stronger sense of hopelessness based on a history of reproductive difficulties. People process grief and loss in varying ways and coping after a miscarriage is no different. Some may find themselves overwhelmed with sadness upon accepting the loss of their child, while others may experience intermittent bouts of depression as time passes.5 It is often difficult for women and their families to process miscarriage in that it leaves no physical trace to mourn or remember in future years.8 However, feelings of loss and emptiness are as normal for miscarriage as they would be for the death of any person.

For the Expecting Mother’s Partner

The process of grieving after a miscarriage not only applies to the female who has miscarried, but to a partner as well. As an expecting parent, a partner can feel the loss of an unborn child just as deeply as the pregnant female. In this position some may feel caught between their own feelings and those of the female who has experienced a miscarriage, and may focus on being supportive rather processing the loss internally as well.

Given that women are often the focus in the discussion of grief and loss post-miscarriage, the male grieving process is often overlooked. Many men do not allow themselves to truly feel the loss of a child they helped to create and feel pressured by society to take things “like a man.” Some feel responsible to serve as a solid comfort for their grieving partner. As such, some men experience more specific symptoms of depression, such as aggression, avoidance, hostility, increased alcohol or drug use, and overall emotional suppression.9 However, as previously discussed, all people process grief individually, and these symptoms may not appear in all men.  In addition, not all partners of miscarrying females will be male.  Still, it is important to recognize the significance of the grieving process in both expecting parents, and for partners to acknowledge that their feelings are valid and normal. 

For the Expecting Mother and her Partner

While grief is usually a matter to be processed individually, a miscarriage can also affect a couple as a unit. Partners may come together in their time of sadness in order to help one another process and understand the loss. Factors of age, both of a couple and of an unborn fetus at the time of miscarriage, can also affect a couple in its aftermath. Studies have found that younger couples experience increased levels of grief and anxiety following a miscarriage than older couples, and that men may feel strong senses of guilt and sadness when losing a child earlier on in the pregnancy.6 Though loneliness and isolation are common feelings for people affected by spontaneous abortion, it is important for couples and family members to remember that miscarriage is not uncommon, and that many other people have also gone through the devastation of losing an unborn child.7

Couples should understand that they might mourn differently from one another and exhibit separate symptoms of sadness and loss. Nonetheless, it is helpful for partners who have experienced a miscarriage to come together, to lean on one another for support, and to keep open and honest communication throughout the emotional healing process.1

In order to help someone cope with a miscarriage, it is important to be supportive and offer to help in any way. People should avoid making light of the situation, or criticizing those affected.1 The woman, couple, or family members may need some time and space to cope with their loss and return to normal life. However, if those affected by the failed pregnancy suffer long-term psychological turmoil, such as depression, weight loss, anxiety, and/or feelings of loneliness, it would be wise to consult a counseling specialist to help relieve these lasting effects.1

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Moving Forward

After taking time for both physical and emotional recovery from a miscarriage, couples may eventually wish to continue trying to conceive. After having one regular period following the miscarriage, it is usually safe to begin trying for a baby. Open communication between partners, as well as with a doctor, can help couples decide when is the right time to try again. Some doctors encourage further testing to discover the possible cause of spontaneous abortion.3 Becoming pregnant again is a joyous occasion, but can cause concern and anxiety for women who have experienced a miscarriage before. While it is impossible to prevent spontaneous abortions that occur due to chromosomal abnormalities interfering with zygotic implantation, there are several measures one can take to keep the body as healthy and strong as possible during pregnancy. Regular exercise, stress management techniques, and healthy eating are several examples of healthy habits. In addition, ending habits of smoking, drug use, or excessive drinking can further help prepare the body for pregnancy. It is also best to avoid activities that could injure the abdomen or environments in which others are smoking.2 Maintaining a healthy body while trying to conceive and during pregnancy provides a more nurturing environment for a baby to grow and develop. Moving past a miscarriage may be difficult, yet it is not impossible.  Recovery and subsequent progress offer couples the chance to begin again, and to fulfill their goals of having children.

Overview

Miscarriage is a common form of pregnancy loss, but can be heartbreaking for hopeful parents all over the world. It is important to be aware of the general symptoms of miscarriage, and to immediately contact a medical professional if a female believes she is experiencing one. While moving forward can be difficult among thoughts of hopelessness, experiencing a miscarriage does not mean that having children is impossible. Consulting a doctor can clear up uncertainty surrounding the cause of miscarriage, and may provide some clarity and insight in how to progress. If infertility causes recurrent miscarriages, there are many other options for couples to start a family. Assisted reproductive technology provides tools to help couples conceive a child. Like any death, the loss of an unborn child is devastating to expectant parents and family members, and those affected may grieve in different ways. Above all, offering love, understanding, and support for those who have suffered a miscarriage provides a foundation for them to grieve, heal, and move forward.

 

References

1. “Miscarriage.”  plannedparenthood.org.  Planned Parenthood.  Web. 13 Apr. 2017. 

2. “Miscarriage.” americanpregnancy.org.  American Pregnancy Association.  Aug. 2016.  Web. 13 Apr. 2017. 

3. “Miscarriage.”  Marchofdimes.org.  March of Dimes.  Jul. 2012.  Web. 13 Apr. 2017. 

4. Agenor, Angena and Sohinee Bhattacharya.  “Infertility and miscarriage: common pathways in manifestation and management.”  proquest.com.  World Health Organization.  Jul. 2015.  Web. 11 Apr. 2017. 

5. Duffey, Thelma PhD.  Creative Interventions in Grief and Loss Therapy: When the Music Stops, A Dream Dies.  2005.  Web. 14 Apr. 2017. 

6. Huffman, Carolyn S., Todd A. Schwartz, and Kristen M. Swanson.  “Couples and Miscarriage: The Influence of Gender and Reproductive Factors on the Impact of Miscarriage.”  elsevier.com.  Women’s Health Issues Journal.  10 Apr. 2015.  Web. 14 Apr. 2017. 

7. Hercz, Daniel et al.  “A National Survey on Public Perceptions of Miscarriage.”  Department of Health & Human Services.  Jun. 2015.  Web. 14 Apr. 2017. 

8. Harris, Janice.  “A Unique Grief.”  proquest.com.  International Journal of Childbirth Education.  Jan. 2015.  Web. 11 Apr. 2017. 

9. Lewis, Julie and Rima Azar.  “Depressive Symptoms in Men Post-Miscarriage.”  Journal of Men’s Health.  2015.  Web. 14 Apr. 2017.    

 

Last Updated: 24 May 2017.