At least 10 percent of all known pregnancies will end in miscarriage, according to the American College of Obstetricians and Gynecologists (ACOG). Pregnancy loss is an emotional experience for everyone involved, especially mothers. And while many women have a difficult time discussing this sensitive topic, if you or someone you know has had a miscarriage, it’s healthy to be open about it if you’re comfortable doing so.
To help you learn more about miscarriages, we spoke with Lauren Linden, a midwife at Mountain Vista OB/GYN and Midwifery in Denver, Colorado, about common miscarriage symptoms and causes, plus what you can expect to happen afterwards.
What is a miscarriage?
In short, a miscarriage is a pregnancy that ends on its own, usually sometime in the first 20 weeks of gestation, or 20 weeks from your last period. The risk decreases as pregnancy progresses; just 1 percent of miscarriages occur after 20 weeks. “Miscarriages are most common before a woman reaches 12 weeks—the earlier in your first trimester, the more common they are,” says Linden.
What causes a miscarriage?
It can be hard to understand why pregnancy loss happens. There are numerous factors, but just about half of miscarriages occur because there is some sort of chromosomal abnormality, or problem with the baby’s DNA. Some things that can increase your risk include:
- Maternal age. women over 40 have a higher chance of miscarriage
- Lifestyle issues like smoking and drug use
- Exposure to radiation or toxic elements
- Maternal trauma such as car accidents and major falls
- Previous miscarriage
- Problems with implantation of the fertilized egg
- Immune system disorders such as lupus
- Chronic conditions like uncontrolled diabetes, or heart, kidney or thyroid disease
- Malnutrition
- Abnormal uterine shape
- Blighted ovum, or when a fertilized egg attaches to the uterine wall, but the embryo does not grow
- Ectopic pregnancy, or a pregnancy that implants outside the uterus, typically in the fallopian tube
Often, women worry they may miscarry because of something they do within the first few weeks of pregnancy. But many of the things women are concerned about—like working, exercising, sex and previous birth control use—are unlikely to trigger a miscarriage.
Drinking alcohol before you know you're pregnant or during the first trimester could increase the risk of miscarriage. And alcohol is not recommended at any point during pregnancy.
Signs and symptoms
Sometimes, you may have a miscarriage even before you know you're pregnant. Other times, there are no symptoms at all; this is called a silent or missed miscarriage. When there are signs of a miscarriage, they vary from woman to woman. The most common are:
- Bright or dark red bleeding
- Mild to severe back pain
- Intense contractions every 5 to 20 minutes
- Tissue with clots passing from the vagina
- No longer feeling like you’re pregnant
In general, if something feels off, you should see your healthcare provider (HCP)—especially if you’re having any or all of these miscarriage symptoms.
What happens afterwards
Once you're in your HCP’s office, they will conduct a pelvic exam and ultrasound to determine whether the baby’s heart is beating normally, or if you’ve had a miscarriage. Your HCP may also perform an hCG blood test. If your hCG levels are doubling, the baby is growing normally. If your hCG levels are falling, that may be a sign of miscarriage.
Miscarriages that occur earlier on in pregnancy may not require surgery or medical procedures, since the tissue may pass through your body naturally. However, if your HCP suspects the miscarriage was incomplete—that any fetal tissue remains in your body—it may need to be removed, because it can lead to infection. Treatment may also be needed if there’s heavy bleeding.
The most common surgical procedure for this is called a dilation and curettage (D&C). In this hospital procedure, the cervix is dilated, or opened, so any remaining pregnancy tissue can be removed by a suction device or curette, a small instrument used to scrape the tissue from the uterine wall. Another procedure is called a vacuum aspiration, where a thin tube connected to a suction device is placed inside the uterus to remove remaining tissue.
Can you prevent miscarriages?
Since most miscarriages happen because of chromosomal issues, many of them are inevitable. However, if you’re trying to get pregnant—or you’re not—you should always practice healthy habits to keep your body in tip-top shape and reduce your risk. Here are some simple guidelines:
- Get regular exercise
- Eat a well-balanced diet
- Keep your stress levels under control
- Avoid smoking
- Take a daily folic acid supplement
- Maintain a healthy weight
If you’re taking any type of prescription medication, talk to your OBGYN about whether it's safe to continue while you’re trying to conceive, says Linden.
Miscarriage and future pregnancies
A common misconception is that once you’ve had a miscarriage, you won’t be able to get pregnant again. The majority of the time, this is absolutely not the case. In fact, 87 percent of women who have lost a baby go on to have regular pregnancies and births down the road.
It’s always best to speak with your HCP if you’ve had a miscarriage and you’re ready to start trying again. "There is not a proven recommendation for the correct time to ‘wait,’” says Linden. "However, I do recommend waiting at least one menstrual cycle, or the appropriate time that is needed to grieve the loss."
Your OBGYN may suggest you wait up to three months before trying, or that you receive the hormones to improve your fertility. If you’ve experienced two miscarriages in a row, your OBGYN may advise you take a break from trying to conceive until they do a work-up to determine the cause.
The most important thing to remember is that you should not blame yourself for a miscarriage. Take some time to process the loss afterwards—to heal both physically and mentally. Talk to your HCP about support groups that will allow you to discuss your feelings in an open and honest way.
