What is miscarriage? Causes, warning signs and how to cope

About 1 in 5 medically recognised pregnancies end in miscarriage, but we still don't talk about it anywhere near enough.
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Guide To Understanding A Miscarriage | Kin Fertility
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Content warning: Miscarriage, pregnancy loss

The very first and single most important thing to know about miscarriage is that you're not alone.

When we go through situations that throw us into the pits of grief, shame, and utter confusion, it can be difficult to remember this simple fact. Your experiences and feelings are unique, but it’s important to know there are other women out there who have experienced their own version and can help you or simply validate your feelings.

While the reality of miscarriage is devastating and hard to accept, it helps to remember that this is your body ensuring the best for yourself during pregnancy as well as your overall health.

What is miscarriage and how common is it?

Medically, miscarriage may be referred to as spontaneous abortion, miscarriage or early pregnancy loss, all of which refer to a loss prior to 20 weeks, typically within the first trimester.

The commonly cited statistic is that about 1 in 5 medically recognised pregnancies end in miscarriage [1].

The earliest detection of pregnancy is 2 weeks after implantation, at the first sign of a missed period. Often, women who miscarry in these very early weeks mistake the situation as a late period, never knowing they were pregnant to begin with. On top of that, many fertilised eggs are lost prior to implantation, which is classed as implantation failure.

For those who know they're pregnant, miscarriage can happen at any time during the pregnancy, though about 80% occur within the first trimester [2].

Loss after 20 weeks — which is referred to as stillbirth — is far less common, with only 2-3% of pregnancies ending in the second trimester [3].

Why do miscarriages happen?

There is so much information out there on the causes of miscarriage. It can be overwhelming to consider all of the factors that may or may not affect our health on a day-to-day basis, let alone that of our unborn child. Plus, it can often feel like ‘if only you’d done something differently’, maybe this wouldn’t have happened to you.

While certain factors do put some women at higher risk, a miscarriage can happen to anyone, and the number 1 cause of miscarriage — random genetic error — is completely out of our control.

Essentially, during cell division, chromosomes misalign resulting in errors that would make normal foetal development impossible. Put simply, this is the body’s natural process for expelling a pregnancy that just wouldn’t be able to develop.

On the male side of things, poor sperm parameters — as well as poor lifestyle, which can increase DNA fragmentation in the sperm — have been associated with miscarriage.

As hard as the reality of losing your unborn child is to cope with, simply knowing that it isn’t your fault helps ease some of the heartache and mental blocks that may arise about the future of your fertility.

So, what risk factors are linked with miscarriage?

Age

It’s an unfortunate fact of biology that as we age, our fertility naturally decreases as we’re born with all of the eggs we’ll ever produce already in our ovaries.

While the ability to get pregnant naturally and carry a full-term, healthy baby will always vary from individual to individual, chances decrease as both women and men age [4]. For a couple in their early 30s, the chances of falling pregnant per month are about 1 in 4, whereas these decrease to 1 in 10 for women over 40.

Plus, the risk of genetic abnormalities in the pregnancy increases as you get older (this includes through IVF), as do the chances of random genetic errors occurring.

In fact, nearly 80% of miscarriages in women over 35 are the result of chromosomal abnormalities, and a study done at the University of New South Wales shows that the risk of any chromosomal abnormality steadily increases with the mother’s age, reaching 1 in 8 by the age of 49 [5][6].

As always, every individual body is different, and plenty of women are able to conceive and carry viable pregnancies later in life, but it’s important to have all of the information at hand if you’re planning on having children.

Physical or structural causes

In some cases, uterine abnormalities or health conditions may raise your risk of miscarriage. Thankfully, knowing if you have any of these conditions means you can work closely with your doctor to take the best route in decreasing the effects of these issues on your pregnancy.

One such condition is uterine fibroids, the most common benign tumours in women of childbearing age. Fibroids are associated with infertility in 1-2% of cases, and women who have them are 20-30% more likely to miscarry than women who don't [7].

Note that not all fibroids have an impact on fertility: the only ones that have been proven to cause fertility problems are those that impact the uterine cavity [8]. There is also an increased risk of miscarriage if there is a uterine septum.

If you’re experiencing symptoms of fibroids or know you have them, reach out to your doctor about options for treatment and how they may affect your plans to become pregnant.

Other conditions that may increase the risk of miscarriage — and that you should speak to your doctor about if you suspect you have them — include:

  • Poorly controlled diabetes
  • Thyroid dysfunction
  • Autoimmune disorders, including coeliac disease and antiphospholipid syndrome (APS)
  • Blood clotting disorders, known as thrombophilias

When these diseases are undiagnosed or poorly managed, they drastically increase the risk of fertility issues, recurrent miscarriage, and a range of other intrauterine concerns including growth restriction.

Lifestyle

Just up front, we’d like to mention that any type of excessive drug or alcohol intake will increase a range of risks during pregnancy, including, but not limited to, chances of miscarriage.

An analysis of a series of studies over the last 50 years strongly proves that alcohol intake and miscarriage rates are closely correlated [9]. Of the participants studied, those who were drinking up to 5 alcoholic drinks per week increased their risk of miscarriage by 6% with every additional drink.

If you feel you may be at risk of excessive use of substances, speak to your doctor about treatment plans and the best options for a successful pregnancy.

Outside of illegal drug use, it’s also important to note that there's a range of over-the-counter and prescription drugs that can create complications and increase risks during pregnancy, including some consideration towards nutritional supplements and complementary medicines (such as herbal medicines).

For example, in Denmark, a study of pregnant women using a selection of herbal medicines for general well-being indicated that taking licorice supplements was associated with increased blood pressure [10]. They also found that patients' healthcare providers were often unaware of their consumption of alternative medicines.

One Danish study showed that the use of anti-epileptic drugs increased the risk of miscarriage by 13% [11]. In contrast, a study out of Quebec suggested that the use of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with a 2.4 times higher risk of miscarriage [12]. However, the Canadian Medical Journal reported that the study didn’t prove these risks were caused by NSAIDs alone.

Being completely open and honest with your doctor about your medical history and drug use (including herbal medicines or anything you take recreationally) will help ensure the best outcome of your pregnancy.

Weight

Women whose body mass index (BMI) was classified as overweight by the World Health Organisation (WHO) standards correlated with an increased reoccurrence of miscarriage [13].

Menstrual disorders, infertility, and sporadic pregnancy loss are associated with women who fall into higher BMI, and complications later in pregnancy — including gestational diabetes, hypertension, preeclampsia, thromboembolism, and antepartum stillbirth — all increase with higher BMI.

If you feel that your BMI may put you at risk for any of these, we’d recommend speaking with your doctor about weight management or precautions you can take prior to and during your pregnancy. A program like Juniper's Weight Reset Program can also help you reach a healthy weight through medication, health coaching, and regular 1-on-1 check-ins with a GP.

Does stress cause miscarriage?

Strangely, it’s a topic that medical professionals seem to disagree on, with many medical associations claiming that psychological stress doesn’t have any effect on rates of miscarriage. That said, a 2017 analysis of 8 medical studies showed significant evidence that prior psychological stress did indicate an increase in the occurrence of early pregnancy loss [14].

Stress has a significant negative impact on the nervous, endocrine, and immune systems, therefore it's fair that it raises concerns amongst women, and stress management should be considered when planning for a pregnancy.

Warning signs

When it comes to the process of supporting new life, it’s understandably easy to worry that something may go wrong and to err on the side of caution more often than not.

If you have any concerns or questions, we encourage you to see your doctor, obstetrician or midwife because we believe you’ll rest more easily knowing you’ve acted on your concerns. They should be able to give you the rundown on what you can expect during pregnancy and what’s not so normal.

That said, here are some common warning signs which warrant a visit to your doctor ASAP.

Vaginal bleeding

Spotting during early pregnancy is common and 20-30% of women experience some vaginal bleeding within the first trimester [15].

What many women may not realise is that it’s common to experience what’s known as implantation bleeding. This is when a small amount of spotting occurs when the embryo is implanted into the uterine wall. Implantation bleeding usually occurs around the first couple of days of a missed period, so women may mistake this for a period, even though it’s generally much lighter.

All of that aside, some light bleeding during early pregnancy may be okay, but anything heavy or accompanied by cramping should be cause for concern, including the appearance of blood clots or tissue. If you're worried about bleeding, go to your doctor or a nearby hospital. Depending on the stage of pregnancy, they may be able to do blood tests or scans to hopefully ensure all is OK.

The risk of experiencing this can be associated with a C-section, trauma, previous uterine surgery, or the baby’s position in the womb, as well as previous miscarriages.

Cramping

While some bleeding may be normal, cramping is not. Women experience cramping during the normal cycle when the uterus is contracting to shed the uterine lining, as well as during labour when the uterus is contracting to deliver the baby.

Any cramping or abdominal pain during pregnancy could be a sign of distress, showing that your body is reacting in a way to expel the pregnancy. This includes back pain, which may not be a cause for concern if it’s mild, but we’d still recommend speaking to your doctor if any of these occur.

Sudden changes in pregnancy symptoms

Sometimes a pregnancy just doesn’t progress and the only way you’ll know is when your obstetrician doesn’t find a heartbeat at one of your checkups. There may just be no signs or symptoms.

Bear in mind that morning sickness (or nausea, because let’s be honest, it doesn’t only happen in the morning) usually fades after 13 or 14 weeks, but for some women, it can last the entire pregnancy (known as Hyperemesis Gravidarum).

If you're experiencing morning sickness early in your pregnancy and it suddenly stops, particularly if it’s accompanied by any other precautionary signs as the ones we mentioned before, see your doctor immediately.

Do my risks change throughout my pregnancy?

As previously mentioned, 80% of pregnancy loss happens within the first trimester. Based on a study out of Victoria performed over a 2-year period at an antenatal clinic, the chance of miscarriage after 13 weeks (with no other symptoms) is low, at 1.6% or less after a healthy gestational visit at 11 weeks [16].

The same study shows that chances of loss continuously decrease week-on-week as pregnancy progresses up to 13 weeks.

That said, late-term pregnancy loss can still occur, and the above study doesn’t consider any causes other than the duration of pregnancy.

What happens to your body after a miscarriage?

When diagnosed as a miscarriage, your doctor may refer to your loss as a:

  • Complete miscarriage, if all the pregnancy tissue has already passed
  • Incomplete miscarriage, if some of the tissue has passed but some still remain in the uterus
  • Missed miscarriage, if the pregnancy has stopped growing but the tissue has not passed and the sac surrounding the embryo or foetus is still within the uterus

Once a loss occurs, there are 3 treatment options.

1. Natural miscarriage

The first option is to wait and let the tissue pass naturally, which can take up to 2 weeks. The experience can be intense for a number of reasons, not least the pain of the contractions that assist the body to expel the pregnancy.

For the most part, in the early stages of pregnancy, it’s healthy for a woman to miscarry naturally, but the situation will depend on your general health, background, and if you feel mentally able.

Women may choose this method to avoid taking medication and needing to stay in the hospital but the difficult side of this (aside from the above listed) is that you won’t know how long it will take to start or to pass, which can cause a lot of pain and anxiety.

2. Medical miscarriage

You can also choose to take medication to expel the tissue within a week. The pros of taking a medical miscarriage include speeding up the process, avoiding being put under anesthetic, and avoiding the surgical procedure of dilation and curettage (or D&C, which we'll get to next).

However, similar to naturally miscarrying, the process can be very painful. Additionally, with both medical and natural miscarriage, there will always be a chance that not all pregnancy tissue will pass and you’ll end up needing to proceed with a D&C regardless.

3. Dilation and curettage

Dilation and curettage, or D&C, is a medical procedure used to dilate the cervix and scrape out the tissue. Many women prefer the procedure over the above options because it’s the fastest option. You’ll also be under anesthetic, which means some of the physical and emotional pain of actually passing the tissue may be avoided. Plus, it’s much more likely that all of the tissue will be removed the first time around with a D&C.

D&Cs can, for the most part, be avoided if you'd prefer not to go through the procedure or have the experience in the hospital. However, it should especially be avoided if you have a pelvic infection, issues with clotting or other medical issues that may raise concern (your doctor can help you understand the risks).  

It's important to know that there are complications associated with D&C procedures including haemorrhage, infection, and perforation of the uterus.

Additionally, the procedure comes with a very small risk of Asherman Syndrome, the formation of thick scar tissue, which can lead to infertility. That said, Asherman Syndrome is very rare and generally only occurs in women who’ve had multiple D&Cs.

D&C can be a good option for women who don’t feel prepared to experience the pain and processes of naturally completing a miscarriage, and while it comes with its own risks, with a proper ultrasound and medical pre-check, most can be avoided.

Breast milk

It seems unfair knowing that your body is switched on enough to naturally expel a nonviable pregnancy but doesn’t recognise that once a stillbirth occurs, there's no need to carry on the rest of the birthing process. Yet, after a stillbirth, breast milk will still be produced.

This can add to the emotional distress of the event overall, and it’s something that often gets left off when discussing the experience, meaning when it happens, it can feel crueller and more shocking.

Women who experience stillbirth are given medication to suppress lactation. However, if any does occur, applying ice packs and taking a mild pain relief tablet will help ease the pain of swollen and engorged breasts which occur due to milk production.

Cramps

It’s normal to experience cramping similar to labour contractions as your uterus reduces back to normal size. Medication can help ease some of the pain.

Bleeding

Again, there are some natural birthing processes that still must occur during stillbirth, including lochia, which is the heavy period that women experience after birth. Lochia is the body shedding the lining of the womb and blood from where the placenta was attached, generally lasting around 2 weeks.

What happens emotionally?

In a world where social media makes it easy to put our best life forward for all to see, pregnancy loss can feel even more harrowingly lonely and silent.

Nearly 20% of women who experience miscarriage become symptomatic for depression and anxiety, and continuing regular mental health checks starting at 6 weeks after your loss can help you manage these conditions [17].

Lacking the belief that society understands or accepts your experience can exacerbate these emotions. That’s why it’s important to talk about your loss (when you’re ready) and seek support from friends, family and professionals.

Guilt

Because miscarriage is so uncommonly discussed, many women and couples don't realise how common it is. On top of that, they're often inclined to believe something they’ve done has caused it.

It’s easy (and normal) to be plagued with questions about why any shocking or traumatic experience has happened to you, and pregnancy loss is no exception. Particularly for a mother whose body is carrying the child, it’s easy to feel that something you’ve done has meant you haven’t provided properly for that pregnancy to grow.

But as we mentioned at the very beginning of this article, not only is pregnancy loss common, it’s often due to completely random development issues, and while there are some factors about the mother’s health that can contribute, they are much less likely to cause miscarriage.

Something else about grief that feels important to mention: healing is not selfish. Starting to feel better — however long it takes — doesn't denote your lack of care or memory of your unborn child in any way.

Healing is healthy, it’s natural, and it will allow you to move back into the swing of things, rebuild connections with friends, family, and your partner, and eventually, if you want to, continue to plan for a family.

Shame

Shame is one of the heaviest emotions we're capable of feeling. Different to guilt over our actions or embarrassment over how we’re being perceived, shame denotes our internal feelings about ourselves — the idea that we're fundamentally bad.

It’s one of the top emotions women recall after pregnancy loss. A feeling that your body doesn’t work properly, or that you’ve let your partner down, or that as a mother you haven’t been able to save or care for your baby. Or simply that you're different or worse than everyone else because you weren’t able to carry a full-term pregnancy.

In these cases, again, it’s important to remember not only that miscarriage is common, but that it’s a natural occurrence in the body that cannot be stopped.

Speaking with your doctor after a loss and covering all of the information about what happened is a good option to help ease the questioning in your mind about why something like this has happened.

Being armed with information may help you feel more in control, and better manage the feelings of shame and guilt that occur. It’s a good reminder that the loss wasn’t your fault and that, if you want to try again down the line, it doesn’t mean this will happen again.

Post-traumatic stress disorder

One study out of Imperial College in London surveyed 113 women after early pregnancy loss, monitoring their mental conditions at 1, 3, and 9 months after the event [18]. In this study, 38% of women reported symptoms of post-traumatic stress disorder (PTSD) 3 months after their loss.

The Mayo Clinic defines PTSD as a mental health condition triggered by experiencing or witnessing a terrifying event [19]. Symptoms can include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event.

Bear in mind that miscarriage is a traumatic experience on a variety of levels, including physical, emotional, and social. So, the fact that so many experience PTSD isn’t at all a surprise.

If you feel that may be the case for you, seek medical support.

Sharing your experience

Talking about your experience openly can help ease the pain, because not only will you be releasing some of the burdens of holding your feelings in, but you’ll likely find that many women around you can relate or have had similar experiences. This can make you feel less alone and in turn, make them feel less alone too.

There’s really no way to avoid or ease the sense of loss of a miscarriage. It’s important to take the time you need to heal and to seek help from a mental health professional if you feel that your pain isn’t easing naturally.

How miscarriage affects your partner

As with any traumatic experience, miscarriage can test a relationship. As both partners grieve, it can be difficult to know how to support one another, and many couples report that this experience creates a disconnect in communication.

While everyone has their own way of processing tough emotions, one of the most important things to remember is that open, honest communication is key.

Both partners should feel that they are supported in the emotional process and that their own emotions and thoughts are valid. One of the best ways to understand that is through sharing with your partner and getting their own feelings and perspectives.

Remember that as a partner, you’re experiencing both the loss of the unborn child and the pain of watching your partner endure it. And while it’s not your body that’s been through the experience, it will still have traumatic effects.

If you’re having trouble discussing the miscarriage with each other, you can always seek professional help in grieving together. After all, it can be hard to understand how to process and support each other through trauma if you’ve never experienced it in your relationship before.

Seeking outside support for yourself may also be beneficial in a number of ways — especially because in the early stages, your partner may not feel ready or capable of supporting you. Plus, it may bring valuable insight that you can share.

What to do if your partner miscarries

The partner who experiences the miscarriage may feel that their partner lacks the depth of grief if they attempt to carry on as normal, such as going back to work or showing less emotion, and that in itself can be hard to deal with.

For both people, it’s important to remove expectations around how the other should be reacting. Everyone experiences emotions differently, and the most important thing for anyone is knowing their feelings are valid and being given the space to experience them.

Be kind to each other, try to hear and understand each other’s thoughts and emotions, and feel completely comfortable sharing your own feelings. This will help you feel stronger and more supported as a couple and as individuals.

When can I start trying again?

If you’re ready to start trying again sooner rather than later after a miscarriage, it’s important to speak to your doctor to confirm if there are any medical reasons for you to wait.

Deciding to try again after a miscarriage is a personal choice, and your mental and physical health should be carefully considered.

That said, a study done at the Mater Research Institute at the University of Queensland showed that 66% of couples who experienced stillbirth were able to conceive within the year [20]. The participants themselves, as well as those in another study conducted in Ireland, suggested they required more frequent examinations in their subsequent pregnancies to ease their concerns about recurrent miscarriage or stillbirth [21].

When you feel ready to start trying again is entirely up to you, as long as you’ve been cleared by your doctor. It’s important to consider all aspects of how you’ve processed the loss and how the new pregnancy might make you feel, but it can be difficult to know until you’re experiencing it, so having the support you need in place can help ease some of the anxieties and concerns that may arise.

Kin's Conceiving Essentials can also help you restart your conceiving journey. Packed with prenatal vitamins for him and her, as well as ovulation tests and pregnancy tests, it's a good kit to have at hand if and when you decide to start trying again.

What causes recurrent miscarriages?

As most of the evidence in this article suggests, miscarriage is fairly common and usually a one-off experience. Unfortunately, this isn’t the case for everyone.

Approximately 1% of those trying to conceive experience recurrent miscarriages, which are defined as 3 or more successive miscarriages [22].

Having a miscarriage can be a traumatic experience, full stop, so understandably, experiencing consecutive losses can take a toll and prevent couples from wanting to continue trying.

There are a few things that can increase the chances of recurrent losses, one of which is repeated genetic errors, which is the case in 2-5% of couples [22].

As the leading cause of miscarriage, there is a chance that you or your partner may have chromosomal abnormalities, or the tendency to pass them along, which can be tested with a blood test, called karyotyping. If this is the case, working with a geneticist for further testing to determine the cause and risks will be recommended.

Other causes include blood clotting disorders, uterine problems (such as an abnormally shaped uterus) or cervical weakness, though unfortunately, often, recurrent miscarriage can't be attributed to any one cause.

Pregnancy after miscarriage

Between 50-80% of women who experience a miscarriage become pregnant again [17]. However, it can be an emotionally tumultuous time. While you may feel elated and hopeful, the understandable anxieties of a repeat loss will be present.

According to the above study out of the US, 68% of women reported they were still upset 2 years after their experience and 64% said it affected their decision to become pregnant again.

These stats are real, and being afraid is normal.

No one can tell you what you’ll feel once you do become pregnant after a miscarriage, the most important thing is setting in place the support you need to help you throughout the process mentally and physically.

Perhaps the light at the end of the tunnel of all of this information, is that becoming pregnant again and carrying a full-term, viable pregnancy is likely, and there are plenty of people in place to help you through both the processes of loss and new pregnancy.

References

  1. https://www.acog.org/womens-health/faqs/early-pregnancy-loss
  2. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5533459/
  4. https://www.acog.org/womens-health/faqs/Having-a-Baby-After-Age-35-How-Aging-Affects-Fertility-and-Pregnancy
  5. https://www.livescience.com/56609-myths-about-miscarriage.html
  6. https://embryology.med.unsw.edu.au/embryology/index.php/Genetic_risk_maternal_age
  7. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14742
  8. https://www.ncbi.nlm.nih.gov/pubmed/21806566
  9. https://www.ncbi.nlm.nih.gov/pubmed/31194258
  10. https://bmccomplementmedtherapies.biomedcentral.com/articles/10.1186/s12906-018-2419-y
  11. https://www.bmj.com/content/349/bmj.g5159
  12. https://www.reuters.com/article/us-painkillers-miscarriage/common-painkillers-tied-to-miscarriage-risk-idUSTRE7854I820110906
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3515955/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5431920/
  15. https://www.msdmanuals.com/en-au/home/women-s-health-issues/symptoms-during-pregnancy/vaginal-bleeding-during-early-pregnancy
  16. https://www.ncbi.nlm.nih.gov/pubmed/18310375
  17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4468887/
  18. https://bmjopen.bmj.com/content/6/11/e011864
  19. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
  20. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.14424
  21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513002/
  22. https://www1.racgp.org.au/ajgp/2018/july/recurrent-pregnancy-loss/
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