Disclaimer: Please note that this article will discuss miscarriages and describe what women can expect when undergoing one. It may be upsetting or triggering for some women.
In the United States, miscarriages often induce a miasma of tension and hushed whispers. It’s no surprise that you seldom hear about a woman experiencing one; most women abide by the rule of thumb of keeping their pregnancy hushed until the first trimester is over, to preemptively safeguard against the conversations that may emerge given that 80% of early pregnancy losses occur in this period. This speaks to the more significant issue at hand: the topic of miscarriage is considered taboo.
Tanika Dillard, author of best-selling Building A Family Breaks My Heart, said it best in her TED talk. The talk follows her journey of having felt pre-destined for motherhood but being devastated with miscarriages. Tanika said when discussing her personal experiences of miscarriages:
“I choose to break the silence of pregnancy loss because of the number of women who came alongside me after each of our grief experiences to whisper, ‘I know how you feel. I’ve lost a baby too.’ That number was alarming. It was as if a secret society of women were emerging to say, ‘I’ve lost a baby, but I’ve been told to get over it- you didn’t know that baby anyway.’”
In her time of grief, Dillard learned that while so many women had gone through miscarriages, she would have remained ignorant had they not approached her. Despite miscarriages being a common phenomenon amongst women (with 10% to 15% of diagnosed pregnancies ending in miscarriage), the U.S. lacks a supportive culture to help mothers effectively cope with this traumatic experience.
So, let’s chat. Miscarriages occur for a plethora of reasons -some being apparent and some remaining unclear. According to Cleaveland Clinic, a significant culprit for miscarriages in the first trimester is chromosomal abnormalities. Chromosomes are genetic carriers found from the sperm and the egg that determine the genes of a potential embryo. Though a sharp rise in these chromosomal abnormalities are correlated with maternal age (and specifically, after ages 37-38), they are not necessarily indicative of deeper health issues for the originators of egg and sperm; rather, these abnormalities are commonly deduced as “unexplained.” Other causes for miscarriages include infection, uterine abnormalities, and certain lifestyle factors like smoking or drug use. These conditions, among others, can increase a mothers’ likelihood of experiencing a miscarriage. However, many times, the cause may not be as clear-cut as the presence of one of these conditions.
Given this knowledge, many mothers internalize miscarriages, feeling guilty and hyper-analyzing what they may have done to cause it. There are misconceptions that exercise, sexual intercourse, heavy lifting, or stressful events cause miscarriages. However, it is important to note that nothing that you do can be the sole reason you had a miscarriage. Of course, there are certain risk factors for miscarriage, and some of them are modifiable, such as smoking, drinking, etc. that we mentioned above. However, it is highly unlikely that a single action such as a workout or a fall is the root cause of a miscarriage. In fact, most miscarriages women have are never diagnosed (it is estimated that ~50% of all pregnancies, diagnosed and undiagnosed, end is miscarriage), which means that it's hard to say that there are "causes" of miscarriage. While we understand that there are certain risk factors, miscarriages can be incredibly random and occur for a combination of factors we are not always privy to. So, it is crucial that we make it clear to our mothers to avoid blaming themselves for something, that a majority of the time, is uncontrollable.
Regardless of why they may occur, miscarriages often have some telling symptoms in their onset. The most common symptoms include vaginal spotting or bleeding, pain or cramping in the abdomen or lower back, and fluid or tissue passing from your vagina. It is important to remember that vaginal spotting or bleeding does not automatically signal a miscarriage; sometimes, it also occurs in successful pregnancies.
If you experience these symptoms and suspect a miscarriage, this may be an incredibly challenging period for you; but one you shouldn’t have to face alone. First, it is important to contact your health care provider to determine if you are indeed miscarrying. If you are noticing heavier bleeding that resembles a menstrual period (and especially if you have bleeding that soaks through a pad in less than one hour), you should head to the emergency room right away. If you’re feeling concerned yet unsure due to other reasons, we encourage you to still get in touch with your medical professional to share your symptoms, and schedule an appointment to help confirm through ultrasound and measuring blood levels of HCG, the pregnancy hormone.
Besides your medical, surgical, or expectant management options, it’s also important to see your provider for things like blood typing, blood count, and confirming diagnosis of miscarriage; then, if a miscarriage is confirmed, you will then have to develop a plan to safely treat your miscarriage. The Miscarriage Association explains that treatment plans are based upon the size of the pregnancy and this will help guide management plans. Management plans are categorized as being natural, medical, or surgical. Natural management, also referred to as expectant management, entails allowing your body to expel the contents of your womb naturally. Medical management indicates the presence of medication to help support and quicken the process. Finally, surgical management would mean that the contents are removed through a surgical procedure. This management often utilizes an operation called a D&C, or dilatation and curettage. These forms of management collectively aim to prevent hemorrhaging and infection, and you can depend on your health care professional to help you choose and navigate the appropriate process.
Physically, it will take time for you to recover. You can expect to have discomfort and bleeding for up to two weeks following your miscarriage. It is recommended that you avoid tampons, instead opting for pads to help manage the bleeding. Other things to avoid include intercourse and swimming until the bleeding has stopped. During this time, if your discomfort evolves into pain, consider utilizing medication like paracetamol to help manage it. To assist the recovery process, make sure you are hydrating, eating nutritious food, sleeping, and even getting a little light exercise. Treating your body kindly will be especially important; consider a postnatal massage, which your health insurance plan may cover.
Of course, treating yourself kindly extends beyond looking after just your body. Emotionally, you should know that your reaction -whatever that may be-is part of the natural grieving and healing process, and is completely valid. Miscarriages can evoke an array of emotions. For women who anticipated motherhood and welcomed pregnancy, it may be profoundly upsetting. Georgetown University School of Nursing & Health Studies notes that emotional attachment starts early and miscarriage transcends losing a pregnancy; rather, it’s losing a baby. Unfortunately, the American culture’s clumsy treatment of miscarriages leads to women being told to keep it to themselves and wait for the sadness to disappear. Yet, an overwhelming amount of evidence suggests that the impact does not occur in a vacuum and that it may be consequential to a woman and her family for years to come. For one, the American Psychological Association outlines the psychological impact that miscarriage poses to women and its lingering: a woman who miscarries is at a higher risk for depression and anxiety symptoms following the miscarriage. However, there are support systems that can help. First, consider seeking counseling (either one-on-one or group counseling are helpful) and finding a community of women who have undergone a miscarriage. If you are feeling hesitant or restricted from an in-person meetup, you can also find a community online. There are websites where you can constantly access information and even interact with others through Facebook groups and web-based forums. Whichever path you choose, understand there are routes for support and that you are not alone in this.
On the whole, recovery from miscarriage is nuanced. Accepting that the pregnancy existed, instead of trying to suppress or overlook it, is productive in helping you validate your experience and reactions. Consider having a memorial to recognize your and your family’s loss - it can be a healthy way to honor the baby. As for trying again, keep in mind that regardless of the recent loss, it is very likely that you will have a successful pregnancy later. American Pregnancy Association notes that 85% of women who had a miscarriage will have a successful pregnancy after; 75% with two or three losses will as well. If you’re experiencing two or more losses with the same partner, don’t be discouraged; you can usually get a referral to Reproductive Endocrinology and Infertility for an evaluation and extra help in getting pregnant - but first, you should know that many studies stress the importance of first prioritizing recovery. Biologically, you can get pregnant the very next cycle, but it is crucial to allow yourself (and your partner if applicable) some time to grieve, plan and physically heal so that you’re fully comfortable before trying again.
While miscarriages have been taboo for so long in the United States, more and more women are opening up about their losses, thanks to brave figures like Dillard. Celebrities like Beyoncé, Kim Kardashian, and Olympian Shawn Johnson have also opened up about their own experiences with miscarriages. This emerging transparency reflects the larger tides changing; miscarriages should not be swept under the rug for mothers to quietly grieve by themselves. If mothers want to deal with it more independently, then so be it. However, this is the vital qualifier- they should not feel that they are alone, in hiding. Miscarriages can be traumatic and painful, and feeling uninhibited to share, process, and mourn - is something every mother is entitled to.