Preventing a miscarriage that has already begun

I know if you are here you are scared or worried. I hope I can help give you some information that will help.

Very few miscarriages that are preventable, even if you know in advance that there is a problem. Well over half of all miscarriages are caused by random genetic problems in the baby that could not be avoided.

Additionally, when you search for this on the Internet, you see a million products pop up, most probably synthetic progesterone creams, that claim to stop miscarriage.

But there is no getting away from reality: When a true miscarriage is occurring, there is no magic way to stop it from happening.

Remember that bleeding happens in 60 percent of all pregnancies, but only 10% end in miscarriage. Call your doctor, and follow their advice about going to the emergency room.  Your treatment there will not be prioritized and can often be traumatizing, but they can usually give you some sort of answer, especially if you are seven weeks or more along and they give you a sonogram.

Bleeding can be normal (such as near the time you expect your period, or from a random hormone shift) or can be a sign of a complication (most often a sub chorionic hemorrhage). It doesn’t mean it’s the end. Take it easy and call your doctor to see what they say.

If a miscarriage is indeed happening, by the time you begin bleeding, the baby has almost always already died. This is a frustrating and terrible situation to be in, and when it happens to you, you will initially have no idea that it is so common. Before your research is done, though, you will find that one out of every 10 pregnancies ends in miscarriage, and that one in every four women will have one at some point in her reproductive years.

An important section to read if you are sure you could have prevented your miscarriage is the page on myths. There you will find the most common things women blame for their miscarriage, and why they are not a factor.

The few types of preventable miscarriages involve the following causes:

• Hormone deficiencies
• Physical problem with the uterus or cervix
• Immunological problems

Read about them on the page for Causes of Miscarriage.

Trying again for a new pregnancy

This information and MUCH more is in my FREE eBook on getting pregnant after a loss.

Read an expanded version of the Sperm Meets Egg Plan, including sections for moms over 40, couples with fertility issues, and trying after a loss. It’s free!

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But here is the basic information if you don’t want to download the free book.

This can be the most difficult topic of all, because everyone has an opinion, and your doctor and your friend’s doctor, and internet sources, and your mother, and your partner will all say different things. You will personally go from wanting to try again RIGHT NOW to never wanting to try again, sometimes in the span of five minutes. You may not agree with your doctor. Your partner may not agree with you. You are already grieving, and upset, and feeling like a failure, and thinking too long about this topic can make you feel so very much worse.

Accept that there are many opinions. Let me tell you a bit about why.

Doctors are trained to recognize that a woman needs emotional healing, but not really to help them or explain it to them, since it goes beyond their “bones and tissues” type of practice. Three months is considered the average amount of time a women will grieve hard over a loss, and will have a difficult time (and be a difficult patient) if she gets pregnant prior to that. While there are a few doctors who believe that your uterine lining must take three cycles to get back to rebuilding itself fully each time (especially after a D&C, where it gets scraped pretty thin), most doctors know that it doesn’t really matter in about 80% of the cases, and getting pregnant again right away does not carry any increased physical risk or miscarriage risk.

So even among doctors, some will say the standard “wait three cycles” and might even scare you into thinking you’ll have another miscarriage if you don’t wait, and others will say go ahead and try again now.

As for my opinion, I’ve been running this site since 1998, and have talked to thousands of women who have had miscarriages. From what I’ve seen, you really should wait for one cycle to complete, because if you do not, you will experience one of two situations, both of which will cause you much unnecessary grief and pain:

1. If you do get pregnant again before having a period, you will not establish a reliable Last Menstrual Period date (your miscarriage date is of no use). You will run into lots of problems when you go in for your first prenatal sonograms and blood tests, causing you tons of grief (often for nothing) and can wreck your relationship with your doctor (supporting the “difficult patient” theory.)

For example, the blood test will say you are six weeks; you will insist you are eight. The sonogram will not show a fetal pole yet, but you have read that you should see a baby by now. You will think your doctor should do something, but he or she will just say your date is wrong and come back in a week. You will spend a week of torture, wondering if the baby is dead, and why do you have to wait for answers. All these things can be avoided by knowing your LMP, or preferably ovulation. Most of the time, the babies are fine, but sometimes you are having another miscarriage. Everything is murky because you don’t know for sure when you got pregnant, because you didn’t complete a full cycle.

2. If you have retained tissue, your period will be “late” (although all post-miscarriage periods take more than four weeks and are late) and you can even have a POSITIVE PREGNANCY TEST, but you are not pregnant. This is hCG left in your system from the miscarriage, which has not completed. You may begin bleeding and cramping and think you are having another miscarriage, but you are just still going through the first one. We have had women on the site grieving over a 2nd lost baby, naming it and everything, when it turned out she only had missed tissue from the previous loss. Having a D&C does not guarantee that all the tissue was taken. About 1/4 of the women on this site with missed tissue had a D&C. If you did not wait for a real period, you will not know if a pregnancy test really means you are pregnant again, or if your loss has become a long drawn-out ordeal.

Additionally, charting and even ovulation predictor kits are not reliable tools during that first cycle after a miscarriage, and the body will put out lots of signs of fertility or lack of it as it tries to adjust itself. Women may be absolutely sure of their pregnancy’s gestational age, and still be wrong! Once you get past that point, try the sperm meets egg plan to see if you can speed up the trying again process. On the other extreme, not getting pregnant that first cycle, or for the next few, when you are fervently trying, will actually push your grief further down the line, month by month, and it can really be detrimental to healing, your life, and your relationship. Often your life will completely revolve around trying again and you will feel even more a failure, more unable to cope. This may also happen if you wait, but is more likely to pull you into a clinical depression if you are not yet dealing with your loss and are still having some hormonal upheaval.

Even if you feel like you are fine, the grief is really out there, and you need to work directly through it. I don’t worry about the women who write about crying and saying they can’t go on. They are working through their pain and grief. I worry about the woman who just wants to try again, and doesn’t mention or think about the pain of losing a baby.

In the end, this is your life and your body, your baby, your future, and your decision. Make your choices well, and try not to look back.

Monitoring a New Pregnancy

Some doctors will respond to your worries and bring you in for additional hCG tests and early sonograms to monitor the new baby more closely. Most will not do anything. It can be frustrating and scary to think about waiting until 8 or 9 weeks to see the doctor, when every day brings a new twinge or cramp or cervical discharge that makes you panic.

I think it is reasonable, if you have had only one loss, to still request an early blood test and a sonogram at 7 weeks to see the heartbeat. This will reassure you. If you have had more than one loss and no healthy babies yet, then you should be able to request more frequent monitoring of your hCG and progesterone levels, just to see where the pregnancies are failing. This could help give you a clue as to a cause.

Stocking Up

If you follow the Sperm Meets Egg Plan, you will want to buy inexpensive ovulation kits or a digital fertility monitor like these:

Natural Miscarriage

If you choose to wait it out for a natural miscarriage, you will most likely have a difficult wait. It may not seem real; you will harbor hope that it will never happen. Eventually the cramping and bleeding will begin, and you may react with severe grief and panic. You may feel ridiculous or morbid trying to catch tissue in a jar or plastic bag for testing. All these things are fine. Do the best you can. If all goes well, the cramps will subside and a regular blood flow will resume. Keep in mind that you may not pass all the tissue and will have to have a D&C to empty your uterus.

During the next few days you will likely experience the following:

• Cramps and bleeding, sometimes quite painful and heavy.
• Passage of tissue, resembling large blood clots in the earliest weeks up to pinkish/grayish material, possibly even in a discernible sack. Try not to traumatize yourself by searching for the baby. Most of what you see will be bits of the placenta. Believe me, I understand the impulse. Not seeing my baby was traumatizing in itself. And mine was fully formed at 20 weeks. Just do the best you can.
• If you collect the tissue, it may be refrigerated until you take it for testing. If this is your first miscarriage, it is not necessary to keep the tissue. It is rarely tested in this case. Any tissue that falls into the toilet is not testable, so you do not need to retrieve it.

Call your doctor if you experience the following:

• Any sort of abdominal pain that lasts beyond the cramping stage. You could be developing an infection. Don’t panic though, just call and you will get an antibiotic and a check up.
• A fever that starts to approach 100 degrees. Again, infection is a possibility.
• Cramps beyond endurance. You may need a pain medication or a D&C.
• Bleeding that comes heavy and fast, soaking a pad every few hours, for more than three days. If the bleeding does not slow down after that, you may have tissue that is causing hemorrhaging, and you will need a D&C.
• Bleeding that lasts longer than two weeks. A D&C may be necessary.
• Bleeding that starts and stops and starts and stops for weeks. Some tissue is still causing hormones to be created, and you will need intervention.

You will feel some of the following as the days and weeks wear on:

• A mild start and stop bleeding pattern up to two weeks. You should have a new cycle, unrelated to the first bleeding, between 4 and 7 weeks after the miscarriage. I didn’t get a fresh cycle until the last day of the 7th week, so don’t panic if you are still waiting. A few women need a Provera shot to jump start their cycle, but this is not terribly unusual. Call your doctor if you go much longer than 7 weeks, just for your peace of mind. You may want to start charting your temperatures after the bleeding stops to see where you are. Remember that you can get pregnant that first cycle, so use contraceptive. For more information, see the section on trying again.
• Snappy, unhappy, angry feelings. Wanting to be left alone or wanting to talk about what happened with everyone you know.\
• A sense that it isn’t real, that it never happened.
• Hypersensitivity to sad TV or reading materials, being revolted or angry about happy scenes of families, seeing symbols in everything you do, from gardening to dreams to what you eat.
• Anger at the baby, wishing you never knew about the pregnancy, wanting to throw out all the baby reminders, or clinging to the little angel you lost, thinking about him/her nonstop, wanting everyone to recognize that the baby was real.
• Anger and/or jealousy of other pregnant women, even friends and family, to the point you don’t want to even talk with them. This is okay. I felt this way for several months.

Miscarriage Myths

Miscarriage Myths

Sometimes after your miscarriage you will remember straining to lift something, worry over the three martinis you drank before you took the pregnancy test, or wonder if you should have still been working out. None of this matters. Miscarriage happens, whether we do our best to prevent it or not. Here is a list of commonly blamed factors that are NOT causes of miscarriage.

These things do NOT cause miscarriage:

Stress. All mothers worry about their babies. Many experience traumatic life events during pregnancy, such as family deaths, even deaths of children or the baby’s father. You will get through it, and your baby will too. As a strong case in point, over 50 women were pregnant when their husbands died on September 11 in a terrorist attack on the United States. Their babies are arriving, kicking and squawling, despite the pregnancy occurring during the absolute worst days of their mothers’ lives.

Sex, even the passionate kind. Orgasm may scare you when your uterus enlarges because you can feel the contractions, but it doesn’t do anything to the baby other than maybe rock him to sleep (or get him to kick you to stop and let him sleep already.) Sometimes you will have spotting after sex, but this is just because the cervix is very soft and filled with blood. A little banging sometimes makes it bleed a little, but this is not a problem. You only need to curtail your loving if your doctor has told you to do so.

Lifting your toddler or older children. Your body will complain to the point of making you drop them well before you can do anything that is harmful. Remember to pick them up by squatting and lifting with your legs, not bending over and lifting with your back. This is still not a miscarriage factor, but will save you many aches and pains.

Working out. This is actually something that helps you and the baby. There are some rules, however. Do not get your heart rate above 140 (still not a miscarriage factor, but does start to reduce the amount of oxygen to the baby) or work until you feel faint or exhausted.

Getting kicked or hit in the stomach. Remember the baby is well protected, and only you will hurt. This is often done during the night by a sleepless child you have pulled into bed with you, but if it is by a partner or other adult, get help. You don’t need to bring a child into a world where abuse is present. Please visit  http://www.ncadv.org/ for help and information on domestic violence.

Poor eating habits. The baby will rob you of the nutrients it needs and only you will suffer. However, you can cause a low birth-weight baby with developmental problems if you refuse to have a healthy diet through the entire pregnancy. You should still eat well, but don’t blame a miscarriage on your eating habits.

Drinking before you knew you were pregnant. The majority of women do this and it has no bearing on miscarriage. I personally tossed quite a few tequila shots the night I had a negative pregnancy test on the ninth month of trying. Two days later another test was positive. I didn’t blink an eye. The baby doesn’t get a drop of blood before implantation, and receives so little for the first few weeks that you really just don’t need to worry about it. If you continue drinking once you know you are pregnant, however, you can cause a serous problem with Fetal Alcohol Syndrome. Once the test is positive, pick up baby bottles, not liquor ones.

Scaring the baby. Just because a near accident, or loud terrible noise, earthquake, or other event scared you, does not mean the baby even noticed. Even if the baby does jump upon hearing something loud, this is just a startle reflex and actually a healthy sign that he or she is developing normally. Babies do not have “heart attacks” from fright or get scared “to death.” This is a persistent myth in several cultures and simply does not have any basis in fact.

The baby “knowing” it was unwanted. Just because a pregnancy surprised you, and even if you debated having an abortion, you did not cause your baby to die. This is a grief and guilt emotion you are feeling, but it is not true. The fact is, at least 10% of all babies die, whether they were desperately wanted or not.

These things may cause complications, but not typically a miscarriage:

Falling. We all become klutzes as our belly expands, joints loosen, and our center of balance changes. Most falls do not cause any harm to the baby. If, however, you experience bleeding or serious soreness afterward, or if you landed square on your belly in the second trimester or later, see a doctor to check the placenta for tears. Otherwise just be embarrassed.

Car accidents. While some people will blame their miscarriage on an accident, usually it isn’t so. The baby is very well protected in its amniotic fluid, so unless the stomach and uterus is punctured, or the woman undergoes a period of cardiac arrest or without breathing, the baby should survive. Certainly get checked after a car accident, especially if you begin bleeding, as you may have pulled a bit of the placenta from the wall of the uterus, but don’t worry too much about miscarriage. It is rare in this case.

Lifting something heavy. This caution is really for women who can cause a placental tear in the second or third trimester. This does not necessarily mean a miscarriage, and usually if you feel terrible pains later, it just means that you strained one of the round ligaments holding your uterus in place.  A little rest will be all that is needed. If you have bleeding, however, it is time to get a sonogram just to be sure you didn’t pull a bit of the placenta away, although this will almost always heal itself without incident.

BUT!

Yes, I know. You started bleeding right after sex, or right after a workout. Or your baby died the day after the car accident, or the checkup at the hospital after you fell down showed no heartbeat. These things MUST have caused the miscarriage, because babies don’t just die, right?

WRONG.

Babies do just die. Over half of all miscarriages are caused by chromosomal factors that are completely out of our hands. Not preventable. Nothing we can do. The majority of the others are also unrelated to anything we personally did, but some infection that got us, a poorly formed placenta or umbilical cord, a hormone problem, or health condition we didn’t know about. Don’t let anyone, not even your partner or your mother (or yes, the mother-in-law) tell you this was your fault. It absolutely, positively was not.

Symptoms of a miscarriage

On this page you will find four categories of miscarriage symptoms: definite signs of a forthcoming miscarriage, possible signs, signs that might scare you but are really okay, and unusual periods that are not necessarily miscarriages.

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Definite Signs of a Miscarriage

You are having a miscarriage if you have already had a positive pregnancy test, then get these symptoms:

• Heavy bleeding that soaks a pad in a few hours or less and does not stop.
• Strong cramps that make you double over or breathe in a huffy way and leads to bleeding.
• Passage of tissue, resembling large thick blood clots in the earliest weeks up to pinkish/grayish material, with or without cramps or pain.

A certain amount of bleeding is pretty common in pregnany, but call a doctor. It could just be a complication, not a loss.

Small darting cramps, even if they hurt, are also okay, usually they just signal the body stretching and pulling to accommodate the growing baby. Lie down and drink some water (dehydration causes cramps), and the cramps will usually go away within the hour.

These symptoms can be other things rather than a loss of pregnancy, however, if you are not sure you are pregnant. Check the “I’m not sure I was pregnant” section.

What should you do?

If it is during doctor’s regular working hours, call your regular doctor first. They will give you instructions. If it a night or weekend, first call your regular doctor’s after-hours number. Usually this will be on their answering machine or with their answering service. The nurse or doctor on call who calls you back will help you decide if you need immediate attention or not. Don’t feel like you are bothering them needlessly; this is a natural and expected part of any OB practice.If you can’t get through, don’t have a doctor, and you are afraid, then go to an emergency room.

Be prepared for some possibly insensitive treatment. While some hospitals are well equipped for handling this situation and do a good job, often you are left alone in a room for hours, or told to sit on a toilet and catch tissue, or just sent back home because “there is nothing they can do.” It may be worth the trip, though, if they draw blood for an hCG test or give you a sonogram.

When I began bleeding heavily on an airplane on a Friday afternoon, I still waited until Monday to see my doctor. I did not want some total stranger telling me the baby had died, or to have a sonogram in an emergency room and be told to “call my doctor for the results.” While I was sad about the possible loss of the pregnancy (turns out I lost one of a set of twins at 10 weeks), I was resolved to wait for a comforting, familiar doctor’s office.

There is not really a risk to waiting until Monday or the next morning if you are in your first trimester. There is no magic way to stop an early miscarriage at the hospital. What is going to happen will happen. If you are farther along than 12 weeks, though, and you are merely in labor and not bleeding, then you should take quick action to see if labor can be stopped.If you are passing tissue at home, and it is your first miscarriage, it is not necessary to catch the tissue and take it in. You may do this if you choose, however, and you can store it in a sealed plastic bag in the refrigerator until you get to a doctor. However, it is rare that tissue caught this way will be usable. Tissue from first miscarriages is rarely tested, since it is assumed your miscarriage was due to a genetic defect. The best way to ensure testable tissue is to have a D&C.

Possible Signs of a Miscarriage

Sometimes, but not always, there may be signs that a miscarriage is pending. None of these things means a miscarriage is certain, but usually you will want additional monitoring if they happen.

Bleeding: Bleeding that starts and stops and starts and stops can be a sign that your hormone levels are falling. While you may still be okay, you need to have your blood hCG pregnancy hormone levels monitored. Heavy bleeding that soaks a pad in an hour is sometimes a sign that a miscarriage may be beginning. Keep in mind that while bleeding is always scary, 60% of all pregnancies have bleeding at some point. Both of my normal pregnancies had bleeding, heavy and red. And the one I lost at 20 weeks never even spotted.

Cramping: You are going to feel a lot of random cramping down there the whole pregnancy, front and back. The only time cramping is a concern is if you are breathing in a labor-like huff, or if you also begin bleeding with the cramps. Most cramps subside with water and rest.

Loss of pregnancy symptoms: This is a question I get all the time. While the complete and sudden loss of pregnancy symptoms can signal a pending miscarriage, usually it is not the first sign. You will have many days where you don’t feel pregnant, when the nausea abates for a day or two, or your breasts are less sore. This is expected and not a concern at all. Around weeks 10 to 14, this is completely normal, as your hormone levels even out and the placenta takes over. The loss of pregnancy symptoms during a miscarriage is usually something you see in hindsight, not ahead of time.

A pregnancy test that fluctuates between positive and negative: If you have tested super early, this is normal. However, if you are a couple weeks in, this could mean an ectopic pregnancy. Often you may also see spotting. If you have taken a pregnancy test that is positive, then another one a few days later that is negative, alert your doctor immediately. You want to rule out an ectopic or take care of it before you have to go the surgical route. If you are taking the tests in the same day, though, you might be right on the edge of a positive result, and urine later in the day may not be concentrated enough to keep the test positive. Test again the next morning to be sure.

You should always call your doctor when you are worried, however; because it is better to call for something that does not turn out to be a problem than to stay up half the night worrying about it.

When You’re Okay

Whether it’s your first pregnancy or you have already been through a loss, one thing we all have in common is worry, worry, worry. This is okay, but remember that 90% of pregnancies end with a squawling baby, regardless of the turmoil the mom has gone through to get there. Here are the most common things you will fret over, and why they are not really a problem.

Bleeding: Small amounts of brown blood (which means it’s old) are expected when the egg implants in the uterus (7-10 days after ovulation) and sometimes at the point when you would have expected your period. You may also bleed slightly after having sex, but this is probably NOT from the baby. Your cervix is soft and filled with blood, so it may bleed a little from sex. This is not considered by many doctors to be a problem, but if it alarms you, call. Up to 70% of all pregnancies have bleeding.

You will be especially scared if you see bright red blood. If you are between 10 and 12 weeks, or if it is a time you would have expected your period, do not panic. Remember that until you are quite far along, much of your uterus is not involved in nourishing the baby, and can bleed with a minor hormone fluctuation. If you are not cramping, call your doctor to let them know, stay lying down on your left side, and hopefully it will slow down, start to turn brown, and eventually stop. If you push the issue, your doctor might schedule a sonogram to put your fears to rest.

When bleeding is a problem: If it is heavy enough to make you change pads or bright red, call your doctor right away. If you begin to have cramps with the bleeding, follow the instructions under “Definite Signs” above.

Cramping: You are going to feel a lot of random cramping down there the whole pregnancy. Most of the time it is caused by the round ligaments expanding to accommodate your growing baby and uterus. If it goes away after a few pains or after you sit down and rest a bit, then you are probably all right. Cramping is a sign you are growing to accommodate the baby and sometimes a sign that you are overdoing it and should rest.

When cramping is a problem: If it continues or gets worse or if you start bleeding too, call your doctor immediately. If you begin to have labor-like breathing or a gush of fluid or blood, follow the instructions under “Definite Signs.”

Inability to eat or keep food down. This is normal! Remember that the baby is the size of a grain of rice and not exactly demanding steak dinners. When the baby starts to need the extra 300 calories a day, you will be eating fine. Just do the best you can with your saltines and soda, and remember that the more severe your morning sickness, the better your hormones are functioning.

Few or no pregnancy symptoms. Not everyone spends each day throwing up or sleeping all the time. Many people have symptoms that are light or nonexistent. This does not mean you will miscarry. Each pregnancy is different, and usually pregnancies after the first will be easier on your body. I had so few pregnancy symptoms the third time around that I actually ordered a margarita at a restaurant before my husband said, “Aren’t you forgetting something?” This never would have happened with Emily, when I spent every non-working hour sleeping or bawling over a migraine.

You should always call your doctor when you are worried, however; because it is better to call for something that does not turn out to be a problem than to stay up half the night worrying about it.

Unusual Periods that Are Not Necessarily Miscarriages

There are many things that can happen in a cycle to make you wonder if you were pregnant and lost a baby, but you never took a test to know for sure. For information on this topic, click on “I’m not sure I was ever pregnant.”

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What causes miscarriage

Most early miscarriages (as many as 60% of first trimester ones) will remain unexplained. It is usually assumed these losses are genetic, where the chromosomes simply did not replicate correctly. Many people will assume that something that happened recently, such as an illness, fall, or exposure to something will have caused the miscarriage. This is rarely true, since by the time a miscarriage is diagnosed or begins, the baby has been lost for quite some time. Hopefully this section will help you understand the causes; you should also read the section on myths.

There are several categories of miscarriage causes:

Hormones

When we talk about a hormone problem, you have likely miscarried in less than 10 weeks. After that, the placenta has taken over hormone production and any normal deficiency you have is not a factor.

Low progesterone, the most common problem, is not as easy to treat as you might hope. Progesterone suppositories, while frequently prescribed, are not proven to be helpful and often actually cause a nonviable pregnancy to last longer than it should.

The only situation where progesterone is a sure solution is with a luteal phase defect, where the corpus luteum, which is formed along with egg at ovulation, does not produce the hormones needed to sustain a pregnancy. For most women, however, this is usually not an every-month problem. Usually the situation rights itself with the next egg and the next corpus luteum. This problem, if it is a permanent one, can be diagnosed through two separate endometrial biopsies. Progesterone must be started 48 hours after ovulation to work. By the time you have missed a period, it is too late to save a pregnancy with a luteal phase defect.⁵

Low progesterone, however, is usually a symptom of an nonviable pregnancy, and not the cause. Doctors often prescribe progesterone suppositories out of patient pressure when the hormone levels are low, but their use is controversial and usually completely ineffective. A common treatment for a suspected progesterone problem is Clomid, a pill taken for five days early in your cycle to rev up your hormone production. Not everyone is a candidate for Clomid, and 25% of women will have decreased cervical mucus, which can actually make you less fertile. See the Sperm Meets Egg Plan for more information.

Other hormone problems may be created when you have an untreated thyroid disorder. Your thyroid function can easily be tested, and this problem is very treatable.

Chromosome Defects

There are many factors that come in to play when the egg and sperm unite and form that first cell. Even if both the egg and sperm come with perfect chromosomes, the first few cell divisions can see an abnormality crop up that would certainly be devastating. Chromosome defects that cause a newly fertilized egg to die can account for as much as 60 percent of early miscarriages.

You can usually find out if you had a baby with a chromosome problem through testing tissue from the miscarriage. This must be done RIGHT AWAY when the tissue comes out or the cells cannot grow and the test won’t work. If this is your first miscarriage, however, do not go to great lengths to save tissue. Very few doctors will test it, and a chromosomal cause for the miscarriage will be assumed without testing.

Even when you have a D&C and the doctor sends the tissue immediately, the test still might not work. (Mine didn’t.) But if you do find your baby had a chromosome defect, find a small measure of comfort in knowing that although you lost this one precious baby, the chances of it happening again are extremely small. Another threshold will be crossed, however, at age 35. At that point, your eggs will begin to age, and your odds of a chromosomal miscarriage will begin increasing dramatically.

After the 2^nd trimester begins, the number of miscarriages caused by genetic factors drops to less than 10 percent.³ If you have had several miscarriages in a row, then your odds of this being your problem are quite low, about 7%.⁴² 

Physical Problem with the Uterus or CervixSome women have a uterus that does not have the usual shape. Others have a cervix that may be weakened by a number of causes, including multiple D&C procedures or their mother taking DES when she was pregnant (although note that DES was discontinued in 1971 and most DES daughters are leaving their childbirth years behind.) Both of these problems can cause early labor, usually during a critical period from 12-24 weeks. This cause is responsible for 12 percent of miscarriages during this time period. As the baby grows, especially during the very rapid growth spurt during this time frame, the irregularly shaped uterus may not be able to expand or the weak cervix may start to open up and let the baby out. There are treatments for both of these that are quite effective—corrective surgery on the uterus and a cervical stitch that holds the cervix closed. This problem WILL REOCCUR if not treated.

A uterine abnormality often causes a miscarriage due to early labor, but it can also cause fetal demise, which is what happened to our Casey. Sixteen weeks into my pregnancy with Emily, we had an abnormal AFP screening. Since we were near the point of the pregnancy when Casey died, naturally we were frantic. We saw a perinatologist, who discovered I had a septate uterus. When I was a fetus, the two sections of tissue that normally fuse together to form the uterus only fused on the bottom. Therefore, there is a huge wall going down the middle of my uterus. When Casey implanted, he chose the middle wall. This section, however, has little blood flow. As Casey grew and required more and more blood and nutrition, this area could not support him. Although Emily chose a better implantation spot, this problem caused her to be breech and required a c-section. While I did have the surgery to correct this problem, my next pregnancy still had complications, and I was not allowed a vaginal delivery.

Be aware that there are varying levels of septums. Some are paper-thin and simply move out of the way for the baby, causing no problems. Others, like mine, increase your chance of miscarriage significantly. Only a high-level sonogram or an HSG dye test can uncover this problem.

Immune Disorders

While many experienced and well respected reproductive endocrinologists specialize in this field now, many “regular” ob/gyn doctors are quite resistant to the idea of this type of miscarriage cause and its treatment. Specialists in immune disorders claim up to an 80% success rate with women who have had three or more miscarriages, but there is still much skepticism even among infertility and reproductive specialists.

Antiphospholipid antibodies can cause blood clots in the placenta that block or slow down the baby’s blood supply, causing growth to slow or the baby to die altogether. Your blood can be tested for these antibodies. These tests are called anticardiolipins or the associated lupus anticoagulant. These are inexpensive tests, and sometimes you can get them after only one miscarriage. If antibody levels are thought to be high enough to affect the pregnancy, treatment involves baby aspirin and sometimes a blood thinner called Heparin. In rare cases, the woman is actually found to have Lupus, which may be mild enough not to affect her, but needs management anyway to protect her pregnancies (see antinuclear antibodies). While a miscarriage due to this problem can happen at any time, often the baby will grow past the first trimester. 10 to 15% of recurring miscarriages are caused by these antibodies.⁶ 

Antinuclear antibodies are caused by an auto-immune problem, in Lupus or a Lupus-like syndrome, where the body attacks itself. The treatment for this problem is Prednisone, a corticosteroid, which calms down the inflammatory process of auto-immune disease. Prednisone, however, is really a horrible drug and will cause all sorts of terrible side effects, including swelling, bruise marks on the face, and discomfort. You do not ask for this drug without really needing it.⁶

Fetal-Blocking Antibodies work to protect the baby from the mother’s immune system, which will recognize the father’s genetic material as foreign to her body and attack it. When the sperm penetrate the egg, it provides foreign material, but it also contains histocompatibility locus antigens (HLA). The sperm’s HLA will “talk” to the mother’s HLA, which would normally attack the baby, and stimulate the mother’s body to protect the baby. In some cases, however, the father’s genetic material is too similar to the mother’s. In that case, the mother’s response is weak and insufficient to prevent her white blood cells from attacking the new cells. Standard testing for this is not yet available, and you would have be accepted into one of the few elite clinics working in this field. If your tests show you and your partner’s DNA to be too similar, you can receive injections of your partner’s white blood cells, in hopes of getting enough of his HLA in your system to stimulate a stronger protective response. This is an expensive and controversial tactic, but allegedly (a word I use since there isn’t solid 3rd party data to support it) succeeds 80% of the time.^{7, 42} This type of problem usually causes an early miscarriage, well before 12 weeks, and is often suspected when several miscarriages have occurred at the exact same time in the pregnancy

The average OB/Gyn may not be up to date on these immune issues. Read up on it yourself and find a specialist who can determine if this is a problem that might be affecting your babies. You are not usually a candidate for the more involved testing, which is expensive and not typically covered by insurance, until you have at least three losses.Premature Rupture of Membranes and Early Labor

Many miscarriages begin with cramping and labor-like symptoms, but true PROM and Early Labor are usually associated with babies that are in the second or third trimester. Early labor can often be treated with drugs that relax the uterus and women are placed on bed rest either at home or in the hospital.

Sometimes, however, the baby comes anyway. This is one of the most traumatic of losses, technically a stillbirth and not a miscarriage after 20 weeks, because you will hold and see your baby and beg him or her to breathe. For some women, the baby will even be born alive, but only live for a few minutes, hours or days. There really is nothing harder in life than this.

PROM is defined as your water breaking prior to 37 weeks, the age that is considered full term. Most women who have leaking or gushing amniotic fluid will be placed on antibiotics and placed in the hospital because the risk of infection is very high. Once an infection comes, the baby will almost always have to be delivered.

Babies must weigh 500 grams, or about a pound, to survive. Because I was at high risk for PROM and early labor, I kept this day on my calendar and waited with fear for it to pass. For women expecting a normal pregnancy, suddenly having your water break is very frightening. Your are stuck in the hospital, having to rely on what people tell you, and unable to get information on your own. It is scary.

PROM is thought largely to be caused by infections or inflammation of the uterus or fetal membranes. How these infections come or why they cause the membrane rupture is not completely understood. Pelvic exams and yeast infections are NOT considered to increase your risk for PROM. I do know, however, just in reality through talking with women, including a close friend of mine, that PROM tends to recur. Knowing you are at risk and taking all the appropriate precautions is essential to keeping your baby in the uterus as long as possible.

Fortunately, even though PROM cannot always be treated or prevented, most babies are able to make it far enough to survive and lead normal lives. If you have experienced unexplained PROM, I highly recommend finding a doctor with experience with this sort of pregnancy.

Others — Infections, Age, Chronic Disease

Many infections can cause miscarriage, but they are the big ones like syphilis, mycoplasma, toxoplasmosis, and malaria. An upper respiratory infection is NOT going to cause a miscarriage, even though it may worry you to death. Viruses are the same. Normal illnesses like the common cold will not cause a problem, but AIDS and German Measles can. Infections that directly affect the uterus are bigger risk. This does NOT include yeast infections, which are extremely common in pregnancy. See the section on Premature Rupture of Membranes for more information on these infections.

There are a few common illnesses that can cause a miscarriage or fetal malformation if you get them for the FIRST TIME during pregnancy, including Chicken Pox and Fifth Disease. The vast majority of women already have immunity to these diseases, however, and should not be concerned about exposure to them during pregnancy. If you think you may not have immunity, ask your doctor to run an antibody titer to see if you have a live antibody, or only an old antibody to the disease in your blood. Only the live antibody without the old antibody present is a danger.

An infection that causes a fever of over 101 degrees Fahrenheit should be treated immediately, however. There is a small risk that prolonged fever can affect your baby. Take Tylenol to keep your fever down and stay in touch with your doctor.

Age is only a factor in miscarriage when you consider what aging can do to your body. The first and most common is with chromosomes. It is not YOU who have a problem, it is likely your egg or sperm, which have also aged. Age can, however, bring other problems such as poor health, disease, or hormonal imbalance that can make a pregnancy harder to sustain. You don’t start seeing these problems in great numbers, however, until after 40.

Health problems in the mother can create problems with the pregnancy. Diabetes, heart problems, and thyroid disorders are just a few that may complicate the pregnancy. Having these does NOT mean you will certainly have a miscarriage. You will simply have to be more careful and make sure your treatments are adapted if needed during pregnancy.

Accidents typically do not cause a miscarriage. The baby is well protected in its amniotic sac, surrounded by fluid, and even a hard blow to the abdomen will likely only rock it. Most women who have a car accident, even with a certain amount of trauma, have their babies just fine.

The Unknown

The hardest thing to accept is no reason at all. You live in fear, wondering if the same terrible cause of your first baby’s death will cause another one to die. You scarcely dare to try again. I have been in this situation and I tossed my doctor’s statistics aside. I had already been on the wrong side of the statistics; I didn’t care for anymore. But I do know this. One miscarriage hardly raises your chances to miscarry again at all. You are simply back at square one. Try to put the risk as far back in your mind as possible and enjoy another pregnancy. But I understand if you can’t.

Blighted  Ovum, Ectopic Pregnancy, Molar Pregnancy, and Stillbirth

Sometimes a pregnancy ends unhappily, but it is not technically a miscarriage. This section will touch on these types of situations.

Blighted Ovum is a condition (with a terrible, unfortunate name) where the gestational sac grows, the woman gets all the pregnancy symptoms, but the baby itself never develops. The sac will continue to grow and grow, and most women do not know there is no baby until an ultrasound is done. The bleeding, if that happens before the blighted ovum is found via ultrasound, is slow and brown. Your pregnancy symptoms will seem to go away. A blighted ovum is believed to be caused by an egg or sperm with poor genetic material. When the egg is fertilized, instead of creating both a sac and a baby, the part that should be a baby never grows. A D&C is almost always needed to empty the uterus, because the body is very slow to realize there is no baby. Some women do experience more than one blighted ovum, but most women go on to later have a baby.

An Ectopic Pregnancy is a normal fertilized egg that gets stuck in the fallopian tube (although occasionally it will fall into the abdominal cavity) and implants there. This type of pregnancy cannot survive and puts the mother at great risk for severe hemorrhaging and possibly even death as the baby grows and eventually bursts the tube. When the ectopic is discovered based on pain and symptoms rather than an early ultrasound, the mother will immediately have surgery to remove the baby. Things will happen very fast, and most likely if this has happened to you, you are reading this after it is all over. If you are afraid you have an ectopic, the symptoms that you really want to watch for are: sharp, intense pain in your abdomen or possibly in your shoulder; a pregnancy test that is positive, then turns negative a few days later; and spotty red bleeding that continues day after day.  Ectopics that are caught early can be treated with a cancer drug called Methotrexate, which will end the pregnancy safely and without surgery.

Ectopics are usually caused by scar tissue in the fallopian tubes that could have been caused by: previous surgery in the pelvic region, uterus, or tubes; a pelvic infection such as chlamydia or pelvic inflammatory disease; or endometriosis that blocks the entrance to the tubes. If you have had one ectopic, your risk increases for another one. See additional information on treatment.

A Molar Pregnancy is a very rare type of pregnancy where an abnormal mass forms inside the uterus after the egg is fertilized. The baby usually does not form, but the uterus is filled with big bubble clusters.  A molar pregnancy is caused when a sperm fertilizes an empty egg (called a complete molar pregnancy) and no baby grows, or when two sperm fertilize an egg and both the baby grows a little as well as an abnormal placenta (called a partial molar.) Even if a baby does grow, it cannot survive. The longest documented molar pregnancy I have seen was a 24-week stillbirth, and most molar pregnancies will be diagnosed and a D&C performed before the end of the first trimester. If a molar pregnancy has been diagnosed, your medical condition will be carefully monitored. In about 15% of molar pregnancies (usually complete molars and not partial), the moles spread to other parts of the body like cancer. A mild form of chemotherapy will have to be used (with methotrexate), but rest assured that the cure rate for this type of disease is very high. The signs of a molar pregnancy include: bleeding in the 12th week of pregnancy, a uterus that is larger than normal, and hCG levels that are too high. The molar pregnancy is removed by a dilating the cervix and gently suctioning out the clusters. Women who have had a molar pregnancy are usually advised not to get pregnant again for at least a year to ensure the cancerous form is not present. It is absolutely essential to follow doctors orders on when to try again with a molar pregnancy diagnosis. Do not cheat, and have regular follow ups even after your hCG is zero, to make sure it does not rise again.^8,9

A stillbirth is technically any pregnancy that ends after the 20th week and the baby does not survive. Some babies die in utero and are discovered when the heartbeat is not found. The most common causes of this are: uterine abnormalities, a knot or other umbilical cord accident, infections of the lining of the gestational sac or cord, and placental abruptions that cause the placenta to pull away from the uterine wall. These babies are usually born through the induction of labor, although some babies are small enough to be taken by D&C or D&E procedures.

Other babies are lost through early labor. The causes of early labor are Premature Rupture of Membranes, uterine abnormalities that make the uterus too small to hold the baby, and anincompetent cervix, which opens up and lets the baby out. Sometimes a stillbirth occurs during the birth, by an umbilical cord that gets pinched between the baby’s head and the cervix, or the cord wraps around the baby’s neck. Repeat stillbirths are extremely rare and are almost all related to uterine or cervix problems, which can be fixed or treated once found.

____________________________

I know you may be frightened by what you’re going through.

Remember Deanna has a private group on Facebook to help.

Will it happen again?

I know this is a big question. If it happened once, you worry that it will happen again. If this is your first pregnancy, you worry that it will happen every time.

It’s not very likely that you will lose every pregnancy. The stories I hear about women losing even two in a row are pretty rare. I’ve included a chart to give you some idea of what books and medical sites tend to say. Know that hardly any of them agree, as some are hard numbers, others are extrapolated from what they assume are unreported losses.

Some doctors distinguish between a “clinical pregnancy” that has been tested on the less sensitive office urine tests and ones that were done with home tests that can go positive even before you miss a period.

Most doctors are unwilling to get into statistics, as you may have discovered. I researched this issue well and am going out on a limb because I know you want to know something, even if it may not apply to you in the end.

For most normal, healthy women in their first pregnancy, the statistics look like this:

Statistics for repeat miscarriage

Statistics on Ectopic Pregnancy

Even though your rate of ectopic is a bit higher when your tube is preserved, you want to keep your tube if you can. It dramatically increases your ability to get pregnant again.

Description of the D&C Procedure

Surgical Procedures

If you opted for a D&C or D&E, first you will have the procedure done. Remember that if you can, insist on some time to gather loved ones around you or to get yourself together before you do this. Don’t let anyone panic you into rushing into a procedure you’re not ready for. This is usually all done in one day, but if you were farther along than 14 weeks, it may be a two-day procedure, with the laminaria sticks being inserted the first day, the dilation occurring overnight, and the procedure being done the next day. If your pregnancy was very young, you may get a dilation cream instead, or even not need dilation if your cervix is already slightly open as the miscarriage is beginning.

The surgery will be pretty fuzzy to you, due to the drugs and anesthesia. You may be put completely under, or you may be given a local and laughing gas. If you are awake, you may feel some pricking or sucking sensations, but it will not be uncomfortable. You will spend a couple of hours in a recovery room to wait on the anesthesia to wear off. Some doctors will prescribe antibiotics as a precaution; but many will not unless you develop symptoms of an infection.

During the next few days, you will likely experience the following:

• Mild to medium pain in your abdomen or tenderness. Most women report no pain at all, but those pain pills are not prescribed for nothing. Hopefully you will not need them.
• Deep muscle soreness in your thighs from your position during the procedure.
• Mild to heavy bleeding with some mild cramping.
• Sun sensitivity, nausea, and weakness from the strong antibiotics.
• Heavy groggy feeling, from the anesthesia and your sadness.

Call your doctor if you experience the following:

• Any sort of abdominal pain after the second day. You could be developing an infection. Don’t panic though, just call and you will get a stronger antibiotic and a check up.
• A fever that starts to approach 100 degrees. Again, infection is a possibility.
• A sudden stoppage of bleeding, then severe cramps, almost as if you are in labor. This happened to me, and I can’t tell you how I panicked. I ended up passing tissue, then the bleeding resumed normally. I called the doctor and they checked on me every few hours at home, but I didn’t end up having to go in (good thing, since I was 150 miles away).
• Pain, flu feelings, or overall debilitating sickness that last more than a day or two.

You will feel some of the following as the days and weeks wear on:

• A mild start and stop bleeding pattern up to two weeks. You should have a new cycle, unrelated to the first bleeding, between 4 and 7 weeks after the miscarriage. I didn’t get a fresh cycle until the last day of the 7th week, so don’t panic if you are still waiting. A few women need a Provera shot to jump start their cycle, but this is not terribly unusual. Call your doctor if you go much longer than 7 weeks, just for your peace of mind. You may want to start charting your temperatures after the bleeding stops to see where you are. Remember that you can get pregnant that first cycle, so use contraceptive. For more information, see the section on trying again.
• Snappy, unhappy, angry feelings. Wanting to be left alone or wanting to talk about what happened with everyone you know.\
• A sense that it isn’t real, that it never happened.
• Hypersensitivity to sad TV or reading materials, being revolted or angry about happy scenes of families, seeing symbols in everything you do, from gardening to dreams to what you eat.
• Anger at the baby, wishing you never knew about the pregnancy, wanting to throw out all the baby reminders, or clinging to the little angel you lost, thinking about him/her nonstop, wanting everyone to recognize that the baby was real.
• Anger and/or jealousy of other pregnant women, even friends and family, to the point you don’t want to even talk with them. This is okay. I felt this way for several months.

Medical Terms

AFP (alpha-fetal protein) — A byproduct of fetal waste. Levels that are too high or too low may indicate a problem with the baby, such as a neural tube disorder (spina bifida or anecephaly) or Down’s Syndrome. The early test (done around 16 weeks using the mother’s blood) is called the triple screen, or AFP-3 test. The false positive rate on the test is outrageously high at around 80%, making it a very controversial test for unnecessarily upsetting pregnant women. AFP screening during amniocentisis, which is the second tier test, is far more accurate. An abnormal blood test will usually be repeated, with an amnio or Level II sonogram following.

amniocentesis — a test where amniotic fluid is pulled from the sac using a sonogram-guided needle. This fluid is used for AFP screening and genetic karyotyping, and is recommended for women over 35. While infection and possible miscarriage from the procedure is a known risk factor, the incidence is very low. The procedure is best left to perinatologists or high risk doctors who perform it regularly, and have little or no incidence of complications due to their experience.

anencephaly — a type of neural tube disorder where the baby’s brain does not form. This is caused by a failure of the neural tube to close properly very early in the baby’s development. Anencephalic babies often die prior to birth, but can live a few hours after being born. Recent studies show that the presence of folic acid in the mother’s blood at the time of conception greatly reduces the number of neural tube disorders. It does not, however, prevent them entirely. In Westernized countries, most women get sufficient folic acid in their diet and the numbers of the disorders have not dropped dramatically despite huge campaigns.

anti-cardiolipin antibodies — see immune causes of miscarriage

anti-phospholipid antibodies — see immune causes of miscarriage

bicornuate uterus — a uterus shape where the two ducts that form the uterus do not fuse and form a single open area, but remain two distinct uterine cavities that may be fused only at the bottom, or even half way. This condition significantly increases the chance for miscarriage and infertility. Depending on the severity of the shape, surgery may be an option to correct the uterus or improve the uterus’ ability to carry a pregnancy to term.

blighted ovum — a condition where the egg creates a sac and the pregnancy seems to progress normally, but an ultrasound reveals that the baby never formed. See more under see causes of miscarriage.

cervical incompetence — a condition where a woman’s cervix, or opening between the uterus and vaginal tract, is not strong enough to remain closed during pregnancy. During a critical time period of growth, most often from about 16 to 22 weeks, the cervix may open and labor will begin prematurely. A cervical stitch can be used to help hold the cervix closed.

cervical stitch, cerclage — a stitch placed around the cervix, or opening between the uterus and vaginal tract, to keep it closed during pregnancy. This is only needed in cases where a woman has a diagnosis of cervical incompetence. This procedure will work for most women, and although early labor may still occur, it will often be past the viability age for the baby.

chemical pregnancy — usually a general term to apply to many early miscarriages where a baby never develops. The “chemicals” or hormones of the pregnancy were produced, but a baby did not form. Often the pregnancy itself could not be diagnosed, as the loss happened too early. See also blighted ovum.

chromosomal anomalies — any problem in a person’s genetic code, or DNA. Very minor anomalies may not even be noticeable. More serious ones cause problems such as Down’s Syndrome and other known genetic disorders. The most dramatic ones will cause the death of the baby, usually during the first trimester, and most often before the mother knew she was pregnant. The chromosomal problem may have started with a poor quality egg, poor quality sperm, during fertilization, or in the early cell divisions.

Clomid — also clomiphene, a drug used to stimulate ovulation in women who may not be ovulating or may have a luteal phase defect

complete abortion — a miscarriage where all tissue has been passed out of the uterus

cord accident — a general term for many problems with the umbilical cord, including prolapse (see below), a knot tied in the cord, or any failure of the cord to provide oxygen and nutrients to the baby

cord prolapse — a condition when the umbilical cord falls through the cervix and possibly even into the vaginal canal, usually during labor or when water breaks. Delivery or cesarean is usually performed immediately

CVS (chorionic villus sampling) — a test where a small bit of the chorion surrounding the baby is sampled with a tube going up through the cervix. Testing this can reveal genetic problems with the baby and tell its sex. This test can be performed much earlier in a pregnancy than amniocentesis, although the risks are higher for complications, such as infection leading to miscarriage. These risks are still quite small, but need to be weighed against the need for the test.

depo provera — a synthetic hormone given in larger doses as a form of birth control that works about three months, or a smaller dose to help stimulate periods in a woman whose cycle is not ending

ectopic pregnancy — a pregnancy where the fertilized egg has implanted outside the uterus, usually in the fallopian tube, or rarely in the abdomen. This pregnancy cannot continue, as the pregnancy will eventually stop growing and miscarry, or grow until the tube bursts or causes intense pain in the mother. The first signs of an ectopic may be a pregnancy test that is positive, then negative a few days later, hCG levels that fail to double,  or persistent spotting. An ultrasound can usually locate an ectopic by six weeks. See also treatment for ectopic pregnancy.

edema — excessive swelling during pregnancy, which can be a sign of complications, such as preeclampsia

elective abortion — usually refers to a D&C surgery performed to end a pregnancy around 7-9 weeks, even as late as 15 weeks. Sometimes an elective abortion is performed (depending on where you live) in early pregnancy via a drug called RU486, which will also end the pregnancy.

endometrial biopsy — a test for progesterone where a bit of the lining is taking from the uterus to check if the lining is “in phase,” or at the proper point of development for that part of the cycle

fetal demise — death of the baby in utero, diagnosed via ultrasound

Fifth Disease — an illness commonly acquired by small children resembling the flu with a rash across their cheeks. Most adults have been to exposed to this disease already and are immune, but a pregnant woman who has never been exposed to this disease may pass it on to the fetus, causing (in very rare cases) complications or fetal death.

habitual aborter — a woman with several unexplained spontaneous miscarriages

hCG levels — the amount of pregnancy hormone in a woman’s body. A level of 5 is considered “pregnant,” although a home pregnancy test will require a level of 50-80 to be positive. See page on hCG for more information.

heparin — a blood-thinning drug used to treat women suspected of certain immune causes of miscarriage. The drug cannot cross the placenta, so does not affect the baby. It should be discontinued, however, well prior to delivery since it will hamper the mother’s ability to clot from labor or surgery.

hormone testing — a general term for dozens of types of testing for progesterone, hCG, estrogen, and other important hormones for general health or during pregnancy. See page on testing.

human chorionic gonadotrophin (hCG)–a hormone only produced during pregnancy. This is the hormone tested by doctor’s blood tests and home pregnancy tests to determine if you are pregnant. See page on hCG for more information on proper levels.

hydatidiform mole — see molar pregnancy

hysterogram — in most cases, this term is just a shortened version of hysterosalpinogram below

hysterosalpingogram (HSG) — a test where dye is pushed into the uterus, and then x-rayed to see the shape of the uterus, and if there is blockage in the fallopian tubes. This test cannot be performed when you are pregnant. See also testing.

hysteroscopy — a test where a tiny scope is inserted through the cervix so the doctor can view the walls of the uterus

incompetent cervix — see cervical incompetence

incomplete abortion — a miscarriage where some pregnancy tissue remains in the uterus even though blood and tissue has been passed. A D&C procedure is often needed to empty the uterus, although sometimes a mild contraction stimulating drug such as Cytotec or a drug called Methotrexate can be used.

karyotype — genetic testing where tissue or blood cells are cultured and grown to reveal their chromosomal structure

luteal phase defect — a condition in which a woman does not produce sufficient progesterone to create the proper lining for a fertilized egg to implant. For more on this problem, see hormone causes of miscarriage

lupus anticoagulant antibody — see immune causes of miscarriage

methotrexate — a drug used to end an ectopic pregnancy before surgery is necessary. See treatment for ectopic pregnancy.

missed abortion — a miscarriage where the pregnancy tissue has not been expelled from the uterus. See also pregnancy treatment.

molar pregnancy — a pregnancy where huge bubble clusters form in the uterus instead of a baby, or occasionally in addition to an underdeveloped baby. This condition can sometimes be related to a form of cancer, and the woman will not be allowed to try again for an extended period, and may need chemotherapy. See more information in the miscarriage causes section.

mycoplasma — a bacteria sometimes found in the vaginal tract that has been linked to miscarriage. This is a common test following a miscarriage and is easily treatable if found.

placental abruption — a condition where all or part of the placenta has pulled away from the uterine wall, disrupting the flow of blood and oxygen to the fetus. Small abruptions can heal, but larger ones can cause fetal distress or death. Abruptions can be caused by several factors, including blood clotting disorders, an infection, or poor chromosomal development. Rarely, an abruption is caused by an accident or severe strain.

polycystic ovarian disease (PCOD) or polycystic ovarian syndrome (PCOS) — a diagnosis that covers a range of hormonal problems that result in the ovaries not ovulating, often forming tight cysts rather than fertile quality eggs.

premature separation of the placenta — a condition where the placenta pulls away from the uterine wall prior to or during labor. This serious situation can cause fetal distress and death if not caught and the baby delivered immediately.

premature rupture of membranes (PROM) — any time your water breaks prior to the 37th week, you have PROM. You will be usually be hospitalized until the baby is delivered, and typically placed on antibiotics, since infection is a very common complication. PROM can be unexplained, and may recur, but many babies’ deliveries can be held off until viability age, preferably 32 weeks, but even as early as 24 weeks.

progesterone — a hormone produced in in every menstrual cycle after ovulation. This hormone plays a very important role in pregnancy. See more information in  causes of miscarriage

PROM — see premature rupture of membranes

provera — a synthetic progesterone often given to women to bring on a period after a seven or more week delay, when she is not pregnant

reproductive endocrinologist (RE) — a specialist in handling high risk pregnancies and in diagnosing causes of miscarriage. This type of doctor receives specialized training beyond the standard ob/gyn.

rH incompatibility — a situation where the mother’s blood type is rH negative, and the father is rH positive. This is not a concern during a first pregnancy, but if the mother is sensitized to rH-positive blood during pregnancy, subsequent pregnancies may be attacked by her immune system. A shot is given to the rH negative mother at the end of any pregnancy, regardless of length or outcome, to prevent the production of harmful antibodies.

spontaneous abortion — a term for any sudden miscarriage

sub-chorionic hemorrhage — an area, usually near the edge of the placenta or in fluid just outside of the gestational sac, that is bleeding. This can either bleed out and show as spotting or bleeding, or can form a bruise that does not bleed. A sub-chorionic hemorrhage is not uncommon, and does not mean the pregnancy will end in miscarriage. It most often happens because during the normal course of the uterus stretching and growing, a bit of the placenta peeled away and bled. It will almost always heal on its own. There is a slightly increased risk of miscarriage if the hemorrhage is large (over 200 ml in volume), as it may mean the placenta implantation is weak. Bed rest is not always given, as many hemorrhages are very minor.

Sub-chorionic hemorrhage can be very scary — big clots and lots of red bleeding. But it starts and stops. It can be fairly painful too. You will want to see a doctor right away to assess your risk and decide if you need to stay off your feet.

threatened abortion — a pregnancy where bleeding has occurred, and a miscarriage may be forthcoming

toxoplasmosis — a disease found most often in cat feces. It can cause fetal death should the pregnant woman become exposed for the first time during pregnancy. Most women are routinely screened for toxoplasmosis in early pregnancy to determine immunity. Exposure prior to pregnancy makes you immune. Most women with outdoor cats will already have exposure, but should still avoid handling cat litter.

translocation — a chromosomal anamoly where two pieces of genetic material are switched in position. A translocation will usually show no symptoms in parents, but may greatly increase their chance of miscarriage, as the chromosomes in the egg and sperm will not align correctly. A karyotype of the parents can uncover this rare problem.

triple screen — see AFP

septate uterus — a uterus with a band of tissue coming down the middle. The septum may be very minor and paper thin, causing no problem to a pregnancy, or may be very thick and unmovable, adding to your risk of miscarriage and premature labor. An HSG test is used to diagnose this condition, which is usually treated with surgery if necessary. (Deanna herself has this condition and has had the HSG and the surgery.)

viability age — usually babies must weigh 500 grams, or 1 pound, to survive, although as technology advances, some babies smaller than this do make it. This point is usually crossed at about the 24th week. Babies can have severe complications however, any time before 32 weeks, and a few complications after that mark. This term also refers to the point in pregnancy when you can no longer seek a legal end to a pregnancy. See politics for more information.

Telling friends and family about your miscarriage

I remember the moment I called my parents as if it were this morning. We were supposed to have found out the sex of the baby, but instead we learned he had died. It was the hardest moment of all, I think, because when you tell someone else what has happened, it becomes real.

In these conversations, I think you have to be as straightforward as possible. They will have lots of questions that you may or may not be able to deal with right now. I would keep the conversation brief if possible and let the details work themselves out over the next few days. Once the grandparents know, then you can move on to others. You may find it easier to tell a close friend or sibling first and let them tell the grandparents. This depends on your family make up.

If no one knew you were pregnant, you may be tempted to remain silent. I don’t recommend you keep this all to yourself. Most of your friends and family would want to be there for you during this difficult time. You are denying them an opportunity to help you. You don’t have to pretend this was no big deal, or that the baby wasn’t real. You were pregnant, you were expecting great joy, and you lost it. This is not a small thing.

We sent out an email to all our friends once our parents and closest friends had been called. The text of it is included below.

To our friends,

This is a difficult e-mail to write.

On Tuesday, April 28, we learned that the baby whose September arrival we had so anxiously anticipated, had died. The cause is as yet unknown; we will probably never know why.

We have named the baby Casey Shay. Casey will be delivered on Thursday and cremated.

We know that you feel for us. We ask that you send your sympathy and condolences to us by writing instead of calling, if you don’t mind. It is difficult to find words to say anyway, and it is hard for us to relive the entire experience over and over again. We would cherish any cards or notes you would care to send.

We also know that you will have a hard time knowing how to act around us for a while, especially those of you who are expecting a child. While this will be hard for us to handle for a little while, we will eventually be all right. In a couple of weeks, you may certainly give us a call to go out for dinner or drinks, or a movie. We are strong people and have a very strong relationship with each other. We will be fine and will, sometime later this year, be ready to try again.

Our lives are going to be a little different now. Deanna, of course, had already resigned her teaching position and has no intention of going back. She will be looking for a new job in June, in a new career. Once the delivery and recovery are behind us, we will be traveling for a week or so and visiting some of our favorite places, so don’t be surprised if you don’t hear from us for a while. When we were first married, one of our favorite places to visit was the seawall at Galveston. We will most likely stay there a few days.

Keep the three of us in your thoughts and prayers.

John and Deanna

 

No one will talk about it.

Many, many women write me and say that no one will let them talk about their baby, and even their close friends, church members, and family shy away from the topic. This is so common that it has become the number one comment I get in emails.

What is really happening? Your friends, your coworkers, your church acquaintances know you are hurting, and hurting deeply. They do not know what to say. They want you to feel better, so they think somehow, if they ignore what happened, you will forget about it sooner. There are a lot of people who honestly believe that the more you talk about something, the worse you feel. Nothing could be further from the truth.

Unfortunately, unless you feel comfortable bringing it up (and you SHOULD; it is perfectly okay), no one else will. Would you want to be talking on the phone with someone, having a perfectly normal conversation, and then suddenly say something that makes the other person burst into tears? This is what your friends believe will happen (and they are probably right), and they don’t want to put you through that. They don’t understand that this is exactly what you need to do.

I forced the issue on my friends for a while, refusing to talk about anything else. All the while, however, I got on the internet, in chat rooms and bulletin boards, talking to other women in my situation who were interested in every detail. When you can’t get the support you need in your current circle of friends, reach out to those of us who have been there. I have made countless friends through our shared experiences, and these are people you can count on to understand and not to say anything stupid. They have been there, and for a while, they are the best friends you will have.

Find an online forum for women who have experienced a loss. Visit it and get the support you need outside your normal circles, for a while. When you are used to talking about your baby, then you may be ready to bring up the subject with your family and friends. I think you will find that many of them really want to know what happened. Deanna runs one on Facebook, which is private and friends cannot see your posts.

People might say awful things.

Most people don’t really know what to say, so they make something up on the spot or repeat old-fashioned sayings that don’t really apply. I think that they feel the need to say something, and they want somehow to make it all better. While many of the stupid things that people will say to you upon learning you have lost a baby seem thoughtless and even cruel, do realize that it is difficult to find the right thing to say to you. You will probably be upset no matter what they say. This is okay, you can always just walk away from the conversation.

For those of you who want to retort, here are some replies to the most common comments you will hear.

Comment: “This was probably a blessing in disguise.”
Reply: “I don’t see it that way; this is actually very hard for me

Comment: “At least you weren’t farther along.”
Reply: “I think a baby is a baby no matter how big he or she is

Comment: “Now you have an angel in heaven.”
Reply: “Yes, but I’m sure I’d rather have a baby here

Comment: “This was God’s will.”
Reply: “I don’t think I or anyone really knows what God’s will is exactly

Comment: “Be glad you didn’t get attached to it.”
Reply: “Actually, we were quite attached to our little baby

Comment: “Stop worrying. My cousin had four miscarriages and she had a baby just fine.”
Reply: “I am very sorry for your cousin. I know how hard those four miscarriages must have been.”

Comment: “If you stop thinking about it, you’ll feel better.”
Reply: “Actually, thinking about the baby is important to me.”

Comment: “You can always have another one.”
Reply: “Yes, but I still lost this one, and one child can never replace another

Sometimes the best way to handle difficult people is to simply avoid them until you are up to it. If the problem is a mother-in-law (and it often is), ask your husband to handle her calls and keep yourself busy in the kitchen or elsewhere when she visits. Don’t take her or anyone else’s comments as being critical of you. Even when they seem that way; they are rarely meant to be.

Mean and Petty People

We all know they are out there. People who are thoughtless, crude, or mean. Who knows why they are like they are. Maybe life was too harsh for them. Maybe they are socially inept. But they have the power to really really upset you.

It’s best to avoid these people, but sometimes their meanness seeps into your life, and sometimes they are your family. Here are some examples of terrible, horrible things people have said to women on the bulletin boards. Maybe the people you know will seem like angels in comparison.

• From a woman who had just had a baby to a woman who had just lost one: “Thank God I didn’t follow your pregnancy advice!” (Did she think this was a joke?)
• From a mother-in-law when both her daughter and the daughter-in-law were pregnant and the daughter-in-law lost her baby: “Well at least my daughter knows how to take care of herself and give me a grandchild.”
• From a “friend” after hearing about the loss of a baby during a vacation: “I told you not to go on that plane trip. Everyone knows it causes miscarriage.” (It does not.)
• From another friend, who was also pregnant. “God, I hope it’s not catching.”
• From a mother to her daughter. “You shouldn’t have had a baby with that creep anyway. Thank God it died.”

How did you handle this difficult moment?

Leave a note in the comments about what you did as you told others about what happened.

Where is God in all this?

I’m losing faith in God

It is hard to imagine a loving, compassionate God who would let things like this happen. What did an unborn baby ever do to deserve this? What have you done?

You may feel your faith is being tested right now, and it is completely understandable that you will doubt in God. Regardless of your religion, “Why, God?” is a universal question when we face suffering. In many ways, you will have to think your way through your conflicting feelings about a God that you love and believe in, but you feel has failed you. Your clergy, pastor, preacher, rabbi, or priest may be able to help.

I thought of it this way: God is here for us. He will carry us through our troubles if we let Him, but He does not guarantee that life will go as we wish. Death and suffering are part of our life, and our faith is there to help us through it, not prevent it. The last thing I wanted to do in my hour of need was to cut myself off from the only person who would not say something thoughtless or let me down–God.

At the bottom of this post, please feel free to add your ideas about managing these hard days in your religion.

Thoughts for Christians

We should always remember that earth is not heaven. Heaven is our reward for going through trials, pain, and suffering of this earth and remaining faithful Christians. God does not always answer our prayers in exactly the way we want, but He is there, listening, and caring.   Many words from the Bible are comforting for moms going through miscarriage. Here are a few:

About your baby:

Isaiah 49:1 – The LORD called me from the womb, from the body of my mother he named my name.

Jeremiah 1:5 – Before I formed you in the womb, I knew you.

About you:

Isaiah 41:10 – So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand.

Mark 11:24 – Therefore I say to you whatever things you ask when you pray, believe that you receive them, and you will have them.

Jeremiah 33:6 – Behold, I will bring you health and cure, and I will cure you, and will reveal unto you the abundance of peace and truth.

Sarah W. passed along her experience with angels.

Both times I had to have the D&C, I asked the angels to just help me get through. The first time was more like a dire plea for help, with no politeness or really gratitude, it was more like ‘please just get me through this hell, any angels out there just please take me away somewhere and then bring me back once it is all over’ kind of plea. But strangely it really worked, and all through the experience I felt a huge love and support carrying me through. I managed to get through surgery being delayed for 4 hours, waking up half way through the procedure because I stupidly told them I was a sensitive person and they took this to mean I won’t need as much drugs, whereas I actually meant that I can feel the pinprick of a needle already a foot away before it has touched my skin, kind of sensitivity. Anyway, I got through it with lightness and sometimes even laughter.And the same last Friday when I went for my 11 week scan and discovered there was no heartbeat. I had to wait until Tuesday (2 days ago) to have the dnc and asked again for the angels to just get me through the weekend without me miscarrying myself or having any complications or fear. It seems to have gone well again, and I felt all Saturday and Sunday a huge feeling of love and compassion surrounding me.My belief in angels comes from a personal experience I had about 5 years ago following a break up of a long term relationship. One night while alone in the house, I experienced and felt (but not saw) a very overpowering energy envelope me, giving me the feeling of infinite, unconditional, and overwhelming, far beyond anything I can explain or have experienced, love.  It completely freaked me out at the time of course, and it took me a few years to assimilate the experience, and all I can equate it to, in my mind, is that it really was an angelic presence.

So, occasionally, when I remember that I am also a spiritual being and not simply just a physical one, I remember to call on these guardians to support me through difficult times, and I recommend anyone try it. One doesn’t need a candle, a ritualistic approach, or any trite incantation to make it happen. For me, simply by asking from the heart, begging even (which most of us really want to do at times like this), wherever you are – in the car, in bed, in the hospital room, or at the midwife, just ask the angels to come and help you, to give you comfort, to get you through it, to just relieve some of your pain, or whatever you personally need or want, and you may be surprised what occurs.

I think a spiritual outlook or a philosophical approach can be the most invaluable at times like this.  After all, us women are creators, we can create and nurture new life. That is so magical, and we have such a strength to be able to do that and to continue to try to do that. We mustn’t let the medical profession rationalise it too much, and get too bogged down in talk of chromosomes, progesterone…etc, but remember that something far more magical is at work, and we are the magicians.

Thoughts for Buddhists

Sent in by Derek

Thank you for your time and effort in developing and maintaining your website. My wife and I found it to be a great help.

We are Buddhists, and perhaps you would consider posting this regarding our recent loss.

We believe that we choose our life; our parents, our family, our friends, how we live, and how we die.

We believe that the life who chose us, did so to bring us joy, and to allow us to experience being parents.

We hope that next time, he/she will stay longer, and help us to experience even more joy.

Derek

Thoughts for Mormons

Sent in by Melanie

My name is Melanie, I am a member of The Church of Jesus Christ of Latter Day Saints. I have recently lost my first baby, whom I had been waiting for three years. I t was been an extremely hard thing for me, but there is one thing that has brought me peace more than anything. As members of the church we believe that Families can be together forever, meaning that your relationship with your husband and children does not end at death. When we get married in the Temple, we are married for time and eternity. We believe that there will be a time that we will see each other again and we will live together as a FAMILY. This has brought me hope and has reminded me of how merciful God is that he will allow us to be with the people we love them most for the rest of our lives. There is a great website that explains this hope that I am talking about and it is

http://www.mormon.org/blog/solace-after-loss-loved-one

I invite every single woman who is going through the same thing I am going through, to visit this website. I promise them that this will bring hope and happiness to them and their families.

Add Your Own

If you would like to contribute additional verses from your own personal trove of scripture or sacred text of any religion, feel free to add them in the comments below.

Miscarriage strikes women of every religion, and we find solace in our beliefs no matter where they originate.

Choosing between D&C and Natural Miscarriage

When you have a choice between surgery and natural miscarriage or labor

Usually you will be offered a choice between surgery and either waiting for a natural miscarriage or having induced labor. The two types of surgery are D&C (dilate and curettage) or a D&E (dilate and evacuation–for bigger babies between 14 and 20 weeks).

Some doctors prefer you wait for it to happen naturally due to the small risks of dilating the cervix for a D&C. Waiting it out is typically only for those less than 10 weeks along due to the risk of blood clots and hemorrhage, but this depends on your doctor. On rare occasions, you may be offered a methotrexate shot and a suppository to bring on a natural miscarriage. As for the choosing between a D&E and actual labor, state laws vary about the age of viability, and you may fall in the gray area, which will be discussed later.

Things to think about when choosing between natural labor and D&C surgery:

Do I want to wait for a natural miscarriage?

Advantages: If you wait, you can feel certain that there was no mistake made. When the baby comes you will know that nature has run its course. You can go home instead of going immediately to a hospital or office procedure. You can take a little time to say goodbye and gather loved ones around you.

Disadvantages: For some women, this process is not much worse than a bad period, for for many, it can take several days and be extremely painful and scary. You may have to have a D&C anyway if everything does not come out (called an incomplete abortion). It may be distressing to think of walking around with your baby who is no longer living. Having tissue come at home may be frightening and you may feel awkward, not sure if you save it, or bury it, or what to do.

Do I want a D&C?

Advantages: This is mostly painless and will get you back on track to start trying again much sooner. The physical part of the ordeal will end.

Disadvantages: There is some risk of damaging the cervix during dilation, although that has mostly been taken care of by using laminaria, or seaweed sticks to dilate you gently overnight. Some doctors now use a cream to begin dilation. (If this will not be done, ask if you are going to be dilated (very early pregnancies may not need it, and your cervix may already be opening), and how. Mechanical dilation is riskier. Some women also worry about punctures or perforations of the uterus. While this is a possibility, the risk is small. Even if this should this happen, the uterus will usually heal without complications or harm to your next pregnancy. The main disadvantage to this procedure is that you will not get to see the baby, ever. Most clinics and hospitals will have the baby’s remains cremated. If you are pretty far along, holding the baby may be very important to you.

If your doctor does not agree with your decision to either wait or to have a D&C, GET A SECOND OPINION. This is your baby and your life. If you need a second opinion, a good place to go is a women’s hospital or clinic, where they usually focus on you, not the procedure, and help you make the best decision based on all the information available.

The Gray Area

The death of your baby becomes a legal issue somewhere between 20-28 weeks gestation. Some countries, or regions within a country, require labor and delivery at 24 weeks; some allow the doctor some discretion. Naturally, if you have already begun early labor, you may not have a choice. If your labor could be stopped, then the miscarriage might not happen at all. Otherwise, the cause of the miscarriage is usually Fetal Demise, and if the baby died well before the exam that showed no heartbeat, then it may measure out smaller than the pregnancy would indicate.

There will be a viability point, usually at 24 weeks, where you have no choice but to deliver the baby. To find out more about this, and whether or nor you want or will be able to have your baby’s remains, you may want to read about the politics of fetal death.

If you are more than 20 weeks:

Things to think about when choosing between a D&E and induced labor:

Do I want a D&E (if eligible)?

Advantages: This is mostly painless and will get you back on track to start trying again much sooner. The physical part of the ordeal will end.

Disadvantages: You will never see your baby, and if you are like me, where the baby was too small to see its sex and the chromosome tests do not come out, you will never even know if your baby was a boy or a girl.

Do I want to deliver the baby through labor?

Advantages: You will get to hold your baby, take a picture if you want, and say goodbye. It will be very, very hard and sad, but it will make you feel better later.

Disadvantages: Although this is not always the case, the drugs they give you to dilate your cervix and induce labor might make you very sick—throwing up, diarrhea, some women have mentioned hallucinations and terrible fear. It can take many hours or even days to get dilated enough to get the baby out. And the result is the same: you have done all this labor to see a baby that is not alive.

Different doctors will push different options. Weigh them the best you can and make sure you get what you want. Even if you regret your decision later (as I did for many years), remember that there simply is no good way to deliver a baby who has died. It’s a terrible thing no matter what.

Signs of Miscarriage

I have a very complete page about the signs and symptoms of a miscarriage on this page:

SYMPTOMS OF MISCARRIAGE

Preventing Miscarriage

I’m going to start this page with the important point that there are very few miscarriages that are preventable. Well over half of all miscarriages are caused by random genetic problems in the baby that could not be avoided.

As you go into your next pregnancy, you may wonder what the doctor will do differently. What are they going to do to keep it from happening again?

The key is finding out what caused the loss, and if that cause was random or recurring.

I have a huge section on this: Diagnosing the cause of miscarriage

An important section to read if you are sure you could have prevented your miscarriage is the page on myths. There you will find the most common things women blame for their miscarriage, and why they are not a factor.

The few types of preventable miscarriages involve the following causes:

• Hormone deficiencies
• Physical problem with the uterus or cervix
• Immunological problems

Read about them on the Causes of Miscarriage page.

Books about Miscarriage

Baby Dust: A Novel about Miscarriage and Pregnancy Loss by Deanna Roy The five women sitting in the circle of chairs all had great dreams of motherhood. Then their babies died. Melinda sees blood on the floor every day after her loss. Dot believes the wrath of God caused her baby to die. Teenage Tina is trolling internet dating sites for a father for another baby, and Janet’s failure to cry means her wedding is off. Stella, the support group leader, must help them while facing the old choices that cost her ever having a family of her own. Based on the stories of dozens of real survivors, Baby Dust is a moving tribute to the strength of mothers who must endure this impossible loss. Paperback copies Barnes and Noble   Amazon  Amazon UK   Signed copy through the publisher Ebooks Kindle or Kindle UK   Nook   Goodreads   Smashwords   Kobo

In the Company of Angels: A Memorial Book In 2009, 11 years after losing Casey Shay, Deanna decided that she’d gone long enough without having a baby book to fill out for her first baby, and to write down her memories of her pregnancy. So she made one herself and got it published. It is a 40-page full-color hardcover book filled with images of angels and space to tell about your baby’s pregnancy. Every single baby or child she photographed as angels in the book has a story, as all of them had a brother or sister lost to miscarriage. This company of angels are there to guide you through the process of telling your angel’s life story, and to remind us that we mothers are the ones who carry so much hope in this world. The video about the book is on the left side of the page. To order your own copy, visit the publisher’s page. You will also get a set of Baby Love Notes, little angel cards to use in the book if you have no sonograms or other images (although pages can be removed) or to use as a card for a grieving friend. If you have questions about this book, feel free to email the publisher. They have discounts for book stores that want to carry it and nonprofits who want to give copies to bereaved parents. You can also buy this book at Amazon if you prefer.

The Sperm Meets Egg Plan, a FREE download on getting pregnant again Read an expanded version of the Deanna’s Sperm Meets Egg Plan, including sections for moms over 40, couples with fertility issues, and trying after a loss. It’s free! Download at iTunes for iPads or iPhones. Download at Barnes & Noble for the Nook. Download at Amazon for Kindle Download at Smashwords for your computer, smart phone, Kindle, Nook, or other eReaders. Download at Kobo for international eReaders. Download at Sony if that is your reader.

Deanna’s Top Recommendations I have personally read the following books and believe they are helpful.

Davis, Deborah L. Empty Cradle, Broken Heart. Golden, Colorado: Fulcrum Publishing, 1999 revised edition. This is the book John and I read in the car in the weeks following our first loss. It takes you through every step of the grieving process, including moving on and trying for your next baby. It includes a solid section on what to expect both physically and mentally after a miscarriage or neonatal death. This book helped us a lot when we worked through it as a couple. Click here for more information.

Weschler, Toni. Taking Charge of Your Fertility. New York: Harper Perennial, 2006. This book is a MUST HAVE if you are trying to get pregnant. For the first time in my life, I finally understood what all my discharges were about, how to truly interpret my temperatures, and all those fine details that mom, doctors, and pamphlets enclosed with products never explained. This book will definitely help you get pregnant faster, or clue you in quicker if you have an infertility problem that needs medical attention. A life saver. Click here for more information.

Friedman, Lynn, M.D. and Irene Daria. Miscarriage: A Woman Doctor’s Guide. New York: Kensington Health: 2001. A very quick reading book that concisely covers the causes of miscarriage and the treatments for those causes that can be identified. The emotional side of miscarriage is only glossed over, so this book is for the woman looking for hard facts. One of the better features of the book is a section with three very well written women’s stories in complete detail, which is much more helpful than little sound bites from women that most books have. Click here for more information.

Other Popular Books   Eisenberg, Arlene, Murkoff, Heidi, and Hathaway, Sandee. What to Expect When You’re Expecting.New York: Workman Publishing, 1996. This is the classic book all pregnant women should own. Ask your doctor if he/she will provide you a copy before you buy one.  Click here for more information.   Cirulli Lanham, Carol. Pregnancy after a Loss. New York: Berkley Books, 1999. While this books is very popular and would probably be helpful to someone really worried about the emotional aspects of trying again, I didn’t put it on my recommended book list for several reasons. I found it a little trying to harp on every little detail surrounding trying again, and the section on miscarriage causes was woefully short. This will take you slowly and in fine detail through each step of another pregnancy, but I think most women find that once the first few weeks are through, they want to focus on the new baby and not so much the scare. I’m not sure this book would help you enjoy a new pregnancy, and might keep you stuck in a mode where you don’t feel like a normal pregnant women. I believe that while you will have nagging doubts throughout a pregnancy after a loss, you do want to move on eventually and are better served if you can do that. Click here for more information.   Children’s Books   We Were Gonna Have a Baby, But We Had an Angel Instead by Pat Schwiebert.  A sweet children’s book that helps both parents and siblings understand about the loss of the baby that was in mommy’s tummy. Click here for more information. You can also watch a sweet video of a little boy reading the book out loud.     Something Happened: A book for children and parents who have experienced pregnancy loss.

Recovery after a Miscarriage

Physically, you will recover completely from a D&C or D&E in about two weeks. The bleeding should subside, your cycle will start up again, and the hormone-induced mood swings will even out. It will still take four to seven weeks to start a totally new cycle, and you should wait at least that long before trying again. 

A birth takes considerably longer to recover from. You may have shaved areas that will grow out and itch or burn. You may have stitches that will be sore for a few weeks. This recovery is like any other post-partum. Check with your doctor in how long you must wait to try again. A general rule of thumb is that you must wait a cycle for every two months you were pregnant.

A natural miscarriage can take considerably longer. You may have to wait days or even a couple of weeks before the bleeding and cramping begin. (Don’t go more than two weeks without talking to your doctor about possibly getting a D&C. Studies show the longer you carry a lost pregnancy, the more likely you are to get seriously depressed, and the more likely you may have physical complications.) The actual miscarriage may only take a few days, or may drag out over several weeks. 

For more information on the actual passage of tissue or how a D&C or D&E is handled, see descriptions of a natural miscarriage and a surgical intervention. Usually you will have to wait four to seven weeks for a new cycle to begin regardless of how the miscarriage happens, although a birth near term can delay your first period for several months. You should not try to conceive again during this time. For reasons why, see trying again.

The emotional recovery is another story altogether. One thing I will point out immediately is that your level of sadness is not at all tied to how far along you were. Everyone will be surprised by their emotions. Some will be near absolute despair and wish to join their baby. Some will be unpleasantly numb and feel nothing at all. Most will swing somewhere in the middle, seemingly okay one minute, then sobbing as if it were only yesterday. All the stages of grief will almost always be visited. Shock, numbness, denial, anger, guilt, depression, and finally resolution are all emotions you will experience. They do not come in order; some stages may go on for many weeks and others only a few hours. No two people grieve the same, as you will quickly see when your partner does not react the same way as you do. Don’t expect that you will “get over it” in a few weeks or even months. Don’t assume that getting pregnant again will turn everything around. Don’t give yourself a timetable. Just let the emotions come and go and try to keep your life going. 

So, you ask, when WILL I feel better? In some ways, you never will. The complete innocence and pure joy of pregnancy will not come back. But you will feel better than you do right now. Your life will go on, you will try again, and you will survive. There is much more to happen in your life. You have to keep going to see what it is. Only when you look back on where you were will you see that you do indeed feel a little bit better. There are many sections on this web site about emotional recovery, grieving, and memorializing your baby. Find them in the How to Cope section.

There are five distinct stages of recovery:

[The First Few Days]

[Waiting for Your First Post-Miscarriage Period]

[First Period]

[New Cycles]

[Trying Again]