Though miscarriages are a common part of the pregnancy journey, the grief they cause is often carried alone. Those who’ve experienced pregnancy loss may feel too guilt-ridden and downhearted to share their experience with others, even though they’ve done nothing to cause it.
Know that coping is complicated; the effects are felt physically and emotionally on no certain timeline. Understanding the causes of miscarriage, and what happens after one, can be essential to eventually move forward—on whatever timeline feels right to you.
How common is miscarriage?
According to the American College of Obstetricians and Gynecologists (ACOG), 10% of reported pregnancies end in miscarriage. Of those miscarriages, 80% happen in the first trimester. Note these numbers do not account for those who experience a miscarriage without seeking medical help, or those that occur before a person knows they are pregnant.
The difference between a miscarriage and a stillbirth is that a miscarriage is the loss of a fetus before 20 weeks of gestation; a stillbirth is the loss of a baby at or after 20 weeks of pregnancy. ACOG reports that 1 in 160 pregnancies, or 0.63%, in the U.S. result in a stillbirth.
But knowing something is relatively common does not reduce its pain, as so many expectant parents have come to learn. Pregnancy loss is a wholly individual experience. Some want to process it emotionally first, and others want to focus on managing it from a medical perspective and dealing with the loss later. I recommend reaching out to friends and family when you are ready to process; you may be surprised by the support and connection you find.
What causes miscarriage?
Patients often ask me, “Why did I miscarry? Was it my fault?” Miscarriage is not anyone’s fault.
It’s human nature to want to find an explanation when something bad happens. Women, in particular, often look inward and blame themselves when pregnancy complications occur, even while also understanding they have no control over what happened.
While it’s natural to ask yourself “Did I exercise too much?” “Is it because I ate the wrong thing?” “Did this happen because I have been too stressed?” or any other countless things you may or may not have done; I want to assure you, you did NOT cause your miscarriage. Despite what you might hear from others, stress does not cause miscarriage. We simply don’t have that much control over the fate of a pregnancy. So you have permission to let go of that self-blame and guilt.
In reality, the most common cause of miscarriage are fetal chromosomal abnormalities, which account for 50% of early pregnancy losses.
Early in pregnancy, a fetus receives 23 chromosomes from the sperm and 23 from the egg. These have to come together and replicate without error. It’s a biologically complicated process. In that early cell division, if a chromosome gets missed, duplicated, copied incorrectly or mutated, the developing embryo does not have the correct DNA needed for development. And if it doesn’t have the information it needs to develop normally, the tissue stops growing. It’s nature’s way of saying we need to try again because this won’t be a healthy baby.
Other miscarriage causes are related to medical issues, for example thyroid disorders, poorly-controlled diabetes, thrombophilias (blood clotting disorders), some kinds of uterine structural abnormalities, and rare chromosomal translocations. Your doctor may test you for these conditions if indicated. Many miscarriages also have no known cause.
Recurrent miscarriages
If someone has two consecutive miscarriages, it’s considered recurrent pregnancy loss. In these situations, there may be a medical cause beyond chromosomal abnormalities. Anyone who’s had two miscarriages should speak with their provider about an evaluation for medical causes.
What are the risk factors for miscarriage?
While anyone can experience a miscarriage, there are two common risk factors for early pregnancy loss.
Advanced maternal age. Egg quality declines throughout the reproductive lifespan. At age 35, that rate of decline increases. The frequency of known miscarriages looks like this:
- Age 20 to 30: 9-17%
- Age 35: 20%
- Age 40: 40%
- Age 45: 80%
Prior early pregnancy loss. Miscarriages are more common in those who’ve already experienced early pregnancy loss. This is possibly because of other risk factors or underlying medical conditions.
What are the signs of miscarriage?
A few common symptoms of miscarriage can also be normal symptoms of pregnancy. So it’s important to call your provider about any change in symptoms.
- Vaginal bleeding. This is the most common sign of a miscarriage and can range from light spotting to heavy bleeding similar to a menstrual period. Spotting can also be normal in pregnancy.
- Abdominal cramping. You might experience mild to severe cramping, similar to menstrual cramps. Mild cramping can also be a sign of normal growth of the uterus.
- Passing tissue or clots. Tissue or clots passed from the vagina along with bleeding can indicate a miscarriage.
- Decrease in pregnancy symptoms. If you notice a sudden decrease in pregnancy symptoms (breast tenderness, nausea or fatigue), call your provider. Loss of pregnancy symptoms can also occur in normal pregnancy as one nears the end of the first trimester.
- Back pain or abdominal pain. Persistent back or abdominal pain can be a symptom of a miscarriage.
Can tests detect a miscarriage?
If you experience any miscarriage symptoms, it’s important to reach out to your provider immediately. They can help diagnose a miscarriage through an ultrasound, blood test and/or pelvic exam.
- Ultrasound. An ultrasound scan is used to help us visualize the fetus and the gestational sac to check for signs of development, heartbeat and any abnormalities. If the ultrasound shows no fetal heartbeat, or if the fetus is not growing as expected, it may indicate a miscarriage.
- Blood tests. We use blood tests to measure levels of pregnancy hormones like human chorionic gonadotropin (hCG). A series of blood tests taken over a few days can show whether hCG levels are rising appropriately or decreasing.
- Pelvic exam. A pelvic exam allows us to check for any signs of bleeding, abnormal discharge or changes in the cervix.
When is a miscarriage “over”?
A miscarriage is not complete until the products of conception have passed or are removed. How a person chooses to complete a miscarriage is based on their situation and personal preference. There are three options you can discuss with your provider.
- Expectant management. In this scenario, we can wait up to eight weeks for the pregnancy tissue to pass on its own, as long as there is no sign of infection or abnormal bleeding.
- Medications. To expedite the miscarriage completion process, your provider can prescribe medications. Mifepristone and misoprostol are used to trigger cramping and contractions to help the uterus pass the pregnancy tissue, and when both are used together, there is an 88% success rate.
- Surgery. Dilation and curettage (D&C) is a medical surgical treatment to complete a miscarriage and is done in the hospital or clinic setting. This is usually performed with IV sedation and a cervical nerve blocker. Once the cervix is dilated open, the tissue is suctioned out.
Gestational age, symptoms of miscarriage such as presence of bleeding or cervical dilation, and a patient’s medical history may factor into the decision. Patient preference is also a key factor in decision-making. Some want to be in the comfort of their own home, while others want the process to be over with as quickly as possible. It’s important to note that once a miscarriage physically ends, the resulting hormonal drop may increase feelings of sadness. And the emotional processing has no “typical” timeframe.
Is miscarriage painful?
Having a miscarriage can involve painful cramping. The cramping is often worse when heavy bleeding and passage of tissue occurs. Your doctor can provide medications for pain relief, if needed. If you are experiencing unbearable pain or severe heavy bleeding, reach out to your doctor right away. You may need to seek care in the emergency room.
How long does a miscarriage last?
For those who complete their miscarriage through expectant management or medication, most of the pregnancy tissue passes within 2 to 4 hours after cramping and bleeding start. While cramping can stop within a day, spotting may last for 4 to 6 weeks.
How long should I wait to try again for a baby after a miscarriage?
Trying to conceive after a miscarriage can be emotionally fraught. There’s no recommended, or right, timeframe.
When pregnancy tissue has completely passed, hormones will gradually return to normal. How long that takes depends on how far along the pregnancy was at the time of the loss. Ovulation will begin again when the hCG level returns to zero, making it possible to conceive—even before the next menstruation.
Your provider may recommend abstaining from sex for one to two weeks, or while bleeding is still happening, to avoid infection. It can also be beneficial to wait until after your next menstrual cycle, mostly because it helps with dating any subsequent pregnancies, and lets us know the body has fully healed.
The odds of having a successful pregnancy after a miscarriage are about the same for any person because miscarriage is usually a one-time occurrence. More than 85% of those who have suffered one miscarriage will go on to conceive and have a successful pregnancy. And, according to ACOG, about 65% of those with unexplained recurrent pregnancy loss end up having a successful pregnancy.
Emotional support after a miscarriage
Whether or not you’ve experienced pregnancy loss, WHA offers early testing to track hCG levels and can provide an early ultrasound before the typical eight-week mark.
WHA providers have deep compassion for miscarriage. It doesn’t matter how common they are, or how frequently we see them. We have empathy for your experience and share your grief. If you have concerns about potentially experiencing a miscarriage or think you’re having one, contact your provider right away. WHA’s behavioral health team is also available to help you through the grieving process.
And if you’re looking to support someone who has had a miscarriage, you can help by absolving them of any internalized guilt. They may understand logically that it wasn’t their fault, but will need help getting there emotionally.
