Understanding miscarriage

A pregnancy lasts about 40 weeks for most women. Miscarriage occurs when there is a loss of pregnancy before Week 20 of the pregnancy. Doctors sometimes refer to miscarriage as a "spontaneous abortion." It is estimated that miscarriage occurs in about 15% to 25% of pregnancies.

The risk of miscarriage is highest within the first 13 weeks of pregnancy. Some women have a miscarriage before they even know they are pregnant. The risk of miscarriage is higher for women who are older than 35 and for women who previously had a miscarriage.

Most of the time, the cause of miscarriage is unknown. Although many women may feel guilty that they did something to cause a miscarriage, most pregnancy losses could not have been prevented. A miscarriage usually occurs when there is a problem that makes it impossible for the baby to develop properly.

Possible causes for a miscarriage include:

  • chromosome (genetic material) problems
  • problems with implanting the fertilized egg in the uterus
  • hormone problems
  • infection
  • injury to the fetus
  • abnormal sperm or egg cells
  • physical problem with the woman's reproductive organs (e.g., cervix, placenta, or uterus abnormality) - these problems are usually not discovered unless a miscarriage occurs

Despite common misconceptions, exercising, having sex, previous birth control use, and working have not been proven to cause miscarriage.

The most common symptom of miscarriage is bleeding. Bleeding at the beginning of pregnancy is called threatened miscarriage. Most women who have threatened miscarriage during the first few months of pregnancy have healthy babies, but some of these women will have a miscarriage. Other symptoms of miscarriage include lower back pain, lower stomach pain, or clot-like material that passes from the vagina.

If you bleed while you are pregnant, you and your doctor will need to monitor your symptoms for a few days. Your doctor may order tests, such as blood tests (to detect the pregnancy hormone, human chorionic gonadotropin or hCG) or an ultrasound (to get a visual of the baby's development). The diagnosis of miscarriage is based on your symptoms and these tests.

If you have spotting or bleeding, heavy or persistent bleeding with pain or cramping, a lot of fluid discharge from your vagina with no pain or bleeding, or if you suspect that you have passed fetal tissue, you should get medical attention immediately.

Pregnancy loss can have a huge impact on a couple's relationship. Read "Coping with the loss" and "Moving on from miscarriage" in this health feature to learn more about feelings of loss and grief that a couple must cope with when they have a miscarriage.

What happens after miscarriage?

After a miscarriage, you may need to wait a few days and up to 2 weeks for all of the tissue to pass out of your uterus. Your doctor may ask you to save the tissue so that it can sent to a laboratory for testing.

Your doctor will also perform an ultrasound to check to see if any tissue remains in the uterus. If the ultrasound shows that there is tissue remaining, your doctor will usually recommend removing the tissue because there is concern about continued bleeding or infection. This is usually done by taking medication to help pass the tissue or by a procedure called a dilation and curettage to clear the tissue from your uterus. Dilation and curettage, also called D&C, involves dilating the cervix and gently removing the tissue from the uterus with an instrument called a curette. You and your doctor will discuss which option is best for you.

After removing the remaining tissue, your doctor will probably want to see you in a few weeks to check on how you are doing.

Your recovery period will take some time. Physically, you may still look pregnant and leak breast milk. Your menstrual cycle may return within a few weeks, and can occur as soon as 2 weeks after a miscarriage. If you do not want to become pregnant again right away, use birth control. If you want to become pregnant again, experts recommend waiting until you've had one normal menstrual cycle before trying again.

You are also grieving. It can be hard to go back to "normal." Take the time to rest and allow yourself to grieve. For more on the emotions you may be feeling and how to cope with them, read "Coping with the loss" and "Moving on from miscarriage" in this health feature.

What happens after a miscarriage can be difficult to understand. You may want to ask your doctor some questions. Write them down before your appointment so you are prepared. Here are some you can start with:

  • What tests are you going to perform?
  • Do I need to prepare for the tests?
  • What happens during the test?
  • What symptoms will I experience? Are there any signs to watch out for after the tests?
  • What happens during the recovery period?
  • When can I start trying to become pregnant again?
  • Is there someone I can talk to about my loss?

Coping with the loss

The loss of a pregnancy can have a huge impact on your life. It can affect you, your partner, your relationship with your partner, and your family and friends.

Miscarriage is one of the most traumatic events you may ever experience. After experiencing a miscarriage, it is normal to go through a grieving process. While your body is recovering, you also need to attend to your emotions. Emotional healing tends to take much longer than physical healing. Allow yourself time to grieve. Grieving can help you accept your loss before moving on with your life.

Emotions you may be feeling include sadness, guilt, self-blame, shock, depression, confusion, and a sense of failure. You may be asking yourself why the pregnancy ended. You may experience headache, appetite loss, tiredness, or have difficulty sleeping or concentrating. These are all normal after a significant loss. Allow yourself to go through these feelings.

Remember that it is not your fault and it's unlikely that you could have done anything to prevent the pregnancy loss.

Your partner is also trying to cope with the loss. Your partner may not express emotions the way you do, or even at all, because your partner may be trying to be strong for the both of you. Miscarriage can greatly affect your relationship. The important thing to remember is to cope with the loss together. Now is not the time to isolate yourself. Share how you feel - you need each other the most at this time. It is one of the most important things you can do to get through this difficult time.

You can also get support by talking to your family and friends. A sympathetic ear may be all you need. Considering that miscarriage occurs in about 15% to 25% of pregnancies, you may be surprised to hear of their stories of miscarriage. You can also talk to other people who have also had a miscarriage by joining a pregnancy loss or grief support group.

Most women who have had a miscarriage can go on to have a healthy pregnancy and baby, even if they had more than one miscarriage. Having a miscarriage doesn't necessarily mean that you cannot have children or that there is something wrong with your health. When the time is right, you and your partner may decide to try becoming pregnant again. Read "Moving on from miscarriage" to learn more.

Dealing with the emotions of a pregnancy loss can be difficult. Talk to your doctor about your loss. Your doctor can also refer you to a counsellor or psychologist, who can provide further support for you. You and your partner can do this together to help you through this difficult time.

Women and couples who experience a miscarriage after struggling with fertility issues may feel their loss more acutely. Your fertility specialist or clinic can refer you to a counsellor who specializes in this area of pregnancy loss.

Moving on from miscarriage

Before trying again to get pregnant, allow yourself to grieve and cope with the pregnancy loss. You and your partner have suffered a significant loss. Your body and mind should be healed so that your next pregnancy is as healthy as possible. The time for this healing process is different for each woman and her partner. You can read more in "Coping with the loss" section of this health feature.

A healthy pregnancy is possible for most women who have had a miscarriage. Even women who have had more than one miscarriage can have a healthy pregnancy. Having a miscarriage doesn't necessarily mean that you cannot have children or that there is something wrong with your health, and it does not make you less fertile. Remember that it is not your fault and it's unlikely that you could have done anything to prevent the pregnancy loss. Your chances of having a baby are still good.

Discuss with your partner when you want to start trying again. It is possible to become pregnant again soon after a miscarriage, so if you do not want to become pregnant again right away, use birth control until you are physically and emotionally ready. If you are ready to become pregnant again right after a miscarriage, experts suggest you wait until you've had one normal menstrual cycle before trying.

There are some things you can do to ensure a healthy pregnancy:

  • have a complete medical exam before you try to get pregnant again
  • quit smoking if you smoke
  • reduce alcohol consumption
  • reduce caffeine consumption
  • get enough physical activity (check with your doctor when you can start exercising again after a miscarriage)
  • take a multivitamin supplement that contains at least 0.4 mg of folic acid
  • maintain a healthy weight
  • eat a healthy, nutritious diet by following recommendations in Canada's Food Guide

When you are ready to start trying to get pregnant again, discuss your decision with your doctor. For your peace of mind, try not to compare your current experience with your previous one. No two pregnancies are exactly the same. To keep you motivated, consider talking to people who have had a successful pregnancy after a miscarriage.

Pregnancy loss is a difficult experience. You and your partner need to get through this difficult time together as a team. Talk to each other to keep your relationship strong. Consider talking to your doctor about your loss. Your family doctor can also refer you to a counsellor or psychologist who specializes in helping couples who have experienced a miscarriage.

Remember that many couples have a successful, healthy pregnancy after a miscarriage.