The facts about miscarriage

Why did it happen - was it my fault?
When you fall pregnant and a baby is created, it takes half its genes from the sperm and half from the egg that ovulated that month. At the exact time of conception, the cross-over of these genes takes place. Sometimes, for no reason other than bad luck, some information is lost and the pregnancy is destined from that point not to be successful. It might be that this lost information is not needed for many weeks, and the pregnancy will continue as normal until that time. When the needed information is not there, it is then that the baby dies and you begin to miscarry. Sometimes when this happens, the miscarriage doesn't happen right away. This is called a 'missed' miscarriage and may not be picked up until some weeks later.

Another cause might be that the baby did not implant, or bury itself, into the womb lining properly - once again, most often just due to bad luck.

These are the most common reasons that women miscarry. Not because of something you did or didn't do, but just because of chance. Not because you drank alcohol, ate some unpasteurised cheese, or didn't take folic acid. Definitely not because you had sex or didn't rest enough. Whether you lay in bed from the day of your positive pregnancy test or went hang-gliding every day wouldn't have changed things. Its nature's way of making sure that when you do have a baby, it has the best chance for all of its life. Having a miscarriage doesn't mean that it will never happen for you.

What are the symptoms of miscarriage?
The most common symptoms that women experience during a miscarriage are:

bleeding - it might be only light to start with, or it can come on heavy from the outset. With a missed miscarriage, the bleeding is often only light and dark brown in colour.
pain - the pain of miscarriage is usually deep in your pelvis, and cramping or period-like in nature. Sometimes it comes in waves and makes you want to double over.
passing tissue - during a miscarriage, either all or part of the pregnancy is passed vaginally. Sometimes the whole pregnancy sac comes away in one go, other times it is broken up and comes away in pieces that do not really look like anything identifiable. When you pass the pregnancy, the pains are usually worse and then settle down afterwards.

Will I need an operation?
Most women who miscarry do not need to have an operation. If the bleeding is very heavy and your body does not pass the miscarriage swiftly then it might be necessary to have an operation. This will stop the bleeding and the consequences of losing a lot of blood. Sometimes, even though you do not bleed very much at all, the miscarriage may stay inside for a long time, such as when a missed miscarriage occurs. In this situation it might be advisable to have an operation to complete the miscarriage.

How long will this bleeding last and when will my periods return?
The loss will probably continue for about 7-10 days, tailing off toward the end of this time. It shouldn't be heavier than a period, and shouldn't have an offensive odour. Normally your next period will come by 6 weeks or so. If they were irregular before, then it may be longer. Also, your fertility returns before your next period, so if you feel pregnant again a pregnancy test might be useful.

I had a D&C - will this cause any problems?
A D&C (dilatation and curettage) or evac is carried out for the reasons above and will usually ensure that you don't continue bleeding over the following weeks. Rarely, it can cause infection of the womb lining with persistent loss or an offensive odour. If this happens it usually responds well to a short course of antibiotics. The D&C doesn't weaken your cervix or make you more likely to miscarry in subsequent pregnancies.

How common is miscarriage?
When considering this question, it is helpful to ask how often pregnancy occurs on average each cycle. Studies looking at very sensitive pregnancy tests suggest that pregnancy will occur in around 60% of natural cycles in fertile couples.

The risk of miscarriage reduces as pregnancy progresses. It is possible that as many as 40-50% of pregnancies miscarry before implantation in the womb occurs. Early after implantation, pregnancy loss rate is about 30% (ie this is still before a pregnancy is clinically recognised). After a pregnancy may be clinically recognised (between days 35-50), about 15% will end in miscarriage. The risk of miscarriage decreases significantly after the 8th week and as the following weeks go by.

I've miscarried before - is it more than bad luck?
Many women miscarry more than once in their life. Considering the frequency of miscarriage, about 1 in 36 women will have 2 miscarriages due to nothing more than chance. Any miscarriages after that would prompt me to suggest some tests to ensure that it isn't happening for some other reason. Sometimes these investigations are done after two miscarriages in a row, depending upon the exact circumstance.

Other things which may contribute to early pregnancy loss include:

multiple pregnancy, such as twins
age - there is a rise in miscarriage risk as maternal age increases. For women less than 35, the clinical miscarriage rate is 7%, for age 35-40 it is 15% and over the age of 40 it is 23%.
poorly controlled diabetes - but not if the condition is well controlled
fever over 100F
smoking increases the risk of miscarriage by 30-50%
previous contraceptive pill use results in a slight reduction in the risk of miscarriage
occupational exposure to solvents increases the risk of miscarriage

When can we start trying again?
Some couples decide that they want to begin trying for a pregnancy right away, while others feel that this is too soon and need time to get over this loss. There is no 'right' thing to do, and you have to go with your feelings.

I normally recommend that you wait for your first period after going home, and begin trying from then, if that's what you decide. It is not imperative, however, and don't worry if you find yourself pregnant before you even have a period - many successful pregnancies have started that way. In any case there's no reason you can't make love as soon as you feel ready. If you don't want to get pregnant, talk to someone soon about contraception suitable for you.

What can I do to improve my chances for next time?
As I mentioned above, the most common reasons for miscarriage can't be helped, however you can prepare yourself for pregnancy. Taking in regular exercise, a healthy diet, reducing stress and getting your weight to within normal limits gives you something to concentrate on, and improves chances for long-term fertility. Certainly reducing your alcohol intake and stopping smoking will help, too. Remember to start taking folic acid to help normal development of the baby's nervous system.

How will I feel afterwards?
Reaction to a miscarriage is very variable and once again there's no 'right' way to feel - a range of reactions are possible and normal. In addition to the grief you may feel, your body will be undergoing some profound hormonal adjustments, which may make you feel very emotionally volatile.

Grief is a very normal reaction to the loss you have experienced and it may be as intense as that after any other loss. Many women describe a feeling of numbness and emptiness following a miscarriage. Some couples withdraw, feeling alone and isolated, others may wish to talk about their loss.

Men often feel they have to be strong for their partner and find their loss particularly difficult to talk about. Although it is difficult at first, it may help to try and tell family or close friends how you feel.

Where can I get more information?
The web is a great resource and some bookshops stock books on pregnancy and many of these contain some information on miscarriage and optimising health for future pregnancies.

If you are reading this on behalf of someone else, some advice on how to help them.

Do let your genuine concern and caring show.
Do be available... to listen or to help with whatever seems needed at the time.
Do say you are sorry about what has happened and about their pain.
Do allow them to express as much unhappiness as they are feeling and are willing to share.
Do encourage them to be patient with themselves and not to expect too much of themselves, nor to impose any 'shoulds' on themselves.
Do allow them to talk about their loss as much and as often as they want to.
Do reassure them that they did everything they could and that it wasn't their fault.
Don't let your own sense of helplessness keep you from reaching out.
Don't avoid them because you are uncomfortable. Being avoided by friends may add pain to an already painful experience.
Don't say that you know how they feel (unless you have experienced their loss yourself, and then you can be particularly supportive).
Don't say 'you ought to be feeling better by now' or anything which implies judgment about their feelings.
Don't tell them what they should feel or do.
Don't change the subject when they mention their loss.
Don't avoid mentioning their loss out of fear of reminding them of their pain (they won't have forgotten).
Don't try to find something positive about the loss (eg. a moral lesson, closer family ties, etc).
Don't point out that at least they have their other....
Don't say that they can always have another.... (they wanted this one).
Don't say that they should be grateful for....
Don't make comments, which in any way suggest that the loss was their fault (there will be enough feelings of doubt and guilt already).

The Miscarriage Support Auckland site provides some additional information on miscarriage and their local contacts page has details of support groups.

Last update December 2006