Anatomy of a Miscarriage
Vaginal bleeding is the most common miscarriage symptom, although many women also experience menstrual-like pain, cramping in the abdomen, or low backache. Some women, like Suzanne, have no bleeding. “I didn’t know you could have a miscarriage without bleeding,” Suzanne says. Likewise, some women who have light spotting do not miscarry—but any vaginal bleeding merits a call to your healthcare provider.
After a miscarriage, the placenta and fetal tissue must come out of your body. “You can let nature take its course and let it pass on its own, but some women can’t emotionally deal with that,” says Barbara O’Brien, MD, a maternal-fetal medicine specialist and director of perinatal genetics at Women and Infants Hospital of Rhode Island in Providence. If the woman doesn’t want to wait for it to pass, if it’s been more than a week, or if there is heavy bleeding or signs of infection, she must have a D&C (dilation and curettage)
A D&C is a surgical procedure that takes place in a doctor’s office, health clinic, or hospital. A woman receives anesthesia (general, epidural, or IV, depending on the situation), and then her doctor opens the cervix and removes the fetal and placental tissue from the lining of the uterus.
If it’s your first miscarriage, your doctor may not have the tissue analyzed—the assumption is that it’s a genetic fluke that has a very low likelihood of occurring again. If it happens a second time, however, testing makes sense. “Many doctors would evaluate someone after having two miscarriages to determine the cause,” though the definition of recurrent pregnancy loss is technically three miscarriages, Dr. Skiadas says. “The goal is to identify if there are factors that, if treated, will decrease her miscarriage rate for future pregnancies.
Some of the tests done after multiple miscarriages include bloodwork, analysis of fetal chromosomes, ultrasound, hysteroscopy (a test in which a scope is inserted through the cervix to examine the uterus), and biopsy of the uterine lining.
There are several other conditions that, while not technically considered miscarriages, also bring about the end of a pregnancy: Blighted ovum is a condition in which the gestational sac grows, but the fetus doesn’t. An ectopic pregnancy occurs when a fertilized egg becomes lodged in a place other than the uterus, usually the fallopian tubes. A molar pregnancy is a condition in which an abnormal mass forms in the uterus instead of a baby. And a stillbirth is a pregnancy that ends after the 20th week. All of these are far less common than miscarriage.
Coping with a Miscarriage
Miscarriage can trigger powerful emotions. It’s normal to feel grief, anger, self-blame, depression, and shame. “Women tend to blame themselves, even though nothing they did caused the miscarriage,” Dr. O’Brien says.
Many women keep their miscarriage secret, but Dr. Young says opening up can be cathartic. “Like all things that are associated with a feeling of grief, it is better to talk about it. Once you do, you may find that it’s as if you’re a member of a secret club—you’ll find that there are lots of women who have had the same experience, but they never told you about it.”
If friends and family can’t offer you the support you need, consider seeing a therapist or attending a support group meeting. “People may tell you that you should just get over it, it’s just a miscarriage,” Dr. O’Brien says. “But those kinds of comments belittle it and are very unhelpful. It’s a normal response to grieve.” Suzanne found comfort in writing a letter to her lost baby. “I attached the positive pregnancy test stick to it and saved it,” she says. “It was a way for me to mourn.”
Although they may not show it, fathers also may feel grief after a miscarriage. “We tend to ignore the man, and I think that’s unfair,” Dr. O’Brien says. “He’s feeling it, too.”
Starting Over after a Miscarriage
Medically, it’s okay for most women to start trying to conceive again one or two months after a miscarriage—doctors suggest waiting until after you’ve had one normal menstrual cycle—but for others, that’s too soon. “You really should wait until you’re emotionally ready,” Dr. O’Brien says. “That could be right away, or it could be a year.”
Suzanne and her husband decided to try to conceive again as soon as possible. Shortly after, she got pregnant—but this time, she and her husband kept the pregnancy a secret until they heard the heartbeat. “When we heard a heartbeat at seven weeks it was a blessing,” she recalls. “But even five months into the pregnancy, I was still getting high anxiety.” Suzanne’s doctor referred her to a psychologist who helped her use mind/body techniques to feel less anxious. Several months later, Suzanne gave birth to a healthy son.
A version of this article originally appeared in the Fall 2008 issue of Conceive Magazine.