Pregnancy problems: Dealing with miscarriage!
Once that pregnancy test turns a BFP (big fat positive!), many women start planning ahead nine months for baby. They search Pinterest for nursery themes, talk about which room the baby will have and start shortlisting names.
For other women, often those with a history of loss, the first 12 weeks is more stressful because they worry about the risk of miscarriage or abnormalities, and they often keep their pregnancy on the down low until prenatal testing is complete and confirms a healthy, viable pregnancy.
Whether you are in the former or latter category, miscarriage concerns are a real thing, and the truth is that a certain percentage of women will miscarry in the first 12 weeks.
What is the actual risk, and how do you cope if a miscarriage happens to you. Most importantly, what are your next steps towards a healthy pregnancy?
What is the risk of miscarriage?
Miscarriage risk increases with maternal age. Under 35, the risk is about 15%, and it increases to 30% after 35, with the risk increasing significantly over age 40. The stats sound scary, but keep in mind that most women will still likely have a live birth and not a miscarriage. Certain medical conditions predispose a woman to a higher risk of miscarriage (such as diabetes, multiple pregnancy, or certain genetic conditions).
What is the cause of a miscarriage?
The vast majority (over 90%) of miscarriages are due to chromosomal or genetic errors in the pregnancy and are totally unpredictable and typically random. A woman of any age can undergo one miscarriage and go on to have multiple successful pregnancies afterwards. However, as we age, the number of chromosomal errors increase. This is due to the fact that early on in a woman’s reproductive life (her 20s and 30s), the eggs are healthier and more genetically normal, but as a woman ages, the remaining eggs are more likely to be abnormal.
Some patients experience repetitive miscarriage (two or more miscarriages). This is a unique category and might have other causes that need to be investigated.
What happens during a miscarriage?
A miscarriage often starts with spotting or some bleeding and some cramps in the first trimester (i.e. the first 12 weeks of pregnancy). If it’s after six weeks, an ultrasound can help to determine what is happening. If before, your doctor might order pregnancy blood testing to determine whether a miscarriage is happening. Declining beta hCG levels often signify an early miscarriage. With an ultrasound, if the fetus is measuring smaller than it should or there is no evidence of a pregnancy in the uterus after bleeding occurs, you may have had a miscarriage.
Usually, the bleeding is, at most, like a heavy period and could be accompanied by cramping. In rare cases, very heavy bleeding can occur, and you might feel dizzy or feel like you might pass out. If this is the case, going to the hospital for an evaluation might be necessary. Most miscarriages, however, can be managed conservatively by your doctor, and you can go to your clinic the next day to be looked at.
How do you treat a miscarriage?
The majority of early miscarriages do not require extensive treatment. You will bleed like you’re having a heavy period, and the tissue will pass on its own. In some cases, especially with twins or later on in the first trimester, you will require medication to help expel the tissue or require a small procedure called a dilation and curettage (D&C) to remove the miscarriage tissue from the uterus. The D&C is a safe and low-risk procedure and is performed under sedation, typically in your doctor’s office or in a hospital. It is a same-day procedure, and you can go home that day and resume normal activity the next day.
“How soon after a miscarriage can I try again?”
After an early first-trimester miscarriage, it can take up to eight weeks until you have a normal menstrual cycle. If this is your first miscarriage, it is perfectly safe to start trying again. You don’t need to wait a few cycles for your body to recover, and you can start tracking and trying once you feel mentally ready. And remember: The likelihood is that the next pregnancy will be successful.
“I have had more than two miscarriages. What do I do now?”
If you have experienced two or more miscarriages, you should see a fertility doctor for further evaluation. In some of these cases, there are other causes that need to be looked for and require more specialized testing that can only be done in a fertility clinic. Ask your primary doctor for a referral to a fertility specialist before trying to conceive again, because you don’t want to have another miscarriage if it can be prevented.
“My body has recovered, but what about my mind?”
While a miscarriage is tough on the body, most women physically recover fairly quickly, but the psychological implications can last longer. Women worry about whether it will happen again and are scared to conceive again. The loss of a pregnancy can be very hard and can create tension in a relationship and stress when the couple starts trying to conceive again. Speak to your partner and your doctor and consider meeting with a counsellor to sort through your concerns, both mental and physical. Often, speaking to someone can really help make you feel ready to try again.
Having a miscarriage can be scary and can engender worry, but remember that most women who have had a miscarriage will go on to have a baby. So, stay positive and think happy future baby thoughts!