Pregnancy is an exciting time, but it is wise to be informed about miscarriage in the unfortunate event that you find yourself or someone you know faced with one.  There are different types of miscarriage, different treatments for each, and different statistics for what your chances are of having one. The following overview of miscarriage is provided so that you might not feel so confused or alone if you face a possible miscarriage situation. As with all pregnancy complications, the best person to ask questions of is your health care provider.
1. How do I know if I’m having a miscarriage?
Symptoms of miscarriage vary. For some women, the first warning sign of miscarriage is a feeling that they aren’t pregnant anymore, or sudden decrease in pregnancy symptoms.  If anything out of the ordinary happens, you should contact your care provider immediately.  A woman who is miscarrying may experience any of the following:

• Minimal to severe cramping
• Bleeding, ranging from light to heavy.
• Signs of blood loss, such as weakness, dizziness or light-headedness
• Mild to severe back pain
• Intense abdominal pain or cramping, sometimes described as similar to labor.
• Any discharge with an odor or clot-like material passing from the vagina
• Fever
• Weight loss

2. How is a miscarriage treated?
During or after a miscarriage, the main goal is to prevent hemorrhaging and infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a dilation and curettage, known as a D&C. Drugs may be prescribed to help control bleeding after the D&C is performed. Bleeding should be monitored closely once you are at home; if you notice an increase in bleeding or the onset of chills or fever, it is best to call your physician immediately.

3. Why did this happen to me?
It is normal to wonder why or even feel responsible, despite the fact that very few miscarriages are actually caused by anything in your control. Here are some of the most common causes:

Genetic: About half of all early miscarriages occur because of random chromosomal abnormalities or maternal genetic blood factors.  Unfortunately, such factors may not be looked for until a woman has experienced two or more losses. In such cases, it is best to seek out the services of a genetic counselor through the National Society of Genetic Counselors.

Anatomical: A defect in the connective tissue of the cervix or an abnormality in the shape or capacity of the uterus may be responsible. Scar tissue may impede implantation or development, and larger myomas (fibroids) may cause improper implantation or may draw blood flow away from the developing embryo.

Hormonal: Women with hormonal abnormalities may experience infertility, and when they do conceive they are more likely to miscarry. A short post-ovulatory phase of the menstrual cycle may lead to repeated miscarriages. The incidence of miscarriage also increases with age, from 15 percent at ages under than 25 years to 35 percent after age 38.

Immunological: Some infections or a specific immunity factor, such as “anticardiolipin antibodies” or antiphospholipid syndrome, may cause miscarriage. A medical professional would perform blood studies to rule out such causes.

Male factors: There are increased numbers of early pregnancy losses that seem to be associated with low sperm counts or with a high ratio of abnormal sperm.

Environmental: Research on environmental causes of early pregnancy loss are still ongoing. To create a healthy womb environment, women should eat a healthy diet and avoid smoking, drug use, excessive caffeine and exposure to radiation or toxic substances.  But even women who have used drugs or smoke or eat junk food can maintain a healthy pregnancy. The vast majority of miscarriages have nothing to do with the activities of the mother. Nevertheless, in the search for answers we often look to ourselves first.

4. How long will it take to miscarry?
Generally a woman will experience bleeding, which progresses from light to heavy, as well as cramping. The process may take one day or may last several days. If you think you’re having a miscarriage, contact your midwife or doctor. You’ll have a physical exam, and perhaps an ultrasound. If the miscarriage is complete and the uterus is clear, then usually no further treatment is required.

5. How long will the bleeding last?
If the miscarriage is complete, bleeding should last about a week, two at the most, with some minor cramping for a few days after the loss. The bleeding should never be heavier than the heaviest day of a period. If blood loss exceeds a pad or tampon an hour, or if bleeding lasts longer than two weeks, notify your care provider. It is possible to miscarry without much, if any, bleeding, as the embryo can be reabsorbed.

6. When will my period return?
Following an uncomplicated miscarriage, most women who had regular cycles will have a period within four to six weeks following the completion of the miscarriage.  If you had a spontaneous miscarriage without any prolonged bleeding, it is a safe bet that you would ovulate within two to four weeks after the miscarriage.

7. How long will it take me to recover?
Emotional recovery from a pregnancy loss may take many months. It is not unusual for a woman to recall the pain of a miscarriage her whole life. Physical recovery can depend on the length of the pregnancy, whether or not complications have occurred and whether there is any remaining tissue. In an uncomplicated miscarriage, physical recovery may take only one to two weeks.

8. When can we start trying again?

How long you decide to wait is a personal decision, made after discussing your situation with your care provider and your partner. It is important to take time to heal emotionally as well as physically after a miscarriage. Emotions– such as stress and anxiety– may affect hormonal balance, and waiting until you have recovered may also help you approach your next pregnancy with less apprehension.

Many healthcare providers encourage woman to wait at least a few months to strengthen the chance of a healthy pregnancy.  It takes time for the uterus to recover and for the endometrial lining to become strong and healthy again.  If a woman’s body isn’t ready to support a pregnancy by the time that she conceives again, she faces an increased risk of experiencing a repeat miscarriage.

Medically, it is safe to conceive after two or three normal menstrual periods if tests or treatments for the cause of the miscarriage are not being done. Some couples wait six months to a year before attempting another pregnancy in order to come to terms with their loss, whereas others feel there is no compelling reason to wait so long.
9. How can I support my partner?
Supporting your partner while you yourself may be grieving the loss of a son or daughter of your dreams can be very difficult. You need emotional support as well. Try to talk to your partner about the loss. While it will bring up fresh memories, it is best to communicate openly about your wide range of feelings.

Many parents want to find a way to help hold on to the memory of the baby they lost. You may want to gather together mementos, such as an ultrasound picture of your baby, your baby’s footprints or other items that help you feel close to your baby as you move through the grieving process.
Learn more from the March of Dimes.

10. How will a miscarriage affect my next pregnancy?

Your next pregnancy might not be as joyful as you would like because you’ve learned that life doesn’t always go according to your plans. You can’t say it’s your first pregnancy, but you also cannot say that you are a parent. The following are recommendations to make this time a little easier.

Prepare your body as much as possible for your next pregnancy:

• Exercise regularly
• Eat healthy
• Manage stress
• Keep weight within healthy limits
• Take folic acid daily
• Do not smoke

When you become pregnant again:

• Ask that your pregnancy be monitored carefully.
• You may want to avoid early preparation for the baby’s arrival. Some couples request that baby showers be held after the arrival of the baby.
• Sometimes people who are close to you are also emotionally invested in your pregnancy, and they will make suggestions about what you should do.  The easiest way to handle their suggestions is to listen, and then do whatever you, your partner, and medical team feel is best.
• Your birth experience might be bittersweet because memories of your loss may resurface. You will probably need to do some grieving in addition to celebrating your new baby.
• Your parenting may be influenced by your past loss, so moments of panic might occur, especially when the new baby is ill, or too quiet.
• You may feel the need to protect yourself from more sorrow, so you might be cautious bonding with your new baby until you’re certain he or she is safe and healthy.
• If you feel you are struggling, speak to your healthcare provider about possible support groups or counselors who could help you through this difficult time.

For more information:

American Pregnancy Association

iVillage: Answers to your 10 Most-Asked Questions

www.nationalshareoffice.com
www.mend.org
www.aplacetoremember.com