It’s time to talk about miscarriage

“Don’t tell anyone until the first trimester has passed” — that’s the recommendation that pregnant people often hear. While this advice is intended to save parents-to-be from the anguish of having to explain a miscarriage to others, it can also contribute to the taboo nature of this topic.

“In our society, we are often encouraged to sweep miscarriage under the rug,” says Lacey Marks, MD, an OB/GYN at MultiCare Rockwood Clinic. “But miscarriage can be a devastating loss, and the secrecy surrounding it sometimes contributes to misunderstanding and often leaves people feeling incredibly isolated.”

Learn more about the causes of miscarriage and what to expect after experiencing this loss.

What causes miscarriage?

Miscarriage refers to a pregnancy loss that occurs before the 20th week of gestation, and these losses are common — approximately one in four confirmed pregnancies ends in a miscarriage.

“For most pregnant people under the age of 35, the risk of miscarriage is just under 20 percent,” Dr. Marks says. “That number goes up the older a person gets. By the time you hit 40, the statistical risk of experiencing a miscarriage is about 30 to 35 percent.”

The most common causes of miscarriage include:

Chromosome problems with the embryo. Chromosomes contain our DNA — the genetic code that shapes our health, growth and development. Sometimes an embryo may have missing chromosomes or extra copies of chromosomes, making it unlikely it will survive. These abnormalities account for most first-trimester miscarriages.

“Chromosomal problems are random events that can’t be prevented,” Dr. Marks says. “It doesn’t mean that there is anything genetically wrong with either parent. In fact, if you have had one miscarriage during the first trimester and you get pregnant again, your likelihood of having a successful pregnancy is the same as anybody else’s.”

Problems with the uterus. Some uterine conditions can increase a person’s risk of repeated miscarriages. These problems can include excess scar tissue or benign growths in the uterus, such as fibroids or polyps. A condition called uterine septum, where the uterus has a thick layer of connective tissue that divides it in two, may disrupt the flow of nutrients to an embryo, resulting in miscarriage. Once these conditions have been treated through surgical procedures, a successful pregnancy is often possible.

Chronic medical conditions. Some medical conditions, when untreated, can increase the risk of miscarriage. These include diabetes, blood-clotting disorders, thyroid disease and autoimmune conditions. Regularly taking prescribed medications and ensuring a condition is well-controlled can increase the likelihood of a successful pregnancy.

Sometimes it isn’t always clear why a miscarriage happens, but whether the cause is known or unknown, it’s common to feel a sense of guilt.

“A lot of people blame themselves for a miscarriage,” Dr. Marks says. “But it isn’t because you exercised too much, had sex, lifted something heavy, ate something you weren’t supposed to or fell behind on your prenatal vitamins. The loss may hurt deeply, but it isn’t your fault.”

“If you are supporting someone who is newly pregnant after a miscarriage, the most important thing you can do is just listen. Being present without offering judgment, without telling them what to do and without brushing off their concerns is the most meaningful type of support you can offer.”

What to do if you’re having a miscarriage

The most common signs of a miscarriage include vaginal bleeding as well as pain or cramping in the abdomen or lower back. If you think you’re having a miscarriage, Dr. Marks recommends calling your OB/GYN, midwife or family medicine provider so you can schedule an office visit.

“There’s typically no need to go to the emergency room unless you’re experiencing extremely heavy bleeding, for example soaking through more than a pad in an hour,” Dr. Marks says. “You should also go to the ER if you are experiencing symptoms of a uterine infection like fever, chills or severe pain.”

Sometimes a miscarriage may occur without symptoms, and the loss is only discovered through a routine ultrasound. It may take up to two weeks, or longer in some cases, for your body to pass fetal tissue naturally through the vagina. Depending on your situation, your doctor or other health care provider may also recommend medications or a procedure known as dilation and curettage to help remove the tissue.

“One thing that many people aren’t aware of is that we do have the ability to test the genetics of a fetus that has been lost,” Dr. Marks says. “This step may be something to talk to your doctor about if you’ve had recurrent miscarriages. While not necessarily warranted for those who have experienced a one-time miscarriage, it can help bring closure.”

What happens after a miscarriage

Physical recovery after a miscarriage is often quick — most people resume regular activities within a day or two of passing the tissue or undergoing a procedure. However, miscarriage can also take a psychological toll that may last much longer, bringing feelings of sadness, grief, anxiety and depression.

“A lot of people who experience miscarriages don’t feel empowered or comfortable enough to talk about it, but reaching out for support can help with emotional recovery,” Dr. Marks says.

If opening up to friends and family members is not for you, or if you need additional support, consider joining a support group — whether in person or online — or finding a counselor who specializes in pregnancy loss.

Next steps after a miscarriage depend largely on how you feel and your specific circumstances. If you’ve experienced one miscarriage, Dr. Marks recommends waiting until you’ve had one normal period before attempting to get pregnant again to reestablish baseline hormone levels.

If you’ve had more than one miscarriage, you may want to consult with your doctor or other provider about testing for potential issues before trying again. There are some genetic factors that, when present in one or both parents, can increase the likelihood of recurrent miscarriages. Tests your provider may perform include pelvic ultrasounds, blood work, chromosomal tests and screening for conditions like diabetes.

“If you are supporting someone who is newly pregnant after a miscarriage, the most important thing you can do is just listen,” Dr. Marks says. “Being present without offering judgment, without telling them what to do and without brushing off their concerns is the most meaningful type of support you can offer.”