Understanding miscarriages and how to cope

August 20, 2008 12:00:00 AM PDT
Understanding miscarriages. How to cope if you have had one. Find out how common miscarriages are and ways you can protect yourself. Nurse practitioner Barbara Dehn of NurseBarb.com shares this advice.

Nurse Barb's advice

Miscarriage

Pregnancy is usually considered a happy time for women, and yet in approximately 1 in 5 pregnancies, a miscarriage occurs. Though everyone experiences a pregnancy loss in their own way, it is heartbreaking. Couples need time to grieve before they can try again. Wanting a baby, allowing ourselves to be hopeful, and yet preparing for a possible loss is like walking a tightrope.

Rates of pregnancy loss

About 1 in 5 or 20% of pregnancies miscarry. Most are discovered before 12 weeks. Women over 40 have a slightly higher rate of loss, which some experts estimate as much as 25 - 33 %. One miscarriage Does Not mean that a woman has a higher chance of miscarriage with her next pregnancy. The rates are the same as the first time. However, after 2 or 3 miscarriages, testing is recommended.

Symptoms

Many women feel just fine and have no symptoms that would alert them to the possibility of a miscarriage. Other women will experience bleeding and not "feel" pregnant because they don't have any of the typical pregnancy symptoms of tender breasts, fatigue or nausea.

Ultrasounds aid in diagnosis

An ultrasound is used to determine if the baby is growing and if there is a heart beat. Sometimes a blood test for HCG, the pregnancy hormone, will be tested. During an ultrasound, we are looking for a fetus that's growing and has a rapid heartbeat to determine if it's healthy. With a vaginal ultrasound, a heartbeat can be seen by 6 ½ weeks. If the growth isn't what we'd expect based on the number of weeks of pregnancy, or if there is no heart beat a 2nd ultrasound may be recommended before the diagnosis is made.

Causes

It may be frustrating to find out that the pregnancy has miscarried and yet not be able to find a specific explanation for the cause. Unfortunately, in many situations, we aren't able to find a reason for the loss.

What doesn't cause miscarriage

Many of my patients rack their memories for something that they could have done differently to prevent their miscarriage. There are many myths swirling around about what can cause a miscarriage which can cause lots of guilt and shame.

  • Forgetting your prenatal vitamins
  • Drinking 1-2 cups of coffee or tea each day
  • Having sex
  • Exercise
  • Ambivalent thoughts about the pregnancy

Medical causes

Women with thyroid disorders, auto-immune disorders such as Lupus, and women with diabetes are more at risk for miscarriage. Women over 40 are also at higher risk.

When is it safe to try again?

It's best to check with your health care provider about your specific circumstances. In general, though some women will feel fine in a few weeks, many women need about 2-3 months to recover emotionally from their loss.

Grieving This has to be one of the most vulnerable times in a woman's life. The emotional experience of miscarriage can vary from complete devastation to a more mild response. We know from the groundbreaking work of Dr. Louann Brizendine, the author of The Female Brain, that pregnancy hormones have a tremendous influence on our moods, no matter how long the pregnancy lasts. It helps explain why women react to miscarriage differently than their male partners.

It's good to allow yourself time to grieve. As I tell my patients, with a miscarriage, it's not the loss of a "pregnancy", it's the loss of the possibility of meeting a newborn baby, holding them and being their mom. Don't be surprised if you're not able to attend events where there will be lots of babies and little ones. As you'd expect, everyone copes in their own way, but there are a few things that are fairly common:

  • A Feeling of being out of control
  • Frustration - feeling that your body betrayed you
  • Shock and disbelief
  • Anger
  • Confusion? Why me?
  • Overwhelming sadness

Trying Again

It's scary to think about getting back on the emotional roller coaster of trying to get pregnant again and worrying about another miscarriage. Be sure to get some guidelines from your health care provider and when to start trying, whether you'll need any special tests or medications. Don't forget to take your prenatal vitamin. For more information, please visit www.NurseBarb.com.

About Barb Dehn, RN, MS, NP
Barb Dehn is a practicing Women's Health Nurse Practitioner, award winning author, and a nationally recognized health expert. She holds a BS from Boston College and earned Masters degree at the University of California, San Francisco. An in demand and popular national speaker on all aspects of women's health, she also lectures at Stanford and is a frequent health expert on NBC's iVillageLive and recently In the Loop with iVillage.