Miscarriage

Miscarriage refers to the loss of a fetus during the first 20 weeks of pregnancy. Pregnancy loss may occur for any number of reasons, though in many cases, the cause cannot be determined. Though miscarriage is common, it is difficult and traumatizing for many, and those who experience this loss, whatever the stage of their pregnancy, often face lasting feelings of sadness, shame, and anxiety, among other concerns.

What Is a Miscarriage?

Miscarriage, medically known as spontaneous abortion, is common. An estimated 15-20% of confirmed pregnancies end spontaneously, usually in the early stages of pregnancy. The actual occurrence of miscarriage may be closer to 30-40%, when all conceptions are accounted for—many miscarriages occur about the time of one’s expected period, and a miscarriage is experienced without pregnancy ever being realized. Because most miscarriages occur within the first 13 weeks of pregnancy, many wait until the end of the first trimester to announce their pregnancy.

The symptoms of miscarriage include bleeding or spotting, cramps, back pain, passage of clot-like material, and the loss of pregnancy symptoms such as nausea or morning sickness. There is no way to stop a miscarriage once it has started, but it is still important to seek medical attention when dealing with miscarriage in order to prevent hemorrhaging and possible infection. If all of the fetal tissue is not expelled naturally, a medical intervention called a dilation and curettage, or D&C, is often necessary.

What Causes Miscarriage?

Most often, the cause of miscarriage is a genetic abnormality in the embryo or fetus. Other risk factors include advanced maternal age (over 35), substance use, listeria, chronic illness, infection, and maternal trauma (such as a motor vehicle or other accident). A miscarriage can also result from weakness in the cervix, a condition known as cervical insufficiency, which can be treated by putting a stitch in the cervix before future pregnancies to hold it closed until the time of delivery.

Another type of pregnancy loss is what is known as a chemical pregnancy. This term refers to a pregnancy that involves the egg being fertilized but never implanted in the uterus. The fertilized egg leads the body to produce the pregnancy hormone (which can result in a positive pregnancy test), but because the egg does not implant properly, the pregnancy is not viable. Chemical pregnancies account for more than 50% of all miscarriages. Most chemical pregnancies are never realized as pregnancies, since those who experience them typically bleed around the time of their expected period.

Many people who have a miscarriage may blame themselves, but it is important to understand they are typically due to factors outside an individual’s control. A majority of those (at least 85%) who experience pregnancy loss will have a healthy and successful pregnancy in the future.

How Can Miscarriage Impact Emotional Health?

Pregnancy is an exciting time for many new parents, who often begin to bond with their unborn baby and prepare for their arrival very early on. Miscarriage can thus be a traumatic experience that is marked by lasting feelings of grief and loss, and those who experience pregnancy loss are at risk for depression and anxiety in the future.

In addition, they have a higher risk for postpartum depression following future pregnancies, and they may also be likely to experience anxiety during future pregnancies as they worry a miscarriage will happen again. For many, miscarriage represents more than just the loss of the pregnancy. It can signify the loss of one’s dreams for the future. Individuals may experience feelings of guilt and self-blame, and their sense of self can even be compromised.

Further complicating the experience of miscarriage is the fact that losing a pregnancy has long been a private grief, despite the fact that it is so common. Because of this, many mourn without the social support or rituals that may have otherwise helped them address their feelings of grief. When they do share what they are going through, people may try to be supportive by encouraging them to focus on the positive, for example, by highlighting the likelihood of the couple having more children in the future. Well-intentioned comments such as, “You’re young, so you’ll get pregnant again easily,” or “At least it was an early miscarriage” may be meant in a helpful way, but these and other similar comments often have the unintended negative effect of dismissing the grieving person’s feelings.

Miscarriage can also affect the mental and emotional health of the partner who was not carrying the child, though their sadness and grief may often be largely dismissed. Partners may also feel helpless as they see their partner grieving and be uncertain of how to offer support or communicate after the loss and may feel more distant from their partner as a result.

Talking About Miscarriage

While many who experience miscarriage may feel alone, the fact that around one in five pregnancies end in miscarriage means there are many people who have had the same experience. Talking about miscarriage and getting support can have the benefit of decreasing feelings of isolation and self-blame. It can also serve as a way to help family members honor the unborn child who was lost.

People may also benefit from discussing their experience with their medical provider, trusted friends and family members, and/or a therapist. Online forums may also provide a space where those who have lost pregnancies feel safe because they can get support while remaining anonymous.

Talking about miscarriage more openly can also have the added benefit of increasing awareness on this topic and helping diminish the belief held by many that miscarriage is something a person can easily move on from. Many individuals, especially working women, often feel pressured by others to move on from their grief, go back to work, and physically and emotionally heal more quickly than they are actually able to. Miscarriage is a loss, and greater recognition and awareness of this is needed.

Addressing Grief in Therapy

Everyone who experiences miscarriage mourns differently. Recent research indicates those who have experienced a miscarriage may grieve for years, regardless of the stage of pregnancy at which the loss was experienced. Many individuals, particularly those who were uncertain about the pregnancy, also often experience guilt. When miscarriage leads to significant feelings of grief, guilt, or other emotions, it can be helpful to address these in therapy.

A therapist can provide a safe space where an individual can discuss all of the thoughts and feelings experienced about the loss of the pregnancy and the resulting grief, guilt, and/or other emotions. Therapists can teach methods of coping with lasting sadness and help grieving individuals identify ways to mourn the loss and create a sense of connection and support with their partner, family, and/or community.

References:

1. Dashiell, A. (2016). Miscarriage: Causes, signs, and what to expect. Retrieved from http://www.parents.com/pregnancy/complications/miscarriage/understanding-miscarriage
2. Leis-Newman, E. (2012). Miscarriage and loss. Monitor on Psychology. 43(6). Retrieved from http://www.apa.org/monitor/2012/06/miscarriage.aspx
3. Miscarriage. (2016). Retrieved from http://americanpregnancy.org/pregnancy-complications/miscarriage
4. Murray, J. (2014, October 14). Baby loss awareness week: We need to talk about miscarriage. The Guardian. Retrieved from https://www.theguardian.com/women-in-leadership/2015/oct/14/baby-loss-awareness-week-we-need-to-talk-about-miscarriage
5. Pregnancy and miscarriage. (2015, January 29). Retrieved from http://www.webmd.com/baby/guide/pregnancy-miscarriage#1

Last Updated: 03-6-2017