Ten percent of all known pregnancies end in miscarriage. So why does the subject still feel so taboo? For women dealing with the complicated grief of miscarriage, it's not the stat that's comforting—it's the knowledge that they're not alone, that there is a space to share their story. To help end the culture of silence that surrounds pregnancy and infant loss, Glamour presents The 10 Percent, a place to dismantle the stereotypes and share real, raw, stigma-free stories.
When I had a miscarriage, I had no idea what was happening. I was seven weeks pregnant when I began spotting one Friday night. By Saturday morning the spotting turned to bleeding and the whisper of cramps felt more like shouts. Within the hour I was in the emergency room, learning from the ultrasound tech there was no heartbeat found in my uterus. I felt blindsided.
If I had known the signs of a miscarriage or at least what the terms threatened miscarriage or complete miscarriage meant as they were thrown around me, I may not have felt so alone. In honor of October as Pregnancy and Infant Loss Awareness Month, we spoke with the experts to understand what a miscarriage is, the signs of a miscarriage, what causes a miscarriage, and treatment for a miscarriage.
What Is a Miscarriage?
A miscarriage is a loss of pregnancy that occurs before 20 weeks; the vast majority of them take place in the first trimester, according to Kate White, M.D., an associate professor of obstetrics and gynecology at Boston University Medical School. (A smaller amount occur after the first trimester, and stillbirths occur closer to term.)
What Causes a Miscarriage?
There are a lot of harmful myths about what causes a miscarriage. For the record, exercise and sex don’t cause miscarriages. Here’s what can:
“More than half of early miscarriages are due to chromosomal problems,” says White. “If your body recognized a healthy baby is not growing, it’s going to start the miscarriage process.” Chromosomal abnormalities aren’t anyone’s “fault”—most often they occur entirely by chance, not as the result of an inherited genetic mutation, according to the Mayo Clinic.
There are certain health conditions that might lead to a miscarriage in a few cases, according to the Mayo Clinic. If you have uncontrolled diabetes, hormonal problems, a history of uterine or cervix problems, or thyroid disease, talk to your doctor.
Types of Miscarriages
Miscarriages in early pregnancy can include chemical pregnancy and threatened and inevitable miscarriages.
In a chemical pregnancy, an egg gets fertilized but never successfully implants. You may get a positive result on a pregnancy test, but blood work will show levels of hCG—called the pregnancy hormone—decreasing. With these types of losses, the pregnancy will never get to the point of a clinical pregnancy, where the fetus can be detected on an ultrasound.
A threatened miscarriage is exactly what it sounds like—your body is threatening to miscarry but hasn’t yet started. In this scenario you may experience spotting and can even go on to have a healthy pregnancy. The key in a threatened miscarriage is that the cervix is closed. If it’s open—determined via a pelvic exam—it’s inevitable a miscarriage will occur. “In threatened miscarriages, 50% of the patients will go on to have a normal pregnancy and everything will be fine. The other 50% may end up having the inevitable miscarriage,” says Rachel A. McConnell, M.D., a fertility specialist at Columbia University Fertility Center. “I tell my patients this is going to be left up to nature. There’s really nothing you can do [to stop it.]”
When we do see miscarriage depicted in movies or on TV (which is rare), it tends to be a dramatic event marked by debilitating cramps and heavy bleeding. But it’s possible to have a miscarriage without even knowing it. In what doctors call a missed miscarriage, most patients have no symptoms at all (or may notice slight brownish discharge) before learning of the miscarriage at an ultrasound appointment. In these cases, the fetus at one point had a heartbeat.
An incomplete miscarriage is when a person experiences bleeding and severe cramping and may pass some pregnancy tissue at home. When an ultrasound is done, the gestational sac may not be visible, but there may remain pregnancy tissue. In that case, treatment options to remove the remaining tissue will be discussed. A complete miscarriage means all of the tissue has been passed and an ultrasound reveals no tissue remains in the uterus. This scenario would not require additional medical treatment because the uterus has fully released all pregnancy tissue.
After 20 weeks, pregnancy loss is no longer officially considered a miscarriage. But White believes that stillbirth, ectopic pregnancies, and molar pregnancies belong in the discussion.
Stillbirth is the birth of an infant who has died in the womb after surviving at least 20 to 28 weeks. Ectopic pregnancy is when an egg implants outside the uterus, usually in the fallopian tube. Molar pregnancy is when the fetus never grows and there’s hypergrowth of the placenta. In all of these cases, the pregnancy ends before term, often risking the mother’s health.
Signs of a Miscarriage
The first signs of miscarriage are spotting and cramps. Anytime you experience spotting, especially if you’re spotting before your first ob-gyn appointment, it’s important to call your doctor. “I would never tell a patient bleeding or spotting in pregnancy is normal. It’s not uncommon, but it’s not normal,” says McConnell. You may notice that any symptoms you might have had with pregnancy—like exhaustion, tender breasts, and nausea—disappear.
If your pregnancy hasn’t been confirmed by an ultrasound, a doctor will take one to ensure the bleeding doesn’t indicate an ectopic pregnancy. If you don’t yet have an ob-gyn or your doctor’s office is closed, go to the emergency room to have an ultrasound done. “It’s possible that at some point you will miscarry on your own [before an appointment],” says White. “That’s the hard thing. Sometimes you’ll be in a position to know it’s happening, and other times it starts on its own and you end up passing tissue before you can even get in to see your doctor.”
Treatment for a Miscarriage
Miscarriages don’t always happen on their own—most of the time they require medical treatment. Depending on timing, necessity, and cost, you’ll have one of three treatment options: expected management, medication, or a surgical procedure.
Opting for expected management is essentially letting nature run its course, giving your body the space to expel the fetal tissue on its own. This can take weeks—80% of people will pass the pregnancy tissue within eight weeks of the cervix's being open, according to White.
With this method you will most likely experience heavy bleeding and severe cramping; your doctor may recommend ibuprofen or acetaminophen to mitigate the pain. (In pregnancy, acetaminophen is typically the only medication approved, but if you’re miscarrying, it’s safe to take other pain-relieving medications.) Expected management means you can miscarry at home, which may make it more comfortable.
If you decide to have your miscarriage at home but don’t want the limbo of waiting for your body to miscarry naturally, your doctor may prescribe you a medication called misoprostol, one of the medications commonly referred to as the abortion pill. You will still experience bleeding and cramping, but the miscarriage would take place within one to two weeks.
The third option is the quickest: a dilation and curettage procedure, also called a D&C. In this procedure the doctor will dilate the cervix to manually remove the tissue from the uterus. General or local anesthesia is given for the procedure, and spotting and light cramping may persist for a few days after.
Recovery & Healing
The physical side of recovery can take up to three weeks. After a treatment it’s common to bleed for two to three weeks and experience cramping over the first 48 hours, with it calming down in the following days. “Your doctor may say the pregnancy is over, but when you’re still managing symptoms for two to three weeks, it may not feel like it,” White says. “I tell people if you push it too hard [with work or exercise], you may increase your bleeding. It’s okay, but it might make you uncomfortable and want to slow it down. See how your body reacts and then slowly ramp it up.”
In general, your menstrual cycle should return within six weeks, and hormonal changes, like pregnancy acne, should balance out within three months. If you experience ongoing heavy bleeding or severe cramping, you should contact your doctor immediately.
As far as trying to conceive again, White recommends waiting two weeks, to be on the conservative side. “You don’t always feel like having sex, but at the same time having sex can also be really life-affirming,” she says.
The aftermath of miscarriage, like grief itself, is different for everyone. Some people are ready to try again soon after, and others, like me, bury their grief for months. The absolute last thing a person experiencing miscarriage needs is someone telling them how to feel. There’s no right or wrong way to move forward.
Rachel Wells is a writer based in Nashville, covering the intersection of reproductive rights, mental health, and sexual violence. Follow her on Twitter @rachelwells and on Instagram @rachelwells1.
