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The Harsh Realities of Miscarriage

As a veteran ob-gyn, I hold many moments close to my heart. One is especially dear. I was soaking up the joy and magic of another newborn safely delivered into the arms of one of my patients. Photos were taken, hugs exchanged, and I was preparing to slip away from this most sacred of moments when the new mom grasped my arm and pulled me in close. With tears in her eyes, she shared, “I loved having you share my birth, but I needed you for my miscarriage.” The loss of a pregnancy often can be emotionally challenging. I am forever thankful for this mom’s reminder to me that supporting both of the roads experienced by women demand my heart, time, and expertise.

A miscarriage can be an intense event, and frequently, it’s extremely private; as such, miscarriages rarely receive the same emotional support and recognition as birth events. The woman and her significant other are often left with a sense of failure and frustration. Here is a brief overview of facts associated with pregnancy loss.

Miscarriage is most often caused by a chromosomal mistake early in the creation of the pregnancy. Genetic problems can cause the embryo or fetus to stop growing. A woman has no control over these genetic errors other than the timing of her pregnancy. The potential eggs in a woman are formed when she herself is a fetus and are carried in her ovaries to be released over her reproductive lifetime. As a woman ages, so do her eggs, and they become more prone to making chromosomal mistakes. These errors result in higher miscarriage rates. In one older study, miscarriage was thought to occur approximately 4 percent in someone younger than twenty,  and 19 percent in a woman over thirty-five. That number can be up to 30 percent for a woman undergoing in vitro fertilization.

A woman’s health can also play a role. Poorly controlled diabetes, undiagnosed thyroid conditions, and an abnormal shape of the womb can influence conception and early pregnancy. Avoiding significant alcohol and any cocaine use, as well as not smoking cigarettes or marijuana, is recommended. A recent infection can be a rare cause of miscarriage. If two or more pregnancy losses have occurred, blood work can be performed to rule out thyroid disease or an autoimmune condition. Referral to a reproductive specialist can sometimes be considered.

Nowadays, it can both be a blessing and a curse that pregnancy can be detected four to five days before even missing one’s period with exquisitely sensitive home urine tests. The challenge is that pregnancy loss is very, very common in the first days and weeks following conception. Some recent studies suggest that miscarriage rates may approach 50 percent in these first days. That means miscarriages occurring very early in pregnancy may have gone unnoticed less than a decade ago.

Pregnancy dating is counted from the first day of a woman’s last period. An early ultrasound around the sixth to seventh week should be able to reveal a small embryo with a heartbeat. A pregnancy not forming within a womb – known as an ectopic pregnancy – as well as evidence of a baby not developing can be detected at this point. Certainly, an early ultrasound confirming the start of a pregnancy is reassuring. However, even with an ultrasound at six weeks of pregnancy, there remains a 10 percent chance of miscarriage; this risk drops to 2 percent by the eleventh week. Take it from me, both the hopeful pregnant woman and her caregiver are relieved to safely move past the first trimester.

Despite the heartache and challenges associated with miscarriage, there is a silver lining. Most women who suffer a miscarriage go on to have a successful pregnancy with a marvelous baby to arrive some day in her arms. As sadness and loss is experienced, trust that more joyful chapters may soon be written.

Alice Hirata, MD, is an obstetrician and an advocate for low-intervention births. However, certain circumstances – such as high-risk pregnancies and multiple gestation births – require expertise she enjoys providing. Dr. Hirata is the proud mother of two teenage sons. She sees patients at Bon Secours Richmond OB/GYN.
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