This chapter is dedicated to those of you who have experienced early pregnancy loss. You are part of a distinct group of women who have felt the happiness and joy of conceiving, only to have your hopes and dreams shattered by the loss of your pregnancy. What a challenging ordeal you've endured. Not only have you had to go through the physical pains and hormonal swings, but you've also faced the emotional ups and downs of losing your baby during the early stages of pregnancy.
Introduction to Early Pregnancy Loss
A normal pregnancy is supposed to last approximately 40 weeks. Pregnancy loss prior to 20 weeks is referred to as an early pregnancy loss. In most cases, the early pregnancy loss is a miscarriage. Sometimes the loss is an ectopic pregnancy, which is a pregnancy located outside of your uterus. Rarely, the loss is an unusual type of pregnancy called molar pregnancy, which is a condition that results in growth of placenta-like abnormal tissue within your uterus.
The loss of a pregnancy usually involves more than the loss of the baby. It also triggers a tremendous emotional impact, including feelings of sadness, guilt, and grief.
If you have experienced a miscarriage, you are well aware of the physical and emotional difficulties that come with it. Chances are you were delighted when that first pregnancy test showed up as positive. You might have shared the good news with friends and family. However, within a short time, you started to bleed and cramp. A visit to the doctor revealed a miscarriage. With shock and disappointment, you must come to terms with the grief of miscarriage.
WHAT IS MISCARRIAGE? WHAT HAPPENS TO MY BODY?
A miscarriage is a pregnancy that is lost prior to 20 weeks of pregnancy. When you stop and consider all of the complex steps involved in forming a human being, it's very sad but not surprising that sometimes not all the steps go as planned. The fertilization process of combining the male sperm and the female egg is very detailed and intricate. If any one step doesn't occur exactly right, miscarriage may occur. For this reason, many medical professionals believe that a miscarriage is the body's way of dealing with a fetus that is probably abnormal. Even so, this is not much consolation to a woman who is experiencing the heartbreak of miscarriage.
The two primary symptoms of miscarriage are vaginal bleeding and cramping in the lower abdomen or back. While bleeding is certainly something to have checked out by your doctor, it does not necessarily mean you are miscarrying. In fact, the majority of women who experience light bleeding during the first trimester continue their pregnancies and deliver healthy babies. However, sometimes the bleeding is quite heavy, and you may even pass some fetal tissue. If so, try to collect the fetal tissue in a clean container and bring it to the doctor for evaluation.
Remember to call your doctor right away if you experience bleeding or cramping. Your doctor will want to examine you and find out exactly what is happening to your body.
WHO IS AT RISK? WHAT CAUSES MISCARRIAGE?
Miscarriage is the most common type of pregnancy loss, occurring in about 15 to 20 percent of all pregnancies. Most miscarriages happen during the first three months of pregnancy.
Miscarriage is a sad event, and many women look to blame themselves or search to find a reason for the miscarriage. In most situations, you won't find an answer because the cause of miscarriage is usually not known. It has been estimated that more than half of all miscarriages are due to problems with the chromosomes of the fetus. These chromosomal problems occur randomly. When the egg and sperm combine, thousands of steps must be accomplished to form a normal fetus, and if a problem occurs with the number of chromosomes or the structure of a chromosome, then miscarriage may occur. The American College of Obstetricians and Gynecologists states that most aspects of daily life do not increase the risk of miscarriage. They go on to say that no proof exists that activities such as work, exercise, or sex cause miscarriage. Most falls do not result in miscarriage either. Likewise, fright, stress, and morning sickness do not lead to miscarriage.
Do not blame yourself. Most miscarriages seem to happen by chance and not because of something you did or didn't do. In most cases when you have experienced a miscarriage, it's not likely to happen with future pregnancies.
HOW IS MISCARRIAGE DIAGNOSED?
Sometimes it is difficult to tell if your pregnancy is going to miscarry or not. You and your doctor need to be extra attentive during the first few months of your pregnancy. If concerns such as bleeding and cramping arise, you may be asked to reduce your physical activity and perhaps even rest in bed. It's also important to avoid sexual intercourse during this time. These precautions may not necessarily prevent a miscarriage, but they may reduce your discomfort and may also provide you with peace of mind, knowing that you did everything within your power to avoid miscarriage.
Your doctor will probably do a pelvic exam to see if your cervix has opened and fetal tissue is passing. In addition, your doctor will likely perform an ultrasound to view the pregnancy. If a developing fetus with a heartbeat is seen, that's an encouraging sign. However, if no heartbeat is noted, more concern and evaluating are warranted.
If it is still uncertain whether you are miscarrying, your doctor may draw your blood to check your pregnancy hormone levels. During early pregnancy, the pregnancy hormone human chorionic gonadotropin (hCG) rises in a certain pattern. In the case of miscarriage, the hCG level typically does not rise. Therefore, your doctor may draw your hCG level one day and recheck it a few days later to establish a pattern.
Within a few days, after pelvic examination, ultrasound, and hormonal level testing, the diagnosis of miscarriage may be confirmed.
HOW IS MISCARRIAGE TREATED?
Once the diagnosis of miscarriage has been made, treatment is largely based on whether tissue is still present in your uterus. If all of the tissue has been passed, the miscarriage is considered complete and no further treatment is needed.
Oftentimes some tissue remains within your uterus. This tissue must be removed to avoid future problems with bleeding and infection. In most cases, your doctor will recommend a dilation and curettage (D&C). During this procedure, your cervix is dilated and the tissue is then removed from within your uterus. Anesthesia is typically required, so the D&C is performed in an operating room. In most cases, you may go home within a few hours after the procedure. It's normal to experience some spotting and mild cramping for several days afterward.
Follow-up care after a miscarriage is very important. Your doctor will want to check on you within a couple of weeks to ensure that you have no remaining problems.
Most doctors recommend that you wait about three months before trying to get pregnant again. This time period allows your body to get back into its regular cycle. It also gives you a few months to deal with your emotions from this difficult ordeal.
About 90 percent of women who miscarry will become pregnant again. However, there is still the normal 15 to 20 percent chance of having another miscarriage. Therefore, you should see your doctor right away when you become pregnant again.
Having one prior miscarriage should not affect your ability to have normal pregnancies in the future. But if you have experienced two or more miscarriages in a row, you may need some special medical attention. Your doctor may want to investigate for possible underlying medical problems.
About half of recurrent miscarriage cases have no underlying cause. For the remaining half, certain risk factors have been identified. It's possible that recurrent miscarriage may be caused by particular lifestyle factors, chromosomal problems, low progesterone, abnormalities of the uterus, or your own medical condition.
Diagnostic tests can be performed to help you and your doctor determine if you have one of these health concerns. In many cases, treatment is available and you can avoid problems in future pregnancies.
Enduring recurrent miscarriages is extremely difficult, both from a physical and an emotional standpoint. Keep in mind that even if you have experienced recurrent miscarriages, you still have a good chance to have a baby.
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