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Coping with Miscarriage
Learn to deal with fears, family, and friends after a loss.

Friends and Family

No matter how briefly a pregnancy lasts, a miscarriage kills hopes and dreams. Parents ache for their baby, even if they never got to hold it. The distress and depression can last for months, long after others expect the bereaved parents to feel better.

Even when the sorrow is fresh, friends and family may inadvertently trivialize the couple's loss. They unwittingly make hurtful comments: "You can always get pregnant again," or "It probably was for the best," or "A miscarriage isn't as bad as losing a child." Often it's because they simply don't know what else to say.

At the same time, friends and relatives also can offer needed encouragement and support. Just knowing that they are cared about by their friends and family helps grieving couples progress through the painful process of healing from loss.

Finding Support

At this time, couples who have "been there" say that it's important to talk to others who've suffered a similar loss. How can you find such people?

Ask your hospital or an organization that matches you to a trained volunteer and/or support group.

Ask your family doctor for a referral to a therapist who specializes in grief counseling.

Seek support from a spiritual counselor in your particular denomination.

Reach out for help through the Internet on a message board or chat devoted to pregnancy loss.

Talking with people who've also experienced pregnancy loss in a support group setting can help couples come to terms with their loss. It also teaches couples how to respond to painful comments and invasive questions.

Different Ways of Grieving

The grief-stricken couple may find themselves very confused by the way their own reactions differ. One partner may want to cry and talk a lot, while the other may withdraw and act angry.

Holding back from expressing normal feelings can make it impossible simply to embrace each other, let alone the challenge of a new pregnancy. But it's important to let each person grieve in his or her own way. If this is too difficult for one or both partners, a therapist or trusted friend can help to provide support and act as a sounding board until the partner is ready to open up.

Help for Dads

While much of the focus after a miscarriage is on the mother, dads hurt, too. Each man has his own style of dealing with grief or loss, as well as of coping with subsequent pregnancies. In her book When Pregnancy Isn't Perfect: A Layperson's Guide to Complications in Pregnancy (Dutton, 1991), Laurie A. Rich offers these tips for men whose partners have lost a baby:

Talk it over with a clergy person, a professional counselor, or someone else to whom you feel close.

Don't feel you have to tough it out -- ask your family and friends for their help.

Don't treat your partner like an invalid -- you need her support every bit as much as she needs yours.

Acknowledge your fear. It's natural.

Lighten your load. If you can afford it, take some time off work, and hire help around the house.

Make time for yourself. Jog, work out at the gym, read a book or newspaper, or see a movie. Do something to help take you away from your grief, even if it's just for an hour or two.

Remember that the grief process takes time, and can't be rushed. You've suffered a loss. Be good to yourself, and your partner, during your period of healing. Don't pressure yourself, let go of feelings of guilt or blame, and seek support from people who understand and care about you.

Miscarriage Facts
Who's at the greatest risk of having a miscarriage -- and why?

How often do miscarriages occur?
About 15 to 20 percent of all pregnancies end in miscarriage. Most of them occur in the first 13 weeks, or first trimester, with the greatest chance for miscarriage in the first eight weeks.

Does age affect miscarriage rates?
For women in their 20s and early 30s, the chance of miscarriage is about 15 percent. At 35 the chance of miscarrying rises to one in four, and at 40 the miscarriage rate is close to one in three or even higher.

What causes miscarriages?
Most early pregnancy losses are due to genetics and cannot be prevented. But losing a pregnancy doesn't mean that anything is wrong with a woman's health or that she can't have more children. Ninety percent of women who have one miscarriage go on to have a healthy pregnancy. Despite the fact that recurrent miscarriages may increase the risk of future pregnancy losses, even women who have had three or more miscarriages in a row may have a good chance of carrying the next pregnancy to term. However, these recurrent miscarriages may be an indication of problems that require medical help.

What are the symptoms of miscarriage?
The following signs and symptoms may overlap and could indicate a complete miscarriage, or an incomplete one in which tissue remains. The remaining tissue would need to be removed by your doctor with a procedure called D&C (dilation and curettage).

Vaginal bleeding that may be preceded by a brownish discharge

Cramps in the pelvic area

Tissue or blood clots passing from the vagina

A decrease in the usual signs of early pregnancy, such as nausea and breast tenderness

Pain in the lower back or abdomen

What are the warning signs of miscarriage?
Spotting or bleeding without pain

Heavy bleeding with severe abdominal pain or strong cramps

A gush of fluid from your vagina but no pain or bleeding

Tissue or blood clots passing from the vagina

What will the doctor want to know?
Your doctor will ask you to describe your symptoms. She'll also want to know whether or not you've passed tissue out of your vagina. If you have passed tissue, save it in a sterile container or plastic bag for later examination.

How will my doctor be able to confirm a miscarriage?
Your doctor will give you an internal pelvic examination. This will determine the size of your uterus and reveal whether your cervix is open. An ultrasound will be performed to confirm whether or not your baby still has a heartbeat or if you have passed out of your body some or all of the products of conception.

You will also have a blood test to check your hormone levels; decreases in pregnancy hormone levels may indicate that you've miscarried.

Can miscarriages be prevented?
A miscarriage that is about to occur usually can't be prevented. But you might be able to decrease your chances of miscarrying by taking good care of yourself early in your pregnancy and not smoking, drinking, or taking drugs. If you've had several miscarriages in a row, your doctor may recommend genetic testing to see whether you or your partner carry any chromosomal abnormalities that could affect the egg or sperm.

Your doctor may also give you instructions to reduce your risk of miscarriage. These can include putting your feet up for the day, avoiding intercourse for a short period of time, or avoiding some forms of exercise.

What happens if I do miscarry?
After a miscarriage, any remaining tissue may be removed by dilation and curettage (D&C). This procedure involves dilating the cervix and gently scraping the tissue from the lining of the uterus.

You can expect spotting and some discomfort for a few days. However, call your doctor if you experience heavy bleeding, fever, chills, or severe pain -- these can be signs of an infection. Your doctor will probably want to see you again in a few weeks to check your recovery.

It is generally recommended that women not try to get pregnant for three months after a miscarriage. This is usually enough time for her body to return to its nonpregnant condition and resume normal menstrual cycles.

I've had several miscarriages. What does this mean for my current pregnancy?
If you have had repeated miscarriages, future pregnancies should be planned, diagnosed early, and monitored carefully.

Get a complete medical work up before you try to get pregnant again and try to have the cause of your earlier miscarriages diagnosed and treated by your doctor.

As soon as you think you're pregnant, seek prenatal care. The sooner you can receive any care you need, the more likely that you will delivery a healthy, full-term baby.

Don't forget to follow your doctor's instructions. She can instruct you on keeping you and your fetus healthy.

Miscarriage: Frequently Asked Questions
Answers to common questions following a miscarriage.

Did I do anything to cause this?
Probably not. Most miscarriages are due to chromosomal abnormalities -- too many, too few, two sperm in one egg, any number of things, explains Carolyn Salafia, MD, a developmental pathologist at Columbia University. The earlier in pregnancy that miscarriage occurs, the greater the likelihood that it was a random genetic defect. In fact, miscarriages that occur in the first trimester are almost always the result of natural "accidents" that happen at conception, which prevent the embryo from developing properly.

How common is miscarriage?
Experts say that between 15 and 20 percent of diagnosed pregnancies end in miscarriage, and that the rate increases with age, so there's a 50 percent chance of miscarriage after the age of 40. Chances are you already know at least one woman who has had a miscarriage, and as you break the news to your friends and family, you're likely to learn about more.

Most miscarriages occur in the first trimester, many before a woman even misses her period. If you make it past week eight and a fetal heart rate is detected, the loss rate drops to about 5 percent.

How much bleeding and pain is normal?
A miscarriage typically resembles a very heavy period with lots of cramping, explains Veronica Ravnikar, MD, head of the ob-gyn department at St. Barnabas Medical Center in New Jersey. You'll know you've passed the embryo when the pain ceases and bleeding subsides. This could take a few hours to a few days.

You'll want to see your doctor, even if you're sure it's all over. Ask about taking a pain reliever for any remaining cramps -- most medicines are fine, but your doctor may want to evaluate your bleeding before advising ibuprofen or aspirin. If you feel you need something stronger, don't be afraid to speak up.

If heavy bleeding continues for more than a few days, check in with your doctor again. Go to the emergency room if you have excessive pain, dizziness, chills, or are bleeding to the point where you soak a pad an hour for three hours -- these are possible signs of an incomplete miscarriage or infection and need immediate attention.

If an ultrasound shows that the baby has no heartbeat, but you haven't actually miscarried, what should you do?
As doctors increasingly use ultrasound as soon as pregnancy is confirmed, more women are learning about problems long before telltale bleeding or cramping. There are two ways to go. You can wait for nature to take its course and expel the embryo on its own or elect to undergo a D&C (dilation and curettage). Talk to your doctor about the pluses and minuses of each.

For a D&C, the cervix is opened and tissue is removed from the uterine lining. It's done in your doctor's office, a hospital, or surgical center, with a local or general anesthesia. All the products of conception must be emptied from the uterus, either spontaneously, medically (with medications), or surgically (D&C). Once everything is expelled or removed, you can concentrate on emotional healing.

On the other hand, allowing miscarriage to occur on its own may feel more natural. But waiting, perhaps for up to a week or two, can take an emotional toll. Plus, if your body doesn't expel the pregnancy completely, you may need a D&C after all.

Could I have done anything to prevent the miscarriage?
Probably not. But if you have another loss, your doctor may begin to look for reasons beyond random genetic defects. For instance, lupus and uncontrolled diabetes increase your risk, as do heavy drinking, smoking, and drug use. Environmental factors, such as heavy exposure to dry-cleaning solvents, can also increase your chances of miscarriage.

Hormonal imbalance (or progesterone, estrogen, prolactin, or thyroid) can also factor in. Some women, for instance, don't produce enough progesterone and may receive hormone injections in an effort to maintain a subsequent pregnancy.

Some bacteria and viruses such as streptococcus, mycoplasma (related to the organism that causes tuberculosis), and listeria monocytogenes (a food-borne bacteria) are associated with miscarriage. The listeria risk is why experts urge pregnant women to avoid foods likely to carry bacteria, such as cold cuts, soft cheeses, raw fish, and unpasteurized juices.

Finally, physical problems with the structure of the uterus, fibroids, uterine scarring, or an incompetent cervix can lead to miscarriage -- often in the second trimester. A tiny number of women have problems with blood flow, clotting, and generating the vessel network needed to deliver enough oxygen and nutrients to the placenta, and these too can cause a miscarriage.

So there's a chance I'll miscarry again?
Each pregnancy has the same 15 to 20 percent risk, notes Dr. Salafia. In every pregnancy, a woman has a chance -- which increases with her age -- of having an embryo with the wrong number of chromosomes.

That said, experts estimate that recurrent miscarriage -- the loss of two or more consecutive pregnancies for a nonchromosomal reason -- is rare, occurring in just .5 to 1 percent of pregnant women. Studies show that 80 to 90 percent of women with a single early pregnancy loss go on to deliver a baby with their next pregnancy.

At what point should I be tested for miscarriage causes?
Not after a first loss. After two or more miscarriages, most women are advised to have a thorough evaluation, which may involve physical exams, endocrine testing, endometrial biopsy, genetic screening, and testing for lupus and certain antibodies. If you miscarry again, your doctor may recommend a D&C so that the embryo can be tested. Unfortunately, the chance of reaching a definitive diagnosis is 50 percent at best. Test results don't always reveal something that helps you proceed.

How long will recovery take?
Most women are physically well enough to continue with their normal activities, although they may still feel pregnant for a bit as their hormone levels decrease. Many doctors caution against sex for two weeks to avoid infection. You should expect your period within six weeks. If you haven't resumed menstruating by then, call your doctor, but don't be alarmed. Your doctor may just ask you to wait longer, notes Dr. Ravnikar, or she may suggest a pregnancy test, or induce your period with progesterone.

When can we try again?
Most doctors recommend waiting through one or two menstrual cycles for hormone levels to right themselves and the uterine lining to heal. You can become pregnant again within two weeks of a miscarriage -- before you resume menstruating. But if you get pregnant without having gone through a menstrual period, it's hard to date the pregnancy, says Sandra Carson, MD, professor of obstetrics and gynecology at Baylor College of Medicine. However, there's no increased risk of miscarriage or birth defects.

What can I do to reduce my chances of miscarrying again?
Very little, which is frustrating. Women who miscarry tend to become ritualistic, says Dr. Carson. They go over every minute, trying to guess what caused it. All you can do is eat well, exercise, and take prenatal vitamins, and hope for the best.

Pregnancy After Miscarriage
Do you have conflicting emotions about being pregnant again?

What to Expect

If your last pregnancy ended in a loss, you may find yourself feeling overwhelmed with anxiety at every single milestone you reach during your current pregnancy. The fact that miscarriages are a common occurrence isn't likely to lessen the impact of what happened before. Nor will having other healthy children at home -- though people might assume that this can help diminish your grief.

If you've experienced an early miscarriage -- the most common type -- during your next pregnancy you might be worried until you've reached the point at which things went wrong the last time. Or if you lost a baby later in pregnancy or endured multiple miscarriages, you might never feel completely relaxed during this pregnancy.

It's only natural to rein in your excitement about having another baby after you've suffered a loss. You might do this in order to protect yourself, hoping to lessen your grief if you miscarry again. Your normal urge to assert a degree of control over a risky situation frequently fuels another common desire: to do things very differently during this pregnancy. Some typical behaviors include:

Playing it extra safe: Experiencing profound loss teaches an unwelcome lesson: Life sometimes defeats our most cherished plans. It's natural for you to be concerned throughout your next pregnancy. But talk with your doctor and get the reassurance you need to achieve some peace of mind so you can actually enjoy the pregnancy without being paralyzed by fear that everything you do could be a threat to the baby.

Seeking a new medical strategy: If your previous pregnancy experience was very medically oriented, you may seek less intervention with the next pregnancy. Alternately, you might seek more medical intervention.

Maintaining emotional distance from the baby: If you've miscarried, you might be surprised by how relatively detached you feel from your baby during your next pregnancy. You might not reveal your pregnancy for a long time, or you may try not to personalize the baby for a time. If you've suffered a loss, it's common to want to hold back the next time by choosing to know as little as possible about the baby before the birth.

What to Do

If you've miscarried before, you'll need extra support from family, friends, and health-care providers this time. Your husband might need additional attention too, if he's been experiencing powerful and troubling feelings. Sometimes it's more difficult for men to know where to turn for help and how to ask for it. Here are some good sources of support:

Your partner: It's especially important for you and your partner to talk to each other about what you're feeling. Honest communication helps you appreciate each other's viewpoint and encourages you to pull together rather than apart. Who better to turn to than each other for the compassion you need?

Doctors, nurses, midwives: Whether or not you seek a more medical approach to this pregnancy, you certainly should expect extra attention from your health-care provider. For instance, your provider can indulge you by seeing you more often, if you wish. Sometimes, all you require is a little reassurance that everything is progressing smoothly.

Private childbirth classes: You might feel out of sync in a conventional group class. If you do enroll in a group class, be sure to let your instructor know about your personal situation. She may be able to connect you with other couples in the group who've also had a similar experience. Since about one in every five pregnancies ends in miscarriage, you will probably not be alone.

Internet support groups: Thanks to the Internet, you have access to round-the-clock miscarriage support forums such as chats, message boards, and e-mail loops. Visit the americanbaby.com community for a warm, friendly environment where you can find moms who share similar experiences and concerns.

You may wonder whether you ever could -- or should -- love your newborn the way you love the baby or babies you lost. You may feel conflicted, but allow yourself to feel love for the new child. Loving the new baby does not replace the love for the child who was lost. There will always be a special love in your heart for the baby that could have been.

The Emotional Aftermath of Miscarriage
Coping with your feelings and with other people's reactions.

Introduction

Having a miscarriage is a physically and emotionally difficult experience under any circumstance. But if you've been struggling with infertility or have had one or more miscarriages in the past, the loss can feel especially painful. Though time and comfort are often the best healers, it helps sometimes to understand the grief and mourning process that can accompany a miscarriage, and to know what you can do to start coping with your loss. Here's how to begin.

The 5 Stages of Grief

Many women form an attachment to their baby early on in the pregnancy, particularly if they've been trying to conceive for some time. So after a miscarriage, they're likely to go through a period of mourning and possibly experience the same stages of grief that can accompany the death of a loved one. The stages are:

1. Denial (a refusal to believe what has happened)

2. Anger (blaming yourself or others for the loss)

3. Bargaining (striking a deal with yourself or God to have things return to the way they were)

4. Depression (feeling listless, tired, despondent, guilty, punished, and/or as if there's no pleasure or joy in life)

5. Acceptance (realizing that life has to go on, and regaining your energy and goals for the future)

The Mourning Period

Grief and mourning can last anywhere from less than a month to a year or more, depending on the circumstances of the miscarriage. Initially, the feelings are intense and all-encompassing. But over time, they begin to ease up, giving way to periods of relative calm, well-being, and, eventually, acceptance.

During the mourning period, however, a woman's (and man's) emotions may be thrown into turmoil. If a woman has been trying hard to conceive, she may mourn the child she has lost as well as the fact that she's no longer pregnant. If she's suffered more than one miscarriage, she may be saddened by the fact that she's unable to carry a pregnancy to term. She may also feel empty, angry, irritable, worthless, or jealous of those who are pregnant, and may be preoccupied with her loss or unable to take pleasure in life.

What's more, men and women often experience a miscarriage differently. Men tend to have less of an emotional attachment to the pregnancy in the early months, so they may feel less pained and grief-stricken by the miscarriage. Sometimes this can cause a misunderstanding and conflict in a marriage, since each partner tends to expect the other to react to the miscarriage in a similar way.

The important thing to remember is that mourning is a process that takes time. While some people are able to put aside their feelings and move on, others find that they need weeks or even months to be able to fully function again. Eventually, though, the pain of a miscarriage will subside and the world will indeed look brighter. But until then, it's important to honor your feelings and to take the time you need to grieve.

10 Ways to Cope with Loss

Though there's nothing you can do to "rush" the mourning process, there are simple ways you can take care of yourself as you heal.

1. Ask for help in breaking the news. If you're feeling too fragile to talk about your miscarriage or to deal with other people's reactions, ask a friend, relative, or coworker to tell others so you don't have to discuss it.

2. Don't take hurtful comments to heart. Many people don't realize how profound a loss miscarriage is and may say things like "Don't worry, you can always try again." More often than not, though, people don't mean to be insensitive -- they're just unaware of how you're feeling and can't fully comprehend your pain.

3. Help others understand. If you feel up to it, educate the important people in your life about pregnancy loss. Suggest, for instance, that they read a book on the subject, such as A Silent Sorrow -- Pregnancy Loss: Guidance and Support for You and Your Family by Ingrid Kohn, MSW, and Perry-Lynn Moffitt (Routledge, 2000).

4. Don't apologize for your pain. During your healing process, friends and relatives may pressure you to "move on," "get over things," or "return to life as usual." But don't feel as though you need to comply until you're ready. Your pain is a normal response to the profound loss you've suffered, and you needn't blame yourself or apologize to anyone for how you feel.

5. Seek support. After a miscarriage, it may help to talk with someone who's been through the same experience, or to join a support group that meets regularly. SHARE (www.nationalshareoffice.com), a national organization for couples who've experienced miscarriage, may be able to put you in touch with a support group in your area.

6. Seek professional help. During pregnancy and after a miscarriage, a woman's hormone levels change rapidly. As a result, many women experience mood swings and/or depression. If you're having trouble dealing with these emotions, speak with your doctor, who can refer you to a counselor if necessary.

7. Ask for household help. As you recover from a miscarriage, ask friends and relatives to help with household chores, like laundry, errands, or cooking. You'll need time to physically and emotionally heal, and it can help to lighten some of your day-to-day responsibilities.

8. Be mindful of your feelings. Immediately after a miscarriage, you may find it hard to be around friends and relatives who are pregnant or those who have small babies. If it feels too painful to see them, give yourself permission not to visit. Tell them that you still hold them dear, but that this is a difficult time for you and it's just too hard to see them now. Also, think about how you feel before accepting any invitations to a baby shower, baptism, or first birthday party.

9. Think about anniversaries and holidays. Anniversaries, such as the date the pregnancy was lost or the due date, may also be painful, and you may feel sadder than usual at these times. If you need to, take the day off, attend a religious service, or mark the date in some special way. Holidays may be difficult after a miscarriage too. If you're grieving, think about quietly observing the holiday at home or of attending festivities only briefly.

10. Consider the future. If you and your partner have been through more than one miscarriage, you might begin thinking about how much loss you can bear. At some point, you'll need to discuss whether you want to continue trying or consider adopting a baby, or if you can feel comfortable living your life without children.

When to Start Trying Again
Issues to consider after a miscarriage, before trying again.

Making the Decision

Some couples want to try as soon as possible to get pregnant again after a pregnancy loss. Others are unsure whether they ever want to try again. And most go back and forth between the two. This difficult and personal decision can only be made by you and your partner.

You have just been through a very painful experience. Allow yourself some time to make the decision that's right for you. Keep in mind:

All pregnancies are different.

You might have to deal with the recurrence of a genetic defect. Get as much information as possible from a medical professional before making your decision.

There are advantages both to waiting and to getting pregnant soon after your loss. Waiting will allow you more time to heal physically and emotionally and may help you feel less anxious during the pregnancy. Getting pregnant soon after the loss may make you feel that you're moving toward more hopeful times and help you overcome feelings of "failure."

If you've battled infertility or gone through a number of losses, you need to honestly answer this question: "Can I do this one more time?"

It may be a good idea to wait a few months to allow yourself time to heal emotionally and physically. But how long to wait differs with the individual. Even doctors can't agree because there are many factors -- both physical and emotional -- involved in deciding how long to wait. Other considerations include your age and whether you, as a couple, are experiencing other big changes in your lives. Get information from your health-care provider, books, and other sources. Then decide for yourself. It's normal to find that, while you may feel ready to try again, your partner may not. Or the other way around.

Recognize that you may be balancing many feelings: anxiety, anger, obsession, ambivalence about a subsequent pregnancy, hopeful feelings about the future, and grief and guilt about your loss. Even if you desperately want to try again, most parents find that their grief intensifies in the months following, and that another pregnancy feels too risky to even consider at this time.

Your physical readiness to try again depends on the type of loss you had and the nature of the delivery.

Did the miscarriage expel itself or did you have a D&C?

Did you go through labor and delivery?

Was emergency surgery necessary?

Your doctor will help you determine when it's physically safe to try again.

Once You've Decided

Once you and your partner have agreed to try to get pregnant again, be sure to:

Find a supportive doctor or midwife who is willing to give you the kind of care you want. You may need to see a fertility or maternal-fetal specialist.

Talk to your health-care provider about your timing and the physical issues that affect when you can try to get pregnant again. For example, your milk may have come in, and it may take a while for you to stop bleeding. Your provider may suggest waiting a certain number of menstrual cycles, as well.

Go for genetic counseling, if it's appropriate.

Follow a healthy lifestyle by avoiding alcohol, smoking, and illegal drugs; take a multivitamin containing folic acid every day; eat a healthy diet, including foods rich in folic acid like fortified cereals, leafy green vegetables, dried beans, and orange juice.

When You Become Pregnant

Most women become pregnant within the year following the loss of their baby. Remember, it's okay for you to grieve for the baby you lost even during a subsequent pregnancy. When you do become pregnant:

Be positive and remind yourself that every pregnancy is different and that every baby is unique and special.

Get prenatal care as soon as you know you are pregnant.

Take healthy steps. Continue going for prenatal care and taking folic acid. Eat healthy food, drink lots of water, and get plenty of rest. Decrease stress and avoid smoking, illegal drugs, and alcohol.

Take charge of your medical care. Get information about pregnancy, prenatal care, and other topics that will help reduce your anxiety.

Consider your feelings about whether you want prenatal diagnostic testing. A test is useful when it identifies situations that can be monitored to prevent problems.

Recognize that this pregnancy may be difficult mentally and emotionally, as well as physically taxing, and that the hardest point to get past will be the point of your previous loss.

Get the reassurance you need from your health-care providers and be open about your concerns and fears.

Your should know:

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.