“Immediately, in most women, you’re going to have some kind of bonding to that positive pregnancy test,” explains G. Thomas Ruiz, MD, OB/GYN lead at MemorialCare Orange Coast Medical Center. “Once they learn that this is a nonviable pregnancy, they’re going to go into all of those emotions that are associated with the loss of a loved one. There’s going to be tearfulness, sadness, [and] there may be mild depression.” The person who is pregnant will not be the only one who must come to terms with the loss. “[When] suffering a pregnancy loss, their whole world changes and their dreams for the future are turned completely upside down. The loss is also felt by the partner, the grandparents, and anyone else who already loves this unborn baby,” states Katherine Apostolakis-Kyrus, MD, a maternal-fetal medicine attending physician at John Hopkins All Children’s Hospital. The loss, along with not knowing what to expect, can make miscarriage a scary, confusing, and even traumatic experience. Although up to 50% of all pregnancies end in miscarriage, it’s easy to feel alone, with more questions than answers.
What Happens During a Miscarriage
A miscarriage occurs when there is a fetal loss before 20 weeks of pregnancy. When a person has endured a loss, the first question is often, “why?” Unfortunately, it’s not always easy to provide an answer. “Fifty percent of the time it’s a genetic anomaly where the fetus is not compatible with life. So, you have to think of it as mother nature’s way of not allowing the pregnancy to continue. Now the other 50% we may never understand,” Dr. Ruiz states. He goes on to explain some of the other possible causes of a miscarriage. “There may be anatomic anomalies within the uterus, which is predisposed to miscarriage. The patient may have medical conditions, which make it more difficult to maintain a pregnancy, such as uncontrolled blood pressure, poorly managed diabetes, [or] any of the autoimmune diseases,” Dr. Ruiz says. Miscarriages can begin with spotting or bleeding, along with pelvic or back pain. The symptoms can come on suddenly, and tissue and blood clots may start to pass vaginally right away. Or, it can be a slow process, with the bleeding and pain lasting for days as everything passes. Even if the symptoms seem mild, it’s important to seek medical attention. “With any of the symptoms…it is recommended that they seek medical care. At a minimum, they should call their physician. If, however, they have significant bleeding, more than a [menstrual] pad per hour, the patient should go straight to the ER,” Dr. Apostolakis-Kyrus advises. When the contents come out on their own, it is a spontaneous miscarriage. In this case, the person’s body naturally recognizes there is no longer a viable pregnancy. In cases of a missed miscarriage, the baby’s heart has stopped beating but the child hasn’t miscarried. In situations like these, medical intervention is needed. “If [a person] does not spontaneously deliver, she can choose a medication or procedure. Depending on the woman’s gestational age, she may have the medication at home and pass the uterine contents at home. This can be pretty painful and scary,” Dr. Apostolakis-Kyrus explains. The pain can feel like labor pains when giving birth. If a person prefers not to take the medication, they have the option of a dilation and curettage surgical procedure, known as a D&C. Experts say if an individual chooses medication and all the contents don’t leave the body, a D&C may still be needed. “[The person] has to decide, ‘do I do nothing and wait and see if this happens naturally, take a medication to induce labor, or do I have a procedure?’ There are several options, but none of them are the ones that they were planning for and dreaming of when they pictured their baby,” says Dr. Apostolakis-Kyrus.
Signs of a Miscarriage
Bleeding is a common symptom of miscarriage. A person who has never had a miscarriage won’t know how much or how little they will bleed or how physically painful it will be. Light spotting is normal in early pregnancy and not necessarily cause for alarm. However, if you are experiencing significant bleeding similar to a heavy period flow, or the blood is bright red in color, that can be cause for concern. Uterine cramping that feels like menstrual cramps and lower back pain may also be indications of a problem with the pregnancy. Sometimes a person stops “feeling pregnant”—meaning the breast tenderness, growing belly, and nausea associated with pregnancy starts to disappear. Your baby bump may have started to develop, then seems like it suddenly stops getting bigger. This happens when the baby’s heart has stopped beating in utero. “A D&C…is typically done in the first trimester. The cervix is dilated and then it is curetted, which means to scrape the lining of the uterus until the uterus is empty. However, in the second trimester, it typically requires dilation and evacuation, which is dilating the cervix and evacuating or emptying the uterus via curettage, vacuum suction, and sometimes extraction forceps,” Dr. Apostolakis-Kyrus notes. Though it doesn’t ease the pain of the loss, knowing what to look for and what to expect can help put your mind at ease.
Preparing Yourself for a Miscarriage
Miscarriages can hurt physically, emotionally, and mentally. If it seems like the baby stopped growing, or if you start to have bleeding and pain, seek out medical attention. A physician can help you through the physical process of the loss. The emotional wounds, however, can linger far longer. If you decide it is too difficult to wait for your body to naturally pass your baby, medication or a D&C may be a part of your plan to begin your healing process. You can seek help from other resources for your healing journey, including March of Dimes, The Compassionate Friends, and Share Pregnancy and Infant Loss. Local support groups and places of worship may offer additional help, as well as seeing a therapist or other mental health provider. The important thing to remember is that miscarriage is a common occurrence. You are not to blame. “We should normalize this conversation so that we are there for each other. Talk to your doctor about it, talk to them if you are suffering. There are specific therapy-based options for pregnancy loss, and they can help you. Remain hopeful and follow up with your doctor to make a plan for the future,” Dr. Apostolakis-Kyrus concludes.
A Word from Verywell
It’s not easy when your hopes and dreams for your future included the little one you just lost. Be patient with yourself and give yourself grace and time as you and your family grieve your loss. Prepare yourself with knowledge so you understand what to expect. Seek the help and support that you need. You are not alone.
