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Pregnancy

Understanding Miscarriage

Written By
Jessalyn Ballerano
Certified Childbirth Educator & Doula

Pregnancy loss is an understandable concern among expecting parents, and a more common occurrence than many people realize. Understanding the realities of miscarriage is one way to lessen fear, help reproducing people to take action for their health and safety, and remove the stigma of discussing and recovering from pregnancy loss.

Learning the facts is a necessary component to addressing the important topic of pregnancy loss, which affects as many as 1 in 4 birthing people who identify as women. In addition to our articles on miscarriage support and pregnancy after loss, here we round up some basics on the statistics, the risks, and what to do if you are experiencing a miscarriage.

Miscarriage Realities

  • Miscarriage facts
  • The stigma of pregnancy loss

Experiencing Miscarriage

  • How do I know if I am having a miscarriage?
  • What should I expect if I am having a miscarriage?

Miscarriage Risk Factors

  • What increases the risk of miscarriage?
  • Miscarriage repeats and causes

Miscarriage Support

Miscarriage Realities

Many people do not consider pregnancy loss until it impacts their own life or that of someone dear to them. People experiencing miscarriage are often surprised to learn how common of an occurrence it is, even within their own families. Understanding miscarriage as a common reality is just one way to better understand a personal loss, support someone experiencing miscarriage, and lessen the stigma around discussing death and grief in relation to pregnancy.

Miscarriage facts

Pregnancy loss is common and rarely preventable, yet many people blame themselves when a pregnancy ends with loss. Learning the facts may help you or a loved one to better understand or accept a loss, which is one small step in healing and recovering.

Why does miscarriage happen?

  • The most common reason for pregnancy loss in the first trimester is a random or inherited chromosomal abnormality that makes it impossible for that specific fetus to develop and survive as a baby.
  • Other causes of miscarriage are not well understood and may be hard to identify. We don’t always have a way to know exactly what happened that caused the miscarriage.
  • There is typically no one to blame in the vast majority of miscarriages. Common activities like sex, feeling stressed, or exercising are rarely indicated as a cause.

How often and when does pregnancy loss happen?

  • Miscarriage is more common than many people realize. It is estimated that 1 in 4 pregnancies will result in miscarriage - that’s nearly 25% of all pregnancies - this estimate also accounts for cases in which a person did not yet know they were pregnant. Among confirmed pregnancies, the miscarriage rate is closer to 10-15%.
  • Pregnancy loss before 20 weeks is considered a miscarriage. After that, a loss is considered a stillbirth, although gestational development is not exact, so the language used may vary case to case.
  • The majority of miscarriages - about 80% - occur early in pregnancy, between 0 and 13 weeks, when the most vulnerable stages of fetal development are occurring. After that, the risk falls to less than 1% after 20 weeks.
  • Different kinds of pregnancy loss may require different kinds of care.
  • Most people who experience miscarriage go on to have healthy pregnancies

The stigma of pregnancy loss

Too often, someone experiencing a miscarriage may feel that they cannot share with others what is happening. One of our goals at Seven Starling is to cultivate a culture of reproduction in which people feel safe, supported and respected in sharing their truths - even the difficult ones. Some of the reasons folks may not feel comfortable sharing include:

  • Not yet having announced their pregnancy or feeling unsupported in pregnancy to begin with
  • Concerns about being judged for the miscarriage or their emotions about it
  • Being afraid to bring negative news or emotions into their social circle
  • Feeling that the timing of their pregnancy and loss made it less significant than someone else’s
  • Feeling unsafe to express their full range of emotions
  • Previous experiences being shut down when discussing struggles or hardships
  • Feeling too much confusion or strong emotion to know what to say
  • Expecting that they are alone in their experience and no one will understand
  • Worrying that something was wrong with them or they are somehow to blame

While these beliefs and concerns can be very deeply rooted in our minds, many of them are based in misunderstanding how common miscarriage is, and how it occurs. Most people who do speak up about miscarriage find that other friends and loved ones have had similar experiences, and that more open communication about pregnancy loss helps everyone to feel more supported through it.

Experiencing Miscarriage

How do I know if I am having a miscarriage?

If you think you may be having a miscarriage, it is important to contact your medical care provider. A medical professional can help you identify whether or not you need to seek medical care and understand what may be occurring.

Sometimes a miscarriage does not cause obvious symptoms, but the most common symptoms of miscarriage are listed below. Other processes of pregnancy can cause some of these symptoms, but if you aren’t sure or have a feeling something is wrong, it is recommended to see your doctor or midwife just in case.

  • Unusual (for you) vaginal bleeding or spotting during pregnancy
  • Less concerning spotting can occur early in pregnancy and for some people after sex or a vaginal exam. Contact your provider or urgent care to discuss the specifics if bleeding continues, gets heavier, or if you are concerned.
  • Intense abdominal pain that doesn’t go away with movement, releasing gas or having a bowel movement
  • Severe cramping in your pelvic area/uterus
  • Prolonged inactivity or lack of movement that is unusual for your baby

What should I expect if I am having a miscarriage?

Since miscarriages happen at different stages of pregnancy, the experience can be very different between individuals. Some may experience physical pain, others may not feel much sensation. Variations in cramping, bleeding, the passage of blood clots, the presence of fetal tissue, and the amount of time that symptoms continue will vary, and even if they are normal parts of pregnancy loss, these symptoms can be scary, surprising or stressful. 

Some aspects of miscarriage are universal, although the duration and timing may vary. Here are the most common processes of a miscarriage:

  • The cramping and bleeding described above may last for a few hours or up to about a week
  • Some people may feel this as intensely as labor pains, others may not feel any pain
  • Some people will pass large blood clots (about the size of an egg) during miscarriage, others may pass fetal tissue; early pregnancy loss may not include either, or it may not be possible to visually identify.
  • Heavier bleeding usually lasts for a shorter period of time than light bleeding - heavy bleeding is considered soaking a large pad every hour (or more frequently) and it is recommended that one seeks medical advice in either case.
  • If a pregnancy loss is identified before bleeding and cramping starts, someone may be given the option to induce miscarriage with medications.
  • Medical assistance, including ultrasound, physical exams, blood tests and surgical procedures may be recommended to help complete the miscarriage, resolve unusually heavy bleeding, assess other symptoms (like infection) or determine possible cause.
  • Preferences for reproductive planning may be helpful to discuss in the immediate aftercare for miscarriage, as different options include various long and short-term considerations, timing, side effects, and flexibility.
  • If someone has experienced more than one miscarriage, their provider may offer additional testing to investigate any possible cause that could impact future pregnancies.

Keep in touch with your medical provider so they can help you to know what is normal, what’s not, and what you can do to manage symptoms, pain and safety. Recovery time can vary and may require additional care. Your health care provider may also have resources for emotional support. Click here for more information from Seven Starling about the ways individuals and communities can cultivate support and safety through what can be a very difficult experience.

Miscarriage Risk Factors

While most pregnancy loss is unpreventable and random, there are some general risk factors and specific health conditions that may put someone at increased risk of miscarriage. General risk factors like age or preexisting health conditions are unlikely to be preventable, but understanding them may help you to plan or choose specialized care in your pregnancy. Certain risks may be modified by behavior changes and lifestyle adjustments, so knowing about these factors ahead of time may help you to take actions to decrease your risks in pregnancy if they are relevant to you.

What increases the risk of miscarriage?

While most miscarriage are not preventable, there are some risk factors for miscarriage and specific health conditions that are worth discussing with your care provider if pregnant or planning to be pregnant in the coming year.

  • Age is a risk factor, mostly because human eggs, all of which are already present at the birth of a baby assigned female, decrease in quality over a lifetime. Risk starts to increase around age 35 but is most high for parents aged 45 and older.
  • Lifestyle risks such as smoking or inactivity tend to accumulate with time, which may also contribute to increased risk of pregnancy loss with age.
  • No matter someone’s age, adult use of drugs, including nicotine, stimulants like cocaine and methamphetamines, other recreational drugs, or even high doses of common stimulants like caffeine can increase the risk of miscarriage.
  • Chronic health conditions such as diabetes and high blood pressure can be a risk and may require adjustments to care or medication while pregnant.
  • Miscarriage may also occur in relation to autoimmune illness, hormonal challenges that make sustaining pregnancy difficult, anatomical or structural variation in the uterus or cervix, infection, illness, and blood clotting disorders.

Miscarriage Repeats and Causes 

Most miscarriages happen as a matter of genetic chance or unpreventable health circumstances. There are different kinds of issues that are more likely to cause repeat miscarriages, so understanding some of the reasons for miscarriage we do know of may be helpful in discussing concerns with a care provider. While many reproducing people will experience one miscarriage in their lifetime, if you are experiencing recurring pregnancy loss it is worth seeking supportive medical care and professional support to help you assess the safest path forward, for body and mind, in your family planning.

As mentioned above, more than half of miscarriages occur because a fertilized egg has extra, missing, or incomplete chromosomes - cellular structures that contain our genes. Chromosomal abnormalities include:

  • Blighted ovum - when an embryo implants in the uterus but stops developing
  • Intrauterine fetal demise - when an embryo ceases to develop and dies
  • Molar pregnancy - tissue forms into a tumor instead of a healthy pregnancy

Anatomical challenges in the uterus or cervix may limit development or the processes that need to occur to nourish and protect a healthy pregnancy.

  • Septate uterus - a uterus divided into two sections may be treated with repairing surgery to reduce the risk of miscarriage
  • Asheman syndrome - internal scar tissue that can damage the lining of the uterus
  • Fibroids - may be harmless, but can also limit space and interfere blood supply; the size and location of fibroids influences its effect on a pregnancy
  • “Cervical insufficiency” refers to a cervix that opens too early in pregnancy, which can cause miscarriage but is also treatable with early prenatal care

Infections are one of the few risk factors that, while not possible to control 100% of the time, can be mitigated by preventative measures and within public health efforts. Sexually transmitted diseases and certain types of severe food poisoning (listeriosis) are some of the more common and preventable/treatable causes of miscarriage

Falls, pelvic injury, and exposure to harmful chemicals are all risks to both fetal and parental health. Pregnant individuals have a right to safe accomodations at work, and if someone experiences one of these risks by accident, it is important to seek medical care.


Miscarriage Support

Getting and giving support when someone experiences a pregnancy loss can mean different things for different people. Click here for a close look at the best ways to support someone going through miscarriage, or check out these quotes for healing from pregnancy loss. No matter what, remember that when it comes to pregnancy loss, you are not alone and you are worthy of support.

Selected Sources

Jessalyn Ballerano
Certified Childbirth Educator & Doula
Jessalyn (she/her) is a Childbirth Educator and Doula serving families in the San Francisco Bay Area, nationwide, and in her new home of Eugene, Oregon. She started studying birth in 2010 as an anthropologist, and often brings a systemic approach to helping birthing people to understand their options, experiences and possibilities. She integrates evidence-based training and research with a holistic mindset and an activist’s passion for reproductive empowerment. Jessalyn serves on the board for the Oakland Better Birth Foundation, where birthworkers, birthing people, and care providers work together to end preventable maternal and infant mortality and address racial disparities in health care. Jessalyn is a CAPPA-Certified Childbirth Educator, SMC Full-Circle Doula.
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