According to the American College of Obstetricians and Gynecologists (ACOG), miscarriages are common and occur in about 10 percent of known pregnancies. Even though the loss of a fetus can be devastating, there are options for couples who want to try to conceive again.
Katie White, MD, shares resources to help couples cope with a miscarriage, the recovery process, and when they can try again.
Kate White, MD
Kate White, MD is an Assistant Professor of Obstetrics & Gynecology, Boston University School of Medicine, Boston Massachusetts.
Melanie Cole (Host): According to the American College of Obstetricians and Gynecologists, about 15% to 20% of pregnancies end in miscarriage. For couples, this can be a devastating event. My guest is Dr. Katharine White; she's an obstetrician gynecologist at Boston Medical Center. Dr. White, what exactly is a miscarriage? What is happening in the woman's body that would signal that this is something that's going on?
Dr. Katharine White, MD (Guest): A miscarriage is when a pregnancy is not developing appropriately the way that it should. A woman may know she's having a miscarriage because she may start to have symptoms of bleeding and cramping, but bleeding and cramping are very common in early pregnancy, and most of the time the pregnancy continues normally, but sometimes those symptoms mean that the pregnancy has stopped growing. Sometimes an embryo or a fetus has started to develop and stopped its heartbeat. Sometimes a pregnancy sac is present, but there's no embryo inside at all.
Melanie: I mentioned in the intro ACOG's percent of pregnancies that do end in miscarriage. I mean is this pretty common? Do you see many of them?
Dr. White: I do. Miscarriages are very common in my practice. I think if you think about adding chemical pregnancies to the list, meaning women who are getting blood tests in a pregnancy such as after in vitro fertilization, or when we're watching a pregnancy from the very beginning and a pregnancy sac hasn't even started to develop, but we know someone is pregnant. If you look closer at the pregnancies on the list, 25% of pregnancies end in a miscarriage. It is incredibly common.
A lot of couples, I think, are shocked when they get the diagnosis because you never really think that it could happen to you, especially if you're healthy and feel like you were doing everything right, but it is incredibly common. You're in very good company if you're facing this.
Melanie: That's a very good point you bring up, Dr. White, because people do say, "Well I did everything right, and how could this happen to me?" Do we know what causes it? Are there risk factors? Like if you've had one, you're more likely to have another? Or does it run in families? Are there any risk factors to know about?
Dr. White: Sure, the biggest risk factor for miscarriage unfortunately is the one that we can't stop, which is time. Women getting older have higher risk for miscarriage the older they get. Women in their twenties have about a 10% to 15% risk, but a woman who is forty has a 40% risk.
There are other risk factors like obesity, excessive caffeine consumption, which is more than three cups of coffee a day, or substance use like cocaine use are risk factors for miscarriage. But in a lot of cases, women are completely healthy and don't have any of these things.
Melanie: You mentioned some of the symptoms a woman might notice, bleeding or cramping, and as you say these are common for pregnant women anyways, some of these things. Are there some red flags that you would like women or couples to know about that might signal that, "You know what? Get in right away, because maybe there's something we can do."
Dr. White: I think anytime that a woman has bleeding or cramping when she's pregnant, she should call her clinician's office whether she's seeing a doctor or a midwife, because there's a lot of anxiety that comes with those symptoms. And even if everything in the pregnancy is okay, I think you still deserve to get care in a pretty expedited way, but it's really care for your head and your heart more than it is for your body. If a pregnancy is going to end in miscarriage, there's nothing that we can do to stop it. The most common cause of a miscarriage is a chromosome problem with the pregnancy where there's an abnormal number of chromosomes or genetic material in the embryo that's growing.
And so when- I talk to patients about it's like when you're trying to bake a cake and you don't have all the right ingredients, the cake won't bake. Pregnancy is very similar. It doesn't take a big mistake at all in the genetic material early in pregnancy for it to go wrong for the whole pregnancy and not grow appropriately.
Melanie: One of the most important points of miscarriage many people feel is that emotional part, and the recovery. So first, Dr. White, how long does the physical part take? Because what might be going on, she might have still bleeding, or cramping, whatever's happening after. How long should that technically go on, and then what do you do with the emotional? How do you provide that support that couples need when they go through something this devastating?
Dr. White: Sure, so the biggest physical symptom in the recovery period after a miscarriage are bleeding and cramping, and after the pregnancy has passed, that bleeding and cramping should resemble that of a period; about that much bleeding, about that much pain, and so it's a sign to call your doctor if you're experiencing something more than that.
But sometimes it seems odd that your body is actually recovering much faster than your heart. So when I talk to patients who are grieving a pregnancy, the first thing I do is I stress that it wasn't their fault. Even if we don't always know what caused a miscarriage, I can give a woman a really long list of things that did not cause the miscarriage. Working too hard, exercising, having sex, having used birth control in the past, falling or having any kind of physical injury, or being stressed. All of these things that women look at in their history to say, "Well this thing happened. Did this cause the pregnancy to be lost?" I give them reassurance that none of these things cause a miscarriage, and I think trying to take away that feeling of guilt can be really important in that coping time afterwards.
And I tell couples that it's really normal to feel sad. That you didn't really just lose a pregnancy, it's the loss of all the things that come after. Some couples when they find out they're pregnant, they're already imagining that whole child's future. They're thinking about prom, and high school graduation, and beyond, and so really when that pregnancy is lost even if it's only two or three months, it's the dreams of the next two decades that are lost with it, and that's normal to feel sad.
It is of course though also normal to feel okay and not sad, because not everybody feels that attached that early in the pregnancy, so I also encourage couples not let anyone talk them into feeling bad for not feeling bad.
Melanie: Wow, what a description you just gave, Dr. White, and what important points you made about not letting people make them feel bad if they didn't, but about the dreams that they had for the future. Wow, that was an incredible description. And what do you want people to do if they are feeling that sadness, and if they're feeling it- if it's just the woman feeling it, maybe the partner isn't feeling it quite as severely. If it's this woman, what should she know about getting support, getting help, maybe putting away some of the stuff she had out and ready to go? I mean are any of those suggestions that you make?
Dr. White: Yeah, the first thing I want my patients to do is let me know because they sometimes feel very alone after a miscarriage, and I want to give her all the resources that she can tap into so she knows that she's not alone. Things like support groups, sometimes those are local groups of mother or fathers or couples who get together and talk about pregnancy loss. There are also online resources and hotlines that people can go to, to help with grief and healing.
I think one of the hardest things after a pregnancy loss is putting away all of those things that you may have started to collect or buy for the upcoming pregnancy, and you often don't want to throw them away because you still want to have hope that you're going to use them in the future, but you can also get someone to help you box them up if it's too painful to do yourself.
And then I think some couples find a peace in trying to remember this pregnancy in some ways, whether it's a memory box that you can put the ultrasound pictures in, or a letter that you wrote to the baby, or things like planting a tree in your backyard, or some other kind of ritual that you can put into place that goes with your space, with your culture, with the way that you like to live, that somehow sort of marks the pregnancy as having had an impact on your life, even if it was only for a few months.
Melanie: If you miscarry, when can you try to start trying to get pregnant again? If they're worried about taking that risk again, what do you tell them about starting to try?
Dr. White: That's the one bit of happy news I have for couples, is that in most cases you can start trying again right away. There's no medical benefit to waiting to get pregnant another time after a miscarriage. I do stress that sometimes the body is ready before the heart is, and you might want to feel like you're getting through a grieving process before you try again, but for a lot of couples the best way to manage the grief is to start trying to get pregnant again, and I completely encourage that.
Melanie: What an amazing segment, Dr. White, and I can hear that you are absolutely so passionate and just lovely with your patients. Please wrap it up for us with your best advice for people that have suffered a miscarriage, for couples, and what you really want them to know about trying again, and looking forward to the future.
Dr. White: Please know that if you've suffered a miscarriage, you have joined a long sorority of women who have also been in the same position. It was not a sorority that you intended to join, but you are now in this club of women who have gone through and survived pregnancy loss. So as you're going through, please don't feel alone, please reach out and if it's not to your friends and family, your doctor can help you find other resources of people that you can talk to who understand exactly what you're going through, and who have suggestions on ways to grieve, and know that in the vast majority of cases, your next pregnancy is going to be completely healthy and you're going to take home that baby that you so desperately want to have.
Melanie: Thank you again so much for being with us today, Dr. White, and for sharing your expertise on this very sensitive topic. Thanks again for joining us. This is Boston Med Talks with Boston Medical Center. For more information you can go to www.BMC.org. That's www.BMC.org. This is Melanie Cole, thanks so much for tuning in.