The day Bobbi Daniels learned she’d had a miscarriage, she felt like she’d failed. “After seeing my baby’s heartbeat three days before, I laid on a table as the tech searched and searched for a viable baby,” the mom from Camden County, New Jersey tells HealthyWay. “I had lost my baby, had failed another [IVF] cycle, and was $35,000 deep into the process.” Daniels was seven weeks pregnant at the time, carrying a little boy she’d conceived thanks to in vitro fertilization (IVF) after doctors said she had just a 10 percent chance of ever getting pregnant without intervention. Noah is the name she’d given the boy. Miscarriage is difficult. It’s confusing. It’s heartbreaking. It’s not, however, a failure on the part of a mom-to-be. In fact, doctors say the signs of miscarriage can be so similar to your period that some women who miscarry in the very early stages of pregnancy never even know they were pregnant—let alone that they’ve miscarried. Daniels, on the other hand, had a confirmed pregnancy. She knew she had been pregnant, and she knew she had lost the baby she and her husband were so excited to welcome into their family. “I knew in my heart I had lost Noah,” she recalls. “The morning I was going for my scan and found out I had lost Noah, I was going through the list of podcasts to listen to. It sounds ridiculous, but for a quick second I had the thought ‘I don’t want to start a new podcast because I’ll never be able to listen to it if I lost this baby.’ After I had the scan, the doctor recommended a D&C to make sure everything was cleaned out and to speed the process up of bleeding.” (A D&C, or dilation and curettage, is the surgical procedure of clearing out the contents of the uterus.) “There are no words to explain the pain of walking into a hospital still carrying your child [and] to leave hours later with no baby,” Daniels says. “The nurse had me take a pregnancy test because she didn’t realize what procedure I was there to have done. The torture of watching that stick have two lines, knowing my baby was gone, literally made my chest hurt.” It’s an experience Daniels will always carry with her, even now that she has a little girl who she calls her rainbow baby, a term used by moms who give birth after a pregnancy loss. And she’s far from alone. A miscarriage is defined as a pregnancy loss before the 20th week of pregnancy, and miscarriage rates are hard for experts to accurately estimate. Doctors can only judge miscarriage rates by pregnancies that have been confirmed, and those figures are high. According to the American College of Obstetricians and Gynecologists, early pregnancy loss occurs in as much as 10 percent of all clinically recognized pregnancies. Some 80 percent of those cases occur, as Daniels’ did, in the first trimester. In fact, the majority of miscarriages will occur right between six and eight weeks, says Sherry Ross, MD, an OB-GYN and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California.
Signs of Miscarriage
Although the result of a miscarriage—the end of a pregnancy—is the same in all cases, the signs can vary widely from woman to woman.
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Late Period
Women who don’t know they’re pregnant often miss the symptoms of miscarriage, says G. Thomas Ruiz, MD, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California. These women, who have what’s termed a “chemical pregnancy,” will typically endure a miscarriage within a week of the embryo’s implantation in the uterus. If they’d undergone blood tests, Ruiz says, doctors would be able to see a spike in the hormone hCG, but after a miscarriage, that “rapidly goes to zero.” Then the body starts to bleed, expelling the fertilized egg from the uterus, which most women assume is their period showing up just a week or two behind schedule.
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Bright Red Bleeding and Uterine Cramping
If you have had your pregnancy confirmed, bleeding and cramps will be more likely to serve as a warning sign of miscarriage, Ruiz says. After all, a woman who is pregnant knows she should not be expecting her period, as the menstrual cycle goes into hibernation during pregnancy. “If a woman is having heavy bleeding that is not stopping and/or if she is experiencing severe abdominal pain, she should go to an emergency room immediately,” Ruiz says. Even if the bleeding is not heavy and the pain not intense, it’s still important for a woman to call her doctor. They can determine whether it’s time to run to the ER, head to their office, or go to a medical facility for testing. Bleeding could indicate miscarriage, but it could also indicate an ectopic (or tubal) pregnancy, Ruiz explains. That means the fertilized egg has attached itself someplace other than inside the uterus, typically in the fallopian tube. “As a tubal pregnancy progresses, the [fallopian] tube can dilate and rupture, which will cause severe abdominal pain and a surgical abdomen, which is a medical emergency,” he notes, so the tests are necessary to prevent further complications. For women whose pregnancies have entered the second trimester, testing may also determine if bleeding is being caused by a cervical insufficiency, says Renée Volny Darko, DO, an OB-GYN and founder and CEO of Pre-med Strategies, Inc. Although it sounds like a bit of a slam at a woman’s body, a diagnosis of cervical insufficiency is not a judgment from your doctor. Instead it means that the cervix has dilated too early, which is endangering the pregnancy. In that case, “interventions like a cerclage, which essentially ties the cervix closed, can be used to help keep the pregnancy,” Darko says, although she’s quick to add that cerclages are not always successful.
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No Signs at All
Some miscarriages may simply occur without a sign. A mom may walk into her doctor’s office as Daniels did, ready for standard testing, only to find out that the baby has no heartbeat. “The process of conception and human development is intricate and often imperfect,” Darko says. “But miscarriages might have no symptoms at all. A miscarriage can be diagnosed on a routine ultrasound where the pregnancy is found not to have developed beyond a sac or the fetus has no heartbeat.” For moms like Daniels, that can be the most devastating of all. “I sat there holding the prayer card to my belly, which was the St. Anthony prayer of miracles,” Daniels recalls of the 15-minute scan when she got the news. “As she asked me to hold my breath, and I watched her face, I knew my baby had died. I cried so hard that no sound could even escape my body. Tears soaked the bed. The nurse whispered ‘I’m sorry hon, I don’t see a heartbeat, get dressed and meet me outside.’” Daniels recalls her life flashing before her eyes in those moments. “I didn’t just lose a 7-week baby. I lost the first day of kindergarten, my baby reaching for my hand calling me Mommy, a round belly everyone was going to rub and fuss over, a tired baby I rock to sleep who was comforted by my voice, birthday parties, late night feedings, a lifetime of memories,” she says. Her doctors were able to tell her that she could try again, and her little girl, born in April 2018, is the result of her second pregnancy. Trying again is not on every woman’s mind. Grief and recovery can take all forms, but Darko says moms who do want to try again are typically given the all clear very soon after a miscarriage, depending on the cause of the pregnancy loss and when it happened. “After most first trimester miscarriages, there is really no need to wait to conceive again,” Darko notes. “After a second trimester miscarriage, a woman should be evaluated to see if the reason for the miscarriage can be corrected before conceiving again.” So what are the reasons a woman might have a miscarriage?
Why Miscarriage Happens
Because so many women miscarry before they even know they are pregnant, experts don’t know what causes all miscarriages. They term pregnancies in two camps: normal and abnormal. Again, it’s important to note that these terms are medical in nature. “Abnormal” does not refer to a mom herself. “Normal” pregnancies last beyond 10 weeks, Ruiz says, while abnormal pregnancies make up the bulk of miscarriages. So what causes miscarriage? Here are some of the most common causes, according to the experts:
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Genetic Abnormalities
No parent wants to hear that their baby is abnormal, but again, this is a medical term rather than a judgment from the doctor. In some 60 percent of miscarriages, pregnancy loss will occur seemingly randomly, but it’s due to a genetic abnormality, Ross says. The fertilized egg is unable to continue development, causing the process of pregnancy to end. Turner syndrome, also known as 45,X or 45,X0, is one of the leading genetic abnormalities linked to miscarriage, Ruiz explains. The condition, in which a female embryo is partly or completely missing an X chromosome, has been tied to about 15 percent of miscarriages. Women in their late thirties and early forties are more likely than others to have miscarriages due to genetic abnormalities, Ross notes, and it can be tied to a mom’s eggs. Because we’re born with all the eggs we will ever have, the older a woman is, the older her eggs are too. “What is well known in the medical world is fertility declines progressively with age,” Ross says. “The aging of eggs is a well-known biological phenomenon referred to as our ‘biological clock.’ If you are 45 years old and trying to conceive, you will have a greater than 80 percent chance of having a miscarriage, compared to a woman under 30 years old who will have a less than 20 percent chance of having one.”
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Infection
Simply getting sick during a pregnancy is not a guarantee that a woman will miscarry (although it’s always important to contact your doctor if you are coming down with something). But certain common infections—from the flu to sexually transmitted infections such as syphilis and herpes—have been linked to a higher incidence of miscarriage. To stay ahead of these conditions, your OB-GYN may screen for STIs at one of your early appointments, and the Centers for Disease Control and Prevention recommends pregnant women receive a flu vaccine for their own protection as well as their baby’s.
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Abnormal Uterine Cavity
The uterus is where an embryo implants and then resides, developing until birth. But for some women, problems with the uterus can lead to miscarriage, Ruiz says. Dubbed an “abnormal uterine cavity,” one of the most common is a uterine septum, an upside down, triangular piece of tissue that can divide the uterus in half. “if the embryo implants on the septum, there is high risk for a miscarriage,” Ruiz says.
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Asherman Syndrome
Scarring of the uterine cavity is another issue that can cause miscarriage. Called Asherman syndrome, the condition is rare and typically occurs after an infection or a woman undergoes a D&C, Ruiz explains. Because the condition affects the endometrium, or the wall of the uterus, it can make even getting pregnant difficult to begin with. “The embryo needs a nice endometrium to implant well,” Ruiz adds.
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Medications
If your pharmacist asks you whether you’re pregnant when you’re filling your prescription, they’re not just being nosy. Studies have linked miscarriage risks to everything from certain antibiotics to anti-inflammatory pharmaceuticals.
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Cervical Incompetence/Cervical Insufficiency
The cervix is a narrow passage that separates the uterus—where an embryo develops—and the vagina. When it’s time for a baby to be born, the cervix will begin to dilate, allowing a baby the space to move out of the uterus and into the birth canal to come into the world. But in some instances the cervix begins to dilate too soon—sometimes as much as three to four months before the fetus is ready for birth. More commonly linked to miscarriage in the second trimester, an “insufficient” or “incompetent” cervix is one that begins to dilate too early in the pregnancy. This condition is associated with weakness in the cervical muscles, and Ruiz says it can be related to a previous D&C or biopsy of the cervix (such as one done by an OB-GYN when abnormal tissue is found that might indicate a cancer or pre-cancer). It can also happen to women who’ve had multiple previous births. And although there are several risk factors connected to the condition, it can also happen out of nowhere with no foreseeable cause.
Minimizing Miscarriage Risk
There is never a guarantee, Darko says, as pregnancy loss is a part of life, albeit a difficult one for parents-to-be. The best defense, however, is a good offense. If you’re planning to try to conceive, Darko says to meet with your doctor. Discuss your risk factors and any medications you might need to change or conditions you might need treated. “Seeing a doctor to optimize your health before getting pregnant can be the difference between a good and bad outcome,” she notes. And while one or several miscarriages can be heartbreaking and discouraging, the majority of women do get the all-clear to try again from their doctors, and for many of them, it can be successful. For Daniels, another cycle of IVF and another pregnancy helped bring her little girl into the world. “The road that led me to her was the most difficult, trying time in my life,” she says. But, she adds, “Noah will always be a part of me, he is me, and because of him I continue so he continues. His sister will grow to always know the love I have for her and her brother.”
