Miscarriage is a devastating occurrence. Many women have miscarriages; often it could be the case that you may have work colleagues or acquaintances who have recently suffered a miscarriage, but they haven’t told you about it. It can be very hard for you to talk about, as the grief can be so extreme, that it’s a very painful situation to share. Many women will only tell those very close to them about their miscarriage. You may even feel guilty about having a miscarriage, but you shouldn’t. In the majority of cases there will be a medical reason for miscarriage, and sadly it is often nature just taking its course.
75% of miscarriages happen in the first trimester
What can make a miscarriage even more difficult, is that it is frequently the case that it is not possible to identify the underlying cause. This lack of closure can add to the trauma you have experienced. Plenty of women suffer miscarriages and go on to have a healthy baby in a later pregnancy.
75% of miscarriages occur in the first trimester, which is during the first three months. When this is the case the cause is normally related to the fetus; your unborn baby. A miscarriage that happens during this time normally means that unfortunately your unborn baby wasn’t developing as he or she should have, and nature needs to take its course.
Miscarriage in the second trimester (14 to 26 weeks) is more often the result of an underlying health problem that you may have. It may have been that your baby caught an infection, which results in the sac of waters breaking, before you start to feel pain or begin to bleed. In unusual cases, a second trimester miscarriage can be caused by the womb opening too early.
Miscarriages during the first trimester
A first trimester miscarriage is most often due to chromosonal problems of your fetus.
Issues with chromosomes
Chromosomes are basically blocks of DNA. Estimates show that two-thirds of first trimester miscarriages take place because of chromosome problems. In most cases this doesn’t indicate that there are actual chromosomal issues with either you or your partners, and generally there is a low chance that this type of miscarriage will re-occur.
These DNA blocks, chromosomes, contain complex instructions and they are in control of many factors. Chromosomes control issues such as what colour your baby’s eyes will be, through to how baby’s cells develop. It can happen that something doesn’t happen correctly at the moment of conception, so that the fetus receives either too many or too little chromosomes. Although the reasons for why this happens are not clear, it sadly means that the baby will not be able to develop normally, which will result in a miscarriage.
Here you can discover a number of studies focused on miscarriages and chromosomal problems
Another way that miscarriage can occur during the first trimester is when there are placental problems. The placenta is an organ which plays the role of linking your blood supply to that of your developing fetus. However if something goes wrong with this lifegiving link, this can also result in miscarriage.
Early miscarriages: what can increase your risk
Age can increase the chance of an early miscarriage. Below are the statistics.
Under 30: 10% of pregnancies end in miscarriage
From 30 to 35: 15% of pregnancies end in miscarriage
From 35 to 39: 20% of pregnancies end in miscarriage
From 40 to 45: 25-30 % of pregnancies end in miscarriage
Over 45: Over 50% of pregnancies end in miscarriage
Non-age related risk factors
Regardless of what age you are there are other factors which can increase your risk of miscarriage.
Smoking in pregnancy
Drug misuse in pregnancy
Drinking alcohol in pregnancy – there is ongoing debate about how much, if any alcohol you can consume during pregnancy. For many women it feels natural to avoid it altogether. However if you do take an occasional drink when pregnant, you shouldn’t take more than two units per week. A unit is a glass (half pint) of normal strength lager or bitter, or a spirit of 25ml. 1.5 units of alcohol is a glass of wine of 125ml.
To educate yourself further on this risk, you can check the following studies on alcohol miscarriage risk
Drinking over 200mg of caffeine per day – a mug of instant coffee has around 100mg of caffeine, whereas a mug of tea contains approximately 75mg of caffeine. Caffeine is also present in chocolate, some energy drinks and fizzy drinks.
Previous miscarriage increases your risk slightly at an average statistic of 25%. However remember that this an average statistic and for many women a miscarriage is a one-off occurrence. It is estimated that 10% of women experience recurrent miscarriages, which is considered to be three or more in a row. 60% of these women do actually go on to have a viable, successful pregnancy.
A 2016 study found that a reduced amount of stem cells in the uterine lining could be the cause of recurrent miscarriages, you can read more about that here
Second trimester miscarriages
There are a number of long-term health conditions which can increase your risk of miscarriage in the second trimester.
Diabetes when it is not properly controlled
Thyroid problems – either underactive or overactive
Food poisoning can increase your risk of miscarriage. This can occur if you eat contaminated food, or food that has been undercooked, or is raw. Listeriosis is food poisoning that is associated with unpasteurised dairy products. Toxoplasmosis can be caused by eating raw or undercooked meat, which is infected, especially pork, lamb and venison. Toxoplasmosis can also be caught by handling your cat’s litter box. Salmonella is commonly caused by eating partly cooked or raw eggs.
Medicines that may cause miscarriage
Regardless of what you read online or offline, always check with your doctor if a medication is safe to take during pregnancy.
Here are some of the main medicines that are known to increase your risk:
Ibruprofen family of medicines, which are known as NSAIDs, which means non-steroidal anti-inflammatory drugs. These are used to treat inflammation and pain.
Retinoids – which are used to treat acne and ezcema.
Misoprostol and methotrexate – which are used to treat complaints like rheumatoid arthritis
Infections which can result in miscarriage
Rubella (german measles)
Womb structure abnormalities and issues
Second and third trimester miscarriages can be caused by womb abnormalities and issues. An abnormally shaped womb can result in miscarriage. Also if you have a weak cervix, this can be another factor. This may happen because of a previous injury, or it may be that the muscles are naturally weaker than average. This is also referred to as cervical incompetence. Some women have fibroids in their wombs, which are non-cancerous growths. These can also be a contributing factor to miscarriage.
Polycystic ovary syndrome is when your ovaries are larger than average. It is a leading cause of infertility also, as it results in lower egg production. It happens due to hormonal changes in your ovaries. Although there is a certain amount of evidence that suggests it can be linked to miscarriage in some cases, many women with PCOS have healthy pregnancies.
Misconceptions about miscarriage
Miscarriage is not caused by
Your emotional state
Straining or lifting
Eating spicy food
Exercise that is suitable during pregnancy (you should confirm this with your doctor or midwife) Learn more about exercise in pregnancy by reading these studies
Working unless in some type of unsafe environment
You will need support at this time. Turn to those that you trust and confide in them. You can also get support from the Irish Miscarriage Association, here is a link to their phone support
Each woman is different and will have different ideas as to how she would like to remember her baby. The Irish Miscarriage Association also has some ideas about Miscarriage and Remembering Your Baby
If you have suffered a miscarriage, you can download this informative booklet by the Irish Miscarriage Association
After a miscarriage you will possibly suffer a roller coaster of emotions. These can be so intense that they can also lead to physical reactions also. Many women are numbed by their miscarriage. Even when it is a very early miscarriage, this can happen. This is entirely natural because the bond that was there was such a special one, so you shouldn’t feel strange about this. You may feel depressed, sad, angry and be in disbelief.
It can be difficult to concentrate on normal life. In fact it can seem almost as if normal life shouldn’t be continuing at all. In this sense the grief is no different to losing a close loved one. The main difference is that your unborn baby was actually developing inside your body, so it is a different and very deep bond. You may find it difficult to sleep and you could lose your appetite. Unfortunately the hormonal changes that happen after miscarriage can make all of this even more intense.
Depending on how you are as a person, you may also find it difficult that miscarriage is not spoken about as openly as the death of a family member or close friend. This can be challenging.
Phases you may experience after a miscarriage
Phase 1: Shock and denial
The shock of a miscarriage is very intense. This may be mixed with feelings of denial also, as it is very hard to accept the loss.
Phase 2: Depression, anger and guilt
The rollercoaster of feelings can vary between or encompass all of the feelings of depression, anger and guilt. Sadly this is a normal part of the process.
Phase 3: Acceptance
At some stage you will reach a place of acceptance. A time will come when you feel you can accept your loss. However this is not to say that feelings from phase 2 will have entirely gone away.
For each woman it will be different, although these types of feelings are common to most of us. Although it may not feel like it at this time, you will at some stage feel enough acceptance and have passed all of these feelings sufficiently for life to seem “normal” once again.