It’s not your fault: Understanding miscarriage
February 4, 2020
As an Ob/Gyn provider, part of my role is guiding patients through traumatic pregnancy experiences, such as first-trimester miscarriage.
Early miscarriage is the most common pregnancy complication in the United States, affecting up to 1 million women each year. It can occur due to a range of issues a patient cannot control, such as chromosomal abnormalities in the embryo – the cause of approximately half of all miscarriages.
Research suggests some women find comfort and support on social platforms such as Instagram after a miscarriage. Connecting with others who have been there can help them surface their emotions and feel less isolated.
However, patients' ability to cope with miscarriage varies. Some struggle with guilt, depression, and even post-traumatic stress disorder (PTSD) symptoms.
In a 2019 study of women who had experienced a first-trimester miscarriage, 18% reported symptoms that met PTSD criteria, 17% reported moderate/severe anxiety, and 6% reported moderate/severe depression nine months after their miscarriage.
Part of my role in these situations is helping patients understand what happened and that there are resources available to help them manage their emotions. The first step is to reassure them they are not alone.
Miscarriage is not rare
I read an interesting study on what people believe about early pregnancy miscarriage, or miscarriage in the first three months. The survey-based study revealed just how detrimental misconceptions about miscarriage can be to patients and their families.
More than 1,000 people completed the 33-question survey, which was published in the journal Obstetrics and Gynecology. The goal was to examine what people know about the frequency and causes of miscarriage, and their emotional reactions to experiencing miscarriage themselves.
I was surprised to find that more than half those surveyed thought miscarriage was very uncommon. That’s not true. Ten percent – perhaps even 20 percent – of clinically recognized pregnancies end in miscarriage. That means as many as one in five pregnant women will experience a miscarriage in early pregnancy.
When we talk about “clinically recognized” pregnancies, we include women whose pregnancies have been verified by their physicians and women who have had positive home pregnancy tests but have not seen their physicians.
Over the past 20 years, pregnancy tests have become very accurate. Pregnancy tests you can buy at the grocery store can detect a pregnancy even before a missed period. That means doctors are diagnosing miscarriages that 20 years ago may have been considered nothing more than slightly late, heavier periods.
What causes miscarriage?
The survey showed that the majority of respondents knew the most common cause of early miscarriage is a genetic or medical problem with the pregnancy. A common genetic problem is aneuploidy, which means there is an abnormal number of chromosomes in the cells of the embryo.
The majority of people thought there could be other external causes for early pregnancy loss. Nearly 75% of respondents thought an isolated stressful event could trigger a miscarriage, and that isn’t true. Another misperception many respondents had was that lifting heavy objects or other physical exertion might trigger early pregnancy miscarriage.
Even more surprising was that many people believed their past personal histories could cause them to miscarry. Many respondents thought a history of past sexually transmitted infection or contraceptive use (birth control pills or IUDs) could cause miscarriage, which is also untrue.
What causes misperceptions?
Part of the fault for these misperceptions lies with the medical community. We need to do a better job communicating with our patients who have miscarriages.
Physicians know a 10% to 20% early miscarriage rate means miscarriage is not uncommon. The survey shows that many of our patients think otherwise. As soon as they find out they’re expecting, some families may start thinking, “Will it be a boy or a girl? What names should we consider? What room will be the nursery?”
As physicians, we need to recognize early miscarriage as a family loss rather than a common medical event. We need to let patients take time to grieve and answer their questions as best we can.
PTSD after Pregnancy
You may associate post-traumatic stress disorder with survivors of assault, war, or natural disasters. But as maternal-fetal specialist Dr. Shivani Patel will tell you, symptoms of PTSD can weigh heavy on moms who had complex pregnancies. She knows from personal experience.
It’s not your fault
In my experience, the first thing nine out of 10 patients ask when we determine they’ve experienced a miscarriage is, “Why did it happen?” Unfortunately, we frequently can’t give an exact cause, and that can be very frustrating for patients.
We can tell them the common causes for miscarriage, with chromosome abnormalities being the most likely reason. Some women may lose a pregnancy because of issues involving their body’s production of small blood clots. Women with abnormally shaped uteruses may be more likely to miscarry, too.
Though we can tell you what we know about early miscarriage – that it’s not uncommon, your past choices didn’t cause it, stress didn’t affect it – that still leaves patients with the question of why.
I was saddened to read that half of female survey respondents who had suffered a miscarriage felt guilty about it, and that approximately 40% felt as if they had done something wrong.
As a doctor, this is a cue that we need to think about reassuring people that – almost always – they did nothing wrong and that there was nothing they could have done to prevent it from happening. There is rarely any effective treatment, either at a medical center or at home, to prevent early pregnancy loss.
One final striking point from the study: 28% of female respondents who had miscarried reported feeling less isolated when celebrities disclosed they, too, had miscarried. That number jumped to 46% when a friend disclosed a miscarriage. Like many other personal or medical complications, having someone to relate with or talk to can make a world of difference for families struggling to cope with an early miscarriage.
If we as healthcare providers, family, and friends are more aware of miscarriage and more open to sharing our empathy and experiences, patients will be better equipped to cope with early pregnancy loss.