Miscarriages – what are they, why do they happen, how often etc?

Approximately 1 in 4 – 1 in 5 pregnancies sadly end in miscarriage or pregnancy loss.

The definition of a miscarriage is a pregnancy loss less than 20 weeks gestation. The majority of these occur prior to 10 weeks’ gestation. If you actually think about it, it really is a miracle that when an egg and a sperm meet and become one cell and then divide again and again that this leads to a healthy baby. Sometimes along the way whether it be when the eggs or sperm develop, the cells multiply, or the embryo tries to attach to the uterus things don’t go well and this results in the pregnancy failing. If this pregnancy stops growing after the time you expect your period and we see a pregnancy that is not growing on scan and/or you pass the pregnancy tissue (after it has stopped growing) then we call this a miscarriage. Another form of pregnancy loss is a biochemical pregnancy. This is essentially just a very early miscarriage around the time that you expect your period when you are around 4-5 weeks’ pregnant (and nothing would be visible on ultrasound). These are super common – probably up to 50% of pregnancies end this way (but many women think it’s just their period).

Why do miscarriages happen?

Essentially there are factors such as the genetic material/DNA not being the correct amount in an egg/sperm, medical conditions or environmental conditions in the mother rendering the uterus unsuitable for a healthy pregnancy which contribute to the pregnancy being not quite right. Chromosomal abnormalities accounts for up to 70% of miscarriage – eg. an extra or missing chromosome. The reason a miscarriage occurs is there is essentially a ‘quality control’ process in the body that leads to only the healthy pregnancies progressing. The ones that aren’t healthy will stop growing. A woman’s age affects the quality of the DNA in the eggs hence why women who are older are more likely to experience a miscarriage.

Why do you think there is such a lack of information/support out there? 

There is plenty of information but you need to know where to look. It’s not something you should be looking on the internet for in an ideal world. Like anything, there is plenty on the internet which isn’t correct or up to date. I recommend making an appointment to see your GP or Obstetrician if you need more information or support.

What can we do to make miscarriages less taboo?

We have to chat about it more and also inform our support people when you are pregnant early on if you are brave enough. After-all, the people who should be supporting you are friends and family if things don’t go well. We need to start sharing our pregnancies earlier than our 13 week scans! And if things don’t go well, share your experiences with your friends, family and whoever you can about your miscarriage. Share it on social media. Like all things Women’s health, it should not be taboo.

So, I’ve had a miscarriage… What next?

There is a positive way to look at it – the main thing is you got pregnant – that’s the hardest part. So at least you know everything works. Your body is clever recognising that things weren’t quite right. And better to find out earlier than to find significant abnormalities later in the pregnancy. Make sure you see your GP or Obstetrician to be guided on the next steps. Sometimes we investigate the causes, sometimes we don’t (this depends on many factors). Know that the majority of women the next pregnancy is likely to result in a healthy pregnancy. Don’t blame yourself or feel like you caused the miscarriage. It’s not your fault.

What are the physical symptoms that you could experience during a miscarriage?

Some women experience bleeding and period-like cramps. Passing clots or tissue can also occur. Sometimes there are no symptoms initially if the miscarriage is found on routine ultrasound ( we call this a ‘missed miscarriage’ if we find the miscarriage on ultrasound).

What are some credible resources we can go to for further information / support?

The following online resources can be helpful:

• https://www.sands.org.au
• https://www.bearsofhope.org.au
• https://www.thewomens.org.au/health-information/pregnancy-and-birth/pregnancy-problems/early-pregnancy-problems/miscarriage
• https://raisingchildren.net.au/pregnancy/miscarriage-stillbirth/miscarriage/miscarriage

Your Obstetrician/Gynaecologist or GP are also a very important resource – too many women present to the Emergency Department with a miscarriage and don’t actually sit down with a GP or Obstetrician to chat about what just happened or the next steps. This advice is important in preparing you mentally and physically for the next pregnancy.

Any words of advice for someone who has just gone through a miscarriage?

YOU ARE NOT ALONE. 1 in 4 pregnancies end this way. There is nothing you have done to cause the miscarriage and the next pregnancy is likely to be healthy. It’s also normal to feel sad and grieve about the pregnancy and baby you were hoping for. Everyone deals with a pregnancy loss in different ways – do what works for you whether it be chat to others who have been through the same experience or process your thoughts alone or with your partner. Make sure you seek help if you are not coping.

When it comes to exercising, what do you recommend for during and after miscarrying/having a d+c?

You can pretty much go back to usual activities once you feel up to it after a miscarriage. Exercise can be a great form of release and way to improve your mood and wellbeing. A D&C (Dilatation and curettage to treat a miscarriage) is a minor day procedure. If you feel up to exercising the next day you can go for it. You may have some bleeding for 1-2 weeks after a miscarriage or D&C but otherwise you should feel pretty well. If you are not sure or you have lost a fair amount of blood ( this is not common) then chat with your doctor about getting back into exercise.

Tips for overcoming miscarriage anxiety during pregnancy 

This is a common one and to be expected after pregnancy loss. And even if you haven’t experienced a miscarriage is it normal to be anxious during your first trimester. My tips on early pregnancy anxiety are:

1. Avoid Google/ the Internet – there is so much misinformation out there that is going to lead you to lead you to believe that something is wrong even if things are fine.
2. Talk it out with your partner or a friend who has been through pregnancy to reassure you.
3. Focus on your positive pregnancy symptoms eg. Tiredness/fatigue, nausea, shortness of breath etc – these are all reassuring.
4. Hire a health professional who can reassure you if you are not sure. I have plenty of patients come in for extra scans and there if they are worried things aren’t going well.
5. Focus on the positive statistics. Even though 1:4-1:5 pregnancies end in miscarriage – the majority still are all fine! e.g. 80% are fine. And once you get through the 13 week scan 99% are fine! I found this most useful. Even though I have seen bad outcomes, I know that the majority of my women I have cared for everything goes really well!
6. Find reassurance in each major milestone. Eg. Get through the first few weeks with some bloods to confirm your pregnancy hormone (BHCG) is rising, dating scan to see the heartbeat at 6-7 weeks, NIPT for chromosome number/rule out chromosomal abnormalities at 10 weeks, first early anatomy scan at 12-13 weeks. Once you get through 24 weeks you have a viable baby on board.
7. Find a release. Such as exercise or mindfulness.
8. Seek professional help such as a perinatal psychologist if things are getting too hard to manage by yourself.