Experiencing Early Pregnancy Loss
What you can do next, what you didn’t do wrong and how to cope with the loss
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In 2004, my husband and I decided to start a family. We worried that we wouldn’t be prepared for the challenges of parenting and how children would impact our marriage. But we never once worried that I might miscarry.
Around eight weeks, our baby no longer had a heartbeat. While driving home from my appointment, I couldn’t stop crying. I tried to downplay my emotions. The baby was the size of a grape. I told myself that other women had experienced much greater losses. But my grief was persistent and enormous.
In the coming days and weeks, I felt angry and alone. I wondered if I did something wrong. I wondered if I would ever have children. And I didn’t understand why my heart was taking so long to heal.
Preparing for a new baby is supposed to be a happy time. No one wants to talk about miscarriage. So when a loss occurs, it can come as a shock.
Even among healthy, younger women, the risk of miscarriage is between 10% and 15%, says Dr. Kelly Acharya, M.D., assistant professor of reproductive endocrinology and infertility at Duke Obstetrics & Gynecology in Durham. For women in their mid-40s, the risk can be as high as 50%.
Experiences like mine aren’t unusual, agrees Julia Woodward, a clinical psychologist at Duke Fertility Center in Durham. She says every woman’s journey through pregnancy loss is unique, and it can take months — or even years — to process it.
Woodward says many of her patients, however, grieve their miscarriages in silence and secrecy. Women often dismiss their own grief since it happened early. They may also feel responsible for the loss, even when they know better.
Early pregnancy loss happens before 14 weeks and has several causes, Acharya says. Before five weeks, chemical pregnancies can occur. A pregnancy test shows positive, but a pregnancy never develops.
Embryonic pregnancies often come to light between six and eight weeks. A gestational sac forms but never develops a fetus. Genetic abnormalities could cause early miscarriages as well. The sperm and egg don’t share genetic material correctly.
The risk for miscarriage is at its highest in the first trimester, Acharya says. However, once a heartbeat is detected, the risk greatly decreases.
For women who experience two or more miscarriages, Acharya recommends a panel of tests to rule out common causes. Uterine abnormalities such as fibroids are detectable via an ultrasound. Blood work may uncover undiagnosed diabetes or thyroid issues. Both parents can undergo chromosomal testing to rule out genetic concerns.
The panel of tests may help providers understand why miscarriages took place. Providers then take appropriate action to prevent future losses. However, there aren’t always answers when it comes to miscarriage, Acharya says.
“About 40% of the time, we can find a reason with one of these tests for multiple miscarriages,” she says. That means, however, that 60% of those women never discover a medical cause for their loss. Women often have to look for other ways to make sense of their experience.
Woodward started a support group in 2017 to help women cope with the challenges of pregnancy loss. The group meets once a month and supports women who have experienced a miscarriage in their first or second trimester.
“It’s really powerful to hear from other women who have been through what you’ve been through, and to know that you’re not alone,” she says.
Support group members develop coping tools such as self-care, emotional expression, identifying negative thoughts and loss rituals. Woodward also coaches women on ways to communicate their needs to family members and partners supporting them.
The good news is that even after as many as three miscarriages, a woman’s chance of giving birth within two years is still 70%. Acharya says most women can begin trying to conceive again once a miscarriage is complete and they feel ready.
Sara Rosenquist, a board-certified clinical health psychologist in Cary, counsels women in issues relating to reproductive health, including early pregnancy loss. She says subsequent pregnancies are an especially stressful time. But these situations also provide opportunities for growth.
“It’s an invitation to learn to hold our hopes and expectations lightly, and to recognize that life is fragile,” she says. “We have no guarantees, so we begin to tolerate ambiguity and uncertainty.”
Rosenquist says meditative practices help women embrace the present moment. “It helps you take the attitude that ‘I will love this baby for as long as I have it, for however long that is,’” she says. “That’s a gift to yourself. You’re not trying to control the future. You are doing your best to love this baby now, no matter what happens.”
Healing from miscarriage and loss is a journey that, sometimes, takes longer than expected. In the end, I experienced three miscarriages, two live births and one adoption. I’m a mom of three now. I still tear up when I think about those early losses. It was a difficult time, but it also made me who I am today.
Christa Hogan is a local freelance writer and mom to three boys.
Supporting a Woman After Miscarriage
When supporting a woman through pregnancy loss, don’t try to make her feel better, says Julia Woodward, a clinical psychologist at Duke Ferticilty Center. Well-meaning statements like, “It’s better that it happened early,” or “The next pregnancy will be healthy,” only cause more anguish.
Sara Rosenquist, a clinical health psychologist in Cary, agrees that friends often don’t know what to say. But it’s better to ask what a woman needs than to leave her grieving in isolation. “It’s okay to admit, ‘I want to be there for you, but I don’t know how to help,’” she suggests.
Women interested in joining Duke Fertility Center’s Pregnancy Loss Support Group can contact Woodward at firstname.lastname@example.org or visit dukefertilitycenter.org/news/pregnancy-loss-support-group. The group is open to nonpatients.
Visit drsara.com for more information on pregnancy loss and reproductive health.