First Trimester Loss / Miscarriage

What is a Miscarriage?

A miscarriage is a pregnancy loss that can occur from conception to 12-14 weeks gestation. Some people consider a pregnancy loss in the 2nd trimester- from 12-24 weeks- also a miscarriage.

A miscarriage is usually a spontaneous event, though the physical delivery of the fetus may not happen on its own and often there is medical intervention. The medical procedure is called a D&C. D&C stands for dilation and cutterage. This is a procedure when a physician will scrape the uterus in order to clean out all the remains so that the woman’s body can heal and prepare for another pregnancy. It may be useful to know that in physician jargon, a miscarriage may be referred to as a “missed AB or spontaneous abortion” (very disturbing term!).

Some women miscarry spontaneously in their homes (or physician offices). It is always important to be checked by your physician in order to make sure that the uterus is clean.

At the Outset of Pregnancy

From the moment a woman, alone or with her partner, discovers that she is pregnant, she may begin planning her life towards the 40 week gestation goal. There are myriad thoughts and activities that are set in motion from the very beginning including figuring out maternity leave, housing needs, car needs and especially taking care of one’s body and developing fetus.

Psychologically a woman begins to prepare herself to welcome the baby into her life – initially by experiencing the physical changes, but mentally maintaining an awareness about the life developing inside of her and beginning a bond with the developing fetus.

Sometimes a pregnancy may not have been planned, but nonetheless, a woman begins the planning process when she discovers she is pregnant. Sometimes this may be a very wanted pregnancy so there is a very real and strong attachment from the positive pregnancy test onwards. Sometimes the pregnancy may be a result of infertility treatments so there may be enormous excitement and disbelief that “it’s finally happening!” And sometimes due to a previous miscarriage, or previous multiple losses, this could be a time of great anxiety, yet anticipation for the best possible outcome.

Personal Reactions to a Miscarriage

It is natural to feel sadness about this loss. Reactions can vary greatly and it all depends on who you are as a person. There is no right way one is supposed to feel following a miscarriage or pregnancy loss. Some women feel fine emotionally, and return to routine functioning with little or no interruption in their lives. Others may feel sad for a short time and then realize that they are ready to move on. And yet some women may feel bereft at this loss and need time to process their reactions and emotions. All these reactions are considered normal and acceptable.

There is also a wide range of physician reactions. Some doctors will express their sympathy with you and offer support; others may encourage you to move on as quickly as possible and “just get pregnant again.” This does not mean that your doctor does not care, but don’t forget, obstetricians are in business to deliver healthy babies and have positive outcomes – so their orientation is to see you move on to another pregnancy as soon as possible.

A woman’s reaction may be influenced by what else is happening in her life. Sometimes unexpectedly, even when a woman thinks she can “move on” without being affected by the pregnancy loss, she may find herself feeling upset and confused by her inner thoughts and reactions.

Sometimes feelings of guilt emerge. It is natural for women to “blame themselves” and try to find a reason for their miscarriage. In a majority of cases there is no “official reason” for the loss and that too is difficult to accept. As competent women we strive to be in control of our lives. Losing a pregnancy or infant, or experiencing infertility, is one of the most “out of control” experiences a woman can feel. It is not uncommon for women to critique their behavior and “retrace their steps” in the preceding days of the loss to try to determine its cause. For the record, usually most food intake and daily activities – even strenuous exercise or lifting, cannot cause a miscarriage. It is also important to note that sexual intercourse does not cause pregnancy loss. Many women or couples may feel guilty that because they had sex that was the cause of their loss.

Managing the Miscarriage

Deciding whom you tell about your loss probably depends on with whom you shared you were pregnant. It is natural to share the exciting news of your pregnancy, but can be harder to disclose about the loss. You may have very confusing thoughts and feelings about this since it’s hard to share “bad news.” Often it is best to tell the truth, “I have some bad news to share” rather than keep it to yourself. If it’s too hard for you to talk about it, you can have your partner or close family member or friend tell others. Once people know you may be surprised how many women will share their personal experience with pregnancy loss.

It is important to note that 1 in 4 pregnancies end in pregnancy loss at some stage. That is a very high statistic and it should not come as a surprise that most women at some point in their active reproductive lives, have experienced a pregnancy loss of some kind.

You Are Not Alone

What options are there in processing your thoughts and feelings? First, understand that you are not alone in your pregnancy loss experience. Some people find comfort doing research on the Internet, joining on-line discussion groups or chat rooms where you can anonymously listen to others and process your reactions. Others find it helpful to speak to family and friends – both those who have experienced something similar or those who are empathetic and understanding about your feelings.

Some women and couples find it helpful to join a professionally facilitated support group in order to share what they are feeling in a safe environment with others who are going through the same thing. Others may find that speaking to a private counselor is the best way to manage this process. All these options – including doing none of them – are considered normal coping techniques for processing feelings of sadness and loss following a miscarriage.