This week’s episode may be a tough one for some of you. We’re talking with a certified doula about miscarriage and pregnancy, and both of us know—from personal experience—that this can be a heavy and grief-inducing topic. Our intent is not exploitation but information and sensitivity, and if this is something you’ve struggled with or worried/wondered about, we hope you’ll join us.
Our guest today is Sarah Perry, a doula with Nashville Doula Services here in middle Tennessee. You may recognize her from some previous episodes (#boymom and “what do you do with a doula”).
Welcome Sarah.
We wanted to talk with Sarah in particular because she’s had first-hand experience in a professional capacity walking with women through the procedures and loss that come with a miscarriage. And, as she’ll share, she’s also (as we have) experienced that loss herself.
First let’s give you a definition. Miscarriage is the spontaneous loss of a pregnancy before the 20th week. About 1 in 4 known pregnancies end in miscarriage. But the actual number could be higher because many miscarriages occur very early in pregnancy — before a woman may even know she’s pregnant. Most miscarriages happen in the first trimester before the 12th week of pregnancy (the greatest number of these in the 6-8 wk mark). Miscarriage in the second trimester (between 13 and 19 weeks) happens in 1-5% of pregnancies. In other words, the likelihood of miscarrying decreases as the weeks go by.
The moment you suspect you’re pregnant (which can be pretty early if you’re one of those people who has an on-the-dot regular cycle), most women imagine the life they’re carrying as a baby. Although you can see the flickering motion of the beginning heart on an ultrasound by around 6 weeks, you typically don’t hear an audible heartbeat with that Doppler fetal monitor until the 10th week.
The heart doesn’t have all its major components until the beginning of Week 10. By this time, all the major organ systems have begun to develop.
Why?
It’s worth noting that this isn’t how things were supposed to be. When Adam and Eve sinned in the Garden of Eden, the world broke in many ways:
- Our relationship with God was severed
- Our relationship with each other was hindered
- Our emotional lives were broken
- Creation itself was subjected to frustration, including our bodies
So, while suffering causes all kinds of why questions, this big-picture “why” gives us a framework to understand what is going on. The way things are is not the way they are supposed to be!
How Might You Know?
A miscarriage can happen any time after fertilization. If you didn’t know you were pregnant, it would be easy to mistake it for a period. Both a period and a miscarriage can cause spotting to heavy bleeding. After the first eight weeks or so, it’s less likely that you’ll mistake a miscarriage for a period.
NOTE: Light bleeding in early pregnancy is fairly common and doesn’t mean you’re about to miscarry.
Other symptoms?
- cramping and pain in your lower tummy
- a discharge of fluid or tissue
- no longer experiencing the symptoms of pregnancy, such as feeling sick and breast tenderness
CAUSES:
Source: Parent
The vast majority of miscarriages occur because of chance chromosomal or genetic abnormalities or, less commonly, hormonal imbalances or problems with the uterus or placenta.
- Other factors that can cause:
- drug or alcohol use,
- certain types of uterine or sexually-transmitted infections,
- uncontrolled diabetes or thyroid disease
- some procedures (amnio carries a small risk),
- and then there’s caffeine. A cup of coffee in the morning is totally fine. But there’s some evidence from a 2008 study that found that people who consumed 200 milligrams or more of caffeine each day (about two cups of regular coffee or five 12-ounce cans of caffeinated soda) had twice the miscarriage risk as those who didn’t have any. And a newer 2020 study in BMC Pregnancy and Childbirth did find a link between increased bleeding in early pregnancy and caffeine consumption. The risk associated with caffeine is also not limited to the pregnant person. For instance, a study from 2016 published by the National Institutes of Health (NIH) demonstrated that the amount of caffeine consumed by both biological parents in the weeks leading up to conception had a significant impact on the risk level of miscarriage.
- Severe stress….like the death of a spouse or parent. Everyday tension/stress is not linked; and even severe stress does not have 100% cause/effect.
- Falling? (like Scarlett O’Hara down the stairs in Gone with the Wind)… unless you’re pretty severely injured in an accident yourself, the baby is generally protected by your body. Risky activities where a serious fall COULD occur (horseback riding, skiing, etc…esp when your balance may be off & joints are looser) is probably not the wisest.
By FAR most of these factors in most miscarriages are nothing that a parent-to-be has control over. Most of the time, miscarriages are completely random and could not have been prevented. The odds are, if you want to try again, you will have a normal pregnancy.
What May Happen:
We already mentioned bleeding or spotting, but if you miscarry at home or somewhere else that’s not a hospital, you are very likely to pass the remains of your pregnancy into the toilet. (This can happen in hospital too.) You may look at what has come away and see a small placenta and/or something you think might be the fetus.
Some simply flush this away, while others want to take a closer look or want a medical professional to confirm that they’ve miscarried. (Sarah—have you dealt with situations like these?)
Often, some of the pregnancy tissue remains in the uterus after a miscarriage. If it’s not removed by scraping the uterus with a curette (a spoon-shaped instrument), you may bleed for a long time or develop an infection. This procedure is what’s known as a D&C (dilation and curettage). The procedure itself shouldn’t be painful. However, you may experience some cramping. Your doctor may order some sedatives for you to take beforehand to help you feel more relaxed.
You can usually go home a few hours after a D&C. You might have mild pain or light bleeding for a few days.
What not to do after miscarriage?
Usually recommended: No sex, tampons, or douching for 2 weeks.
EMOTIONAL SUPPORT
One area that might be overlooked when it comes to miscarriages (especially early ones) is emotional support and the emotional aftermath.
Maybe it’s become sort of a “standard practice” to keep a pregnancy quiet until 10-12 weeks because of the possibility of miscarriage. If you haven’t told many people (or anyone), then you don’t have to go through the painful process of “un-telling” them.
The emotional effects of miscarriage may often be underestimated. The fact is, you were pregnant, with all the hormonal & psychological changes that come with that. When you no longer are, your hormones plummet at the same time you’re grieving the loss of that pregnancy (and all the future for that baby that you’d possibly imagined). Post partum hormone changes can be ongoing for up to a year after a miscarriage.
Miscarriage is a loss and a stressful time and you should take care of yourself (or let yourself be taken care of). Give yourself time to be sad and process through it. Talk with a friend or family member, or counselor if you feel yourself sinking into a deeper state of sadness (like PPD).
Be direct with people who may be insensitive or dismissive (you can always try again; at least you already have a child; it was so early it wasn’t even really a baby yet). Tell them that’s not how you think of it and you’re feeling sad about it—and are allowed to. (Or have a good friend tell them FOR you.)
It’s normal to mourn. It’s normal and ok to feel a little worry about trying again, or—if you have gotten pregnant after a miscarriage—to feel yourself becoming triggered/anxious as the new pregnancy approaches the date when you miscarried.
What’s Helpful: telling yourself the truth, that your body is strong and capable and that you have faith/friends/family who can and will support you through any outcome. Surrendering to doing all that you can and then placing the baby in God’s control. Meditating, prayer, focused breathing to reduce your stress and worry
What’s Not Helpful or even Harmful: trying to micro-control every aspect of the pregnancy to “ensure” the desired outcome. Focusing on untruths that your body has betrayed you or is flawed in some way, that YOU are flawed in some way. Being so consumed with worry/anxiety that you miss the joy of a new pregnancy.
Moms & Dads Can Process Differently
It’s often the case that fathers will not process the loss like mothers. They may have barely had time to absorb and adjust to the idea of a pregnancy; they certainly will not have felt any physical changes like moms will have. It may seem “less real” to them.
This doesn’t mean that they aren’t grieving or sad at all. It’s not helpful to compare your sadness or to judge that the other person “isn’t sad enough.” Grief affects everyone differently… and mothers/fathers DO grieve differently. Try to communicate what each other needs through this time. One may need a lot of downtime or space & quiet while the other feels better when they’re running or “working off” the emotions. Neither is right or wrong.
Another difference is in how other people ASSUME mom/dad may be dealing with the loss. Very often women are comforted and offered support, while men receive very little (as if it wasn’t also their loss). Ask for what you need, or if you can’t, it’s helpful if someone else can reach out/communicate your need on your behalf.
SIBLINGS: talk to your children about the loss. It’s their loss, too, and being open and grieving together can help children process. Leaving things to their imagination can often be frightening and make them imagine things are much worse. Seeing parent grieve can actually teach children how to regulate their own emotions and send the message that it’s good and right to talk about things openly.
Nancy Guthrie, a Christian theologian, speaker, and author, has faced the deaths of two of her three children to a rare genetic disorder called Zellweger Syndrome. A daughter, Hope, in 1999, and a son, Gabriel, in 2001. Nancy offered many of the lessons she learned from this sorrowful experience in her 2002 book, Holding On to Hope: A Pathway of Suffering to the Heart of God. She regularly hears from readers who have been touched by the book from all around the world as the book has been translated into German, Danish, Norwegian, Korean, Chinese, Spanish and Portuguese. Since that time she has gone on to write additional books exploring God’s comfort in suffering—for example, When Your Family’s Lost a Loved One: Finding Hope Together and Hearing Jesus Speak into Your Sorrow.
This may also be in her book, Holding On to Hope, but her worldview on the death of children has been informed by the Puritans. She found that the Puritans had a lot of good teaching on the death of children. This would be because In the healthiest seventeenth century communities, one infant in ten died before the age of five. In less healthy environments, three children in ten died before their fifth birthday. Puritan minister Cotton Mather saw eight of his fifteen children die before reaching the age of two.
Separation creates a relentless ache in grieving parents’ hearts and lives. But the Puritans encouraged parents to see this separation as beneficial for their child and temporary for themselves. Samuel Rutherford asked a grieving mother, “Do you think her lost when she is but sleeping in the bosom of the Almighty? Think her not absent who is in such a friend’s house. Is she lost to you who is found to Christ? . . . [And] ye shall, in the Resurrection, see her again.”
Similarly, he wrote to Lady Kenmure, “Ye have lost a child: nay she is not lost to you who is found to Christ. She is not sent away, but only sent before, like unto a star, which going out of our sight doth not die and vanish, but shineth in another hemisphere.”
Nancy and her husband and minister to grieving parents through their weekend Respite Retreats (https://www.nancyguthrie.com/respite-retreat), and share this perspective with them. It provides tremendous comfort to them to know that their young children have been welcomed into a home—a place where they are loved and cared for—and that they will indeed one day be there with them.
RESOURCES & TIPS:
At the same time you’re investigating birth plans and OB providers, take note of locations of OB ERs in your area. If you have a specialized OB ER, it is always best to go there in case of difficulty or emergency instead of a general hospital ER! Waiting times are lower and they’re trained on what to do in a pregnancy emergency.
Check out Ready Nest Counseling for prenatal and postpartum support! They’re available via Zoom.