Miscarriages: Tough Questions and Tough Answers

I chose to become an OBGYN because I love delivering babies and bringing joy to expectant parents. It is by far the MOST REWARDING part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new life into the world is an opportunity that all of us OBGYNs keep sacred and is the main reason why many of us chose the field. But like all things in life there’s a downside to everything, and my job is no different.

Miscarriage is a topic that no one likes to discuss, myself included. It’s something that no expectant mother even wants to think about. Similarly, no athlete wants to discuss the possibility of a career ending injury, no pilot wants to talk about plane crashes, and no CEO wants to discuss the possibility of his or her company going bankrupt. Women who have miscarried are usually reluctant to discuss their experiences or share their feelings about it, which is totally understandable. It’s a private and personal matter for most that can often bring back painful memories and feelings of uneasiness. It can make women feel isolated, fearful, heartbroken, and at times, even guilty. In addition, it raises many questions like “Did I do something wrong?” “Is there something wrong with my body?” “Can I get pregnant again, and if so, when is the best time to try?” But the most important question for women and couples is “Why did this happen?” Unfortunately, the answer is one of the most challenging and elusive to provide.

Why?

Studies have shown that people are often misinformed when it comes to understanding the causes of miscarriages. In a recent survey of the general public, people were asked what they thought was the most common reason for a miscarriage. The top 7 answers were:

  1. A traumatic event
  2. Stress
  3. Lifting a heavy object
  4. An STD
  5. A previous miscarriage
  6. An IUD
  7. Woman not wanting to be pregnant

The answer to the question of “Why?” is very important for women who have experienced a miscarriage. Finding an answer or cause can lead to a sense of closure, the possibility of a solution, and a plan moving forward as most couples will want to get pregnant in the near future. The truth is that there are many causes of miscarriages none of which include the above. Various causes do include uterine or cervical anatomic problems, immunologic disorders, diabetes, thyroid disease, advanced age, smoking, alcohol, drugs, or environmental toxins. However, the vast majority of miscarriages are from chromosomal abnormalities (problems with the genetic makeup of a fetus), which cause over 50% of all miscarriages. When a genetic abnormality occurs, a woman’s body recognizes that the embryo’s genetic integrity is faulty and aborts or rejects the pregnancy. In a sense, nature is able to tell when development is abnormal and triggers a response to “start over”.

The important thing for women to understand is that while some of the above mentioned factors can be controlled such as smoking, alcohol, or environmental exposures, most of them cannot. For instance, many women are born with anatomical abnormalities or are diagnosed with chronic diseases during their childhood or adult life. Due to social reasons, some women may not be able to start a family until later in life when they are older. Because these causes cannot always be controlled, I tell my patients that they should never feel like it’s “their fault” and understand that sometimes unfortunate things just happen. I always reiterate to patients that they did nothing wrong and there was nothing that they could have done to prevent the miscarriage from happening.

Is there anything I can do?

Unfortunately, preventing a miscarriage from happening is impossible. My main advice to women who are considering conceiving is to optimize their health and body in preparation for a healthy pregnancy. These are some recommendations that I give to my patients.

  1. Eat a balanced diet that includes fruits, vegetables, meats, and carbohydrates. This will provide your body with essential nutrients, minerals, and vitamins for a healthy pregnancy.
  2. Maintain a healthy body weight. Being overweight or underweight can affect the health and the outcome of your pregnancy. It can also lead to complications later in life.
  3. Optimize your well-being if you have chronic medical diseases such as diabetes or thyroid disorders. For diabetics, your hemoglobin A1c level should be low and you should keep a daily log of your sugars and review them with your doctor. If you have a thyroid disorder, remain compliant with your thyroid medications and check with your doctor to make sure that your thyroid levels are within the normal limits.
  4. Stop bad habits. Quitting smoking and alcohol are some of the most important things you can do for a healthy pregnancy.
  5. Eliminate environmental exposures (lead, arsenic, radiation). No amount of exposure is considered “safe” especially if you have a very early pregnancy.
  6. Ensure sufficient folic acid intake. You should start taking prenatal vitamins with adequate amounts of folic acid (at least 400 micrograms daily) ideally 1 month prior to conceiving. Prenatal vitamins can be purchased over the counter at any local pharmacy or grocery store.

What now?

As vital as it is to take appropriate time for grieving and questions, most women will want to find closure and move forward. You should discuss with your doctor what the next steps are, your future plans for children, and how soon you wish to get pregnant if you so desire. You should also discuss the chances of a successful pregnancy and any interventions that may be needed for the next pregnancy. Some women may need laboratory testing or imaging procedures for some of the previously stated causes while others may not. Birth control is also an option as some women do not want to get pregnant for a certain period of time after a miscarriage. Lastly, it’s important for you to understand that while this was a tragic and disappointing time, you should not be afraid to get pregnant again. Even after a miscarriage, the vast majority of women will have no issues conceiving and will go on to have completely normal, healthy pregnancies. With my patients I strive to provide a sense of support, hope, and optimism through this process.

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