Today, I'm going to talk about something that nobody talks about. People don't really want to talk about it. It's hard. It's sad. And if anyone has to endure it, they want it to go away quietly because it's too hard to share. I'm talking about miscarriage. And it happened to me.
Within the past two weeks.
These are the things I have learned about miscarriage in my Internet research and conversations with my health care provider.
Why Does it Happen?
The short answer: no reason, or a gazillion reasons. The longer answer (but still not very satisfying), is that sometimes abnormalities within the egg or the sperm (e.g., not enough chromosomes, too many chromosomes, errors in the DNA code that instructs the embryo on how to form, etc.) cause the development to stop early. Sometimes, environmental factors (e.g., toxins in the water, air, or food; exposure to "something" that one should not have contact with in pregnancy) impact the developing embryo. Sometimes, there just is no answer.
How Often Does it Happen?
The short answer: a lot. The longer answer, according to The Hope Exchange (a website providing help after pregnancy loss), is that as many as 25-33% of all known pregnancies end in miscarriage, and up to 40% of all (including pre-positive pregnancy test) pregnancies end in miscarriage. Most of these pregnancies are lost in the first trimester, though some pregnancies are lost after 20 weeks (called stillbirth beginning at 20 weeks).
Am I Normal?
This is a hard question. My personal philosophy is that "normal" is a setting on the washing machine. But in the grander scheme of things, miscarriage is an unfortunately common experience. Almost 20% of the adult population has experienced the loss of a child (either in utero, or at some time in their lives). About 80% of miscarriages are one-time occurrences. Most people who experience a miscarriage only experience it once. Health care providers only conduct testing after three consecutive miscarriages (unless there is some indication in your medical history to check for problems before that).
What Should I Do if My Pregnancy isn't Viable?
There are three options on how to manage a pending miscarriage from the healthcare perspective.
1. Watch and wait. This is the fancy medical term for "natural" miscarriage. If the gestation stops progressing early (no more than about 7-8 weeks), even if not detected until later in expected pregnancy duration, the body will begin to expel the tissue on its own. 90% of miscarriages using this procedure will effectively end in complete miscarriage (e.g., all pregnancy-related tissue is expelled).
2. Medicine. Taking misoprostol (brand name: Cytotek) will expedite the miscarriage process. The body would still expel the tissue, but the process would occur faster (over a matter of hours, rather than days). Expect to have diarrhea, substantially more cramping than a natural miscarriage, and possibly more bleeding. If the watch and wait method has ended in incomplete miscarriage (e.g., some tissue from the pregnancy remains in the body), this medicine is used to "help" the process along.
3. D & C. Dilation and Curettage (or, more commonly, Dilation and Suction) is a very common treatment of miscarriage that works 100% of the time, no matter what type of miscarriage you are having. This is a medical intervention that involves sedation with anesthesia, local anesthetizing of the cervix, artificial dilation of the cervix, and suction of all tissue from the uterus.
Wait, there are TYPES of Miscarriage?
Yes, there are a few types. Embryonic Demise or Blighted Ovum is when the pregnancy has started but stops progressing for some reason. This usually happens very early in pregnancy. Incompetent Cervix is when a pregnancy is affected later (usually in second or third trimester) because the cervix is weak and begins to open due to the pressure from a growing baby. These happen in 1 of 100 pregnancies, and usually only if the cervix has been affected in some way by previous surgery, a previous traumatic birth (excessive tearing of the cervix), malformed uterus, or other defect. Anembryonic or Empty Sac pregnancy is when the pregnancy begins and a gestational sac is formed, but no embryo develops at all. These types of pregnancies usually require either the medicine or D &C approach to managing the miscarriage because the body will only naturally expel the tissue about 2/3 of the time. It may also be helpful to know that the medical term for miscarriage is Spontaneous Abortion. Abortion when it relates to pregnancy means "stopping the progression of pregnancy," and spontaneous means "it just sort of happened."
How do I Deal with Miscarriage?
This is a very personal thing. Miscarriage results in grief for many families. If it is your friend who is experiencing a miscarriage, imagine that she is experiencing the death of her child. Because she is. The pain and grief is unimaginable. And because of that, she may be acting angry, sad, indifferent, or any combination. Grief is funny that way. Most often, people feel angry and direct it at anything and anyone who happens to be nearby. Do not take this personally. If she's acting like she's in another world somewhere (this is called dissociation), she probably is. The real world keeps going on as if nothing happened. Her internal world is a mess of emotions and pain, and she can't really function there either. So she might "go away" for a while to help herself function in the real world and not necessarily address the internal mess. That's okay for a little while, but ultimately, we all have to face that grief. Otherwise, we might forget our way back to those emotions, and they'll keep poking their way into our lives in situations that are totally inappropriate. Like making us lash out at our spouses or children or friends.
Dealing with miscarriage is a challenge because people don't talk about it. Nobody knows what to say. Nobody has the right words, so they say nothing. Or they change the subject. Or they pretend nothing's wrong because they think that might be helpful. In actuality, it sends the message that our pain is insignificant, or that we can somehow be able to move on faster than we would if grieving a person we'd actually met. But what so many fail to realize, is that parents have made plans, have hopes and dreams, and maybe even imagine they know the little life they've created. They love the child they haven't met yet. And when a miscarriage happens, all of those things become meaningless or lost. They become part of the grief. And in some way, there's a darkening of hope for the future because their new little future is no more. They have to find out what their life is again. Now that it's missing a very special someone they've dreamed about, maybe before that someone was even conceived.
Sometimes, people rely on their faith to help them through this difficult time. Sometimes, people have crises of faith and blame their Deity(ies) for what has happened. Sometimes, people rely on friends who have had this experience. Sometimes, people become angry at friends because nobody has experienced the pain they feel right now. Sometimes, people quietly endure the grieving process. Sometimes, people choose to seek help from a therapist. I have chosen the latter because, again due to my personal philosophy, I am a therapist and cannot sell something I wouldn't choose to buy for myself. Therapy allows me to be angry, sad, afraid, confused, and whatever else I go through, without judgment. And therapy allows me to find the answers I seek within myself. Because they are there, even if I can't see them right now.
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