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Having a miscarriage: 3 things you should know

Pregnancy loss is more common than you think—and it’s not your fault.

by Colleen Denny, MD

No matter who you are or how you feel about being pregnant, it can be scary to hear a health care provider say, “You’re having a miscarriage.” Miscarriage is an old word used to describe the loss of a pregnancy. It can sound almost like you did something wrong ("mis"), but actually miscarriages are very common and rarely have anything to do with how you “carried” the pregnancy.

Finding out you had a miscarriage

There are a couple of different ways you might find out about a miscarriage. Sometimes you have cramping or bleeding; sometimes you have no symptoms at all and find out during an ultrasound. Almost all miscarriages happen pretty early, in pregnancies less than 12 weeks along. Miscarriages can happen when a pregnancy is very wanted, not wanted at all, or somewhere in the middle. They can even happen before you know you’re pregnant.

No matter how you found out about the miscarriage or how you felt about the pregnancy, it’s common to feel a mix of emotions. People having miscarriages describe feeling sad, guilty, relieved, angry, and everything in between—and all of those feelings are totally normal.

3 things about miscarriage you need to know

As you’re talking with your provider, wondering why this miscarriage happened or what happens next, here are three very important things to keep in mind.

1. It is NOT your fault.

Miscarriages happen for different reasons, but most happen because of abnormal genes in the pregnancy itself. The egg and sperm might have joined together in the wrong way, or they just didn’t have the right information to keep growing normally. It’s nobody’s fault—it’s just something unique to this particular pregnancy. (Miscarriages do happen more often for people with serious health problems like diabetes and clotting problems, but these are pretty rare causes.)

You know what doesn’t cause miscarriages? Forgetting to take a prenatal vitamin, eating spicy food, going running, having a glass of wine or coffee, feeling stressed out, lifting something heavy, or other reasonable, everyday-life things. While many people worry that these things cause miscarriage, the truth is that miscarriage is rarely caused by something you did or didn’t do—it’s much more likely something that wasn’t working right in the pregnancy itself.

2. Miscarriages are really, really common.

People can often feel very alone when they’re miscarrying, because we don’t talk about it much in our society. But the truth is that miscarriages are one of the most common things that can happen during your reproductive years. We estimate that up to 30% of women will have one at some point. About 1 in 5 known pregnancies end in miscarriage. If you also count people who didn’t even know they were pregnant yet, up to 1 in 3 pregnancies end in miscarriage.

3. You have time to decide what you want to do next.

It’s common to feel panicked or pressured when you’re diagnosed with a miscarriage, but it’s okay to take a breath and think about next steps. Unless you’re in danger because of heavy bleeding, take the time to absorb the news and learn about the different treatment options.

What are your options?

If the pregnancy tissue has come out of your uterus and your bleeding has stopped, the miscarriage is over. Usually that means the only “treatment” you need is some time to feel better physically and emotionally.

But sometimes people have an “incomplete” miscarriage—that is, the pregnancy has stopped growing but there’s still pregnancy tissue inside the uterus. In this case, your provider will offer some different options to help complete the miscarriage. All of these are safe and reasonable choices, but you may prefer one over the others. Here are your options:

1. “Watch and Wait.” (a.k.a. “watchful waiting” or “expectant management”)

This means that you and your provider decide to let your body take its course. Uteruses are pretty good at recognizing when a pregnancy isn’t normal, and sooner or later most will start the process of pushing that pregnancy tissue out. This causes the cramping and bleeding that people experience during a miscarriage.

Pros: No medicine or surgery is involved. Some may feel this approach is more natural and want to try it first before moving to another treatment.

Cons: It’s hard to know exactly how long it’ll take for the miscarriage to complete, especially if there aren’t physical symptoms of miscarriage when the diagnosis is made. Up to 70% of miscarriages are complete within 2 weeks after diagnosis, and 90% are finished by 8 weeks. Some people find it hard to wait, not knowing exactly when this experience will be over. And some don’t like not knowing whether they might end up needing another different treatment if their body doesn’t complete the miscarriage on its own.

2. Pills. (a.k.a. misoprostol)

Your provider gives you medicine to help your uterus start the cramping and bleeding needed to pass the pregnancy and finish the miscarriage.

Pros: There’s no surgery involved and more control over the timing. About 4 out of 5 women will finish their miscarriage within 48 hours after taking the pills. You can also use these pills at home if you prefer the privacy of being in your own space rather than at a provider’s office.

Cons: About 15% to 20% of people won’t pass the pregnancy after taking the pills and will still need a suction procedure to remove all the pregnancy tissue.

3. Suction procedure. (a.k.a. “aspiration” or “dilation and curettage”)

This means your provider does a procedure in the office to remove pregnancy tissue that’s still inside the uterus.

Pros: A procedure can be planned on your and your provider’s schedule. Some providers can offer stronger pain control medicines as pills or through an IV. It’s very unlikely (less than 1%) that you’ll need any further treatment for the miscarriage.

Cons: While surgical treatment of miscarriage is very safe, there is always a small risk that comes with any kind of invasive procedure. About 1 in 400 people having this kind of procedure have a serious complication.

These are all safe and reasonable options, so talk with your provider about which approach you’re most comfortable with. You know your life better than anyone else!

Take good care—and choose good care

If you find yourself dealing with a miscarriage, it’s important to take good care of yourself physically and mentally. That includes making sure you deal with your miscarriage in whatever way you’re most comfortable with.

Some health care providers may feel more comfortable with one treatment than another, so it’s good to know a little bit beforehand about your options. If your provider doesn’t offer the treatment you prefer, it’s okay to ask for a referral to someone who does. (For example, ObGyns have surgical training and tend to be the most comfortable offering all three options.) Most importantly, take the time to talk with your provider to decide what plan is best for you.

Colleen Denny, MD, is an attending ObGyn at Bellevue Hospital in New York City and a clinical assistant professor with the NYU School of Medicine. She enjoys taking care of women in all phases of life and is especially interested in issues related to contraception access and public health. Outside of work, she's a runner, a dancer, and a bit of a crossword puzzle nerd.

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