The Miscarriage Handbook: A Guide to Not Making Things Worse

Let's face it.  I never expected, or wanted, to be an "expert" on miscarriage.  But losing three babies in thirteen months has made me stop and do a lot of thinking - and a lot of research.

Unfortunately, miscarriage is extremely common.  I never knew this until I experienced it.  However, depending on which reference you use, anywhere from 10% to 25% of all pregnancies end in miscarriage.  Those are really high odds - one in ten?  One in four?  It's mind-blowing.  In fact, many pregnancies end so quickly that a woman may never know she was pregnant at all.  Her body releases the embryo almost immediately and it becomes a part of her period - she never misses a beat.  Other times, though, the loss occurs after a test has confirmed the pregnancy, or, worse, after seeing a heartbeat via ultrasound.  For most women, especially those who desire to be mothers, there is no question whatsoever that the tiny being growing inside is indeed a child - no matter how small.

The point of this post, however, isn't to start a debate on what consistutes human life and what does not.  It's to help guide you - as a person whose loved one has suffered a miscarriage, or as someone who is experiencing it herself - towards understanding and healing.

First things first.  Some questions, and some answers, and then we'll talk about what you can do to help a woman who is recovering from the loss of her pregnancy - or how you can handle it if that woman is you.

What is a miscarriage?  What causes it?

A miscarriage is the loss of a pregnancy.  It occurs most often in the first trimester, or twelve weeks, of pregnancy.  Common reasons for miscarriage include genetic defects (like chromosomal abnormalities) and hormonal imbalances.  Sometimes, the defects are not severe enough to cause the death of the embryo, and the baby continues to grow.  Babies born with genetic defects can often go on to live happy, productive lives.  However, many times, the defects are so severe that the baby is unable to grow at all.  When this happens, the mother's body eventually releases the stunted embryo, along with the uterine lining that was supposed to nuture it.  This looks and feels like a very heavy, intense menstrual period.  If this release does not happen immediately, but days or even weeks later, the situation is called a missed or delayed miscarriage.  The woman's body can continue to "act pregnant" as long as her hormone levels are elevated - which is usually until the miscarriage is complete.

Sometimes, a woman's body is able to fully process the miscarriage without medical intervention.  Other times, a surgery might be planned to help the uterus release the tissue and blood clots that remain.  This outpatient procedure is called a dilation and cutterage, or a D & C for short.  This is the same surgery performed if a patient is choosing to abort her baby, so it can be extremely emotional for a woman who wanted to be a mother.

What can be done to prevent a miscarriage?

It is important to note that miscarriage cannot be prevented, nor can it be stopped once it begins to occur. This is both a comforting fact and a distressing one. Many women are relieved to learn that they did nothing to harm to their babies, while simultaneously feeling helpless to prevent a future loss.   Miscarriage is so common that even after up to two or three of them, doctors often do not look for any type of underlying cause. There are so many variables that go into conceiving a child that they have to account for the genetic defects being almost a given.  However, repeated miscarriages might indicate a problem that can be treated, such as a hormonal imbalance or a medical condition in one or both of the parents.  Women who suffer several miscarriages might be referred to a high-risk specialist who can closely monitor a pregnancy and carry out more research than a general practitioner might be able to so.

What happens after a miscarriage? 

Although a woman's body quickly recovers from a miscarriage, emotional scars can remain for a long time.  She may deal with depression and sadness over the loss, fear that it will happen again, anger that it could not be prevented, worry about ever having a child at all, relief because she was afraid to be a mother, or guilt from any of the above-mentioned emotions.  The husband or father may dealing with the same feelings, but might be less likely to discuss them.  Miscarriage, like any tragedy, can put a strain on relationships.  Some people who suffer miscarriage might opt for therapy or counseling to help come to terms with the loss.  Some couples want to try for a baby again immediately, and some couples never try again.  Like pregnancies, all miscarriages are very different.

My doctor told me that I am going to miscarry.  What should I do?

First, don't give up.  Doctors are people, and people make mistakes sometimes.  (For example, the doctors told my mother I was going to be a boy.  I am very much not a boy.  Also, a couple in my church was told that their oldest son was going to be born with Down Syndrome.  He is now a guitarist on our worship team and has never suffered any genetic disorders whatsoever.)  That being said, doctors generally do know what they are talking about.  Although you are probably feeling a lot of fear, sadness, and anxiety, the best thing you can do is try to have a rational talk with your doctor about your options.  I personally recommend either getting a second opinion or asking the doctor to take whatever steps are necessary to confirm that the pregnancy is not viable.  It's not over 'til it's over! 

Above all, remain calm.  If possible, take someone with you to your appointments - even if you are having a healthy pregnancy.  You might even want to write up a list of questions to ask before you see your doctor, and develop a plan in the event that the pregnancy is threatened.  (We tend to forget what's on our mind when we're sitting awkwardly in a drafty little dress on a cold table!)

Your doctor has probably already told you, but there was nothing you could have done to prevent the miscarriage.  It's true.  You did nothing wrong.  You are not broken.   This is not God or Mother Nature telling you that you should not have children.  You will get through this and you will inspire others.  And, you know what?  It's not going to take forever, either.  I promise.

I already lost my baby.  How am I supposed to move on?

Speaking after three losses, the first few days aren't the hardest part.  The facts haven't often sunk in yet, and you're either being whisked to a hospital for your surgery, or you're too focused on what is happening in your body to actually realize what is happening in your body.

First, do not, under any circumstances, withdraw from the love, support, or help that is offered.  I'm not saying that you have to answer every incoming call or reply to every text.  You will probably need time off work (I did).  You might want to get sucked into a good book or movie.  All those things are not only acceptable, but they do help diffuse the initial sharp pain of grief.  But the biggest mistake you can make is thinking that you're alone.  Not only do your have friends and family who care about you, but you're also one among a literal legion of women who have lost at least one pregnancy.  When I shared about my loss at my church, I was utterly shocked at the number of women who approached me and said that they went through it, too.  Some went through several.  All went on to have children.

Talk to your husband or boyfriend.  Remember that this is his loss, too.  Many couples choose to memorialize their lost child in some way.  A former co-worker of mine had a tree planted in honor of her baby.  Many people name their children, even if they didn't know the gender (my husband and I felt that we were pregnant with a girl, then two boys, and we named them accordingly).  Some people have jewelry or artwork made.   Some might consider a type of funeral, even if there is little or nothing to actually bury.   It's important to acknowledge your loss.  No matter what you might be feeling, please don't ignore it or pretend you were never pregnant.  You can't be healed of what you deny.

Do something special for yourself.  In our case, my husband and I love our sushi dates.  He first took me out for sushi to impress me (I married him less than a year later), and doing that at least once a month is still something that's special for us.  Well, pregnant women can't eat raw fish, so, after all three miscarriages, we went out for a huge sushi dinner.  It helped us reconnect and remember that we are here for each other - no matter what.  Maybe for you, it's getting a manicure or buying a new pair of heels you thought you couldn't wear while pregnant.  Do something to remind yourself that you're alive and as long as you're breathing, there is hope!

Once things settle a bit, talk to your doctor about your options. If this is the latest in a string of miscarriages, you might need to see a specialist who could possibly diagnose, and hopefully treat, an underlying problem. More than likely, though, you will get the green light to try again when you are emotionally ready (your body will likely be ready to get pregnant again in under three months - but the rest of you might take longer).

If, after a few months, you're finding that things are getting harder and not easier, you might want to think about getting some help.  Find out if your insurance covers therapy.  A lot of employers offer limited free counseling through wellness plans.  If you have a church or religious affiliation, you might seek help and guidance from a leader or mentor there.  Miscarriage is an unfortunate and often unexpected part of life, but it doesn't mean that yours is over.  Always remember that.

Oh, and something else...lay off the internet.  Especially if and when you conceive again.  The worst thing you can do is turn to a million and a half women who aren't you, who don't know you, and who don't have the same doctor as you, and ask them if your symptoms are normal.  Don't obsess over what "fruit" your baby is this week.  Don't panic over every single thing that might not seem "right".  Talk to your practitioner and your friends and family.  Not skrappym0m08 from Wisconsin, who claims she prevented a miscarriage by soaking her feet in vinegar and drinking onion juice, or something equally ridiculous.

If you can't get peace from talking to your doctor, try talking to God...even if you've never done it before.  He wants you to be calm and at rest more than you do.

My friend/relative suffered a miscarriage.  What do I do? 

DO:

Offer support.  Send a card or flowers.  Even better: consider bringing a meal to her, or even taking her out for one.  As with a woman who has given birth, a woman who has lost a child is probably not thinking about feeding herself or her family.   Such a simple act is often one of the most powerful things you can do for a couple who is dealing with something so overwhelming.  Also, if she's physically able, offer to take her shopping for a small gift or something to cheer her up.  (On a side note: after I lost my first baby, my friend Jaime, who is also my stylist, cut my hair for free and bought me a beautiful scarf at a local store we both love.  The act cost her practically nothing but I felt very loved and special.)

Be patient.  She might want to share all the details right away, or she may not feel comfortable with telling you what the doctor said.   She may never tell you anything beyond the fact that she lost her baby.  That's okay.  It's not your job to analyze her (unless you're her doctor or therapist).

Let her know you care, you're sorry, and you love her.  Honestly, such simple reminders are more comforting than you imagine.   Grieving people do not need flowery speeches and eloquent encouragement anymore than a fish needs a bicycle.  It's daunting to try to think of the "right" thing to say and, to be honest, there is almost never a "right" thing to say anyway.  So stick with the basics, heartfelt and simple: "I love you and I am so sorry you are going through this."   Offer to pray, if you like.  Few people ever decline prayer, no matter what they believe!

Mourn with her.  Allow her to be sad.  Grief sometimes frightens us because it doesn't feel good.  But allowing ourselves to feel sorrow not only leads to healing, but acknowledges the gravity of the situation.  For most women, the loss of a pregnancy is a significant life experience and should not be treated lightly.  (For a beautiful discussion on grief, please read my friend Dawn's blog post.  She wrote it while dealing with the unexpected loss of her cousin and uncle, which happened to coincide with my most recent miscarriage as well.)

Be sensitive.  If you have children - or if you are pregnant yourself - she might have a hard time being around you or your little ones for a while.  Ask about bringing them to visit before you do.  Respect her decision.

Share, if she's open to it.  If you have been through a similar situation and it may encourage her, gently offer to share your story.  Again, if she declines, respect her decision.  Be careful not to "compete with her grief".  Your story should never be about comparing your grief to hers. 

DON'T:

Tell her she can have more children.  First of all, you don't know that.  (Yes, the odds are high that she will eventually go on to have healthy babies.  But there are also many women who try for years to have children and are unable to do so.)  Second, you certainly wouldn't tell a man who has just lost his wife in a car accident that he'll get married again someday.  This is the same thing!  It's tempting to try to encourage a person like this, but it minimizes the tragedy and makes it seem like trying again will make the grief go away.  Don't do it.  Also; don't ask her if she is going to try again.  Or when.  That's not your business anyway.  (Along the same lines, don't immediately suggest adoption.  Although adoption is a wonderful, even a Biblically-endorsed idea, a woman trying to start a family naturally might see it as a last resort.  Yes, it's an option.  She knows that already.  She's probably already thought of it.)

Say that it's for the best.  Even though chances are extremely high that the baby died due to severe physical or mental defects, no woman wants to be reminded that her child, had it survived, could have been considered by society a "monster" or a "freak".

Quote the Bible (or other religious text). Unless you plan to back it up with your actions, that is.  Let me qualify this: the Bible is a fantastic (may I humbly say that it's probably the best) source of encouragement, promises, life and hope...but please do not dishonor it by simply plastering a verse on someone's facebook wall and never following up with your own loving acts of kindness.  Too often, however, we look to the Bible for a sympathetic or comforting scripture, all the while forgetting that a majority of the Bible talks about loving others, grieving with those who are grieving, and backing up our words with actions. 

Take things personally.  She might not return your call.  She may never mention the card you sent.  That's all right.  You showed that you care, and she knows that.  She won't forget.  It mattered. 

Ignore the signs of prolonged grief disorder.  Although this is not at all common, a woman or couple who has suffered a miscarriage (particularly if it happened later in the pregnancy, after the sex was determined, for example) might sink into a depression that actually interferes with day-to-day living.  This is a serious and debilitating condition that does require medical intervention.  If, six months or so after the loss, your friend has not made efforts to recover or move on with life in any way, you might want to gently suggest that she consider getting help. 

As I am no counselor or medical professional, I can only share the above based on my own personal experience.  For those of you who are, sadly, going through this type of situation, I leave you with the gentle reminder that you are absolutely not alone.  I hope that what I have shared is a practical guide for both the emotional and physical aspects of dealing with and healing from miscarriage.  If there is anyone reading this who feels the need to talk about their experience or who has further questions, I can be reached at RebeccaGodlove@hotmail.com.