1. First and most important, miscarriage is never your fault.
Never ever. There is a reason. We just may not ever figure out what it is. One miscarriage is difficult and heartbreaking. Recurrent miscarriages are confusing and devastating. The timing of a miscarriage may suggest different causes. Kristi Bothur at the blog This Side of Heaven, adds,” Every loss is different. Just because you have “done this” before does not mean you have experienced this loss before. This loss is different and you are a different person than in your last loss, and it impacts you differently each time. Furthermore, when you have loss after loss, the grieving builds on itself, and sometimes you don’t get a chance to truly grieve one loss before you have another. Loss upon loss is exhausting.”
2. Most miscarriages are caused by chromosome abnormalities.
At a meeting of the American Society for Reproductive Medicine, Dr. Mary Stephenson, an international expert in recurrent miscarriage at the University of Chicago, reported that 70% of miscarriages are caused by chromosome errors. Chromosome errors increase dramatically at the age of 40.
The good news? Dr. Stephenson advises people just to keep trying. There is a very strong possibility that there will be one or more living children. The bad news? Keep trying? For how long until you lose your mind? I have spoken with Dr. Stephenson about the psychological impact of that advice. One miscarriage is distressing. Recurrent miscarriage can be destructive to a woman’s psyche.
3. There are other reasons for recurrent miscarriage.
Blood clotting disorders, such as antiphospholipid syndrome, Factor V Leiden, and MTHFR, restrict blood flow to a fetus. Autoimmune disorders, like lupus and antithyroid antibodies, cause inflammation. Some doctors reference natural killer cells, treated with immunologlobulin G infusion(IVIg). Sometimes uterine abnormalities, like a uterine septum or a smaller than expected uterus, or weakness of the cervix, result in miscarriage.
4. Doctors often do not seem very curious about the first miscarriage.
Or the second miscarriage. Or until a woman insists on testing of some sort. This is a moment of self-advocacy. Dr. Julie Bindeman, a reproductive psychologist at Integrative Therapy of Greater Washington says, “Though ACOG (the American Congress of Obstetricians and Gynecologists) suggests testing after three miscarriages, ask for testing after the second. Start with genetic testing to rule out issues. Immune factors often impact pregnancy outcomes but are seldom considered as a standard course of inquiry. Ask for them. If your doctor won’t follow up, get a second opinion, perhaps with a reproductive immunologist.”
5. Doctors may also not pay attention to non-pregnancy symptoms.
You’re just pregnant. Pregnancy is normal. How many of you have heard things like this, especially later in pregnancy? Lizzie said, “A friend of mine had severe digestive issues and the docs told her it was stress for like a month. (She was a PAL). Turns out she has Crohn’s disease.” Unfortunately, sometimes women are sent home from the hospital because something has been missed. Nancy said, “I had an ER doctor assure me that I didn’t have an ectopic pregnancy, and it turned out I did.” The advice that sends me into orbit is “it’s probably nothing”. I always instruct my patients to say, “I’m coming in and we will prove that there is nothing wrong.”
What may help
Advocacy, advocacy, advocacy is a big help to many women. Ask for additional testing. Get your CMV (cytomegalovirus) status. If your doctor says no to additional tests and tells you that you are making an unnecessary scene, ask for your records and get a second opinion. Pronto.
There are other things that you can do. Supplemental progesterone may be helpful to some. Depending on the condition, you can inject Lovenox and take a baby aspirin during pregnancy. Injections are not a thrill but they get the job done. You may need a surgery to repair a uterine abnormality. Again, not a thrill and recovery takes a while but do what you must. Finally, some people may benefit from IVF (in vitro fertilization) and PGS (preimplantation genetic screening). Yes, it costs money but it may be the ticket to a healthy pregnancy and a living child.
Kristi adds, “To other parents, I say to be gentle with yourself because of these factors. To those who are helping parents who are going through this, I say to be gentle as well. Questions about why ‘this’ keeps happening or how long we will keep trying or ‘maybe God is trying to tell you something’ are NOT helpful. Just sit with us in the ashes and walk with us on the journey. That is what we need the most.”
For those of you who have experienced recurrent miscarriages, you are brave and I send you love. How many of you were told something like “it’s just a miscarriage, try again”? What do you wish a physician had said or done? What has been helpful? Your comments are welcome. They may help save a life.