February 19, 2014 • 26 mins
Miscarriage is one of the most common pregnancy experiences, though rarely talked about openly. Cristen and Caroline provide an overview of what miscarriage entails, what causes it, what doesn't and its psychological repercussions of pregnancy loss for women and men.
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Speaker 1 (00:03):
Welcome to Stuff Mom Never Told You from how stupp
works dot com. Hello, and welcome to the podcast. I'm
Caroline and I'm Kristen. Today's topic is one that has
been requested by a lot of you listeners out there.
It's a rather sensitive topic for a lot of women
(00:24):
and their partners. Um it's we're talking about miscarriages today.
It's a it's a common health issue that a lot
of people face, and we have never done anything just
kind of giving you the one oh one on miscarriages before,
so today we thought we would talk about the whole issue. Yeah,
And I think it's also important for us to talk
about miscarriage, not just because so many women experience it,
(00:46):
but because it's something that we don't talk about very much,
probably among ourselves, especially considering how common it is. Um.
So we're just gonna, yeah, walk through what it is
and why happens, more importantly, almost why it doesn't happen,
and the psychological repercussions. So, first off, what is a
(01:08):
miscarriage And this is coming from the National Institutes of Health,
and technically speaking, it's the spontaneous loss of a fetus
before the twenty week of pregnancy. Because pregnancy loss after
the twenty week is actually called a pre term delivery, right.
And another term for miscarriage is spontaneous abortion, and spontaneous
(01:31):
being the key word. This refers to a naturally occurring event,
not anything to do with medical abortions or surgical abortions.
And there are other terms for early loss of pregnancy,
including what's termed a complete abortion, wherein all of the
tissue of conception leaves the body, and there's incomplete, inevitable, infected,
(01:54):
and missed abortion. All of those different terms relate to
how much of a tissue leaves the body, whether or not,
as infected abortion implies whether or not there was some
kind of infection in the womb. Um Missed abortion, for instance,
is when the pregnancy is lost but the products of
conception as they're called, remain inside of the body. Right.
(02:16):
And there's also this term called threatened miscarriage. This is
basically when the symptoms of miscarriage occur, whether without vaginal bleeding,
and half of threatened miscarriages do in fact in in
pregnancy loss, and so the signs of miscarriage include things
like cramping, bleeding, and lower back pain. And there was
one column that I was reading in Slate by a
(02:38):
woman named Sarah shem Kiss who was talking about how
miscarriage is often portrayed on television as this one time event,
like where a woman goes to the bathroom and she
sees blood and then it's over. And one thing that
a lot of people might not realize is that this
can be a process that can take at least in
(02:58):
shem Kisses case, as long as a week to happen. Um. So, yeah,
and that just is just kind of putting it out
there to clarify how the process can can vary for
different women. Right, And so we should take a look
at the causes of miscarriage because contrary to you know,
(03:19):
there's a lot of misinformation I feel like, around around
things like this, having sex, exercise, mild falls, and most
medications do not cause miscarriage. Again, sex exercise, mild falls,
medications not a cause of miscarriage. And a lot of
times when it happens, there might be some guilt on
the part of the mother and her partner thinking that
(03:43):
there might be something wrong with their genes that cause
this pregnancy loss. But in fact, most miscarriages are caused
by chromosomal problems. That essentially make it impossible for the
baby to develop, but those problems are usually not related
two mothers or father's genes, right, And a common chromosomal
(04:04):
issue that comes up is that the embryo or fetus
has a chromosome that causes it to develop abnormally. And
this is not usually a sign of a condition that
could cause problems in future pregnancies because it usually happens
by chance when the egg divides and grows. And this
is actually a problem that causes at least half of miscarriages.
(04:24):
And one thing that medical scholars have been looking more
closely at too in recent years is a correlation between
miscarriage and partners age, not the mother's age, um they're
the frequency. For instance, of these kinds of chromosomal anomalies
in spermatozoa appear to increase with male age, So, for instance,
(04:48):
in two thousand four, there was a study published an
American Journal of Epidemiology which found that pregnancies by fathers
fifty years or older carried twice the risk of miscarriage
compar haired with pregnancies with younger fathers. And some other
possible risk factors for miscarriage include things like drunken alcohol
abuse during pregnancy, exposure to environmental toxins, hormone problems, infection, obesity,
(05:14):
or on the flip side, being extremely underweight, um smoking,
and problems with the body's immune response. Yeah, an age
can also be a factor for risk of miscarriage as well,
as we talked about in our episode on why it's
harder to get pregnant after thirty five, because the risk
of miscarriages hiring women who are older and at risk
(05:36):
starts to elevate after age thirty, but it really escalates
after forty. But no matter the age of the mother,
miscarriage is most likely to happen early. In fact, most
miscarriages occurred during the first seven weeks of pregnancy. Eight
out of ten miscarriages happened during the first three months
(05:56):
of pregnancy, and second trimester miscarriages happen in just one
to five of pregnancies. Yeah, I kind of put another way.
More than half of all pregnancies are spontaneously lost before
a woman even knows she's pregnant, before she even misses
a period. That's how common this happened. So in other words,
(06:18):
women might have miscarriages and not even know it because
they didn't even realize they were pregnant, right, And you know,
as as horrifying as the experience of miscarriage is, typically,
statistically it is usually a one time occurrence. Most women
who miscarry go on to have a healthy pregnancy after
the miscarriage. However, there is a recovery period, and people
(06:40):
kind of debate how long this period should go on,
you know, do you wait a long time, do you
try again immediately? Should you take you know, basically mental
health into consideration when you're doing that. And while it
of course varies from person to person, the physical recovery
from miscarriage in most cases takes only a few hours
to a couple of days. Yeah, I mean, your periods
(07:03):
will likely return within four to six weeks, and it
is possible to become pregnant during the menstrual cycle immediately
after a miscarriage. Now, that said, the World Health Organization
recommends waiting at least six months before trying to conceive.
That six month waiting period seems to be standard advice,
although more recent studies are starting to call it in
(07:25):
a question. Because the w h O is recommending that
six month wait time based largely on maternal health in
developing countries where medical care is less reliable and where
women tend to get pregnant at earlier ages. Correct. Yeah,
and the British Medical Journal actually says that women who
(07:45):
conceive within six months of a miscarriage instead of waiting
up to a year, end up reducing their risk of
another miscarriage by a third, and they also increase their
chances of a healthy and successful pregnancy. But Julius Shelley,
who's an associate professor at Deacon Universe City in Burwood, Australia,
wrote an editorial accompanying that British Medical Journal study offering
(08:06):
a little bit of a qualification, saying, quote, we cannot
really tell whether pregnancy is conceived very soon after a
miscarriage really do have better outcomes, or whether women and
couples who conceive quickly following a miscarriage have better outcomes
in subsequent pregnancy than couples who take longer to conceive. Right.
And so, I mean it kind of depends person to
(08:28):
person really on your own personal health and all of
that stuff. I mean, if you're healthy and feel ready,
doctors say there might not be a need to wait,
you know, if you're if you're taking your prenatal vitamins
or your full like acid supplements. You know that that
usually starts months before you even conceive, as long as
you're maintaining a healthy weight including physical activity, uh and
(08:49):
eating a healthy diet, and of course managing stress and
avoiding alcohol smoking that sort of stuff. Yeah, and I
would imagine too that that weight time might also depend
on the type of miscarriage that occurs, Like we were
referenced at the top of the podcasts of the various
kinds that can happen. Um. But one thing too that
we wanted to mention is the question of whether or
(09:10):
not having a medical abortion of voluntary abortion in any
way predisposes you to miscarriage, because I think that is
a fairly common assumption. When I was just poking around
on Google looking for solid data on this, there were
a lot of uh, sort of inflammatory types of blog
posts that immediately pop up saying that if you have
(09:33):
an abortion, then you are risking you know, a subsequent
miscarriage or infertility. Um. However, the Royal College of Obstetricians
and Gynecologists says, quote, there are no proven associations between
induced abortion and subsequent topic pregnancy, placenta, previa, or infertility.
And one reason that some people have thought that miscar
(09:56):
that abortion might lead to miscarriage is because it's based
on old data. Basically, abortion technology has improved and made
it safer for the mother and left the uterus and
the cervix more intact, So there should not be a
(10:16):
greater risk of miscarriage, right exactly. And one risk factor
that we didn't really touch on fully is the idea
that women who have had previous miscarriages are at a
greater risk of having future miscarriages. And yes, this is
a definite risk factor, but it is it is small.
Less than five percent of women have two consecutive miscarriages
(10:38):
and only one percent have three or more consecutive miscarriages.
And this is coming from the Mayo Clinic. Uh they
write that after two consecutive miscarriages, there's a seventy five
percent chance the next pregnancy will be maintained. Now, somewhat counterintuitively,
after three miscarriages, in fact, that risk drops to six
But when looking for the re sens why someone might
(11:02):
be experiencing recurrent miscarriages. But in cases of recurrent miscarriage,
the big question mark often is why it's happening, because
I believe this was reported on in the New York
Times that in fewer than half of couples experiencing that
will doctors pinpoint a definite cause, and the causes of
(11:25):
recurrent miscarriage really tied back to miscarriage overall. UH the
overwhelming majority of these recurrent miscarriages that happened because of
chromosome or abnormalities, which, as we already discussed, increase with
the mother's age and with the father's age. There could
be genetic errors in the egg or sperm that result
in embryos with too many or too few chromosomes, but
(11:49):
environmental factors are rarely linked to pregnancy loss and there
have been no associations between environmental factors and recurrent pregnancy
loss established. There could would also be an inherited disorder
that raises a woman's risk of blood clots um also
called thrombosis, that can increase the risk of fetal death
(12:10):
in the second half of pregnancy as well. And if
you experience multiple miscarriages, there there are tests that you
can have when you go to your doctor, things like
blood tests. They can evaluate it to detect problems with
hormones your immune system. There are chromosomal tests that you
and your partner, UH might both have your blood tested
(12:30):
to determine if chromosomes can be a factor. If there
is tissue from the miscarriage that's remaining that can be tested,
and these chromosomal analyzes can basically see if there's some
inherited genetic cause that happens. And that's in less than
five percent of couples. But I mean, you know, talking
about the immune system problems and the hormonal problems. Like
(12:50):
you know, we mentioned in our thyroid episode that you
know that is both when you have something like graves
or hashimotos, that's both a hormone and an immune disorder problem.
So how having those tests leading up to pregnancy, whether
you've had miscarriages or not, is very important. Yeah, and
and again we want to underscore that on the bright side,
about sixty of women with unexplained repeated miscarriages still go
(13:14):
on to have healthy pregnancies, So even if you've had
multiple miscarriages, it's certainly likely that you can still have
a baby. So we talked about the physical repercussions of miscarriage,
what what might be going on inside the body, but
we also need to talk about how miscarriage can impact
(13:35):
the mind and your emotional well being, not just for mothers,
but also for partners as well. So we're gonna get
into the psychology of pregnancy loss when we come right
back from a quick break and now back to the podcast. So,
we were talking a lot about the physical causes and
effects of miscarriages, but one thing we have not talked
(13:56):
about yet is the psychological effect, the burden that the
mother and her partner feel when this tragedy has happened,
and calling it a tragedy is I mean, I feel
like a lot of times when miscarriages are discussed, they're
kind of brushed off anyone outside of the couple or
the mother who is having the child. It's kind of
the attitude is like, oh, well, you'll be okay, just
(14:19):
try try again. Well, and especially if it's lost early
and the pregnancy to right there seems to be kind
of this general misunderstanding about the emotional toll that a
miscarriage can take on a couple or a mother, however
early it happens. Traditionally, it's kind of this private event,
you know. I know a friend of mine had a
miscarriage before she had her children, and I didn't even
(14:41):
know about it. You know, it was once she was
pregnant with her now two year old that you know,
she said, oh, yeah, you know, early on, I had
this thing. And and it's almost as if a lot
of moms feel like they're not allowed to be sad,
or they're not allowed to be sad in public. Yeah,
but a new research suggests that some women might actually
more in for a lot longer than expected, which is,
(15:04):
you know, part of why we wanted to to talk
about this issue, to kind of open up these conversational
lines for women to feel more comfortable talking about these experiences,
because it can last even after the birth of a
healthy child, although of course the range and severity of
the symptoms are going to vary, right and uh Janet Jaffee,
(15:26):
who is a clinical psychologist at the Center for Reproductive
Psychology in San Diego, says that it's kind of the
medical commonality of miscarriages that lead us to kind of
brushing them off, to underestimate the impact that they can
have on a family. Um Jaffe says that it's a
traumatic loss not only of the pregnancy but of a
woman's sense of self and her hopes and her dreams
(15:47):
of the future. She has lost her reproductive story and
it needs to be grieved. Yeah, and a woman who
has a miscarriage is understandably at risk for symptoms of
depression and anxiety, not just immediately following the miscarriage, but
in in the years to come and even after having
a healthy child. Women who miscarry also have a higher
(16:10):
risk of postpartum depression. And there is a paper published
in the British Journal of Psychiatry in two thousand eleven
looking at this, and the researcher followed more than thirteen
thousand women for three years post birth and of those
who had miscarriages, they were about hundred. Of those women
who had had a miscarriage, fiftent experienced clinically significant depression
(16:34):
and or exiety anxiety during and after the pregnancies for
up to those three years. And this can really affect
women as they become mothers, as they bear healthy children.
Um A study looked at women who had delivered a
child within nineteen months after a miscarriage and found that
of the infants had disorganized attachments to their mothers that
(16:58):
it was still affecting them the way that they viewed
their healthy children. And not only can it take a
toll on a mother's relationship with her children, but understandably
it can take a toll on her relationship with her partner. Um.
There have been there's been research into how miscarriage can
impact UH sex life, for instance, and a lot of
(17:20):
times you'll see in heterosexual relationships men might be ready
to move on and wanted reignite that flame, whereas women
might not be ready to have sex for a while. Yeah, exactly.
And we should look at at at partners, both both
male and female partners, when it comes to having a
(17:40):
miscarriage because traditionally, the feelings experienced by the partner tend
to be dismissed, both within the family and without, and
studies have shown that men are not satisfied with the
support they get from others. Nonetheless, research also has shown
that that men absolutely grew these losses as well, but
(18:01):
it might not be as intense or as enduring as
their partners, which is understandable because it's not as much
of a physical experience perhaps for them. Right in study
in the Journal of Psychosomatic Research found that UM, for
both men and women in these situations, giving up their
personal expectations, hopes for and fantasies about the unborn child
(18:26):
is a major source of grieving. Some men, on the
other hand, feel burdened, particularly by their wives grief or
depressive reactions. I'm sure, feeling helpless, not knowing what to
do or say. They can't say anything right exactly, I mean,
there's no way to magically fix that situation. Um. And
so you see sort of gender stereotypical differences emerging in
(18:48):
these studies of how men tend to manage their grief
compared to women. For instance, one study publish in n
A Journal of Reproductive and Infant Psychology found that men
might display less what they call immediate active grief, but
they might also be more vulnerable to feelings of despair
and difficulty coping, probably because of a sense of helplessness. Right.
(19:12):
And while studies have shown that no matter how advanced
the pregnancy is, the woman will likely feel the same
sense of loss, for men, the more advanced it is,
the greater their sense of loss, the more it's almost
like they're getting to know this little person from the
ultrasound on, whereas the woman's sense of grief is heightened
either way. Yeah, And there have been similar studies on
(19:34):
this conducted among lesbian couples as well, and it finds
for the non pregnant lesbian partners similar feelings that that
husbands or boyfriends might experience in heterosexual relationships. Um for instance,
in one study talked about how often the response is,
you know, a sense of having not only lost the baby,
(19:57):
but also kind of having lost emotionally speaking, the partner,
not knowing how to sort of rebuild that connection. How
do you move forward from that? Right, and researcher Denuda M.
Wachner said that lesbian couples do face kind of a
unique situation psychologically and emotionally in that they're going to
(20:18):
be a lot of people who didn't approve of this
union and this pregnancy in the first place. So there
might even be a greater lack of support for them
in this time. Well, they might have to go to
greater links as well to go about getting pregnant in
the first place. Right, And and that even ties in
with other studies that have shown that women who go
through like fertility treatments or IVF or something like that,
(20:42):
their grief tends to be extended past the point of
where other women are starting to move on. Yeah, And
and I don't want to leave gay fathers out of
the equation as well, because I'm sure there can be
a similar process. For instance, if you're, you know, hoping
to adopt and that falls through. I mean, any time
you're going to experience some kind of of loss of
(21:05):
unexpected child, we need to be able to to talk
about it into to grieve with them and for them,
and allow that process to happen. So, so the question
would be, then, you know, if you are the friend,
what can you do if you find out that that
someone you know has experienced a miscarriage. Well grief expert
(21:26):
Robbie Miller Kaplan stresses that a miscarriage is a death
in the family, and just like any death, the bereaved
must grieve for the loved ones they have lost. And
so she says, first it's really important to acknowledge the
loss that your friend is experienced. Yeah, she says, you
should treat your friend just like you would treat a
loved one who had who has had a family member die.
Send flowers, write a note, bring a meal, or just
(21:50):
offer to visit and listen. You know, right, And she
stresses that when you're talking with your friend and listening
to your friend, kind of repeat things back to to
him or her so that she or he knows you're listening,
you're actually taking it all in and that they're being heard. Yeah,
and this is this also echoes what we've heard from
(22:10):
stuff I've never told you listeners who have written and
requesting this topic sort of not only the need to
be able to talk about it and sort of isolation
that they felt, but also how helpful it was in
instances when they did have friends who acknowledged the loss
and took it seriously and didn't just pat them on
(22:31):
the head and say, oh, well, you'll get pregnant down
the road, which statistically, yeah, the odds are definitely in
your favor that that will happen, but that doesn't discount
the immediate grief that you're experiencing, right, And I mean,
researching for this episode was educational for for me definitely,
because I mean, how many of us really know what
(22:53):
to say or how to act or how to treat this,
And so I think it's so important that we show
through all of these stead that we cited that this
this is a huge ordeal that families and women go through,
and it is isolating. It is isolating because you have
kind of a general attitude in the culture of like myth,
you'll you'll be fine, You'll you'll totally be fine. You're
(23:15):
not you know, you're healthy, it's fine, whereas a lot
of these women feel, you know, no, it's not fine.
I lost someone important to me. Yeah, So, UM, I know,
like you said at the beginning of the podcast, Caroline,
this was a sensitive topic to talk about, and I
can imagine that for some people listening it might have
been a difficult one, an emotional one to listen to.
But we just want to invite you to share with us. Um.
(23:39):
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listeners and viewers over on Facebook as well. UM, and
we have a couple of messages to share with you.
In fact right now, So we've got a couple of
(24:02):
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F bombs, and women. And this one comes from Jill
who writes, Hi, guys, I was so excited when I
saw you did a podcast on swearing, because it's honestly
one of my favorite things to do. I know that
sounds lame, but I feel such a release of stress
whenever I throw f bombs around. It just feels so free,
(24:25):
and it's one of the best things about being an adult,
not having to limit myself to vocabulary someone else's deemed fit.
With that said, I always make sure I'm not in
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It really shouldn't. They are just words. She writes in
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(24:48):
Crystal Um. She says, being a professional, or as professionals,
one can be in a line of work where you
sometimes feel the need to scream out loud. Insurance claims,
I do feel that urged to curse out loud in
the workplace every so often, sometimes more than once a day.
But I digress. I've heard people say that cursing as
a lady makes you seem less educated. I e. She
(25:11):
couldn't find a better word in her vocabulary to express
that point. I hold a bachelor's degree and would consider
myself highly educated, but sometimes my old standby is such
as fiddle d D or goodness simply won't cut it.
I find myself letting an F bomb slip out at times,
and although I may not be the most pleased with it, later,
it just feels better. Thank you for offering an escape
(25:31):
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(25:52):
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Welcome to Stuff Mom Never Told You from how stupp
works dot com. Hello, and welcome to the podcast. I'm
Caroline and I'm Kristen. Today's topic is one that has
been requested by a lot of you listeners out there.
It's a rather sensitive topic for a lot of women
(00:24):
and their partners. Um it's we're talking about miscarriages today.
It's a it's a common health issue that a lot
of people face, and we have never done anything just
kind of giving you the one oh one on miscarriages before,
so today we thought we would talk about the whole issue. Yeah,
And I think it's also important for us to talk
about miscarriage, not just because so many women experience it,
(00:46):
but because it's something that we don't talk about very much,
probably among ourselves, especially considering how common it is. Um.
So we're just gonna, yeah, walk through what it is
and why happens, more importantly, almost why it doesn't happen,
and the psychological repercussions. So, first off, what is a
(01:08):
miscarriage And this is coming from the National Institutes of Health,
and technically speaking, it's the spontaneous loss of a fetus
before the twenty week of pregnancy. Because pregnancy loss after
the twenty week is actually called a pre term delivery, right.
And another term for miscarriage is spontaneous abortion, and spontaneous
(01:31):
being the key word. This refers to a naturally occurring event,
not anything to do with medical abortions or surgical abortions.
And there are other terms for early loss of pregnancy,
including what's termed a complete abortion, wherein all of the
tissue of conception leaves the body, and there's incomplete, inevitable, infected,
(01:54):
and missed abortion. All of those different terms relate to
how much of a tissue leaves the body, whether or not,
as infected abortion implies whether or not there was some
kind of infection in the womb. Um Missed abortion, for instance,
is when the pregnancy is lost but the products of
conception as they're called, remain inside of the body. Right.
(02:16):
And there's also this term called threatened miscarriage. This is
basically when the symptoms of miscarriage occur, whether without vaginal bleeding,
and half of threatened miscarriages do in fact in in
pregnancy loss, and so the signs of miscarriage include things
like cramping, bleeding, and lower back pain. And there was
one column that I was reading in Slate by a
(02:38):
woman named Sarah shem Kiss who was talking about how
miscarriage is often portrayed on television as this one time event,
like where a woman goes to the bathroom and she
sees blood and then it's over. And one thing that
a lot of people might not realize is that this
can be a process that can take at least in
(02:58):
shem Kisses case, as long as a week to happen. Um. So, yeah,
and that just is just kind of putting it out
there to clarify how the process can can vary for
different women. Right, And so we should take a look
at the causes of miscarriage because contrary to you know,
(03:19):
there's a lot of misinformation I feel like, around around
things like this, having sex, exercise, mild falls, and most
medications do not cause miscarriage. Again, sex exercise, mild falls,
medications not a cause of miscarriage. And a lot of
times when it happens, there might be some guilt on
the part of the mother and her partner thinking that
(03:43):
there might be something wrong with their genes that cause
this pregnancy loss. But in fact, most miscarriages are caused
by chromosomal problems. That essentially make it impossible for the
baby to develop, but those problems are usually not related
two mothers or father's genes, right, And a common chromosomal
(04:04):
issue that comes up is that the embryo or fetus
has a chromosome that causes it to develop abnormally. And
this is not usually a sign of a condition that
could cause problems in future pregnancies because it usually happens
by chance when the egg divides and grows. And this
is actually a problem that causes at least half of miscarriages.
(04:24):
And one thing that medical scholars have been looking more
closely at too in recent years is a correlation between
miscarriage and partners age, not the mother's age, um they're
the frequency. For instance, of these kinds of chromosomal anomalies
in spermatozoa appear to increase with male age, So, for instance,
(04:48):
in two thousand four, there was a study published an
American Journal of Epidemiology which found that pregnancies by fathers
fifty years or older carried twice the risk of miscarriage
compar haired with pregnancies with younger fathers. And some other
possible risk factors for miscarriage include things like drunken alcohol
abuse during pregnancy, exposure to environmental toxins, hormone problems, infection, obesity,
(05:14):
or on the flip side, being extremely underweight, um smoking,
and problems with the body's immune response. Yeah, an age
can also be a factor for risk of miscarriage as well,
as we talked about in our episode on why it's
harder to get pregnant after thirty five, because the risk
of miscarriages hiring women who are older and at risk
(05:36):
starts to elevate after age thirty, but it really escalates
after forty. But no matter the age of the mother,
miscarriage is most likely to happen early. In fact, most
miscarriages occurred during the first seven weeks of pregnancy. Eight
out of ten miscarriages happened during the first three months
(05:56):
of pregnancy, and second trimester miscarriages happen in just one
to five of pregnancies. Yeah, I kind of put another way.
More than half of all pregnancies are spontaneously lost before
a woman even knows she's pregnant, before she even misses
a period. That's how common this happened. So in other words,
(06:18):
women might have miscarriages and not even know it because
they didn't even realize they were pregnant, right, And you know,
as as horrifying as the experience of miscarriage is, typically,
statistically it is usually a one time occurrence. Most women
who miscarry go on to have a healthy pregnancy after
the miscarriage. However, there is a recovery period, and people
(06:40):
kind of debate how long this period should go on,
you know, do you wait a long time, do you
try again immediately? Should you take you know, basically mental
health into consideration when you're doing that. And while it
of course varies from person to person, the physical recovery
from miscarriage in most cases takes only a few hours
to a couple of days. Yeah, I mean, your periods
(07:03):
will likely return within four to six weeks, and it
is possible to become pregnant during the menstrual cycle immediately
after a miscarriage. Now, that said, the World Health Organization
recommends waiting at least six months before trying to conceive.
That six month waiting period seems to be standard advice,
although more recent studies are starting to call it in
(07:25):
a question. Because the w h O is recommending that
six month wait time based largely on maternal health in
developing countries where medical care is less reliable and where
women tend to get pregnant at earlier ages. Correct. Yeah,
and the British Medical Journal actually says that women who
(07:45):
conceive within six months of a miscarriage instead of waiting
up to a year, end up reducing their risk of
another miscarriage by a third, and they also increase their
chances of a healthy and successful pregnancy. But Julius Shelley,
who's an associate professor at Deacon Universe City in Burwood, Australia,
wrote an editorial accompanying that British Medical Journal study offering
(08:06):
a little bit of a qualification, saying, quote, we cannot
really tell whether pregnancy is conceived very soon after a
miscarriage really do have better outcomes, or whether women and
couples who conceive quickly following a miscarriage have better outcomes
in subsequent pregnancy than couples who take longer to conceive. Right.
And so, I mean it kind of depends person to
(08:28):
person really on your own personal health and all of
that stuff. I mean, if you're healthy and feel ready,
doctors say there might not be a need to wait,
you know, if you're if you're taking your prenatal vitamins
or your full like acid supplements. You know that that
usually starts months before you even conceive, as long as
you're maintaining a healthy weight including physical activity, uh and
(08:49):
eating a healthy diet, and of course managing stress and
avoiding alcohol smoking that sort of stuff. Yeah, and I
would imagine too that that weight time might also depend
on the type of miscarriage that occurs, Like we were
referenced at the top of the podcasts of the various
kinds that can happen. Um. But one thing too that
we wanted to mention is the question of whether or
(09:10):
not having a medical abortion of voluntary abortion in any
way predisposes you to miscarriage, because I think that is
a fairly common assumption. When I was just poking around
on Google looking for solid data on this, there were
a lot of uh, sort of inflammatory types of blog
posts that immediately pop up saying that if you have
(09:33):
an abortion, then you are risking you know, a subsequent
miscarriage or infertility. Um. However, the Royal College of Obstetricians
and Gynecologists says, quote, there are no proven associations between
induced abortion and subsequent topic pregnancy, placenta, previa, or infertility.
And one reason that some people have thought that miscar
(09:56):
that abortion might lead to miscarriage is because it's based
on old data. Basically, abortion technology has improved and made
it safer for the mother and left the uterus and
the cervix more intact, So there should not be a
(10:16):
greater risk of miscarriage, right exactly. And one risk factor
that we didn't really touch on fully is the idea
that women who have had previous miscarriages are at a
greater risk of having future miscarriages. And yes, this is
a definite risk factor, but it is it is small.
Less than five percent of women have two consecutive miscarriages
(10:38):
and only one percent have three or more consecutive miscarriages.
And this is coming from the Mayo Clinic. Uh they
write that after two consecutive miscarriages, there's a seventy five
percent chance the next pregnancy will be maintained. Now, somewhat counterintuitively,
after three miscarriages, in fact, that risk drops to six
But when looking for the re sens why someone might
(11:02):
be experiencing recurrent miscarriages. But in cases of recurrent miscarriage,
the big question mark often is why it's happening, because
I believe this was reported on in the New York
Times that in fewer than half of couples experiencing that
will doctors pinpoint a definite cause, and the causes of
(11:25):
recurrent miscarriage really tied back to miscarriage overall. UH the
overwhelming majority of these recurrent miscarriages that happened because of
chromosome or abnormalities, which, as we already discussed, increase with
the mother's age and with the father's age. There could
be genetic errors in the egg or sperm that result
in embryos with too many or too few chromosomes, but
(11:49):
environmental factors are rarely linked to pregnancy loss and there
have been no associations between environmental factors and recurrent pregnancy
loss established. There could would also be an inherited disorder
that raises a woman's risk of blood clots um also
called thrombosis, that can increase the risk of fetal death
(12:10):
in the second half of pregnancy as well. And if
you experience multiple miscarriages, there there are tests that you
can have when you go to your doctor, things like
blood tests. They can evaluate it to detect problems with
hormones your immune system. There are chromosomal tests that you
and your partner, UH might both have your blood tested
(12:30):
to determine if chromosomes can be a factor. If there
is tissue from the miscarriage that's remaining that can be tested,
and these chromosomal analyzes can basically see if there's some
inherited genetic cause that happens. And that's in less than
five percent of couples. But I mean, you know, talking
about the immune system problems and the hormonal problems. Like
(12:50):
you know, we mentioned in our thyroid episode that you
know that is both when you have something like graves
or hashimotos, that's both a hormone and an immune disorder problem.
So how having those tests leading up to pregnancy, whether
you've had miscarriages or not, is very important. Yeah, and
and again we want to underscore that on the bright side,
about sixty of women with unexplained repeated miscarriages still go
(13:14):
on to have healthy pregnancies, So even if you've had
multiple miscarriages, it's certainly likely that you can still have
a baby. So we talked about the physical repercussions of miscarriage,
what what might be going on inside the body, but
we also need to talk about how miscarriage can impact
(13:35):
the mind and your emotional well being, not just for mothers,
but also for partners as well. So we're gonna get
into the psychology of pregnancy loss when we come right
back from a quick break and now back to the podcast. So,
we were talking a lot about the physical causes and
effects of miscarriages, but one thing we have not talked
(13:56):
about yet is the psychological effect, the burden that the
mother and her partner feel when this tragedy has happened,
and calling it a tragedy is I mean, I feel
like a lot of times when miscarriages are discussed, they're
kind of brushed off anyone outside of the couple or
the mother who is having the child. It's kind of
the attitude is like, oh, well, you'll be okay, just
(14:19):
try try again. Well, and especially if it's lost early
and the pregnancy to right there seems to be kind
of this general misunderstanding about the emotional toll that a
miscarriage can take on a couple or a mother, however
early it happens. Traditionally, it's kind of this private event,
you know. I know a friend of mine had a
miscarriage before she had her children, and I didn't even
(14:41):
know about it. You know, it was once she was
pregnant with her now two year old that you know,
she said, oh, yeah, you know, early on, I had
this thing. And and it's almost as if a lot
of moms feel like they're not allowed to be sad,
or they're not allowed to be sad in public. Yeah,
but a new research suggests that some women might actually
more in for a lot longer than expected, which is,
(15:04):
you know, part of why we wanted to to talk
about this issue, to kind of open up these conversational
lines for women to feel more comfortable talking about these experiences,
because it can last even after the birth of a
healthy child, although of course the range and severity of
the symptoms are going to vary, right and uh Janet Jaffee,
(15:26):
who is a clinical psychologist at the Center for Reproductive
Psychology in San Diego, says that it's kind of the
medical commonality of miscarriages that lead us to kind of
brushing them off, to underestimate the impact that they can
have on a family. Um Jaffe says that it's a
traumatic loss not only of the pregnancy but of a
woman's sense of self and her hopes and her dreams
(15:47):
of the future. She has lost her reproductive story and
it needs to be grieved. Yeah, and a woman who
has a miscarriage is understandably at risk for symptoms of
depression and anxiety, not just immediately following the miscarriage, but
in in the years to come and even after having
a healthy child. Women who miscarry also have a higher
(16:10):
risk of postpartum depression. And there is a paper published
in the British Journal of Psychiatry in two thousand eleven
looking at this, and the researcher followed more than thirteen
thousand women for three years post birth and of those
who had miscarriages, they were about hundred. Of those women
who had had a miscarriage, fiftent experienced clinically significant depression
(16:34):
and or exiety anxiety during and after the pregnancies for
up to those three years. And this can really affect
women as they become mothers, as they bear healthy children.
Um A study looked at women who had delivered a
child within nineteen months after a miscarriage and found that
of the infants had disorganized attachments to their mothers that
(16:58):
it was still affecting them the way that they viewed
their healthy children. And not only can it take a
toll on a mother's relationship with her children, but understandably
it can take a toll on her relationship with her partner. Um.
There have been there's been research into how miscarriage can
impact UH sex life, for instance, and a lot of
(17:20):
times you'll see in heterosexual relationships men might be ready
to move on and wanted reignite that flame, whereas women
might not be ready to have sex for a while. Yeah, exactly.
And we should look at at at partners, both both
male and female partners, when it comes to having a
(17:40):
miscarriage because traditionally, the feelings experienced by the partner tend
to be dismissed, both within the family and without, and
studies have shown that men are not satisfied with the
support they get from others. Nonetheless, research also has shown
that that men absolutely grew these losses as well, but
(18:01):
it might not be as intense or as enduring as
their partners, which is understandable because it's not as much
of a physical experience perhaps for them. Right in study
in the Journal of Psychosomatic Research found that UM, for
both men and women in these situations, giving up their
personal expectations, hopes for and fantasies about the unborn child
(18:26):
is a major source of grieving. Some men, on the
other hand, feel burdened, particularly by their wives grief or
depressive reactions. I'm sure, feeling helpless, not knowing what to
do or say. They can't say anything right exactly, I mean,
there's no way to magically fix that situation. Um. And
so you see sort of gender stereotypical differences emerging in
(18:48):
these studies of how men tend to manage their grief
compared to women. For instance, one study publish in n
A Journal of Reproductive and Infant Psychology found that men
might display less what they call immediate active grief, but
they might also be more vulnerable to feelings of despair
and difficulty coping, probably because of a sense of helplessness. Right.
(19:12):
And while studies have shown that no matter how advanced
the pregnancy is, the woman will likely feel the same
sense of loss, for men, the more advanced it is,
the greater their sense of loss, the more it's almost
like they're getting to know this little person from the
ultrasound on, whereas the woman's sense of grief is heightened
either way. Yeah, And there have been similar studies on
(19:34):
this conducted among lesbian couples as well, and it finds
for the non pregnant lesbian partners similar feelings that that
husbands or boyfriends might experience in heterosexual relationships. Um for instance,
in one study talked about how often the response is,
you know, a sense of having not only lost the baby,
(19:57):
but also kind of having lost emotionally speaking, the partner,
not knowing how to sort of rebuild that connection. How
do you move forward from that? Right, and researcher Denuda M.
Wachner said that lesbian couples do face kind of a
unique situation psychologically and emotionally in that they're going to
(20:18):
be a lot of people who didn't approve of this
union and this pregnancy in the first place. So there
might even be a greater lack of support for them
in this time. Well, they might have to go to
greater links as well to go about getting pregnant in
the first place. Right, And and that even ties in
with other studies that have shown that women who go
through like fertility treatments or IVF or something like that,
(20:42):
their grief tends to be extended past the point of
where other women are starting to move on. Yeah, And
and I don't want to leave gay fathers out of
the equation as well, because I'm sure there can be
a similar process. For instance, if you're, you know, hoping
to adopt and that falls through. I mean, any time
you're going to experience some kind of of loss of
(21:05):
unexpected child, we need to be able to to talk
about it into to grieve with them and for them,
and allow that process to happen. So, so the question
would be, then, you know, if you are the friend,
what can you do if you find out that that
someone you know has experienced a miscarriage. Well grief expert
(21:26):
Robbie Miller Kaplan stresses that a miscarriage is a death
in the family, and just like any death, the bereaved
must grieve for the loved ones they have lost. And
so she says, first it's really important to acknowledge the
loss that your friend is experienced. Yeah, she says, you
should treat your friend just like you would treat a
loved one who had who has had a family member die.
Send flowers, write a note, bring a meal, or just
(21:50):
offer to visit and listen. You know, right, And she
stresses that when you're talking with your friend and listening
to your friend, kind of repeat things back to to
him or her so that she or he knows you're listening,
you're actually taking it all in and that they're being heard. Yeah,
and this is this also echoes what we've heard from
(22:10):
stuff I've never told you listeners who have written and
requesting this topic sort of not only the need to
be able to talk about it and sort of isolation
that they felt, but also how helpful it was in
instances when they did have friends who acknowledged the loss
and took it seriously and didn't just pat them on
(22:31):
the head and say, oh, well, you'll get pregnant down
the road, which statistically, yeah, the odds are definitely in
your favor that that will happen, but that doesn't discount
the immediate grief that you're experiencing, right, And I mean,
researching for this episode was educational for for me definitely,
because I mean, how many of us really know what
(22:53):
to say or how to act or how to treat this,
And so I think it's so important that we show
through all of these stead that we cited that this
this is a huge ordeal that families and women go through,
and it is isolating. It is isolating because you have
kind of a general attitude in the culture of like myth,
you'll you'll be fine, You'll you'll totally be fine. You're
(23:15):
not you know, you're healthy, it's fine, whereas a lot
of these women feel, you know, no, it's not fine.
I lost someone important to me. Yeah, So, UM, I know,
like you said at the beginning of the podcast, Caroline,
this was a sensitive topic to talk about, and I
can imagine that for some people listening it might have
been a difficult one, an emotional one to listen to.
But we just want to invite you to share with us. Um.
(23:39):
You can email us mom Stuff at Discovery dot com.
You can tweet us at mom Stuff podcast, or share
with the whole community of stuff mom Never told you
listeners and viewers over on Facebook as well. UM, and
we have a couple of messages to share with you.
In fact right now, So we've got a couple of
(24:02):
letters here from listeners about our episode on cursing, swearing,
F bombs, and women. And this one comes from Jill
who writes, Hi, guys, I was so excited when I
saw you did a podcast on swearing, because it's honestly
one of my favorite things to do. I know that
sounds lame, but I feel such a release of stress
whenever I throw f bombs around. It just feels so free,
(24:25):
and it's one of the best things about being an adult,
not having to limit myself to vocabulary someone else's deemed fit.
With that said, I always make sure I'm not in
public when I do it in case it upsets someone.
It really shouldn't. They are just words. She writes in
all caps. Thanks for the enlightening podcast. I eff ing
love it. Um Well, I have a message here from
(24:48):
Crystal Um. She says, being a professional, or as professionals,
one can be in a line of work where you
sometimes feel the need to scream out loud. Insurance claims,
I do feel that urged to curse out loud in
the workplace every so often, sometimes more than once a day.
But I digress. I've heard people say that cursing as
a lady makes you seem less educated. I e. She
(25:11):
couldn't find a better word in her vocabulary to express
that point. I hold a bachelor's degree and would consider
myself highly educated, but sometimes my old standby is such
as fiddle d D or goodness simply won't cut it.
I find myself letting an F bomb slip out at times,
and although I may not be the most pleased with it, later,
it just feels better. Thank you for offering an escape
(25:31):
from my day to day stresses. You're welcome, Crystal, and
I hope that us relieving you from some of your
stress as means you dropped a couple of fewer f
bond at the office. So thank you for writing in,
and thanks to everybody who's written into us. Mom Stuff
at Discovery dot com is where you can email us,
and you can also find all of our social media links,
(25:52):
every single podcast, blog post, and video. It's stuff Mom
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