A miscarriage is defined as a failed intrauterine pregnancy that ends prior to 20 weeks gestation. Miscarriages in early pregnancy are very common. Approximately 8 to 20 percent of women who know they are pregnant have a miscarriage in the first 20 weeks of gestation. That means that as many as 1 in every 5 pregnancies ends in miscarriage, and 80% of these miscarriages occur in the first 12 weeks.
Given that most miscarriages occur very early in development, it can be challenging to determine the cause. Chromosomal abnormalities are among the most common causes of miscarriage. Chromosomal abnormalities can lead to abnormal embryo development, which results in spontaneous abortion (miscarriage) because the abnormalities are incompatible with life. Other causes of miscarriage include preexisting medical conditions (e.g. diabetes, hypertension, thyroid disorders), or structural abnormalities (e.g. uterine fibroids). When a single cause cannot be identified, we look to possible risk factors that increase the likelihood of miscarriage. The most studied risk factors include increased maternal age, cigarette smoking, alcohol use, hormonal abnormalities (typically inadequate progesterone) and a history of previous miscarriage.
Although miscarriage is common, recurrent miscarriage is not! Recurrent pregnancy loss (RPL) is defined as three consecutive pregnancy losses prior to 20 weeks gestation. RPL only affects 1 to 2 percent of women. As few as 2 percent of women experience two pregnancy losses in a row. Only about 1 percent have three consecutive pregnancy losses. Further, studies have found that women are in fact more likely to get pregnant again immediately after experiencing pregnancy loss. Even women who experience RPL are likely to have a pregnancy with a live birth in their lifetime!
Recovery from Miscarriage
- Make sure you get a lot of rest, especially in the first 24 hours after the miscarriage.
- Take you temperature in the evening for the first 7 days. If you have a fever, seek emergency medical attention right away, as this can be a sign of infection, or a complication from a D&C procedure.
- You may have cramping for 3 days following the miscarriage.
- You will likely have vaginal bleeding, similar to a menstrual period, for 3 days following your miscarriage. Then you could have spotting for up to 1 month.
- Women are advised to avoid putting anything into their vagina for 2 weeks to allow for proper healing and recovery. During this time avoid tampons, douching (always avoid douching), and abstain from sexual intercourse.
- Warning signs of a complication: a fever (temperature over 37.8 C), cramping lasting longer than 3 days, heavy or prolonged bleeding, any severe pain. If you have any of these symptoms seek emergency medical care immediately, and notify your primary care physician.
- Women experience a wide range of emotions following a miscarriage. Expect your emotions to evolve and change with time. Common feeling include sadness, guilt, anger, resentment, and betrayal.
- The best way to support emotional healing is to acknowledge the loss and find a way to commemorate your pregnancy experience. Consider a memento box for your pregnancy test and ultrasound images. Honour your loss by lighting a candle or planting a tree. Have a ceremony to recognize your loss.
- It is important not to rush back into your normal schedule during this emotional time. Take a break to talk with family, friends, healthcare providers, and religious leaders you trust. Talk to other families that have had a similar experience to you. Attend a bereavement support group.
- Seek our grief and pregnancy loss support groups
- www.sharegrief.com – organization of volunteer grief specialists that provide on-line grief support, education and resources for the bereaved
- www.babyloss.com – they provide information and support for anyone affected by the death of a baby during pregnancy, at birth, or shortly afterwards
- www.miscarriageassociation.org.uk – they offer support and information to anyone affected by the loss of a baby in pregnancy
- www.mymiscarriagematters.com – is a free online chat service
- Warning signs of a complication: profound sadness lasting greater than 6 weeks is an indication you need to be evaluated and supported by your physician, seek assistance right away. If you feel like you might harm yourself or someone else seek emergency medical care, and notify your primary care physician.
Planning for a Future Pregnancy After Loss
It is important to remain hopeful. Most women who have a miscarriage have a healthy pregnancy and deliver a live baby the next time they get pregnant. Give yourself enough time to recover from the loss physically and emotionally, and then consider trying to conceive again.
It is important to wait for at least one menstrual period after your miscarriage before getting pregnant again. In my practice, I recommend waiting for two menstrual cycles before trying to achieve pregnancy. This helps ensure that your uterus is fully healed, and the that endometrial lining is suitable for implantation of an embryo. Research suggests that it is both safe and effective to begin trying to conceive again in the first 0-6 months post pregnancy loss.
Sometimes it is helpful to do some laboratory testing or ultrasound imaging to investigate possible risk factors for the miscarriage. Common labs include hematology, homocysteine, fasting glucose, and thyroid function tests. Additional test that are important include autoimmune disease screening, thrombophilia testing, and hormone evaluations (prolactin, progesterone). Speak with your physician to get recommendations as to what tests are right for you.
- Increase vegetable protein, and decrease animal protein
- Focus on monounsaturated fats, and decrease trans fatty acids
- Eat high-fiber, low-glycemic carbohydrates
- Consume foods rich in non-heme iron (e.g. soybeans, spinach, asparagus, tomatoes, kale, beets, oats)
- Decrease coffee, caffeinated tea, and alcohol (maximum of 150mg caffeine/day and 4 alcoholic beverages/week)
- Consume foods high in antioxidants (e.g. dark leafy greens, dark berries, nuts, and seeds)
- Prenatal – A high quality prenatal supplement will help support recovery from a miscarriage, and prepare for another pregnancy.
- CoQ10 – CoQ10 is the most specific antioxidant for the oocyte (egg cell) health. It is a powerful antioxidant to decrease oxidative stress. As maternal age increases, CoQ10 requirements increase.
- N-acetylcysteine – NAC is another potent antioxidant. When used in fertility support, it increases rates of conception and live birth rates.
- Essential fatty acids – Omega-3s help prevent miscarriage, improve velocity of blood flow in the uterine arteries, and improve endometrial function.
Acupuncture is a great treatment modality to support the recovery of the body and mind post miscarriage, and prepare for pregnancy. It activates the parasympathetic nervous system to decrease stress and promote relaxation. It has been shown to regulate menstrual cycles, balance hormones, and promote ovulation. Some of my favourite acupuncture points for miscarriage and preconception support are: KD 3, KD 6, SP 3, SP 10, ST 36, LV 3, LV 8, UB 20, UB 23, REN 4, REN 6, and DU 20 depending on the patient presentation.
In my practice, I find that women who have previously experienced a miscarriage have a lot of fears about their next pregnancy. It is very hard to trust that the current pregnancy will be successful when you have previously experienced loss. My pregnancy after loss (PAL) patients respond well to a more frequent treatment schedule. Shorter, more frequent doctor visits give them the opportunity to ask questions regularly, and discuss emotions and fears that arise throughout pregnancy. These regular appointments offer an opportunity for counselling and emotional healing through sharing their feelings.
The truth is, miscarriage is devastating. Following a miscarriage, both education and compassionate care are fundamental in supporting women remover from their loss and prepare for a future pregnancy. Though miscarriage is common, recurrent miscarriage is not. Allow yourself to heal physically and emotionally and then consider getting some additional support to prepare for your next pregnancy and optimize the outcome. Nutraceutical supplementation, combined with acupuncture and counselling can be very beneficial for patients hoping to achieve pregnancy after loss.
Dr. Laura Nicholas, ND
- Ben‐Meir, A., Burstein, E., Borrego‐Alvarez, A., Chong, J., Wong, E., Yavorska, T., … & Alexis, J. (2015). Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging cell, 14(5), 887-895.
- Ford, H. B., & Schust, D. J. (2009). Recurrent pregnancy loss: etiology, diagnosis, and therapy. Reviews in obstetrics and gynecology, 2(2), 76.
- Kuoch, D. J. (2011). Acupuncture desk reference. your guide to complete knowledge. San Francisco, CA: Acumedwest.
- Lim, CE. et al. (2016). Acupuncture for polycystic ovarian syndrome. Cochrane Database Syst Rev.; 5:CD007689.
- Pizzorno, J. E., Murray, M. T., & Joiner-Bey, H. (2016). The Clinician’s Handbook of Natural Medicine E-Book. Elsevier Health Sciences.
- Provincial Council for Maternal and Child Health (PCMCH). (2017). Early Pregnancy Loss in the Emergency Department: Recommendations for the Provision of Compassionate Care. Toronto, Ontario; 1-34.
- Regan L, Rai R. (2000). Epidemiology and the medical causes of miscarriage. Baillieres Best Pract Res Clin Obstet Gynaecol; 14:839.
- Schliep, K. C., Mitchell, E. M., Mumford, S. L., Radin, R. G., Zarek, S. M., Sjaarda, L., & Schisterman, E. F. (2016). Trying to conceive after an early pregnancy loss: an assessment on how long couples should wait. Obstetrics and gynecology, 127(2), 204.
- H Sekhon, L., Gupta, S., Kim, Y., & Agarwal, A. (2010). Female infertility and antioxidants. Current Women’s Health Reviews, 6(2), 84-95.
- Wilcox AJ, Weinberg CR, O’Connor JF, et al. (1988). Incidence of early loss of pregnancy. N Engl J Med; 319:189.