|
|
How often does this happen?
I've been told dozens of different statistics
from various sources, including my doctor, other women, articles, and books.
These are about as accurate as anything.
For most normal, healthy women, the statistics
look like this:
Week of Gestation Percentage Likelihood of Miscarriage
1-2 (You do not know you are pregnant) 40-60% (this figure marks a current trend of thought and is controversial)
3-6 10% (once pregnancy diagnosed)
6-12 5% (or less if heartbeat heard)
2nd trimester 3% (considered stillbirth after 20
weeks)
3rd trimester 1-3% (some stats don't count labor
& delivery complications or neonatal death, so this hard to figure)
If you have had one miscarriage, your likelihood
of another miscarriage rises from 10% to 13% after the pregnancy is diagnosed.
After two miscarriages, your odds increase to
40%.*
After three miscarriages, it goes up to 60%.*
* One thing to note about these alarming statistics
is that we don't know how many of these women sought additional help to
solve their recurring problem. Until recently, women were required to have
three miscarriages before a doctor could begin testing. THIS MAY NOT NECESSARILY
APPLY TO YOU.
What causes it?
This topic is the subject of entire books, but
I'll give a basic overview of what I've learned. There are several categories
of miscarriage causes:
Hormones
Chromosome Defects
Physical Problem with the Uterus or Cervix
Immune Disorders
Premature Rupture of Membranes and Early Labor
Other
Unknown
Blighted Ovum, Ectopic Pregnancy, Molar Pregnancy,
and Stillbirth
Hormones
When we talk about a hormone problem, you have likely miscarried in less than 10 weeks. After that, the placenta has taken over and a hormone imbalance or deficiency will not cause a miscarriage. A miscarriage this early is still very hard to take but it is the most easily treatable. If a blood test or an endometrial biopsy (where they scrape a bit of the lining of your uterus) shows that you have a progesterone deficiency, then you are well on your way to fixing the problem. You can take extra progesterone and odds are quite good that next time you will sustain a pregnancy. Sometimes a hormone problem is a one-time occurrence and will right itself on its own.
Chromosome Defects
There are many factors that come in to play when
the egg and sperm unite and form that first cell. Even if both the egg
and sperm come with perfect chromosomes, the first few cell divisions can
see an abnormality crop up that would certainly be devastating. Chromosome
defects that cause a newly fertilized egg to die can account for as much
as 60 percent of early miscarriages. After the 2nd trimester begins, however,
it drops to less than 10 percent. You can usually find out if you had a
baby with a chromosome problem through testing tissue from the miscarriage.
This must be done RIGHT AWAY when the tissue comes out or the cells cannot
grow and the test won't work. Even when you have a D&C and the doctor
sends the tissue immediately, it still might not work. (Mine didn't.) But
if you do find your baby had a chromosome defect, find a small measure
of comfort in knowing that although you lost this one precious baby, the
chances of if happening again are extremely small.
Physical Problem with the Uterus or Cervix
Some women have a uterus that does not have the
usual shape. Others have a cervix that may be weakened by a number of causes,
including multiple D&C procedures or their mother taking DES when she
was pregnant. Both of these problems can cause an early labor, usually
during a critical period from 12-24 weeks. This cause is responsible for
12 percent of miscarriages during this time period. What happens is that
as the baby grows, especially during the very rapid growth spurt during
this time frame, the irregularly shaped uterus may not be able to expand
or the weak cervix may start to open up and let the baby out. There are
treatments for both of these that are quite effective—corrective surgery
on the uterus and a cervical stitch that holds the cervix closed. This
problem WILL REOCCUR if not treated.
A uterine abnormality often causes a miscarriage due to early labor, but it can also cause fetal demise, which is what happened to our Casey. Sixteen weeks into my pregnancy with Emily, we had an abnormal AFP screening. Since we were near the point of the pregnancy when Casey died, naturally we were frantic. We saw a perinatologist, who discovered I had a septate uterus. When I was a fetus, the two sections of tissue that normally fuse together to form the uterus only fused on the bottom. Therefore, there is a huge wall going down the middle of my uterus. When Casey implanted, he chose the middle wall. This section, however, has little blood flow. As Casey grew and required more and more blood and nutrition, this area could not support him. So he died. Although Emily chose a better implantation spot, this problem caused her to be breech and required a c-section. I am told that I can have surgery to correct this, and I plan to do it. 20 weeks is too far along to learn your baby has died. And, if I am seeing a specialist, he will probably be able to tell well in advance that the baby has implanted in a bad spot. Then, I would have to carry a baby who is likely to die, and I can't live with that.
Be aware that there are varying levels of septums. Some are paper-thin and simply move out of the way for the baby, causing no problems. Others, like mine, increase your chance of miscarriage significantly. Only a high-level sonogram can uncover this problem.
Immune Disorders
This is complicated stuff. This is a pretty new
cause and affects a very small number of women. The treatments are new
and experimental and there isn't a whole lot of good information about
it. There are two ways to go with this—lupus anticoagulation antibodies
(ending in fetal demise during the 2nd trimester or later) or immune incompatibility
(causing miscarriage during 1st trimester). Basically, the lupus anticoagulation
has no symptoms in the mother but causes the tiny blood vessels in the
placenta to clot, cutting off the baby's supply of food and oxygen. The
immune incompatibility causes your body's blood cells to attack the fetus,
usually due to a lack of the immune suppression most women experience during
pregnancy. Both of these problems can be tested and treated, although it
is difficult due to the number of shots, the side effects, and the diligence
required. The average OB/Gyn may not be up to date on these issues. Read
up on it yourself and find a specialist who can determine if this is a
problem that might be affecting your babies. www.inciid.org is a good place
to start.
Premature Rupture of Membranes and Early Labor
Many miscarriages begin with cramping and labor-like
symptoms, but true PROM and Early Labor are usually associated with babies
that are in the second or third trimester. Early labor can often be treated
with drugs that relax the uterus and women are placed on bed rest either
at home or in the hospital.
Sometimes, however, the baby comes anyway. This
is one of the most traumatic of losses, technically a stillbirth and not
a miscarriage after 20 weeks, because you will hold and see your baby and
beg him or her to breathe. For some women, the baby will even be born alive,
but only live for a few minutes, hours or days. There really is nothing
harder in life than this.
PROM is defined as your water breaking prior to
37 weeks, the age that is considered full term. Most women who have leaking
or gushing amniotic fluid will be placed on antibiotics and placed in the
hospital because the risk of infection is very high. Once an infection
comes, the baby will almost always have to be delivered.
Babies must weigh 500 grams, or about a pound,
to survive. Because I was at high risk for PROM and early labor, I kept
this day on my calendar and waited with fear for it to pass. For women
expecting a normal pregnancy, suddenly having your water break is very
frightening. Your are stuck in the hospital, having to rely on what people
tell you, and unable to get information on your own. It is scary.
PROM is thought largely to be caused by infections or inflammation of the uterus or fetal membranes. How these infections come or why they cause the membrane rupture is not completely understood. Pelvic exams and yeast infections are NOT considered to increase your risk for PROM. I do know, however, just in reality through talking with women, including a close friend of mine, that PROM tends to recur. Knowing you are at risk and taking all the appropriate precautions is essential to keeping your baby in the uterus as long as possible.
Fortunately, even though PROM cannot always be treated or prevented, most babies are able to make it far enough to survive and lead normal lives. If you have experienced unexplained PROM, I highly recommend finding a doctor with experience with this sort of pregnancy. A medical study on PROM is included in my "Books and Links" section.
Others -- Infections, Age, Chronic Disease
Many infections can cause miscarriage, but they
are the big ones like syphilis, mycoplasma, toxoplasmosis, and malaria.
An upper respiratory infection is NOT going to cause a miscarriage, even
though it may worry you to death. Viruses are the same. Normal illnesses
like the common cold will not cause a problem, but AIDS and German Measles
can. Infections that directly affect the uterus are bigger risk. This does
NOT include yeast infections, which are extremely common in pregnancy.
Age is only a factor in miscarriage when you consider what aging can do to your body. The first and most common is with chromosomes. It is not YOU who have a problem, it is likely your egg or sperm, which have also aged. Age can, however, bring other problems such as poor health, disease, or hormonal imbalance that can make a pregnancy harder to sustain. You don't start seeing these problems in great numbers, however, until after 40.
Health problems in the mother can create problems with the pregnancy. Diabetes, heart problems, and thyroid disorders are just a few that may complicate the pregnancy. Having these does NOT mean you will certainly have a miscarriage. You will simply have to be more careful.
Accidents typically do not cause a miscarriage. The baby is well protected in its amniotic sac, surrounded by fluid, and even a hard blow to the abdomen will likely only rock it. Most women who have a car accident, even with a certain amount of trauma, have their babies just fine.
The Unknown
The hardest thing to accept is no reason at all.
You live in fear, wondering if the same terrible cause of your first baby's
death will cause another one to die. You scarcely dare to try again. I
have been in this situation and I tossed my doctor's statistics aside.
I had already been on the wrong side of the statistics; I didn't care for
anymore. But I do know this. One miscarriage hardly raises your chances
to miscarry again at all. You are simply back at square one. Try to put
the risk as far back in your mind as possible and enjoy another pregnancy.
But I understand if you can't.
Blighted Ovum, Ectopic Pregnancy, Molar Pregnancy,
and Stillbirth
Sometimes a pregnancy ends unhappily, but it is
not technically a miscarriage. This section will touch on these types of
situations.
Blighted Ovum is a condition (with a terrible, unfortunate name) where the gestational sac grows, the woman gets all the pregnancy symptoms, but the baby itself never develops. The sac will continue to grow and grow, and most women do not know there is no baby until an ultrasound is done. The bleeding, if that happens before the blighted ovum is found via ultrasound, is slow and brown. Your pregnancy symptoms will seem to go away. A blighted ovum is believed to be caused by an egg or sperm with poor genetic material. When the egg is fertilized, instead of creating both a sac and a baby, the part that should be a baby never grows. A D&C is almost always needed to empty the uterus, because the body is very slow to realize there is no baby. Some women do experience more than one blighted ovum, but most women go on to later have a baby.
An Ectopic Pregnancy is a normal fertilized egg that gets stuck in the fallopian tube (although occasionally it will fall into the abdominal cavity) and implants there. This type of pregnancy cannot survive and puts the mother at great risk for severe hemorrhaging and possibly even death as the baby grows and eventually bursts the tube. When the ectopic is discovered, the mother will immediately have surgery to remove the baby. Things will happen very fast, and most likely if this has happened to you, you are reading this after it is all over. If you are afraid you have an ectopic, the symptoms that you really want to watch for are: sharp, intense pain in your abdomen or possibly in your shoulder; a pregnancy test that is positive, then turns negative a few days later; and spotty red bleeding that continues. Ectopics are usually caused by scar tissue in the fallopian tubes that could have been caused by: previous surgery in the pelvic region, uterus, or tubes; a pelvic infection such as chlamydia or pelvic inflammatory disease; or endometriosis that blocks the entrance to the tubes. If you have had one ectopic, your risk increases for another one. The surgery is usually done by going through a tiny incision in the belly button, and your future pregnancies will have to be carefully watched. If your fallopian tube had to be removed, you have a 40 percent or better chance of having a normal pregnancy in the future. If your tube was spared, your chances are better than 60 percent.
A Molar Pregnancy is a very rare type of pregnancy where an abnormal mass forms inside the uterus after the egg is fertilized. The baby usually does not form, but the uterus is filled with big bubble clusters. A molar pregnancy is caused by a chromosome problem with the egg or sperm. If a molar pregnancy has been diagnosed, your medical condition will be carefully monitored. Sometimes, a molar pregnancy is the first sign of a possible malignant tumor in the uterus, but rest assured that the cure rate for this type of disease is very high. The signs of a molar pregnancy are fairly clear: bleeding in the 12th week of pregnancy and a uterus that is larger than normal. The molar pregnancy is removed by a dilating the cervix and gently suctioning out the clusters. Women who have had a molar pregnancy are usually advised not to get pregnant again for at least a year.
A stillbirth is technically any pregnancy that ends after the 20th week and the baby does not survive. Some babies die in utero and are discovered when the heartbeat is not found. The most common causes of this are: uterine abnormalities, a knot or other umbilical cord accident, infections of the lining of the gestational sac or cord, and placental abruptions that cause the placenta to pull away from the uterine wall. These babies are usually born through the induction of labor, although some babies are small enough to be taken by D&C or D&E procedures.
Other babies are lost through early labor. The causes of early labor are Premature Rupture of Membranes, uterine abnormalities that make the uterus too small to hold the baby, and an incompetent cervix, which opens up and lets the baby out. Sometimes a stillbirth occurs during the birth, by an umbilical cord that gets pinched between the baby's head and the cervix, or the cord wraps around the baby's neck. Repeat stillbirths are extremely rare and are almost all related to uterine or cervix problems, which can be fixed or treated once found.
How do I know for sure?
If you have not yet been diagnosed and think you
are having a miscarriage, go HERE.
If your doctor has told you the baby has been
lost, it is natural to feel like they are somehow wrong. You go home from
the devastating visit, feel your still-sore breasts or a little swoosh
in your belly, and think, "They can't be right." It is one of the most
common questions I get when frantic and frightened women write me.
I won't suggest that it never happens. But it
is extraordinarily rare that a miscarriage is misdiagnosed. A sonogram
showing no heartbeat is usually right. If you are so early in the pregnancy
that there could be a question about the sonogram, earlier than six weeks
along (counting from the day of the start of your last period), then an
hCG test is usually administered. An hCG level that drops or fails to double
quickly almost always indicates a miscarriage, or worse, an ectopic pregnancy.
hCG Level Information
Many women who have experienced early miscarriages,
often due to hormone insufficiencies, or who are undergoing infertility
treatment will be tested for the pregnancy hormone hCG. Human Chorionic
Ganadotropin (hCG) is only produced during pregnancy and is what causes
the body to produce progesterone. It is the hormone that home pregnancy
tests look for as well as blood tests at the doctor.
A blood test at the doctor can detect a pregnancy
as soon as 10 days after fertilization (although I have friends who swear
by 8 days.) Home pregnancy tests require 14 days. I have found that to
be accurate.
The rate of hCG should usually double every 2-3 days, but if it doesn't, that does NOT mean a miscarriage is inevitable. Keep in mind that if you have been given hCG shots to ovulate or to treat a Luteal Phase Defect, it will throw off your reading and could even give you a false positive.
These numbers are only a guideline!
Week since last menstrual period began Amount
of hCG in mIU/ml
3
5 - 50 (less than 5 means you are not pregnant)
4
5 - 426
5
19 - 7,340
6
1,080 - 56,500
7-8
7,650 - 229,000
9-12
25,700 - 288,000
You will likely see the hCG rates go DOWN after the first trimester, when it is no longer a factor in pregnancy or miscarriage because the placenta has taken over.
Definite signs of miscarriage
Visit an emergency room if you have these symptoms:
Strong cramps that make you double over or breathe
in a huffy way.
Heavy bleeding that soaks a pad in a few hours
or less.
Passage of tissue, resembling large thick blood
clots in the earliest weeks up to pinkish/grayish material.
A little bit of bleeding without cramping should
be okay, but call a doctor. Small darting cramps are also okay, usually
they just signal the body stretching and pulling to accommodate the growing
baby.
What are my options?
Usually you will be offered a choice between surgery
and either waiting for a natural miscarriage or having induced labor. The
two types of surgery are D&C (dilate and curettage) or a D&E (dilate
and evacuation--for bigger babies between 14 and 20 weeks). Some doctors
prefer you wait for it to happen naturally due to the small risks of dilating
the cervix for a D&C. Waiting it out is typically only for those less
than 10 weeks along due to the risk of blood clots and hemorrhage, but
this depends on your doctor. As for the choosing between a D&E and
actual labor, state laws vary about the age of viability, and you may fall
in the gray area, which I will talk about later.
Things to think about when choosing between natural labor and D&C surgery:
Do I want to wait?
Advantages: If you wait, you can feel certain
that there was no mistake made. When the baby comes you will know that
nature has run its course. You can go home instead of going immediately
to a hospital or office procedure. You can take a little time to say goodbye
and gather loved ones around you.
Disadvantages: This can take several days and be extremely painful and scary. You may have to have a D&C anyway if everything does not come out (called an incomplete abortion). It may be distressing to think of walking around with your baby who is no longer living. Having tissue come at home may be frightening and you may feel awkward trying to save it, although you must if you want any testing done.
Do I want a D&C?
Advantages: This is mostly painless and will get
you back on track to start trying again much sooner. The physical part
of the ordeal will end.
Disadvantages: There is some risk of damaging the cervix during dilation, although that has mostly been taken care of by using laminaria, or seaweed sticks to dilate you gently overnight. (If this will not be done, ask if you are going to be dilated (very early pregnancies may not need it), and how. Mechanical dilation is riskier.) Some women also worry about punctures or perforations of the uterus. While this is a possibility, the risk is small. Even if this should this happen, the uterus will usually heal without complications or harm to your next pregnancy. The main disadvantage to this procedure is that you will not get to see the baby, ever. If you are pretty far along, this may be very important.
If your doctor does not agree with your decision to either wait or to have a D&C, GET A SECOND OPINION. This is your baby and your life. If you need a second opinion, a good place to go is a women's hospital or clinic, where they usually focus on you, not the procedure, and help you make the best decision based on all the information available.
The Gray Area
The death of your baby becomes a legal issue somewhere
between 20-28 weeks gestation. Some states require labor and delivery at
24 weeks; some allow the doctor some discretion. Naturally, if you have
already begun early labor, you may not have a choice. If your labor could
be stopped, then the miscarriage might not happen at all. Otherwise, the
cause of the miscarriage is usually Fetal Demise, and if the baby died
well before the exam that showed no heartbeat, then it may measure out
smaller than it really was. This happened to me, my 20-week-old baby measured
smaller than he had at my 16-week visit, partly because he died soon afterward,
partly because he began to get reabsorbed by my body. Another lady who
came in had a 24-week baby and was eligible for D&E instead of labor
because it measured out smaller.
There will be a viability point, usually at 24 weeks, where you have no choice but to deliver the baby.
Things to think about when choosing between a D&E and induced labor:
Do I want a D&E (if eligible)?
Advantages: This is mostly painless and will get
you back on track to start trying again much sooner. The physical part
of the ordeal will end.
Disadvantages: This is terrible to say, but it is what I think about almost every day—your baby will come out in pieces. You will never see your baby, and if you are like me, where the baby was too small to see its sex and the chromosome tests do not come out, you will never even know if your baby was a boy or a girl.
Do I want to deliver the baby through labor?
Advantages: You will get to hold your baby, take
a picture if you want, and say goodbye. It will be very, very hard and
sad, but it will make you feel better later.
Disadvantages: Although this is not always the case, the drugs they give you to dilate your cervix and induce labor might make you very sick—throwing up, diarrhea, some women have mentioned hallucinations and terrible fear. It can take many hours or even days to get dilated enough to get the baby out. And the result is the same: you have done all this labor to see a baby that is not alive.
Different doctors will push different options.
Weigh them the best you can and make sure you get what you want. Even if
you regret your decision later (as I do), remember that there simply is
no good way to deliver a dead baby. It's a terrible thing no matter what.
What can I expect?
These are going to be some difficult days.
I'll talk first about D&C and D&E procedures. If you are waiting
for a natural miscarriage, scroll down a bit.
Surgical Procedures
If you opted for a D&C or D&E, first you
will have the procedure done. Remember that if you can, insist on some
time to gather loved ones around you or to get yourself together before
you do this. Don't let anyone panic you into rushing into a procedure you're
not ready for.
The surgery will be pretty fuzzy to you, due to the drugs and anesthesia. You may feel some pricking or sucking sensations, but it will not be uncomfortable. You will spend a couple of hours in a recovery room to wait on the anesthesia to wear off.
During the next few days, you will likely experience the following:
Deep muscle soreness in your thighs from your position during the procedure.
Heavy bleeding with some mild cramping.
Sun sensitivity, nausea, and weakness from the strong antibiotics.
Heavy groggy feeling, from the anesthesia and your sadness.
Call your doctor if you experience the following:
Any sort of abdominal pain. You could be developing an infection. Don't panic though, just call and you will get a stronger antibiotic and a check up.
A fever that starts to approach 100 degrees. Again, infection is a possibility.
A sudden stoppage of bleeding, then severe cramps.
Natural Miscarriage
If you choose to wait it out for a natural miscarriage,
you will have a terrible, paranoid, sad wait. It may not seem real; you
will harbor hope that it will never happen. Eventually the cramping and
bleeding will begin, and you may react with severe grief and panic. You
may feel ridiculous or morbid trying to catch tissue in a jar or plastic
bag for testing. All these things are fine. Do the best you can. If all
goes well, the cramps will subside and a regular blood flow will resume.
Keep in mind that you may not pass all the tissue and will have to have
a D&C to empty your uterus.
During the next few days you will likely experience the following:
Cramps and bleeding, sometimes quite painful and
heavy.
Passage of tissue, resembling large blood clots
in the earliest weeks up to pinkish/grayish material, possibly even in
a discernable sack. Keep in mind that a three-week old embryo is only 2
mm long about like this: _ and you probably aren't seeing the actually
baby, but only the yolk sack or placenta. A four-week old embryo is about
a quarter inch long, more like this: __ , still probably impossible to
see. Even a six-week old embryo is less than an inch long. Try not to traumatize
yourself by searching for the baby. Believe me, I understand the impulse.
Not seeing my baby was traumatizing in itself. And mine was six inches
long and fully formed at 20 weeks. Just do the best you can. Once you collect
the tissue, it may be refrigerated until you take it for testing.
Call your doctor if you experience the following:
Any sort of abdominal pain. You could be developing
an infection. Don't panic though, just call and you will get a stronger
antibiotic and a check up.
A fever that starts to approach 100 degrees. Again, infection is a possibility.
A sudden stoppage of bleeding, then severe cramps,
ones beyond endurance. This happened to me, I can't tell you how I panicked.
I
ended up passing tissue, then the bleeding resumed
normally. I called the doctor and they checked on me every few hours at
home, but I didn't end up having to go in.
Everyone will feel some of the following as the days and weeks wear on:
A start and stop bleeding pattern. Bleeding may continue for a few days or a few weeks. Eventually it will stop and a new cycle will begin. You should have a new cycle, unrelated to the first bleeding, between 4 and 7 weeks after the miscarriage. I didn't get a fresh cycle until the last day of the 7th week, so don't panic. A few women need hormone treatments to get their cycles back in sync, but this is not terribly unusual. Call your doctor if you go much longer than 7 weeks, just for your peace of mind. You may want to start charting your temperatures after the bleeding stops to see where you are. Remember that you can get pregnant that first cycle, so use contraceptive.
Snappy, unhappy, angry feelings. Wanting to be left alone or wanting to talk about what happened with everyone you know.
A sense that it isn't real, that it never happened.
Hypersensitivity to sad TV or reading materials, being revolted or angry about happy scenes of families, seeing symbols in everything you do, from gardening to dreams to what you eat.
Anger at the baby, wishing you never knew about the pregnancy, wanting to throw out all the baby reminders, or clinging to the little angel you lost, thinking about him/her nonstop, wanting everyone to recognize that the baby was real.
Anger and/or jealousy of other pregnant women,
even friends and family, to the point you don't want to even talk with
them. This is okay. I felt this way for several months.
When will I feel better?
Physically, you will recover completely from a
D&C or D&E in about two weeks. The bleeding should subside, your
cycle will start up again, and the hormone-induced mood swings will even
out. A birth takes considerably longer to recover from. You may have shaved
areas that will grow out and itch or burn. You may have stitches that will
be sore for a few weeks. This recovery is like any other post-partum.
The emotional recovery is another story altogether.
One thing I will point out immediately is that your level of sadness is
not at all tied to how far along you were. Everyone will be surprised by
their emotions. Some will be near absolute despair and wish to join their
baby. Some will be unpleasantly numb and feel nothing at all. Most will
swing somewhere in the middle, seemingly okay one minute, then sobbing
as if it were only yesterday. All the stages of grief will almost always
be visited. Shock, numbness, denial, anger, guilt, depression, and finally
resolution are all emotions you will experience. They do not come in order;
some stages may go on for many weeks and others only a few hours. No two
people grieve the same, as you will quickly see when your husband or wife
does not react the same way as you do. Don't expect that you will "get
over it" in a few weeks or even months. Don't assume that getting pregnant
again will turn everything around. Don't give yourself a timetable. Just
let the emotions come and go and try to keep your life going.
So, you ask, when WILL I feel better? In some
ways, you never will. The complete innocence and pure joy of pregnancy
will not come back. But you will feel better than you do right now. Your
life will go on, you will try again, and you will survive. There is much
more to happen in your life. You have to keep going to see what it is.
Only when you look back on where you were will you see that you do indeed
feel a little bit better.
When can I try again?
Most doctors recommend waiting 1 to 3 cycles after
your miscarriage to begin trying again. There are several reasons for this:
Physical. Enough hCG hormone still exists in your
system to make a pregnancy test positive for up to 3 weeks. It can take
anywhere from 4 to 7 weeks to bleed and start a new cycle. Should you get
pregnant that first time, you may never have a period and the pregnancy
will be harder to date right away. This date may be VERY important if you
are having hormone deficiencies as a cause of miscarriage.
You may also have some residual hormones that may run you the risk of another miscarriage. Some doctors also believe that the blood vessels in the uterus need to be "cleaned out" by rebuilding and shedding the lining at least one cycle, preferably three. I began bleeding on the last day of the 7th week, right when I was about to panic that I would never be fertile again. A few women do have trouble getting back on schedule and require hormone shots.
Emotional. You will probably find that you go through phases of wanting to try again immediately and being terrified of ever trying again. Both of these sides have emotional issues that you need to think through as best you can. Wanting desperately to try again means that you feel the need to renew your hope, to get back on track with your family plan, and feel the happiness you felt when you were pregnant before. You want a happy ending, and you want it now. Make sure you are not trying to replace one baby with another. It won't work and you may find yourself pregnant again and still quite sad. It is very hard to get through the hormone rush when you are not grieving, then add anxiety on top of all that. The joy you had with your first pregnancy may not come back the way you hope, making you feel even worse. This is not to say that you won't be fine, but I want to give you some things to consider before breaking the doctor's orders and trying again immediately.
With that said, I should tell you that many women find it extremely easy to get pregnant during that first cycle after a miscarriage. Apparently the hormones are still in place to foster the fertilized egg and implant it, so even couples with fertility problems may get pregnant right away. Keep this in mind if it was hard the first time and don't rationalize that you might as well start trying now because it took you 10 months last time. Pregnancy fosters pregnancy.
Will it happen again?
Most likely, no. The ordinary woman who has never
been pregnant has a 10 percent chance of losing her baby once a home pregnancy
test is positive. After you have had a miscarriage, the odds only go up
to 13 percent. Most of the additional odds go to women with untreated recurring
problems, such as insufficient progesterone levels and uterine abnormalities.
Once you have two miscarriages, however, the odds
skyrocket to 40 percent. This seems scary, but doctors will get very serious
about testing and monitoring you and your baby at this point. Most women
will get some answers and some treatment before trying a third time.
