Let's unpack miscarriage. Today we want to dive a little deeper into pregnancy loss with you.
This can be a very difficult topic to talk about. We were so moved by Chrissy Teigen’s bravery this past October, when she shared her pregnancy loss with the world (Chrissy, we’re still sending you love!). Until you’ve lived it, it is very hard for someone to understand the pain and trauma that comes with a pregnancy loss at any stage, whether it’s the first trimester or the last.
To all the people in our community who’ve suffered loss, we see you and we’re so sorry. We know how deeply painful and traumatic this is. We need to normalize pregnancy loss in the sense that we need it to be okay to talk about. We need women to not feel shame. About 15% of pregnancies end in miscarriage in the first trimester. That number is large but it still feels isolating. We want to tell you more about miscarriage, how to support yourself and breakdown some myths.
Is it my fault?
No! 1 in 4 pregnancies end in a miscarriage in the first trimester and the vast, vast, vast majority of the time this loss is not caused by anything a woman as done.
What causes miscarriages?
Over half are likely caused by a chromosomal abnormality when the embryo was created
In these cases, the baby wouldn’t be compatible with life.
Types of 1st trimester miscarriages:
1. Chemical Pregnancy
This is a very early miscarriage usually around week 4 of pregnancy, and many women think it’s a delayed period. Chemical pregnancies are extremely common, but we don’t talk about them enough because many times women don’t even know they’re happening. We think that chemical pregnancies account for up to 70% of all miscarriages. These miscarriages happen typically in week 4 - you may have a low beta HCG level or a faint positive on a home pregnancy test, but you end up getting a period a few days later. The reason why so many women don’t know they’re having one - it may appear to be a late period with very heavy cramps. While they’re common, it doesn’t make them less painful when you’re TTC.
2. An Empty Sac Miscarriage or Blighted Ovum
Around week 6-8 is when we see miscarriages like a blighted ovum. You’ve likely had good HCG levels and positive home pregnancy tests, you start to feel the symptoms of pregnancy, and you’re ready for your first ultrasound. However, on the ultrasound, no yolk sac or fetal pole is detected. This is why this type of miscarriage is called an “empty sac” because the gestational sac is missing those two critical markers. At this stage, your doctor could advise you to miscarry on your own, take medications to help move the miscarriage process along, or counsel you on a D and E (a procedure to remove the sac - this is a good option if you’re worried about genetics or worried about an ectopic pregnancy).
3. A Missed Miscarriage
This refers to situations where your HCG levels stop rising, or on an ultrasound no fetal heartbeat is detected. These usually happen a little later in the first trimester, when those initial markers like the yolk and fetal heartbeat are detected, but then on the following scan they’re gone. The options here are the same for a blighted Ovum.
How are miscarriages handled?
Miscarriage can be handled in several ways. There is no right or wrong way
If you have a chemical pregnancy or start bleeding on your own, you likely will need no medical intervention and you can miscarry on your own. Some women might choose to use a medication to help move the miscarriage along and be able to pass the gestational sac at home. In other cases, you may choose to have D and E (dilation and excision) to remove the sac. This is very helpful for a lot of women who want to do genetic testing or when there is a fear of ectopic pregnancy. This is okay!
How long will my body take to heal?
Everyone and every body is different, so it varies.
After you miscarry, your body still holds onto the pregnancy hormone HCG. For some women, this will fall and metabolize quickly and you can get a normal period back in 4 weeks. For others, it may take 6 or 8 weeks.
Since the HCG is still in your system for a little while, your body might still seem pregnant, like swollen boobs, increased thirst, fatigue etc. This is normal, and remember that it takes time for your body to regulate itself. Go slowly with yourself and give yourself space and time to heal.
How can a partner help?
Miscarriage feels like an extremely isolating experience, perhaps now more than every since many clinics ban partners from attending appointments. While your partner may not feel the physical changes you felt, they still experience a bond and a loss. Try talking about this together and see what each of you need in order to grieve, heal and decide on your next steps. We always recommend working with a mental health specialist and trying talk therapy for partners who’ve had a loss.
How do I handle the 12 week rule?
The 12 week rule refers to this idea that you should not tell anyone about your pregnancy before the 12 week marker, just in case something happens. Our take on this is that it is up to you to decide how and when to share a pregnancy.
Remember, 1 out of 4 pregnancies end in miscarriage in the first trimester. You need to do what feels best and SAFE for you. If you’ve had a previous loss, perhaps sharing a following pregnancy prior to 12 weeks makes you feel pressured - you might feel like everyone knows your timeline and business. For others with a previous loss, perhaps sharing a following pregnancy prior to 12 weeks makes you feel like you have a built in support group of people who will be there for you if it’s bad news again
In the end, we don’t want you to share sooner than you feel ready just because that’s what people are doing. You do you.
Can I prevent a miscarriage?
Unfortunately, there is typically no way to stop a miscarriage that’s happening. If you have recurrent losses, there may likely be an underlying cause and you need to work with your provider on a testing work up. Once you have a handle on what likely caused a loss, it gives us a better idea of how to prevent them in the future.
What supplements can I take?
While we are obviously big fans of supplements, there is no supplement that we know of that can help prevent an active miscarriage. However, you can take supplements to support healthy egg quality, sperm quality, uterine health and hormonal health.
For egg quality, a lot of women do well with DHEA. This is a precursor to a hormone (androgen) and research shows that a DHEA supplement can improve the outcomes of IVF for women. DHEA is not recommended for women with PCOS, as research indicates it could worsen symptoms, but it can be a great option for most other women.
N-Aceytal Cysteine, or NAC is a powerful antioxidant that supports healthy ovulation and regulation of your menstrual cycle. Research indicates that it can even help improve oocyte and embryo quality in women with PCOS, and it supports the development of a healthy uterine lining.
DHA Omega-3 are essential fatty acids for someone who is TTC, as they also support a healthy uterine lining. A critical component of any prenatal, Omega-3 helps to prevent birth defects and serves as a building block for your baby’s brain development.
Vitamin C is another important antioxidant during pregnancy. Research indicates that a Vitamin C deficiency might make you more susceptible to placental infection, which increases your risk for a premature rupture of the placental membrane, and premature births.
Folate is a naturally occurring form of B9 that may play a critical role in preventing neural tube defects, heart problems, and preterm delivery in developing babies. You can find it in veggies like asparagus, avocados, spinach, lettuce, and citrus fruits.
Choline is also key to support the healthy brain development of a baby. Most women do not need a choline supplement as you can get plenty from a normal diet. Main sources of choline include meat and eggs, poultry, fish, dairy products, brussel sprouts, broccoli, and beans, nuts and seeds.
Want to make sure your prenatal vitamin has everything you need? Check out this article.
No matter the type, a miscarriage is still a loss for many people. It’s important to know that, in the first trimester, many pregnancies end due to genetic abnormalities. If you are experiencing recurrent loss, there may be other underlying conditions. For this, we highly recommend seeking out the help of a fertility doctor who specializes in treating those with recurrent pregnancy loss.
Rather than telling you that miscarriage happens, or to just keep trying, we’re here to tell you that it’s OK to sit in your pain for a while and grieve. If you feel you need the support of a mental health specialist, please reach out to us via chat or Instagram DM and we can help connect you with someone.