Understanding Miscarriage

by Stephanie Slon

Ann, age 41, suffered two miscarriages a few years ago while trying to conceive a second child. Talking about her experience, her eyes still well up with tears. "Maybe some people can look at it philosophically, like peas growing in a pod some of them develop, some don't. But for me the whole thing was devastating."

Ask any woman you know and she'll tell you about a miscarriage. It might be the story of her friend, her sister, her mother, or even the tale of her own loss. Society at-large politely tries to turn away from these personal tragedies, not quite sure how to mourn a pregnancy gone wrong. But, when you listen to the women themselves, you'll hear how the memory of rising hope and dashed expectations is never erased.

The working definition of miscarriage is the loss of a pregnancy anytime in the first 20 weeks. Miscarriages are surprisingly common. For the woman who learns of her pregnancy by the age-old indicator of a missed menstrual period, the likelihood of miscarriage is roughly 15 percent. However, new super-sensitive tests can let a woman know she is pregnant as soon as six or seven days after the egg is fertilized a good week before the expected start of her period. When pregnancies detected this early are added into the equation, the rate of miscarriage shoots to upwards of 30 percent.

The causes of miscarriage are widely contested but experts generally agree that most pregnancies fail because of faulty genetic material in the developing embryo. For this reason, doctors usually chalk up a first miscarriage as a random event, however unsatisfying that assessment may be for prospective parents.

Medical scrutiny usually begins in earnest after a woman experiences her second miscarriage. Again, the odds are that a chromosomal mix-up is to blame. According to Joseph Hill, M.D., Director of Reproductive Medicine at Brigham and Women's Hospital in Boston and an expert in recurrent miscarriage, "The dogma out there is that women with recurrent miscarriages are having normal chromosomal losses. That is simply not true. In 60 percent of miscarriages, the chromosomes are abnormal, regardless of whether the woman is having her second miscarriage or her twelfth."

As far as the other 40 percent of cases go, answers are few but theories abound.

Identifying the cause: The first step in dealing with recurrent pregnancy loss is to undergo a battery of tests to identify or at least rule out some possible causes. One of the first things doctors look for are structural problems in the uterus that make it impossible to accommodate a pregnancy. In the more than 3000 patients Dr. Hill has treated over the years, he has found this to be the root of the problem about 12 percent of the time. Women whose mothers took DES--a hormone, ironically, given to prevent miscarriage, may be more prone to structural problems in their own uteruses. Fortunately, many anatomical problems can be corrected by surgery.

Hormones: Hormone levels are another area of investigation. Sometimes the body doesn't produce sufficient progesterone to prompt the growth of the uterine lining after conception has taken place. In other cases, thyroid and adrenal gland imbalances or diabetes trigger a miscarriage.

Infection/disease: The woman, and sometimes her partner, are also tested for infections ranging from rubella to a number of different sexually transmitted diseases. Both parents also undergo chromosomal tests. In rare cases, one or the other parent is passing on an abnormal genetic structure that is causing the pregnancy loss. This is quite rare, however.

Immune factors: By far the most controversial issue associated with multiple pregnancy loss is the role played by immunologic factors. According to one theory, some women produce antibodies that cause the formation of blood clots in the placenta. When high levels of these antibodies are identified in a women's blood, she can take blood-thinning drugs during her pregnancy to avoid potential problems.

Even more hotly debated are treatments based on the premise that women produce an immune response to the placenta because it contains cells different from her own. There are numerous experimental therapies purported to fight off this response; however, there is no good research at the present to support the effectiveness of any of them.

Many of these treatments are expensive and often not covered by insurance. Therefore, Hill cautions "buyer beware," citing what he calls the "tremendous entrepreneurial atmosphere that has developed around reproductive medicine."

A lost pregnancy leaves a woman struggling to regain her emotional balance at the same time her body is healing from the physical aspects of the ordeal. What's hardest, many women say, is not knowing where to turn for answers. Well meaning friends, family, and doctors attempt to console the grieving with platitudes like "you'll have other chances" or "it just wasn't meant to be."

According to the women interviewed for the book, Miscarriage: Women Sharing From the Heart, the most comfort came from people who could just listen to them talk about their loss without judging or trying to point out the "brighter side."

Many couples turn to rituals to help them mourn. Ceremonies can help bring the grief out into the open, allowing women and their partners to share their feelings. People choose different types of ceremonies depending upon their own belief system. Some find comfort in traditional religious services with clergy officiating, while others prefer quiet meditation, or the symbolism of planting a tree. Often, the birth date of the unborn child becomes the focus for remembrance rituals.

In recent years, the Internet has become a meeting place for women looking for an outlet for their grief.

Scrolling through the pages devoted to miscarriage, you'll encounter hundreds of women recounting the joyful beginning and abrupt end of life in their wombs. What remains strikingly similar throughout all of the stories is the search for comfort and insight. The women behind these words are trading their stories like currency, hoping to find meaning through each other's experience.