What you can and can't do about miscarriage

Regardless of my obstetrician's assurances to the contrary, I was convinced that I was to blame for the miscarriage. I had carried this seed of life, this promise of a child, in my womb, and some shortcoming of mine -- too much stress, too much caffeine, or perhaps that scuba diving excursion before I knew we'd conceived - had caused me to miscarry. On top of the overwhelming grief of mourning for that June baby, on top of hating my body for regressing so quickly to its dormant pre-pregnancy state, I faulted myself, regretting every late night and every cup of coffee that might have prevented that awful evening when I first felt the twinge that something was wrong.

My reaction was not out of the ordinary. Most women who miscarry experience some guilt and even shame over their loss. Dr. Tanya Dailey, a maternal and fetal medicine specialist at Women & Infants Hospital of Rhode Island, eases her patients' guilt frequently. She said, "I always tell women that it's not their fault. Women take on a lot of blame and guilt that should not be there." Women usually suffer in silence, keeping their loss a secret. Few realize how common miscarriage really is, and how many of their peers could empathize with their loss. Dailey explained that 20 percent of known pregnancies end in miscarriage, and the actual percentage is probably doubled when you consider all the unidentified pregnancies that end before a woman even knows she is pregnant.

The most frequent cause of miscarriage in the first trimester is when the fetus does not develop naturally due to a chromosomal abnormality. It is simply the body's way of dispensing of a fetus that could never survive. Dr. Linda Burke-Galloway, a high-risk OB-GYN specialist and author of The Smart Mother's Guide to a Healthy Pregnancy, estimates that 50 percent of all first trimester miscarriages are due to a chromosomal abnormality.

According to the Mayo Clinic, there are two other common scenarios for first trimester miscarriages: a blighted ovum (when the fertilized egg develops into a placenta and membrane, but not an embryo), and intrauterine fetal demise (when the embryo simply stops growing). Another, less frequent, occurrence is called a molar pregnancy, when the placenta becomes a mass of cysts.

Although most miscarriages are natural, not caused by a woman's actions, a number of conditions will increase a woman's risk for miscarriage. A woman's age is an important factor. The older a woman is, the greater the risk of miscarriage. The Mayo Clinic reports that at 35, women have a 20 percent chance of miscarriage, at 40 the risk goes up to 40 percent and at 45, the risk of miscarriage skyrockets to 80 percent. The more miscarriages a woman has had, the more likely she is to have another. Chronic conditions such as hypertension, diabetes and thyroid disorders also increase the likelihood of miscarriage. Fibroids in the uterus can make it difficult for an embryo to implant in the uterine lining. Auto-immune problems such as lupus have also recently been proven to cause miscarriage because of clotting. And women with abnormally shaped uteruses and cervixes also can have trouble carrying a fetus to term.

With so many health factors out of their control, women can easily feel powerless to limit their chances of miscarriage. But Dailey suggests of a number of actions a woman can take to greatly increase her chances of a viable pregnancy:

1. Abstain from cocaine use, other drug use, and intake of alcohol.
2. Limit your caffeine intake. While some studies have linked caffeine to miscarriage, there is no way to quantify the amount of caffeine a fetus can tolerate. Dailey recommends curtailing caffeine intake to be on the safe side.
3. Take prenatal vitamins and folic acid.
4. See your physician early to rule out any issues with the fetus and pregnancy.

If at all possible, try not to stress about losing the baby. A 2004 study published in the New Scientist found a link between stress and miscarriage, showing that stress causes a "cascade of hormones" that can lead to spontaneous miscarriage. The best way to limit stress is to find a doctor who listens to you and calms your fears. At a time when little is in your control, choosing the right doctor is something that you can do.

But even with the best medical care, many pregnancies do end in miscarriage. Lena Arnold suffered many miscarriages before finally carrying to term her three children. When she had her miscarriages, Arnold struggled with the guilt of not providing her husband with what he wanted, and being a failure as a woman. She wrote about her experiences in her book, For This Child We Prayed. Her advice is, "Take the time to grieve, and then get up. Don't let infertility define you. You need to keep on living in the moment and get to the place where you accept that you may never have a child."

Since those weeks I spent crying at my office desk, certain that I would never be called Mommy, I have lost many other babies, more than the three I have carried to term. And although I love my children more than anything and could not imagine the world without each one of them in it, I often wonder about those children I never got to hold, the ones who slipped away before drawing breath. I learned over time to shield myself from the raw bottomless despair I felt after the first miscarriage, but I never managed to abstain from castigating myself every time one of my pregnancies ended early. At an emotional time when so little is within a woman's control, sometimes it is easier to feel needlessly guilty than to face the fear of infertility.

Vanessa Druckman is a freelance writer and blogger living in the Columbus area with her husband and three children. She blogs about cooking and parenting at www.chefdruck.com.

More information

5 things women can do to prevent miscarriage:

1. Abstain from strenuous activity.
2. Take prenatal vitamins.
3. See your physician early and often.
4. Cut down on caffeine.
5. Eliminate drugs, smoking and alcohol.

More resources

A few resources if you have a miscarriage:

1. Find women suffering the same grief online at the iVillage TTC bulletin board, or the Babycenter Actively Trying Group.
2. Find valuable information and local support groups at Share - Pregnancy and Infant Loss Support.
3. Read the book Trying Again, a Guide to Pregnancy after Miscarriage, Stillbirth and Infant Loss, by Ann Douglas.
4. For a more faith-based advice book, read For this Child We Prayed, by Lena Arnold.
5. Process your grief by sharing your story at the March of Dimes website.

Increased risk

Some factors that increase the risk of miscarriage:

• Mother's age (women over 35 have a 20 percent chance of miscarrying, women over 40 have a 40 percent chance, and women over 45 have an 80 percent chance of miscarrying).
• Father's age (sperm from males 35 and older also show an increased risk of miscarriage).
• Having more than two previous miscarriages.
• Chronic ailments such as diabetes or thyroid conditions.
• Uterine or cervical malformation.