In 2019, there were over 1 million miscarriages in the United States. Yet, you have most likely not heard this statistic because the subject is typically considered taboo to discuss. That such a pervasive health issue goes unmentioned tells us that there is much work to do to demystify miscarriage.
Some women are willing to share their stories and as they do so help to bring some normalcy to the idea of talking about their experiences. Last year both Meghan Markle and Chrissy Teigen shared their stories of having miscarriages publicly by writing about them. We know that talking about traumatic events can help to heal psychic wounds, but our cultural discomfort with both death and female body parts leads us to silence when it comes to miscarriage.
When dealing with difficult issues like miscarriage, it is important to start at the beginning and understand what exactly is happening in the body. I spoke with Dr. Rachel Leland, an OB/GYN in Indianapolis, to find out more about what is going on from a physical standpoint in a woman’s body when she has a miscarriage.
Chaise Lounge (CL): Can you explain what happens inside a woman’s body when she has a miscarriage?
Dr. Leland: When a woman miscarries, usually, there’s a separation of the pregnancy sack from the lining of the uterus. Bleeding starts in the space where there were tiny little connections between the sac and the uterine wall and that stimulates uterine cramping. The two most common signs of miscarriage are painful cramping and bleeding, regardless of why the miscarriage happens. Usually, this will happen within two weeks of the pregnancy discontinuing to form. But sometimes it doesn’t. And then it will happen either with the assistance of medication or the surgical approach like a D & C.
CL: Sometimes, though, a woman might have a partial miscarriage that takes weeks to resolve, correct?
Dr. Leland: Absolutely. By design, the pregnancy sack is sticky, and sometimes those pieces don’t come out completely. And then, unfortunately, that process could go on technically for months, but that’s not typical. Sometimes when that process doesn’t naturally complete by itself, that’s where a medication or surgery has to be used as a backup.
CL: Is it important for people to understand that sometimes a miscarriage can take time and people may need medical leave around this issue? I don’t think that that’s common knowledge.
Dr. Leland: I agree with that. When a woman loses a term pregnancy or a baby after delivery, employers are more open to that maternal leave. But if it’s an early loss, it’s still a loss, but they don’t always have the same maternity benefits.
CL: What about the hormonal shifts that happen after a miscarriage?
Dr. Leland: The pregnancy hormone (hCG) declines and that can be a rapid process. But as we spoke about, the tissue sometimes will take longer periods to come out. And as long as there’s pregnancy tissue in the uterus, there’s going to be some sort of beta hCG, typically in the bloodstream. And the other thing that happens is progesterone will usually slowly decline as the corpus luteum (the system within the ovary that helps support pregnancy) starts to dissolve.
CL: I have a friend who told me that after her miscarriages, she just felt like her hormones were raging leading to disagreements and unhappiness. What was causing this?
Dr. Leland: I think that progesterone, in particular, is a cause for that. And then anytime you’re grieving, they are also neurochemical changes that we can expect that can affect mood.
CL: What information do you think is most helpful to share with couples who have just experienced a miscarriage?
Dr. Leland: I think that knowing the cause for the miscarriage, ee want to know the whys. Knowing that the cause often is chromosomal and is always, with rare exceptions, completely out of your control. I guess the rare exception would be excessive cocaine or alcohol use, for example. Women in a follow-up appointment, they’ll often say, “Well, I got in an argument”, or “I was dieting, or I was exercising, or something was happening.” There’s always that incidental thing that was happening that they blame themselves for and think this didn’t have to happen.
The truth is that 50 to 60% of miscarriages are caused by chromosomal abnormalities. And others can be caused by infection, thyroid issues and PCOS can increase that risk. There are also some clotting disorders and other kinds of unusual conditions of the uterus.
CL: What resources can you point our readers to learn more about miscarriage and support for those who have had one?
Dr. Leland: I think it’s important for women to know that while we don’t talk about it while we’re having coffee with our friends, there is no silence around miscarriage in the OB/GYN office. This is something that I talk about every single day, multiple times a day, whether it’s at a wellness checkup or an actual visit for a pregnancy loss. It means that it’s something that your OB/GYN or midwife, doula, and possibly even your family physician would be comfortable discussing if you feel that you have more questions. I also recommend National Share, a website that lists resources by state as well as hosting an online community.
CL: Thank you so much for all of the information that you have shared. I know that I learned quite a bit, and I am sure our readers have too.
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Previously Published on medium
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