Editor's note: This is the third in a series of three articles regarding pregnancy.
LAURIUM - For a woman who has miscarried at any point in her pregnancy, it is common to feel grief or even embarrassment, but she is not alone - it's estimated about one in four pregnancies end in miscarriage.
"I've met women who have miscarried and they do judge themselves as being outside the norm," said James Feeley, M.D. and OB/GYN with Aspirus Keweenaw in Laurium. "They think there is something abnormal about them because they may not recognize how common a miscarriage is."
One hundred years ago, a woman may have had a miscarriage and just thought it was a normal menstrual period, Feeley said. Today, there is sophisticated hormone testing which is more sensitive, and the ability to do an early ultrasound is in existence.
For many women, especially those who have never been pregnant, knowing how common miscarriage is can be a bit scary, but for women who have experienced a miscarriage, it can be reassuring, he said.
"If something happens one out of four times, the law of averages catches up," he said.
Although miscarriages can happen multiple times to a woman, or maybe just once, it doesn't diminish the sort of grief a woman feels.
"It's unfortunate and sad, but it's not going to make an increased risk for a second miscarriage," Feeley said.
Often, when there is an unfavorable outcome with a pregnancy, the woman is left to question if she did something wrong or if something different should have been done. In actuality, there is nothing a woman can do to prevent the inevitable, as most pregnancies end as the result of a chromosome malfunction.
"It's hard to judge whether early pregnancy interventions help," Feeley said. "Sometimes when a couple hears us say that it may have been a bad chromosome combination, they jump to conclusions that all of the father's sperm is bad, or all of the mother's eggs are bad. But remember, with more than 20 million sperm and 400,000 eggs, there's bound to be some bad apples in the bushel."
When a woman expresses interest to try again after having a miscarriage, Sharon Stoll, M.D. and OB/family medicine at Aspirus Keweenaw, said health care providers may evaluate the woman's progesterone levels, and determine whether a hormone replacement therapy, such as prometrium, is needed. With the progesterone, pregnant women can use the therapy for 12 weeks to maintain a pregnancy until the placenta takes over. But again, the woman would need an evaluation before taking such an aid and a progesterone can only do so much.
"There is a general mantra in medicine that you don't start a recurrent miscarriage workup on a patient until she has had two consecutive miscarriages, but as a woman, I'm not sure that I would want to be forced to wait for a second loss to find out something was wrong," Stoll said. "Generally, after one miscarriage, I suggest we look at some basic things, such as luteal phase progesterone deficiency which can be treated with prometrium, or ask ourselves is there any clinical signs of celiac sprue, which is also a risk factor for miscarriage. Also, we should ask ourselves, is there a family history of recurrent miscarriage to suggest some sort of clotting problem, and also, does the patient have any other symptoms of connective tissue disease like lupus, which can lead to miscarriage."
Consider that all of the genetic material from each partner has to be present. One tiny change can throw off the entire pregnancy and not make it viable.
Rebecca Baudoin, M.D. and OB/GYN with Portage Health in Hancock, has worked with several pregnant women and those who have miscarried.
"Most miscarriages occur in the first 10 to 12 weeks of pregnancy," Baudoin said. "The most common miscarriages are in the first eight weeks of pregnancy."
Once cardiac activity, or a heartbeat, is documented with an ultrasound, the risk of miscarriage decreases significantly, Baudoin said. The most likely reason could be because very early miscarriages never develop to the point of having a heartbeat. Once the heartbeat is seen, the early causes of miscarriage have already been bypassed.
"Certainly, once a woman is outside the first trimester, that risk of miscarriage decreases significantly yet again," she said.
Although a woman may not feel completely at ease until the baby is in her arms, the chances of miscarrying outside of the first trimester decreases to a small percent even though women can technically miscarry at any stage of pregnancy. After a certain point of gestation, the miscarriage is considered a still-birth.
Baudoin said it may be normal when a woman feels like an outsider or is ashamed after having an miscarriage, not understanding just how common miscarriages occur.
"I certainly know that it's not something a woman did wrong or can be prevented," she said. "As a women's health care provider, I want to try and help educate women and empower women to not feel ashamed because miscarriage is something that universally cannot be prevented."
Baudoin said it is common, and not surprising, many women don't want to talk about miscarrying as a way to not have to relive a traumatic event, but talking about it may open doors with those who have had miscarriages at some point in their lives, as well.
"I know many times where it's helpful for women to talk about it," she said. "When you have a miscarriage or you lose a pregnancy at any stage, you join a club that you never knew existed and you never wanted to join."
Additionally, Baudoin said the grieving process is a big part of having a miscarriage, as the woman begins to have hopes and dreams for that baby.
"As soon as you know that you're pregnant, you can't help but to have big thoughts," she said. "Whether you want to or not, you picture the baby being born, the baby rolling over or the child going to school."
For many women, bouncing back and getting pregnant after a miscarriage is not only possible, statistically, the next pregnancy has a high probability of working out. Although it doesn't happen all the time, many women who have had a miscarriage go on to have a healthy next pregnancy.
Baudoin suggests waiting for another cycle after a miscarriage to let the body reset before trying again. The most likely outcome of a pregnancy following a miscarriage is a healthy pregnancy, she said.
"Statistically, if you think about pregnancies 20 to 25 percent of the time ending in miscarriage, the next time around with the same statistics, you've got a 75 to 80 percent chance to have a normal pregnancy," she said. "The odds are in your favor of having a better outcome or a non-miscarriage the second time around."