What happened? Understanding miscarriage—and getting help
Miscarriage in the news
We’re hearing much more about loss, miscarriage, and stillbirth in recent years as a number of famous women have come forward on this very personal topic that’s traditionally been taboo.
Michelle Obama discussed her experience with a miscarriage and feeling “lost and alone” in her bestselling memoir Becoming. Chrissy Tiegen shared her experience on Instagram of losing her 20-week old “Jack,” a surprise pregnancy for both she and John Legend and a heartbreaking loss. Megan Markle shared her loss with a first-person essay titled, “The Losses We Share” in the New York Times.
This is just the tip of the iceberg in terms of what’s needed for all the women who’ve experienced miscarriage and all the women who conceive with fear. Learning more about miscarriage, its causes and how to potentially prevent it, as well as leaning into sharing and seeking support can all help.
What is a miscarriage?
A miscarriage is defined as loss of a baby before the 20th week of pregnancy, whereas a stillbirth is loss of a baby at or after 20 weeks of pregnancy.
Common causes of miscarriage
Many miscarriages—approximately half that occur during the first trimester— happen because the embryo is not viable. This means that the genetics of the embryo don’t match up; chromosomal abnormalities—which might be hereditary or spontaneous—exist in the sperm or egg.
As women age, the risk of miscarriage rises and this is largely thought to be due to decline in egg and sperm quality. While the number of your eggs will inevitably decline, your egg quality does not necessarily have to. See my blog The Importance of Egg Quality for helpful details about improving egg quality and why your man’s sperm quality matters, too.
See also my blog My Doctor Says I Have a Low Ovarian Reserve. Help! about your ovarian versus chronological age. The bottom line: your biological age doesn't have to be your actual age or older. You can have a younger body, including ovarian age, with a personalized health program designed precisely for you.
Less frequently mentioned causes of miscarriage
As the Cleveland Clinic notes, “Miscarriages are also caused by a variety of unknown and known factors, such as:
Infection.
Exposure to environmental and workplace hazards such as high levels of radiation or toxic agents.
Hormonal irregularities.
Improper implantation of fertilized egg in the uterine lining.
Maternal age.
Uterine abnormalities.
Incompetent cervix. (The cervix begins to widen and open too early, in the middle of pregnancy, without signs of pain or labor.)
Lifestyle factors such as smoking, drinking alcohol, or using illegal drugs.
Disorders of the immune system including lupus, an autoimmune disease.
Severe kidney disease.
Diabetes that is not controlled.
Certain medicines, such as the acne drug isotretinoin (Accutane®).
Severe malnutrition.
This is why it is important to get routine testing before you get pregnant, such as a pap smear, and blood tests that include a thyroid panel and blood sugar. In my fertility program, we test pre-conception to make sure your health is optimal before trying.
Does nutrition play a role in preventing miscarriage?
Yes! But though nutrient deficiencies can increase your risk of miscarriage, they can be addressed nutritionally to lower miscarriage risk and improve outcomes in pregnancy.
Key nutrients we keep an eye on:
Iron. Linked to recurrent pregnancy loss (having 3 or more miscarriages) and important for recovery from a miscarraige, reducing fatigue, and future pregnancy placental growth.
Vitamin C. A cofactor that helps in the absorption of iron.
Folate. Low folate levels have been found to have a 50% risk of early miscarriage. Important for fetal growth and development. Note: You could be taking the wrong kind of folate for your genetics.
B-vitamins. Important for detoxification. Low b-vitamins have been linked to miscarriage, especially vitamins B-3 and B-6.
Vitamin D. Important for optimal immune function. Low levels have been found in those who miscarry.
How common is miscarriage?
The stats are all over the place on how many women experience miscarriages. Some sources state 1 in 4, others 10-20% of all women, while most argue the number is higher because so many women don’t share this information due to shame, grief, or fear. In some cases the miscarriage happens so early the symptoms can be seen as a late period.
What are normal symptoms after a miscarriage?
The telltale signs of a miscarriage are blood loss and progressive cramping.
The symptoms usually start with spotting. While spotting doesn't always mean a miscarriage will happen, you should contact your OB-GYN, midwife, or reproductive endocrinologist immediately and get off your feet.
Lay down and relax to see if the spotting progresses to additional blood loss and cramping, or stops. Follow your healthcare provider’s instructions for when to come in for a visit.
How long does a miscarriage last?
The amount of time a miscarriage takes can vary among women. If you found out through an ultrasound or declining HCG level that your pregnancy is not viable, it can take days or weeks for a natural miscarraige to initiate. Once you start bleeding, it can take several days to a week. Bleeding generally tapers off in the second week.
Miscarriage treatment
When you first experience spotting, immediately contact your healthcare provider, get off your feet, and lay down. That means if you’re at work, go home.
IF there is a chromosomal abnormality, the body will proceed with the miscarriage. However, note that some women do have bleeding in the first trimester, but go on to have a normal pregnancy.
Since it’s hard to tell in the beginning, you’ll want to rest as much as possible either way.
What should you not do during and after a miscarriage? Heavy exercise, travel, lifting heavy items, or anything strenuous.
What and when to eat during and immediately after a miscarriage
To nutritionally counteract elevated stress levels:
Eat protein/fat at regular intervals.
Have an AM and PM snack in addition to three meals.
Eat good quality protein.
To balance your blood glucose and ultimately your stress hormones, it’s best to eat good quality protein and fat at regular intervals. Also add AM and PM snacks to your 3 meals.
This is when you ask your partner to cook, pick up meals, and/or call on a food delivery service. You are worth it and going through a miscarraige is enough.
What happens to my body after a miscarriage?
Both your body and your emotions undergo a sea change after a miscarriage. Be proactive in nourishing and replenishing yourself. Rest, be patient. Seek the support of your partner or spouse, family, and healthcare and mental healthcare providers. Help helps.
Some changes you’ll experience:
Iron deficiency. Blood is a major source of nutrients including iron, therefore iron deficiency is a common side-effect of miscarraige. While we can’t stop the blood loss, it’s important to eat blood-building foods and supplements to help your body recover.
Hormonal shift. This occurs in your body as your progesterone levels fall. Progesterone is the feel-good hormone that keeps our skin glowing and our hair nice and thick. It also helps us sleep deeply. As progesterone levels plummet, we don’t feel as well, sleep as well, or feel as hungry. Eating small, light meals or drinking shakes or juices to begin with can help provide you with the nutrition you need during recovery.
Biochemically, the experience of a miscarraige also increases cortisol levels, your body’s stress hormones, which can alter blood glucose metabolism. A stress response increases the demand for glucose and so you may sometimes feel like you are very hungry alternating with a lack of appetite.
If you rest and nourish your body, it will heal.
The impact of your emotional experience
The stress, anxiety and fear that accompanies a miscarriage is very real. Research shows that having repeated miscarriages can actually give women symptoms that meet the criteria for a diagnosis of PTSD.
To make matters worse, many women go through miscarriages alone. without support from friends or family, out of shame, not wanting to share, or because the pregnancy was never announced to begin with due to the very real fear of losing the baby.
The intensity of our emotional loss comes with fatigue. Our body is physically overwhelmed; our feelings are depressed, angry, and hopeless. Fatigue is normal—embrace it. Sleep as as much as possible, nap during the day, and don’t focus on doing anything.
Getting the support you need
Getting support and understanding that you’re not alone are two of the most powerful things you can do to help your recovery.
I often get asked, “How can I regain my health after a miscarriage?” And the first thing I say is, “Make sure you take care of your mental health. This is hard.”
Researchers found that a large number of women having experienced a miscarriage or ectopic pregnancy fulfil the diagnostic criteria PTSD. Many women suffer from moderate-to-severe anxiety, and depression. PTSD symptoms persists at least 3 months following pregnancy loss and in my epxerience with clients, I’ve found that PTSD symptoms post-miscarriage can last much longer.
There are free, miscarriage support groups like RESOLVE and now many are virtual reducing the barrier of getting to a physical place especially if there is not one in your hometown area. Or you can find a therapist in your area that specializes in fertility and pregnancy loss.
There is no timeline on grief and healing. Finding resources is critical during this time whether it be professional help or the help of family and friends. I have personally found in my own experience that being part of a support group of women who have experienced a miscarraige is truly helpful because we understand. Either way, do find help and get guidance on coping.
Taking care of your body after miscarriage: the foods to focus on
Nourishing, nutrient-dense foods.
Iron-rich foods, important for your recovery, oxygenation of tissues and your ability to get pregnant again.
A good-quality multivitamin, with good quality folate and iron
Protein, especially animal protein if you’re an omnivore. If you’re vegetarian, make sure you supplement during this time.
Good quality fats, such as olive oil, coconut oil and grass fed butter.
Veggies and complex carbs, brown things like brown rice and other gluten-free whole grains. Carbs do have a role in making us feel better as low-carb diets are linked to depression.
Bone broth soups and nutritious shakes. can do the trick to help you get nutrients if you don't have much of an appetite.
It makes total sense to want to eat a pint of ice cream and that’s ok, too! Sometimes eating a full meal is just too much to stomach.
Conceiving after miscarriage: when should I try again?
There is no right time for everyone. While research shows that some women can conceive in the first three months after a miscarriage, many health providers advise giving your body at least three months to heal emotionally and physically. The key thing is you want to be nourished and replenenished to reduce risk of future miscarriage.
In addition, you want to get tested to make sure genetic reasons such as having antiphospholipid antibodies or a clotting disorder are not the cause of your miscarriage.
Your healthcare provider can do a postmiscarraige panel of genetic tests to rule out this cause of miscarriage. It can be devastating to go through repeated miscarriages when in fact there is a genetic reason. There are treatment options for some genetic disorders so don’t lose hope. My motto is always test, don’t guess, and test early to avoid the loss of time and the heartache.
What can I take to prevent a miscarriage?
These nutrients in the chart below can reduce miscarriage risk that is caused by nutrient deficiency. Making sure you have foods with the following nutrients and the right amount of supplementation of each can help.
It’s best to work with a professional to also see what your underlying health risks and nutrition needs are before taking supplements.
Eat foods with the following minerals and vitamins to reduce your miscarriage risk:
Iron containing foods:
Liver and Other Organ Meats. (Sounds gross, but the bang for each bite is tremendous Liver has 15.mg of iron for 3 oz. vs. Spinach which has 3.5 mg of iron for 3 oz).
Red meat, dark meat turkey or chicken (leg, or thigh - not the breast meat).
Spinach
Lentils
Pumpkin seeds
Quinoa
Vitamin C - Citrus fruit, such as grapefruit, oranges and orange juice, papaya, pineapple, kiwifruit, cantaloupe, and raspberries are also excellent vitamin C sources. Cranberries, blueberries, and watermelon blackcurrants, broccoli, brussels sprouts and potatoes.
Folate - As the name implies, green leafy vegetables (or foliage) are among the best sources of folate. Spinach, turnip greens, bok choy, parsley, and romaine lettuce.
B-vitamins -Meat (especially liver), seafood, poultry, eggs, dairy products, beans, leafy greens, seeds.
Vitamin D - Get a healthy amount of sun exposure daily 1 hour or so year round. Salmon, sardines, pasture-raised eggs and fortified milk or milk substitute.
A final word
Clearly, miscarriage is one of the most devastating things that can happen in your life and fertility journey. So often the goal is two pink lines and a positive pregnancy test—then the relief and joy goes spiraling down with a loss we can’t control.
The good news is that it is not all up to chance. You can do things to help your body heal better from a miscarriage and improve your odds for the next round. There is testing you can do to assess risk for miscarriage and identify potential contributors. Finally, you can get guidance and we offer personalized plans to implement to reduce your risk for miscarriage if you want to conceive again.
To get support and a plan that is personalized for you, book an appointment and we will get started.