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Anatomy of a Miscarriage

Black Health Matters / Our Health  / Women's Health  / Women  / Anatomy of a Miscarriage

Anatomy of a Miscarriage

Why is loss of pregnancy still such a taboo subject?

Midway through my appointment, my gynecologist went silent. Her face screwed up a little, and she announced, “I don’t hear a heartbeat.”

My own heartbeat stopped, too, for a second, maybe two. “What?” I managed to croak.

She was suddenly all business. What had been a jovial visit—with a joke-filled few minutes discussing the difference between amniocentesis and chorionic villus sampling—turned into quiet desperation. I don’t remember getting dressed, but moments later I was in my car, driving through rush-hour traffic to a radiology center. Their ultrasound equipment, my doctor explained, was more sophisticated. She hoped she was wrong and that I’d return to her office and yell at her for scaring me.

Understanding a High-Risk Pregnancy

We hear about women getting pregnant after age 40 all the time these days. The miracles of reproductive science are so commonplace they don’t even seem like miracles anymore. Even before the age of test-tube babies and in vitro fertilization, both my grandmothers had their last children in their early 40s. Though my maternal grandmother’s final pregnancy netted twins, I don’t think anybody ever said the words “high risk” to her.

Times have changed. I knew my pregnancy was high risk. I was 43 (nearly 44), I’d already started perimenopause and the whole event was completely unplanned. Throw in a severely tilted uterus (it has caused every gynecologist I’ve ever visited to exclaim, “I’ve never seen such a tilted uterus!”), and forget the wall; the handwriting was on the ceiling.

But if I had any doubts about my pregnancy’s status, they were erased by the bright red, all-caps, 5-inch-tall words stamped across the front of my medical file: “ADVANCED MATERNAL AGE.”

Three months into a new relationship with a newly divorced guy (who said during our second or third conversation that he a) no longer believed in marriage, and 2) didn’t want any more children), and I was knocked up. Preggers. With child. Confused. Bewildered.

But mostly I was thrilled. I started taking prenatal vitamins immediately and eliminated caffeine. I upped my intake of fresh fruits and vegetables. Normally a type-A workaholic and a night owl, I made sure I got the proper rest. I pulled out the list of baby names I’d been compiling since seventh grade. And I began planning how to scale back my 90-hour workweek. I was a week away from the start of my second trimester, a week away from sharing my good news with family and friends.

Then I had the missing heartbeat doctor’s appointment.

Just the (Miscarriage) Facts

After two ultrasounds, the radiology center confirmed my doctor’s diagnosis: There was no heartbeat. (The technician was pretty rough and cold, but that’s another story for another day.) All my early preparation was fruitless; I was no longer having a baby.

I was hardly alone in my misery. Statistics show 1 in 4 pregnancies end in miscarriage, and most, like mine, occur within the first 13 weeks of pregnancy.

Why Miscarriages Happen

The reasons for miscarriage vary, but most of the time the cause cannot be identified. During the first trimester, the most common cause is chromosomal abnormality, meaning something is not correct with the baby’s chromosomes. But other causes can include:

Hormonal problems or infections
Improper implantation of the egg into the uterine lining
Lifestyle (excessive caffeine, drug use, exposure to radiation)
Maternal health issues (uncontrolled diabetes, thyroid disease, lupus)
Maternal age
Maternal trauma
Types of Miscarriage

To many women who have lost a pregnancy, a miscarriage is a miscarriage is a miscarriage, but your health-care provider may use one of the terms below to refer to the type:

Threatened Miscarriage: Some early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.

Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Bleeding and cramps may persist if the miscarriage is not complete.

Complete Miscarriage: The embryo has emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D and C).

Missed Miscarriage: Embryonic death has occurred but there is no expulsion of the embryo. It is not known why this occurs. Signs of this include a loss of pregnancy symptoms and the absence of the fetal heartbeat on an ultrasound. (This is the type I had.)

Recurrent Miscarriage: Three or more consecutive first trimester miscarriages.

Blighted Ovum: A fertilized egg implants into the uterine wall, but fetal development never begins.

Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated right away, this could end in serious complications.

Molar Pregnancy: A genetic error during fertilization that leads to growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy, including a missed period, positive pregnancy test and severe nausea.

Signs of Miscarriage

If you are pregnant and experience any of the following symptoms, contact your doctor immediately:

Brown or bright red bleeding with or without cramps
Mild to severe back pain (usually worse than normal menstrual cramps)
Sudden decrease in signs of pregnancy
Tissue with clot-like material passing from the vagina
True contractions (very painful and happening every five to 20 minutes)
Weight loss
White-pink mucus
Miscarriage: The Aftermath

After my miscarriage—which I handled alone and terrified—it took a full year for the emotional effects to hit me. During that year I got the “there wasn’t anything you could’ve done; it probably wasn’t your age; it was probably a chromosome problem” discussion from my doctor. I told a couple of close friends, but only in an off-hand, “don’t ask me any questions” kind of way. (“I had a miscarriage last month. Where are you going for summer vacation?”) I went back to my 90-hour workweeks without missing a beat. Of course, I did. I’m a strong black woman.

A year later I agonized. Was it that glass of wine 48 hours after conception? Perhaps the caffeine in my venti hot chocolate; I was certain I’d had five or six of them before I knew I was pregnant. I was envious of two friends who had been pregnant at the same time (though they didn’t know about my pregnancy), and who both went on to have healthy, beautiful babies. Then I was wracked with guilt over the envy. I cried with cause (mom-related Facebook posts sent me over the edge) and without provocation (the garbage man is late; bring on the tears!).

The relationship with the newly divorced guy died a quiet death, largely because we couldn’t deal with the pregnancy or our shared loss. We had one brief conversation about it that went something like this:

Me: Are we ever going to talk about it?

Him: Why? It self corrected. It wasn’t meant to be.

The handful of folks I let in on my misery squirmed when the “M” word came up. I realized that as a society we’re not comfortable with a pregnancy unfulfilled. There was no memorial service for an 11-week-old embryo. I didn’t get flowers or cards, and because I didn’t want to distress other people, I stopped talking about it. I was alone in my grief.

The American Pregnancy Association suggests women who have lost a baby take the necessary time to grieve, seek counseling and accept help. In my haste to move beyond such a painful and sad time, I tried to rush my emotional healing process. It is only now, more than three years later, that I’m able to comprehend my loss and put things in perspective. When folks ask why I don’t have children in that “don’t you like kids?!” disdainful way—as a new guy I started dating did—I say, “I had a miscarriage when I was 11 weeks pregnant.”

And you know what? I didn’t care one bit that it made him squirmy and uncomfortable.

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Kendra Lee