Pregnancy loss is common, devastating, and not spoken about nearly enough.
First up, if this is something you have recently gone through or you know someone that has, it’s vital to acknowledge that this experience comes with a great deal of physical and emotional distress.
It’s important to take the time to grieve and navigate the loss that’s happened.
What we often leave out of the discussion around pregnancy loss is how common it is — as in every ten to twenty percent of pregnancies.
And, although it happens so frequently, it’s only recently that we’ve started talking about it openly.
While no two stories are the same, it can really help to know that you’re not alone in this experience.
We’re firm believers in having these conversations to remove the unnecessary isolation that comes with an already traumatic experience.
Slowly, it’s becoming less taboo.
With that in mind, we’re going to take you through the details of pregnancy loss.
We know this topic can be tough.
And reach out for support when you need it.
In this article: 📝
- What are the two types of pregnancy loss?
- What is the most common cause of pregnancy loss?
- What is the difference between miscarriage and pregnancy loss?
- Symptoms of a miscarriage
- What are the possibilities of experiencing a second miscarriage?
- What’s the best way to announce a pregnancy loss?
What are the two types of pregnancy loss?
Miscarriage is pregnancy loss that happens in the first 20 weeks of pregnancy.
After 20 weeks, pregnancy loss is referred to as stillbirth.
About 80% of miscarriages happen in the first trimester (before twelve weeks of pregnancy).
The American College of Obstetricians and Gynecologists refers to a miscarriage before 13 weeks as “early pregnancy loss.”
It happens in about 10% of known pregnancies.
Whenever it happens, loss is loss.
And healing requires time.
A note on the terminology around pregnancy loss
If you find the terminology around miscarriage and pregnancy loss confusing (and sometimes downright harmful), you’re not alone.
That’s where our #RenamingRevolution comes in — an initiative to revamp some of the outdated, damaging terminology around fertility and motherhood.
If you can believe it, stillbirth was previously known as “fetal demise” — a less-than-comforting term when you’re already going through such a painful experience.
For the same reasons, we’re not fans of “spontaneous abortion” (a natural loss of pregnancy before 20 weeks) and prefer to call it what it is: pregnancy loss.
Very early pregnancy loss was (and often still is) known as a “chemical pregnancy.”
That’s because your body produces enough hCG for a pregnancy test to show positive, but the embryo doesn’t manage to implant itself fully in the uterus.
“Chemical pregnancy” can be a damaging term too, as it doesn’t acknowledge that there was actually a pregnancy and that loss has been suffered — so it doesn’t allow space for grief.
We prefer early pregnancy loss.
Other terms we’ve revamped?
- “Failed pregnancy” is out, and “pregnancy that will not carry to term” is in.
- For “non-viable pregnancy,” we prefer “pregnancy unable to continue.”
- We call abnormal bleeding “pregnancy bleeding” rather than a “threatened miscarriage” or “threatened abortion.”
What is the most common cause of pregnancy loss?
Pregnancy loss before 20 weeks is usually because the fetus is not developing as it should.
Most early miscarriages happen because of chromosome issues.
More often than not, this is because of how DNA is distributed when the egg was fertilized, rather than anything that’s been inherited from the parents.
Chromosomes are in all the cells in your body.
They are threadlike structures that contain your genes.
Simply put, this is your DNA.
Most people have 46 chromosomes, 23 from each parent.
When an egg and sperm come together, they create a zygote, a single cell containing the 46 chromosomes from both sides.
Sometimes, there is an issue with how the chromosomes divide and as a result, how the embryo and fetus develop.
This can either be an abnormal number of chromosomes — either too many or too few — and means the developing embryo may not survive.
Or it could be that the chromosomes don’t divide properly causing a mismatch in gene locations.
This single cell with 23 pairs of chromosomes then splits into two, again and again, in a process called mitosis.
Through this splitting, your zygote becomes an embryo, and that embryo develops into a fetus.
In some cases:
A fertilized egg implants but is unable to develop into an embryo
This is referred to as a “blighted ovum,” but again, that’s not a term we love.
We prefer “early pregnancy without an embryo.”
An embryo forms but is unable to develop
Another bit of terminology we’re done with — “intrauterine fetal demise.”
It’s simply early pregnancy loss.
A full or partial molar pregnancy
This is a pregnancy that has resulted from the abnormal fertilization of an egg.
There are two types, a full molar pregnancy (also known as a hydatidiform cyst) is made up of many fluid-filled sacs, an empty egg containing no chromosomes, and no fetal or embryonic parts.
A partial molar pregnancy results from an egg that has been fertilized by two sperm.
This results in only some fetal or embryonic parts forming.
This is a less severe form of molar pregnancy but can be more traumatic because of what it represents.
Molar pregnancies can happen to anyone, but they are rare, happening in about one in 1000 of all pregnancies.
Unfortunately, it means a complete embryo is unable to form.
The tissue will have to be removed, either through surgery or medication that helps your body get rid of it.
It’s important that all the tissue is removed once molar pregnancy is diagnosed.
Your doctor will guide you through the process.
The good news is that, in most cases, you can go on to have future healthy pregnancies!
What is the difference between miscarriage and pregnancy loss?
As discussed, pregnancy loss in the first half of a pregnancy is called a miscarriage, while a loss in the second half is called a stillbirth.
While there are overlaps, the causes of pregnancy loss tend to depend on when in pregnancy the loss occurs.
We’ll take you through the details of each.
First-trimester pregnancy loss
While chromosome problems are the most likely reason for a miscarriage during this period, there are other possibilities, which we list below:
- Problems with the placenta
- Smoking or taking drugs
- Drinking lots of caffeine
- Drinking alcohol
Second-trimester pregnancy loss
While first-trimester pregnancy loss tends to revolve mostly around chromosome challenges, second-trimester losses tend to be related to the following:
Chronic health conditions
If you have any of the long-term health conditions below, it’s important to get treatment for them as soon as you start your TTC journey.
The more control you have over them, the less likely they are to interfere with your pregnancy.
- Conditions related to high blood pressure
- Conditions like polycystic ovarian syndrome (PCOS) and endometriosis that are related to your reproductive hormones
- Diabetes, particularly if it’s not well controlled
- Autoimmune conditions, including lupus, antiphospholipid syndrome (APS)
- Anything related to your thyroid
- Kidney disease
Uterus or cervix issues
Some people have a uterus that only has one fallopian tube (unicornuate uterus), a uterus that has a tissue that splits it (septate uterus), or a differently-shaped uterus that looks like it has two parts (bicornuate uterus).
Others develop leiomyomas (fibroids) or adhesions (build-up of scar tissue) within the uterus.
These conditions all come with a greater miscarriage risk and potential TTC trouble.
Your cervix is the bridge between the uterus and the vagina.
Sometimes, your cervix shortens and opens before labor, and this can cause premature birth or pregnancy loss.
(This condition is also attached to another harmful piece of terminology — “incompetent cervix.” We prefer “early cervical dilation.”)
Although the research is still ongoing, higher risks of miscarriage have been linked to the following infections:
- German measles (rubella)
- Cytomegalovirus (CMV) — a virus related to the ones that cause chickenpox and mono
- Herpes Virus
- STIs, including chlamydia, gonorrhea, syphilis, and HIV
- Bacterial vaginosis (BV)
- Parvovirus B19
- Toxoplasmosis (related to cleaning cat litter, something you should definitely avoid when pregnant)
- Food poisoning, including listeriosis, toxoplasmosis, and salmonella. (That’s why deli and uncooked meats, raw fish, and unpasteurized dairy products are off the pregnancy menu.)
These medications are linked to an increased risk of miscarriage:
- Retinoids, like Accutane used to treat severe acne
- Non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin, ibuprofen, and naproxen (related to specific periods during your pregnancy – consult your doctor on this, as sometimes this drugs help you during pregnancy)
- Misoprostol, a medication sometimes taken to prevent stomach ulcers caused by NSAIDs.
- Methotrexate, a radiation therapy used to treat various serious conditions, including severe psoriasis and rheumatoid arthritis, as well as certain types of cancers. This medication is often prescribed for ectopic pregnancies.
It’s so important to check in with your doctor before taking any medication while you’re pregnant — even if the specific medication is not on the official no-go list.
That way, you can be confident that any medication you’re on is appropriate for your specific body and health needs.
Other risk factors for miscarriage
There are a number of other factors that put you more at risk for pregnancy loss.
We’ll take you through them.
But know that just because you tick any of these boxes, it doesn’t mean that pregnancy loss is inevitable.
It’s still very possible to have a healthy pregnancy, particularly if you keep up with your prenatal visits and take care of your physical and mental health during pregnancy.
Factors that increase the risk of having a miscarriage include:
- Age. The risk of miscarriage has been shown to increase after 30, and increases significantly after 45, where 53% of pregnancies are lost. (Again, not a reason not to have a baby later in life, just a reason to be aware of the risks so that you can get the care you need.)
- Having had a miscarriage before. While in many cases, miscarriage happens only once, the risks of pregnancy loss increase with multiple miscarriages.
- Weight. Being either underweight or overweight can increase the chances of miscarriage.
- Substance use. Smoking, alcohol, and other drugs can up the risk. (If you need help, SAMHSA provides a number of important resources, including a national helpline and online treatment locator.)
- A medical procedure or treatment. You may require additional testing during your pregnancy which may carry its own risks. Examples are amniocentesis and chorionic villus sampling.
(Still, it’s important to talk to your doctor before trying any new activities while pregnant.)
Symptoms of a miscarriage
The most important thing to watch out for is vaginal bleeding.
Some light spotting is normal at the beginning of your pregnancy (known as implantation bleeding).
But if you experience heavier bleeding, the blood is bright red, or you see clots, it’s important to check in with your doctor.
(It’s also okay to check in with your doctor anytime you’re worried, even if it seems “silly.”)
Other signs to watch for are cramping, pain in your lower abdomen, and unusual vaginal discharge with a foul smell.
And if you’re feeling sick — fever, chills, and pain — talk to your doctor.
This can be a sign of an infection in your uterus (called a septic miscarriage).
Note that many of these symptoms can be due to other illnesses, or simply the ups and downs of pregnancy.
Keeping in touch with your medical team and sticking to your routine prenatal appointments means you are more likely to get the right kind of help when you need it.
The CDC’s definition of stillbirth is the loss of a baby after week 20 of pregnancy or during delivery.
The difference between a miscarriage and a stillbirth is when they occur — both are loss.
Stillbirth happens in about one in every 175 births.
An early stillbirth happens between 20 and 27 weeks, a late stillbirth between 28 and 36, and a term stillbirth is at 37 weeks or after.
Some of the risk factors for stillbirth are similar to that of miscarriages.
Having specific medical conditions or substance abuse troubles, or having experienced previous pregnancy loss are all linked.
According to this study, contributors to stillbirths are:
- Complications in pregnancy and labor (like gestational hypertension, gestational diabetes, and heavy smoking).
- Being pregnant with multiples.
- Problems with the placenta, like placental abruption (where the placenta separates from the womb) or not enough blood flow to the placenta
- Genetic differences in the fetus (which contribute to about 10% of stillbirths) and fetal heart anomalies
- An infection in either the mother or the fetus (although this is more likely to cause miscarriage than stillbirth)
- Issues with the umbilical cord that cut off oxygen to the fetus
- Fetal Hydrops (accumulation of fluid)
- Health issues in the mother, like high blood pressure disorders, diabetes, and uterine rupture
Another possibility is Rh disease, where the mother’s blood builds up antibodies after her first pregnancy.
This means her blood may be incompatible with the second pregnancy fetus’s blood.
And as devastating as the reality is, sometimes, stillbirths just happen.
In fact, there’s a name for this — “unexplained stillbirth.”
Get medical help right away if you experience any serious pain or have new spotting or bleeding.
One of the symptoms of stillbirth is that you stop feeling your baby moving or kicking.
But it’s also possible that your baby is relaxing in there for other reasons.
We take you through what to know about decreased fetal movement here and when you should go to the doctor.
Fetal heartbeat is one of the diagnostic tools for stillbirth.
If a doctor is unable to read the fetal heartbeat with a stethoscope or doppler, they may try an ultrasound.
If there is no heartbeat on an ultrasound, they will give a stillbirth diagnosis.
If this happens, your medical team may wait for you to go into labor on your own to birth the fetus, or they may induce labor.
We know — this is terrifying to think about.
But it helps to know what to look for ahead of time so that you can get medical attention if needed.
The most important thing to know is that if you experience pregnancy loss, it’s not your fault.
This can be an incredibly traumatic experience to go through.
It’s vital that you get support, preferably from a trained counselor.
Lean on your friends and family.
Talk to your Peanut community.
Grieve in the way that you need to.
You may want to have a funeral ceremony for the life that was lost, express your feelings through creative practices like writing and art-making, or simply spend time with your loved ones talking about the experience.
There’s no one way to do this.
What are the possibilities of experiencing a second miscarriage?
There’s good news here — for many people, pregnancy after loss is completely possible.
Repeated miscarriages happen only about one percent of the time.
Know that pregnancy after loss can come with all sorts of feelings.
You’re processing the death of the baby you lost while at the same time feeling the joy of being pregnant again.
You might also be fearful and anxious about how your pregnancy is going to progress.
Again, counseling and having support in your community can really help here.
And know that it’s 100% OK to feel all the complex feelings you might be feeling right now.
Some people experience recurrent miscarriages.
And unfortunately, the risk of miscarrying goes up with each subsequent miscarriage.
After one miscarriage, the risk of miscarrying is slight.
But, with each miscarriage, the risk does go up exponentially.
Of course, the emotional toll of this can be huge.
But there’s hope!
Many women who experience recurrent miscarriages do go on to have healthy, successful pregnancies.
What’s the best way to announce a pregnancy loss?
Firstly, you don’t have to if you don’t want to.
But if you find it a useful part of your grieving process, bringing your community into your experience can be valuable.
And again, how you do this is up to you.
You might only want to share the news with your closest friends and family, or you might want to talk about your experience more publicly.
While we are huge advocates for breaking the taboos around pregnancy loss and bringing the topic more out into the open, you don’t have to share anything unless it helps with your healing.
If you’d like to make an announcement by mail or on social media, these quotes about miscarriage can be a useful anchor point.
Or you can tell people in person or over the phone.
Do what feels right for you.
Pregnancy loss can truly be one of the greatest emotional and physical challenges you ever face.
We’re here for you — wherever you’re at and however you want to navigate this.