Tanya had three miscarriages in her late thirties before she finally told anyone about them — and she was taken aback by the realization that she wasn't alone. “A dozen of my friends [finally told me they] had had miscarriages, too,” she explains. Tanya, a writer in NYC, isn’t necessarily shocked by how hush-hush miscarriage (a.k.a. the loss of a fetus before the 20th week) is often treated, both by the families who have them and by the culture at large. A national survey found that most people — both men and women — incorrectly consider miscarriage “very uncommon.”
In reality, for every 10 pregnancies, one or two end in miscarriage, according to Deborah Nucatola, MD, Ob-Gyn and senior director of medical services at Planned Parenthood Federation of America. That figure may actually be higher; some women never realize they’re pregnant or miscarrying to begin with. Because so many people don’t understand how widespread miscarriage is, they don’t discuss their own experiences and may end up feeling isolated. As Lindsay, who miscarried at eight weeks, explains, “Death is measured by a sort of social barometer — people understand how much comfort to offer when a parent or a spouse dies… A fetus that could have been your baby? Where is that on the barometer? [It] mystifies a lot of people.”
Indeed, a common frustration for women who have gone through miscarriage is figuring out how to navigate through all the awkward or ill-informed questions and comments. Janet Jaffe, PhD, a San Diego-based psychologist and director of the Center for Reproductive Psychology, notes, “When well-intentioned people [say things like] ‘You’re young, you can have another,’ they discount the attachment that a parent may [already] feel, as if one simply can replace one baby, or one pregnancy, with another.”
Obviously that isn’t the case. In fact, Dr. Nucatola believes that talking about miscarriage is still somewhat socially stigmatized because of the intensity of the pain it can trigger. And, those feelings can be even more powerful for a woman who experiences multiple miscarriages — after losing one or more pregnancies, “trying again” can begin to feel incredibly loaded and anxiety-provoking. Some women end up constantly trying to steel themselves for yet another loss.
So, what are the primary causes? According to Dr. Nucatola, most miscarriages are sparked by a chromosomal problem “when the fertilized egg divides and grows.” This is the case in about half of all miscarriages that occur within the first three months of a pregnancy. Other contributing factors are: advanced age; severe, chronic illnesses such as lupus, poorly controlled diabetes, or rheumatoid arthritis; severe trauma or infection; abnormalities in the uterus such as scar tissue or uterine fibroids; smoking, drinking, drug use, or excessive caffeine consumption; and being underweight or overweight.
As for ways to prevent miscarriage, Dr. Nucatola advises women to stay as physically sound as possible. “The healthier you are, the stronger you and your baby are likely to be,” she says. In this case, “healthy” means maintaining good nutrition, exercising, making positive lifestyle choices — and, if possible, making those changes before getting pregnant. She also suggests taking a prenatal vitamin with at least 400 micrograms of folic acid every day.
But, what about women who miscarry repeatedly, like Tanya? “Recurrent miscarriage” is the term used to describe three or more consecutive pregnancy losses in the first or early-second trimester. A woman may want to see an infertility specialist after having two miscarriages in a row — or after any second miscarriage if the woman is 35 or older. A specialist can test for specific causes and intervene with appropriate medical treatments as necessary.
Meanwhile, Tanya has stopped trying to conceive, but: "I often thought about adopting and still do,” she says. “I’m healing...and getting ready for the next phase of life. At the moment, I am not only at peace...but content with being kid-less.” Tanya also wrote a book about women’s fertility, touching on her own experience with miscarriage, which helped her work through some of her feelings.
Overall, our ongoing cultural confusion regarding how to talk about miscarriage seems like a natural, albeit sad, extension of our uncertainty around how to address grief in general. The loss of a child (even an unborn one) is messy, raw, and in some ways feels too terrifying for most of us to even imagine. As author Peggy Orenstein describes in her essay “Mourning My Miscarriage,” “It is only if your pregnancy is among the unlucky ones that fail that you begin to hear the stories, spoken in confidence, almost whispered.”
But, why must we whisper them? Tanya, for one, hopes we won’t — not anymore. We should stop viewing miscarriage as a “tragedy that must be kept private,” she says, and start discussing it emphatically, for what it is: a sad common ground that hundreds of thousands of women worldwide regularly tread upon. Does it feel easier to just stick our fingers in our ears, yell “I can’t hear you,” and try to avoid imagining — or discussing — it at all? Of course. Does that make it the healthiest approach, for ourselves or other women? Definitely not.