Over 90 Percent of What Planned Parenthood Does, Part 24: Miscarriage Management and Counseling

Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl never knew about.

holding handsMiscarriage. It’s a common occurrence — at least 10 to 15 percent of all pregnancies end this way — but one that is not often spoken about. When carrying a wanted pregnancy, its sudden loss can trigger a range of emotions. During this time, Planned Parenthood can help.

There is no “right” or “wrong” way to feel after having a miscarriage.

What Is Miscarriage?

When a pregnancy ends before it has reached the 20-week mark, a miscarriage has occurred; most miscarriages occur within the first eight weeks of pregnancy. Pregnancy loss after the 20-week mark is called stillbirth, and while it isn’t as common as miscarriage, stillbirth occurs in 1 out of 160 pregnancies.

Signs of a miscarriage include vaginal bleeding or spotting, severe abdominal pain or cramping, pain or pressure in the lower back, or a change in vaginal discharge. These symptoms aren’t specific to miscarriage — they could indicate other problems, so visit a health-care provider if you experience them during your pregnancy.

After a miscarriage, you might have pregnancy-related hormones circulating in your body for one or two months. Your period will most likely return within 4 to 6 weeks. While you may be physically ready to get pregnant again after you’ve had a normal period, you might want to consult with a health-care provider about the need for medical tests. You also might need to think about when you will be emotionally ready to try for another pregnancy.

Miscarriage: Causes and Risk Factors

Those who have experienced miscarriages might blame themselves, believing that they must have done something to cause it. However, a miscarriage is almost never the fault of the person who was carrying the pregnancy. While it’s often not possible to pinpoint the cause of any one miscarriage, there are some things we know increase risk. Usually, miscarriages are caused by genetic problems with the sperm, egg, or resulting embryo — for example, when it has too many or too few chromosomes. Obviously, these mistakes in cell division are beyond the control of the pregnant person.

Risk can be increased by severe trauma and serious infections. Miscarriage risk can also increase as the pregnant person gets older, and severe chronic disease, like diabetes, rheumatoid arthritis, or lupus, can contribute to risk as well.

There are a few risk factors for miscarriage that are within the pregnant person’s control: smoking, heavy alcohol intake, and cocaine use are known to increase the chances of a miscarriage. There are conflicting studies on caffeine as a cause of miscarriage, so to be on the safe side, it’s recommended to limit caffeine intake to 200 milligrams a day.

Pregnancy loss is not caused by sexual intercourse, exercise, minor falls, or most medications.

Miscarriage Management

Many miscarriages resolve on their own, and the patient does not need to seek medical treatment. Sometimes, however, some of the pregnancy-related tissues remain inside the uterus and must be removed to avoid infections or further vaginal bleeding. Planned Parenthood Arizona can treat these miscarriages either with medication or by a simple surgical procedure, or can simply monitor your condition. PPAZ will counsel with you to figure out the best option.

Medication will cause the uterus to contract, expelling the remaining pregnancy-related tissues. This can be accompanied by cramping and bleeding, though there are other medications to help control blood loss. Side effects of medications used to complete miscarriages might include nausea, vomiting, diarrhea, headaches, dizziness, fatigue, and chills or hot flashes.

An in-clinic aspiration procedure similar to a D&C, or dilation and curettage, is commonly used to treat a miscarriage surgically. To perform this procedure, a health-care provider will dilate the cervix and use a thin plastic tube connected to gentle suction to remove pregnancy-related tissue.

We also do expectant management, or “watchful waiting,” which means that we’ll monitor you during your miscarriage to make sure it resolves on its own. This method can take longer, but it might be appropriate for those of us who wish to avoid medication or surgical treatment. We’ll monitor your blood pressure, iron levels, temperature, and pain levels to ensure that you’re not developing any infections or bleeding excessively.

Miscarriage Counseling

There is no “right” or “wrong” way to feel after having a miscarriage. For some people, it can be an upsetting and tragic experience. For others, it can be accompanied by a sense of relief. Some people have a more emotionally neutral reaction. Some people’s feelings encompass a seemingly contradictory collection of emotions, from relief to grief, and from anger to guilt. Everyone is different, and that includes their miscarriages and the feelings they have about them.

Whatever your emotions are, give yourself permission to feel them — they are valid. You can also give yourself permission to experience changing or contradictory emotions. If you are suicidal, you can go to an emergency department, or call 911 or the National Suicide Prevention Lifeline at 1-800-273-TALK (8255).

If you have a partner, recognize that he or she might experience the loss differently from you. It’s important to communicate your feelings to one another so you can give each other the support you both need. You also might seek out counseling, support groups, or ways to memorialize the baby you hoped to carry to term.

At Planned Parenthood Arizona, we can talk to you about your miscarriage — not only about the physical and medical aspects of it, but about the feelings, hopes, and fears you may have afterward. If you want to get pregnant again, we can talk to you about when it would be best to start trying for another pregnancy. If you want to prevent pregnancy, we can talk to you about short-term or long-term birth control methods. If you need more extensive counseling, we can refer you to resources in your community for more in-depth services.

Planned Parenthood Arizona offers miscarriage counseling at all of our locations. We offer miscarriage management at our health centers in Flagstaff, Glendale, Tempe, and the Sanger Center in Tucson.