THE MYSTERIES OF MISCARRIAGE The first thing women ask themselves after they’ve had a miscarriage is “what did I do wrong?” Clinical studies show that there are many causes and effects that result in miscarriage. Miscarriage is very common and there is not usually much you can do to prevent it. In my opinion, if women had more knowledge on the controllable causes of miscarriage, the uncontrollable causes of miscarriage, and the likelihood of it happening again, it would help them cope with grief and depression after experiencing miscarriage.

Knowledge of controllable causes is important when preparing for a healthy pregnancy. There are many things within a woman’s control and can easily be avoided. Common controllable risk factors include obesity, previous fertility treatments, the woman’s age over 35, an active infection in pregnancy, smoking during pregnancy, consuming alcohol on a daily basis, cocaine or amphetamine use during pregnancy, and malnutrition or severe anorexia (Young and Zavatto, 2008). Stressful life events and working night shift have been shown to be environmental factors that may induce miscarriage. Sleeping less than 8 hours a day and standing for more than 3 hours a day are also shown to be controllable risk factors in miscarriage (Samaraweera and Abeysena, 2010). Exposure to various teratogenic agents such as high dose radiation, chemical, second hand smoke, and moderate to heave caffeine consumption can cause vascular compromise and embryonic damage (Gilbert, 2007). That is just a list of some of the precautionary measures that can be taken, that are usually controllable.

Maintaining a healthy body weight plays a huge factor in the miscarriage rate. Suzanne Schlosberg says “About half of all pregnant women pack on too much weight (Schlosberg, 2009, pg 72.)” Excess weight increases the risk of preeclampsia and gestation diabetes, boosting the odds that the mother and baby will develop diabetes or obesity years later. Also, cesarean section rates are higher among mothers who are obese. However, eating too little can cause low birth weight and increase the risk of prematurity (Schlosberg, 2009). Schlosberg also says “Eating an extra 300 calories per day in the second and third trimester is required to deliver a healthy baby (Schlosberg, 2009, pg 72).”

However, food intake is not the only controllable risk factor women should be aware of. It is important to limit the exposure to toxic chemicals. Inhaling or ingesting certain chemicals such as solvent, paints, cleaners, and pesticides can cause birth defects and even miscarriage (Schlosberg, 2009). One major toxic chemical to be careful of while pregnant is Polychlorinated biphenyls (PCBs). PCBs are synthetic compounds that are the poisonous leftovers from toxic industrial chemicals, which were banned in the United States in 1977. However, PCBs still exist in many areas of the environment, and are commonly found in the bottom of rivers and lakes. They build up in the fatty tissue of certain fish and, although are not known to be generally harmful in small doses to the average person, they can cause birth defects and possible miscarriage if consumed in large quantities (Young and Zavatto, 2008). Other chemicals pregnant women should try to avoid direct contact with include benzene, formaldehyde, lead, mercury and insecticides.

Not all chemicals are shown to result in miscarriage and harmful to the baby, unless used on an everyday basis and in large quantities. Everyday examples that are encountered, include cleaning fluids, nail polish and hair treatments, household bleach, rubbing alcohol and ammonia, soaps and detergents. Young and Zavatto say “Most paints today are now water-based and therefore safe to use if one is pregnant (Young and Zavatto, 2008, pg 250).” Also, mold, dust, and other airborne particles may cause disease and allergy, but are not associated with miscarriage (Young and Zavatto, 2008).

However, there are some hormonal, chromosomal and genetic factors that cannot be controlled and may cause miscarriage. Early miscarriages are likely to be caused by nonrecurring genetic abnormality of the embryo (Gilbert, 2007). Gilbert says “Approximately 50 percent of most early miscarriages have a chromosomal abnormality (Gilbert, 2007, pg 311).” An abnormal embryo can also be referred to as a blighted ovum. A blighted ovum is an outdated and often inaccurate term used to describe an abnormal ovum, or egg, which is cause for an unhealthy pregnancy instead of an abnormal embryo which is cause for miscarriage (Young and Zavatto, 2008). If the threatened miscarriage is due to abnormal hormones, it is not necessary to perform measures to save the fetus, because the doctor is then just delaying the miscarriage process. However, if the threatened miscarriage is due to inadequate hormones, these tests will identify the hormone deficiency and hormone therapy can usually save what is called an otherwise normal pregnancy.

Another uncontrollable risk factor during pregnancy can be infection. Young and Zavatto say that “Any infection severe enough to produce prolonged high fever, an oral temperature over 101 degrees, can be a cause of miscarriage (Young and Zavatto, 2008, pg 235).” Gilbert says “Severe viral, bacterial, parasitic or fungal infection that causes viremia or bacteremia can also stimulate abortion (Gilbert, 2007, pg 312).” Uncontrolled systemic diseases like diabetes, systemic lupus, erythematosus, sickle cell anemia, hypertensive cardiovascular disease and thyroid imbalance can also cause miscarriage (Gilbert, 2007). Many do not know this, but a single umbilical artery alone can be a leading factor to miscarriage. Hypercoiling and thinning with consecutive constriction of the umbilical vessels can fatally damage the fetus (Horn, L., Faber, R., Stepan, H., Simon, E., Robel, R., & Wittekind, C.). A miscarriage complicated by the malformation of the umbilical cord occurs approximately 3 weeks earlier than in cases without a confirmed malformation. Also, Cahill says “Women who elected amniocentesis were more likely to experience a pregnancy loss than thos who did not (Cahill, 2009, pg 257)”. Amniocentesis is a medical procedure used in prenatal diagnosis of chromosomal abnormalities and fetal infections.

Many women fear that they will not be able to carry a baby full term once they have experienced a miscarriage. However, miscarriage is proven to be very common for women. Young and Zavatto say “About 25 percent of all pregnancies will miscarry (Young and Zavatto, 2008, pg 26).” Miscarriage is typically diagnosed early due to 95 percent of miscarriages occurring in the first trimester. There are some common symptoms related to miscarriage, pain in the lower abdomen, vaginal bleeding with or without passing tissue from the vagina, and cramps similar to strong menstrual cramps. It has been shown that after one miscarriage, the statistics are the same as though the woman had never miscarried. Only after in a row do physicians think about an underlying cause; and only after three recurrent miscarriages is there a statistical increase in the chance for another (Young and Zavatto, 2008). Young and Zavatto say “That even after three miscarriages in a row, there is still a 72 percent likelihood of a term pregnancy and a healthy baby the next time (Young and Zavatto, 2008, pg 33).”

Women experience a lot of guilt, shame, and remorse after experiencing a miscarriage. When conducted in an interview, Jessica Fowler said she felt as if she almost had post partum depression. Fowler said when the miscarriage first happened she blamed herself. She 13 years old, 5 months pregnant, and knew the sex of the baby when her miscarriage took place. She claims she was not well educated on what foods to eat to be healthy, how much weight gain was normal or the limit of everyday physical activity. Fowler also claims that she feels as though she was so young she did not know what questions to ask her health care provider. After have many test done after the miscarriage, Fowler claims she miscarried because her body was not mature enough to carry a fetus full term. Fowler said that is the only form of closure she has had from the miscarriage. Fowler is now 20 years old. She has no sign of pregnancy since the miscarriage but hopes to be pregnant again one day.

All in all, miscarriage is shown to be very common. It is very hard for the mother not to feel the guilt when she experiences a miscarriage. There are a lot of question that will run through her mind like “What did I do wrong?”,” Why did this happen to me?”, or “What can I do to prevent it the next time?” Pregnancy loss has many reasons. Some reasons can be controlled such as obesity, not smoking, not taking in drugs or alcohol, watching the caffeine intake, and avoiding toxic chemicals. Some reasons cannot be controlled such as hormonal, chromosomal and genetic factors. Also systemic infections such as viral, bacterial, parasitic or fungal infections may be uncontrollable causes of miscarriage. But it is important for women to understand that just because a woman miscarries once, does not mean that she can’t ever have children again. Miscarriage is a very common thing, and the likelihood of delivering a full term baby after one miscarriage is a good as if the first miscarriage never took place.