Miscarriage

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Before I formed you in the womb I knew you.
–Jeremiah 1:5

Pregnancy begins psychologically, long before it does physically. From an early age, children have imaginative play about having babies and being parents. Teenagers fantasize of love, marriage, and family. Young couples talk, plan, and dream about birth and how many children they will have.

If you are trying to conceive, it can seem like you already know this child well – the wished-for baby in many become pregnant, bonding increases. This is facilitated by information learned from new medical technology, which just not so long ago would not have been know until after birth. Today, blood tests can let a woman know she is pregnant before she misses her period. Sonograms provide a window into the uterus and a picture of your baby before any physical changes have occurred to make others aware of your pregnancy. Genetic blood testing can let you know the sex of your baby and genetic make-up before you are even wearing maternity clothes. Because of these factors, the fetus is seen as a baby/person much earlier and bonding occurs much sooner than in years past.

The magnitude of miscarriage – to lose a baby within the first few months of conception – can be great. For you to experience the elation of learning you are pregnant, only to feel the despair of discovering you have miscarried, is a multifaceted loss. It is the loss of a baby, a part of yourself, your health, control, innocence, potential, relationships with others, possibly your reproductive capacity, and on and on.

The same kinds of feelings can be experienced after an unsuccessful IVF cycle. You may view each fertilized egg, whether transferred or not, as a baby. When a cycle fails to achieve a confirmed pregnancy it can feel like a miscarriage.

In our society, we measure grief by the size of the coffin.

– – Sherokee Ilse, Empty Arms

It is often difficult for people to understand what a profound loss a miscarriage can be for a couple. And yet the grief can be like a tidal wave that sweeps over you when you lose your baby, no matter how far along you were. Feelings such as disbelief, anger, rage, blame, guilt, sadness, and depression may engulf you, growing and cresting with time. The feelings can recur and are highly individual, based upon your own personality and life experiences. Grieving is a uniquely personal experience.

The size and depth of the tidal wave will depend on a number of factors, primarily concerning your psychological investment in this pregnancy. For example, often the longer one has been trying to conceive, the greater the sense of loss that results from miscarrying. The wave of grief seems to crest somewhere between three to nine months after your loss.

When the crest has passed and the water seems to have calmed, there can still be swells. These are rekindled feelings and are often triggered by reminders of your baby – your due date, holidays, or times of the year. Each person has his or her own triggers which are related to real memories and what you wished or imagined about your baby.

A person is a person no matter how small …

– – Dr. Seuss, Horton Hatches the Egg
Grieving is the way to heal emotionally from the loss of your baby. Here are some positive steps that can help you in the healing process:
  • Recognize that your miscarriage is a significant and real loss. It is the death of a baby, with all the hopes and dreams. Find ways to acknowledge your baby’s existence: have a memorial or religious service; give a donation or gift to a special charity; plant a tree or flowers; put together a memory box; engrave a charm to wear; or give your baby a name.
  • Understand that you and your partner will feel and deal differently with the loss. Be patient and understanding of each other’s feelings, realizing that different doesn’t mean better or worse. You will each need time to integrate this loss into your life. Keep communication open.
  • Let people know how you feel and what they can do to help you. You may find that one of the most difficult tasks after a miscarriage is facing the people who knew you were pregnant. Sometimes they may say things that are hurtful, however well intended. Often people want to help but don’t know how.
  • Prepare ahead for such “reminder” days as your due date, holidays, and the anniversary of your miscarriage. Make some gesture of commemoration, such as lighting a candle, attending a religious service, or making a memorial donation. Have a special dinner or send flowers in your baby’s memory to someone who has been especially supportive.
  • Seek support from others who have had similar experiences, through support groups and friends, or by reading books on the subject. Organizations such as Resolve, Share, MIS, and Return to Zero offer groups and resources specifically for pregnancy loss. Professional counseling with a mental health professional trained in reproductive loss can also help you get through a difficult period.
  • Find creative ways to express your feelings. Use art as a medium to channel emotions, such as writing a letter or journal to your baby, drawing, composing music, or sculpting. This beautiful poem sums up the magnitude of miscarriage:
A Pray for Baby
Never to have known you, but to have loved you.
Never to have held you, the way mothers do.
With you I bury my hopes and dreams
For an unknown child I’d never seen.
But also I bury the love in my heart
And the sadness of knowing that we must part.
And I pray to God to do for you
All the things that I would like to do.
And to keep my baby safe from harm
To laugh and frolic in springtime’s arms.

Suggested Reading

The Miscarriage Map: What to expect when you are no
longer expecting. Sunita Osborn, 2019.

Support Resources

Resolve
Miscarriage, Infant Death and Stillbirth (DMV
area)
SHARE
MISS Foundation
Return to Zero

Used with permission of:
Sharon N. Covington, LCSW-C
August 2022

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It is devastating when a desired pregnancy ends in miscarriage. It is natural to wonder whether a pregnancy loss will affect future fertility. Patients may wonder, “Will this keep happening to me?” or “Was there anything I could have done to prevent this loss?” 

The unfortunate truth is that miscarriages are common. Approximately 20 percent of medically confirmed pregnancies will end in miscarriage—this risk goes up with maternal age. The risk of miscarriage is ~50% for women who get pregnant in their mid to late 40s. For early and unconfirmed (or yet to be discovered) pregnancies, the rate of loss is even higher. Altogether, it is estimated that roughly 60 percent of pregnancies will end in miscarriage. 

However, having one miscarriage or even more than one miscarriage does not mean you will be unable to carry a baby to term. 

What caused my miscarriage? 

“Approximately 50-70 percent of all miscarriages result from genetic abnormalities in the embryos,” informs Caleb Kallen, M.D., Ph.D., who sees patients at SGF’s Philadelphia and Chesterbrook, Pennsylvania offices. “In these cases, one or more chromosomal abnormalities within the embryo are incompatible with normal development so development “stalls.” Additional causes of pregnancy loss may include anatomic, immunologic, or hormonal issues during the pregnancy. In many cases, the cause of pregnancy loss remains unknown.”

Genetic Abnormalities

Patients who have had a dilation and curettage D&C may choose to have the tissue collected and tested for genetic/chromosomal abnormalities. Genetic abnormalities fall into 2 broad categories: 

  • Non-recurrent: not likely to repeat in future pregnancies. The majority of genetic abnormalities are non-recurrent. These include random chromosomal errors in the formation of each embryo—wherein each consecutive loss is attributed to an error different than the one before. 
  • Recurrent: likely to repeat in future pregnancies—most commonly something called a balanced chromosomal translocation in the male or female partner. 

There are treatments that reduce the risk of pregnancy loss from recurrent and non-recurrent genetic causes. If your physician finds that your pregnancy losses resulted from a recurrent genetic cause, there are treatments to minimize the risk of future losses. One strategy is to pursue in vitro fertilization (IVF). The process of IVF includes generating embryos outside of the body, in culture. Embryos can then be sampled by taking cells that the embryo doesn’t need, cells destined to become the placenta—and to screen the genetic content of each embryo. This testing, called Preimplantation Genetic Testing (PGT) can greatly reduce the risk of pregnancy loss from recurrent and non-recurrent genetic causes.  

Immunologic Disorders 

Patients who have experienced recurrent miscarriage are commonly tested for an immunologic disorder for which risk has clearly been established. This condition is known as Antiphospholipid Antibody Syndrome (APS) and is treatable.  

Anatomical Problems 

Imaging studies such as pelvic ultrasound and hysterosalpingogram (HSG) may detect anatomic causes of recurrent loss: conditions such as fibroids, intrauterine adhesions, or uterine malformations (known as congenital uterine anomalies). If an anatomical concern is identified, it can often be corrected through surgery. 

Hormonal/Endocrine Issues 

Using blood tests, doctors can screen for hormonal disorders such as diabetes or thyroid hormone disorders. Because endocrine disorders are often treatable, endocrine causes of pregnancy loss can be corrected prior to attempting pregnancy. 

Will a miscarriage impact my future fertility? 

In most cases, it will not. 

Early pregnancy losses are unlikely to create uterine problems that might impact future pregnancies. 

With some losses, tissue may be evacuated from the uterus with a procedure known as a dilation and curettage (D&C). Rarely, the D&C procedure, like any surgery, may cause scarring within the uterus. This scarring might increase the risk of infertility or recurrent losses. Often, scarring can be surgically reversed. 

If I’ve had a miscarriage, what can I do to reduce the likelihood of having another? 

Because miscarriages are quite common, one miscarriage is not considered cause for exceptional concern. 

Patients who’ve had two or more miscarriages, however, are considered to have “recurrent miscarriage,” and warrant evaluation by a fertility specialist. 

For patients with recurrent miscarriage, determining the underlying cause can be critical. If your physician can pinpoint the cause, your physician may be able to offer preventive measures that reduce the likelihood of future miscarriage. 

There are a number of different tests your physician will perform that may determine the cause of the recurrent losses. 

How can I stop worrying about having another miscarriage? 

Fear of miscarriage exists during all pregnancies—but especially for those who have experienced a prior miscarriage. This fear is understandable. There are support groups that may help to minimize the stress prior to and during early pregnancies. 

It may help if your physician is able to diagnose and treat the cause of your prior losses. Even if unexplained, there can be relief in knowing that the most common causes of recurrent loss have been ruled out. 

It is important, also, to remember that the majority of couples experiencing recurrent pregnancy loss will ultimately succeed in having a child. 

If you’ve experienced recurrent miscarriages, Dr. Kallen encourages you to seek medical support from a fertility specialist. Take control of your reproductive health and together we can improve your chances for a successful next pregnancy. 

Medical contribution by Caleb Kallen, M.D., Ph.D.

Caleb Kallen, M.D., Ph.D., FACOG, is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. Dr. Kallen has expertise in the diagnosis and treatment of infertility, including in vitro fertilization (IVF), ovulation induction with intrauterine inseminations (IUI), donor egg treatments, endometriosis, polycystic ovary syndrome, and preimplantation genetic diagnosis. He sees patients in SGF’s Philadelphia and Mechanicsburg, Pennsylvania, offices.

Schedule Appointment

Editor’s Note: This article was originally published in October 2020, and has been updated for content accuracy and comprehensiveness as of July 2022.

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July 25, 2023 @ 5:00 pm – 6:30 pm

*For Pennsylvania, Maryland, Virginia, and West Virginia patients only*

It is often difficult for people to understand how profound the loss of a pregnancy can be for a woman or couple, especially if you have been trying hard to conceive. To experience the elation of learning you are pregnant, only to feel the despair of discovering you have lost that pregnancy, is a multifaceted loss. It is the loss of a baby, a part of yourself, your health, control, innocence, potential, relationships with others, the future, and on and on.

A pregnancy loss is challenging enough to experience under the best of circumstances, with the most support and understanding. However, during the pandemic it has been much harder due to social isolation and distancing from family, friends as well as medical caregivers. This virtual support group is being offered for those grieving the loss of a very much wanted baby in these stressful times and is also designed to help with the increased anxiety with trying to conceive and being pregnant again after pregnancy loss. Members are invited to stay in the group all the way through their next pregnancy.

The group is FREE for all participants.

Registration is required at least 48 hours before the group event. You must be a current SGF patient and provide the office you go to and your doctors name. An email will be sent to you with a consent form that must be filled before you can attend the virtual group. When you fill out the consent and return it to the group leader via email, you will then receive an invitation with a link to a HIPAA compliant Zoom meeting. Please note that the group may be canceled if there are too few people registered. The group leader will contact you by phone or email if the group will not be held as scheduled.

For more information or to sign up, please email Mia Joelsson.

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November 15, 2022 @ 5:00 pm – 6:30 pm

*For Pennsylvania, Maryland, Virginia, and West Virginia patients only*

It is often difficult for people to understand what a profound loss a miscarriage can be for a woman or couple, especially if you have been trying hard to conceive. To experience the elation of learning you are pregnant, only to feel the despair of discovering you have miscarried, is a multifaceted loss. It is the loss of a baby, a part of yourself, your health, control, innocence, potential, relationships with others, the future, and on and on.

A miscarriage is challenging enough to experience under the best of circumstances, with the most support and understanding. However, during the pandemic it has been much harder due to social isolation and distancing from family, friends as well as medical caregivers. This virtual support group is being offered for those grieving the loss of a very much wanted baby in these stressful times.

The group is FREE for all participants.

Registration is required at least 48 hours before the group event. You must be a current SGF patient and provide the office you go to and your doctors name. An email will be sent to you with a consent form that must be filled before you can attend the virtual group. When you fill out the consent and return it to the group leader via email, you will then receive an invitation with a link to Ring Central video meeting. Please note that the group may be canceled if there are too few people registered. The group leader will contact you by phone or email if the group will not be held as scheduled.

For more information or to sign up, please email Mia Joelsson.

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December 20, 2022 @ 5:00 pm – 6:30 pm

*For Pennsylvania, Maryland, Virginia, and West Virginia patients only*

It is often difficult for people to understand what a profound loss a miscarriage can be for a woman or couple, especially if you have been trying hard to conceive. To experience the elation of learning you are pregnant, only to feel the despair of discovering you have miscarried, is a multifaceted loss. It is the loss of a baby, a part of yourself, your health, control, innocence, potential, relationships with others, the future, and on and on.

A miscarriage is challenging enough to experience under the best of circumstances, with the most support and understanding. However, during the pandemic it has been much harder due to social isolation and distancing from family, friends as well as medical caregivers. This virtual support group is being offered for those grieving the loss of a very much wanted baby in these stressful times.

The group is FREE for all participants.

Registration is required at least 48 hours before the group event. You must be a current SGF patient and provide the office you go to and your doctors name. An email will be sent to you with a consent form that must be filled before you can attend the virtual group. When you fill out the consent and return it to the group leader via email, you will then receive an invitation with a link to Ring Central video meeting. Please note that the group may be canceled if there are too few people registered. The group leader will contact you by phone or email if the group will not be held as scheduled.

For more information or to sign up, please email Mia Joelsson.

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A woman once told me of the painful dilemma she experienced following her miscarriage. She had been longing to be pregnant, hoping for years to hear the words, “You’re going to have a baby.” When it finally happened, her spirits soared. Bu the elation quickly turned to despair when she started to bleed. The confirmation that there was “only an empty sack” was the final blow. She grieved intensely for many months over the loss of this precious baby. Also hurting, her husband felt powerless to help her. She poignantly reflected that she did not want to stop mourning, as it was her only tie to her baby. Resolving her grief would mean letting go of the biological child she might never have.
A miscarriage is an event full of dilemmas and conflicting emotions. If you are involved in RESOLVE and have had a pregnancy loss, you may wonder where you fit in. Having conceived, are you part of the fertile world or do you belong to the infertile world, not having given birth to a live baby? Others may try to minimize your pain by saying, “At least you can get pregnant.”
If you have had difficulty conceiving and then miscarried or if you have had repeated miscarriages, the dilemma grows. You continue to grieve for the wished-for child, while grieving at the same time for the baby you have lost. You feel you are so near and yet so far. For some, the pain is too great to consider trying again. For others, the hope generated from having conceived can be addictive, keeping them in treatment indefinitely. They struggle with the decision over when to stop trying and move on. Unlike other experiences that get easier to handle with repetition, having recurrent miscarriages makes it harder. It becomes especially difficult when you find support from family and friends diminishing with each loss, even though you need it more than ever.
Diagnostic and therapeutic technology available today make the miscarriage dilemma even more complex. During IVF, eggs are retrieved and united with sperm in a laboratory, so that you know conception has taken place within hours of the event. When the embryo transfer fails to result in pregnancy, it can feel like a miscarriage. With any pregnancy loss following IVF/GIFT/ZIFT, there is profound sadness and grief. And yet you may be instructed to undergo another cycle almost immediately. This can thwart your chance to grieve.
In addition, the new technologies used in early pregnancy often facilitate bonding and attachment to a developing baby. Blood tests can confirm a pregnancy before you have missed a period. Sonography enables you to see a heart beating or your tiny baby moving before others are even aware of the pregnancy. This visualization helps to confirm and make the pregnancy a reality. Finally, amniocentesis and chorionic villi sampling can provide information about your baby, including its sex, even before you are wearing maternity clothes. Ach unique detail strengthens your feelings about your baby and can make a miscarriage feel like a death.
Yet miscarriage is enigmatic. Even though it can feel like a death, there is nothing tangible to mourn. There are no burials or memorial services to facilitate grieving. You may find yourself suffering intense emotions, often in isolation, as others may not understand the impact of your loss. The manner in which you grieve is highly individualistic and follows no predictable course; there are no instructions to follow. Much depends upon your own personality and life experiences.
Grief can feel like a tidal wave that sweeps over you with force and fury. Shock, anger, rage, guilt, blame, sadness and depression can engulf you, growing and cresting with time. It peaks somewhere between one to six months following a miscarriage. Nevertheless, swells of grief can be triggered long after the waters have settled. Difficult times include your first menstrual period, due date, Mother’s/Father’s Day, holidays, the anniversary of your miscarriage. It can be especially painful when a friend with whom you were pregnant delivers a healthy baby. As years pass, seeing this child can continue to trigger feelings as you recall what your child might have done at this age. Your triggers are unique and relate to memories and dreams about your baby. For some, triggers may be a song, holiday or time of the year, while for others it may be walking into the doctor’s office or passing a hospital.
Another aspect of the dilemma relates to the difference between men and women and the way they deal with grief following a miscarriage. A woman is usually more attached to the developing baby. The loss of the baby can feel like a loss of a part of herself, shattering her self-esteem and self-image. Her emotions may be more apparent as she tearfully needs to continue to talk about the experience. She may take longer than her spouse to heal emotionally from the miscarriage.
On the other hand, a man is often less bonded with the baby early in the pregnancy and seems to grieve and recover more quickly. He may appear less emotional, partly because he may have been treated like an outsider by medical professionals during the crisis. He may easily be forgotten in the process by family and friends as the focus is often on this wife’s pain. As a result, he is likely to repress his feelings and seem detached from his wife’s grief. Or he may feel that he should be strong for his wife, thinking that being positive and upbeat will make her feel better. In reality, what they both need is a time to cry together, to talk about what has happened and what might have been had this pregnancy continued.
These differences between wives and husbands can sometimes cause misunderstandings and hinder emotional healing. When you are both grieving in contrasting styles, you may find it difficult to be there for your spouse. You need to be patient and understand your partner’s feelings, realizing that different doesn’t mean better or worse. Each of you will need your own time and space to integrate this loss into your life. But you also need to keep communication open between you. Perhaps you want to set aside a limited amount of time each day to talk about the miscarriage. If talking feels too difficult, share your thoughts and needs in a note or letter to your partner. Make a conscious effort to do one thing every day, which shows your partner your love.
Finding ways to recognize and acknowledge your baby’s existence can help diminish the miscarriage dilemma and facilitate grieving. These things can be shared in private or with family and friends immediately following the loss or even years later. Taking positive action to remember your baby may include: having a memorial or religious service; planting a tree or flowers; giving a donation or special gift to a charity; putting together a memory box with special items gathered for your baby; engraving a charm to wear; naming your baby; writing a letter in which you share your dreams about this child and say goodbye; donating a book on pregnancy loss to a support group or library; using creative talents to channel emotions, such as drawing, sculpting, music and poetry.
Several years ago a woman shared with me a poem she wrote after her pregnancy losses. It summarizes to me the many things you feel after a miscarriage while capturing what helps the most.
Your Kind Words
By Nancy Carlson
Please spare me from your kind words.
Just be there for me.
My insides writhe when you tell me “It’s for the best.” “It was meant to be.” “He’s with God now.” (Why can’t he be with me?)
“You’ll have another.” (as if babies were interchangeable)
Your soothing words do not soothe but open the wound that never heals; nothing anyone can say can take away my aching, drawing emptiness. 
Please forgive my pain turned anger that mistakes your intentions and pushes you away.
Please just be there.
Suggested Reading:
Miscarriage After Infertility, M.C. Freda and C.F. Semelsberger. Fairview Minneapolis Press, 2003. www.fairviewpress.com
Contributed by: 
Sharon N. Covington, MSW, LCSW-C
Director, Psychological Support Services

2026 Shady Grove Fertility

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