March 25, 2015 - Life with Gremlins

Multiple Miscarriages: A Look at Recurrent Miscarriage Statistics

6 months after my first miscarriage, I had another. I was dumbfounded. I had three previous problem-free healthy pregnancies that went beyond full term, and I was only 28. If you’ve suffered multiple miscarriages, often referred to as “recurrent miscarriage” when the loss number reaches three, I know whether or not your next pregnancy will end in miscarriage is at the forefront of your mind. Part of you wants to try again so very badly, and another part is terrified that it will be a fruitless endeavor wrought with pain-again. The question is: what are your odds?

What are the chances of multiple miscarriages?

Think of getting pregnant like the roll of a dice. The chance you’ll roll a 1 is 1 in 6 on that first roll, but if you roll again probability starts to come into play, your chances just got higher. This is true when it comes to miscarriage. On that first roll, around 10 and 25 percent of women miscarry depending on age. On that second roll, only about 5 percent of women miscarry a second consecutive time. Of the unlucky 5 percent of women that have to roll a third time, only 1 percent miscarry. Once you’ve had three consecutive miscarriages, it’s safe to assume someone’s cheating, and you should seek medical testing to determine if there is an underlying cause. Unfortunately, most medical professionals will not actually do any testing before this point.

What are the chances of a successful pregnancy after multiple miscarriages?

Now, this is where things get confusing. While only 5 percent of women suffer two consecutive miscarriages, the chances of a successful pregnancy after one miscarriage is 90 percent, and while only 1 percent of women suffer three consecutive miscarriages, the chance of a successful pregnancy after two losses is 75 percent. The chance of a successful pregnancy after three losses is even lower at 65 percent, and lower still after 4 losses at 55 percent. How does that work? One statistic is looking at the overall probability weighed against all pregnancy data. Of all pregnant women only 1 percent of those miscarried three times in a row. The other statistic looks at rates of miscarriage within categories. A woman in the category of “two consecutive losses” has a 25 percent chance of miscarrying again (75 percent chance of a successful pregnancy).

So, does a miscarriage increase your risk of miscarriage?

Not exactly. The reason that your chances of a successful pregnancy decrease as you have more miscarriages is that the chance that you’re getting a fair roll decreases. For example, after one miscarriage it’s likely that it was just bad luck. Something went wrong on a genetic level and nothing could have been done to prevent it. You just rolled a 1. However, after three losses, chances are far higher there is an underlying cause such as poor egg quality, unusual uterine shape, or other health issues. You had a weighted dice and just didn’t know it until you kept rolling 1’s. Bad analogy aside, the cut and dry?

Your chances of consecutive miscarriage are low, and get lower the more losses you suffer, unless you have an underlying health issue, which can lead to the appearance of higher rates of loss in women who have had more losses. Sadly, you won’t know if you have an underlying health issue until three losses, and even then many women never find the cause. I had two losses, then a beautiful baby girl this month.

Trying to Conceive After Miscarriage: FAQ and Tips

Oddly, after my miscarriages I was actually really anxious to begin trying again. My losses made me want a baby even more than I did before. However, after my first miscarriage, I had a lot of questions about trying to conceive after a miscarriage. The final step in my miscarriage journey was to research trying again. I spoke with my midwife as well as other women who had suffered losses to create this FAQ for other women in my position.

How long will I bleeding after my miscarriage?

This is one area where talking to other women that have suffered losses really helped. The length of bleeding after a miscarriage seemed to vary by the week in which the loss occurred with early losses equating to less bleeding, and late losses to more bleeding. Generally, however, the bleeding should stop within 2 weeks of the passage of tissue. If your bleeding continues, you should contact your health care provider as this can be a sign of retained tissue.

When will I get my period after miscarriage and ovulate?

Based on those same interviews with women who have suffered miscarriage, return of menstruation and ovulation also really varies on the type of loss suffered, and the week of pregnancy it occurred. Generally, the earlier the loss the quicker the return of menses and ovulation. Natural losses, which usually take longer than say a D&C, also usually result in a quicker return to normal after the bleeding has stopped. This makes sense, being to ovulate after a miscarriage your hCG levels must reach 0. In early losses hCG is lower, and with a natural loss it has usually had more time to decrease before the actual miscarriage itself. You may have a “wonky” cycle just after your loss with early or late ovulation, irregular bleeding, spotting, unusual basal body readings, and other symptoms of hormonal imbalance. In most cases, the second cycle after a miscarriage is far more normalized.

How soon can I try to become pregnant after a miscarriage?

The experts argue on this one, you’ll find citation supporting everything from immediately after to wait an entire year. In my opinion, it is more a matter of your emotional state. Are you ready to try again after a miscarriage? When you are, it’s been long enough. From a medical standpoint, it may make sense to wait at least a cycle, however. This gives your uterine lining time to restore entirely and your hormones time to balance. This may not be necessary if you suffered a particularly early loss (before week 5).

Your next question is how likely are you to have another miscarriage?

Other articles in this series:
Missed Miscarriage or Misdiagnosis?
How Do I Know If I’m Miscarrying?
Miscarriage Bereavement

Miscarriage Stories: What Does it Feel Like and Other FAQ

Prior to my rainbow baby born this month, I had two back-to-back losses. The first was a missed miscarriage at 8 weeks, and I decided to have a natural home miscarriage as opposed to a D&C. I’d heard that it was very much like a “mini-labor,” and having had three children already, I was pretty sure I could handle it. Once things actually started happening though, it was a scary experience, one that would have been far worse if I hadn’t had other children to have an idea what to expect. The second was a spontaneous loss at 7 weeks. In my effort to share the entire process of a miscarriage from start to finish, I spoke with other women who had suffered losses, read countless forums, and talked with my mid-wife in regards to what most can expect during and before a miscarriage. My miscarriages were rather typical of my findings, but I will caution that your experience may differ as every body is different.

When will the bleeding start during a miscarriage?

I decided to start here, because this factor and the next, pain, seemed the most variable. Some women, like myself, start spotting and slowly progress to heavy bleeding over the course of anywhere from a few days to a few weeks. Others seemed to have a very sudden gush-like bleed that arrives without warning. This is likely related to the cause of the loss and your personal hormone balance/drop rate.

What does a miscarriage feel like? Does it hurt?

A miscarriage is, in function, a mini-labor as many women suggest. Contractions cause the cervix to dilate so the tissue can be expelled. The pain you’ll experience from this depends on a variety of factors. For example, early losses tend to be less painful, because the fetus and sac are smaller, meaning the cervix has to open less. Women who have had children, and so stretched the cervix already, usually experience less pain. Pain tolerance and psychological state also are considerations. The pain level of a miscarriage can be quoted anywhere from “barely felt a thing” to “worst pain of my life.” As a mother of four, I’d rank my losses with bad menstrual cramps.

What happens during a miscarriage? How long does it take?

Once the pain begins, the bleeding will likely pick up to. For me, my early loss was mostly painless. I bled much like a period, but passed several large white-ish grey tissues pieces. The later missed miscarriage, it was 3 hours from the point where I felt the pain to finish. The later the loss, the more blood. You’ll also see large clots in a late loss, I’d describe them as liver-like in appearance, many of my cots where hand-sized. This is normal. You’ll pass lots of clots long before the fetus, sac, and placenta itself.

Don’t stress yourself out more trying to examine each one worrying it’s your baby, you will know the placenta when you see it. One helpful recommendation I received from some of the women I spoke with was to use a colander. This eliminates the mess of trying pads (I do not recommend this, the blood is far too copious for pads) and the emotional shock of having to pull your baby from a toilet bowl, if you choose to do so. Which brings me to my next point…

How will I know when my miscarriage is complete? What do I do with the baby?

If you’ve never given labor, I highly recommend looking up some pictures of placenta just to avoid the guessing game. Placenta is often greyish in color and lumpy, it looks like tissue, not clot. There is a very clear difference. The sac will actually look like a sac, though it may also be burst, and appear as a thin membrane. Depending on how far along you were, you may also see your baby. Remember, that at 8-10 weeks even, your baby is about the length of 2 pennies side-by-side and not fully formed. It will not look like a miniature newborn.

What you choose to do with the tissue that comes out is really a matter of personal preference. You can take it to your care provider and request testing, though they often will not do so unless you have reoccurring losses. You can bury it. You can have it cremated. You can even cremate it yourself. I choose that route. There is so little tissue, a good hot bonfire does this fairly easy. Many women I spoke to just could not emotionally handle retrieving their baby, and flushed it. For me, I did not examine it closely, I only looked enough to try to confirm everything came out. You don’t even have to do that. You can have a care provider confirm this via ultrasound if you wish. Prolonged heavy bleeding or excessively heavy bleeding (soaking a maxi-pad every hour) are both signs you may have retained tissue. Any fever or signs of infection are also a seek-medical-attention situation.

What is it like after a miscarriage?

If there is someone you trust that can be present while you miscarry, not necessarily in the room, but in the house, this is highly recommended. My losses went smoothly, but after the later loss I tried to shower, and fainted from blood loss in the tub, luckily my husband heard me fall. Blood loss in particular is a major concern during a miscarriage. If you begin to feel dizzy or see spots, you need to get help. I was able to play with my kids and go to the grocery store within hours, but took a nap beforehand and ate. You’ll likely be tired, emotionally drained, and low on blood sugar (and blood for that matter) so try to eat even if you don’t feel hungry.

The bleeding after a loss is on-par with a period for most, and should last no more than 10 days. You may see more clots than you typically do.

The next installment of my miscarriage journey will be on trying to conceive again after a loss. You can read article one and two by clicking the links below:

Tips for Handling the Grieving Process
Missed Miscarriage or Misdiagnoses? What to Do if You’ve been Told You’re Miscarrying