Data shows that about one in four known pregnancies ends in loss, and the majority of miscarriages, approximately 80 percent, happen in the first trimester. If a second-trimester loss happens before 20 weeks, it is also considered a miscarriage, while a loss after the 20-week mark is a stillbirth.

The physical aspects of miscarriage vary depending on the fetus’s gestational age, but the emotional and mental toll of pregnancy loss can be a heavy burden to bear. Many pregnant people begin envisioning life with that baby the moment they get a positive test. This means that even a very early miscarriage can be devastating. It’s not only the loss of a pregnancy; it’s the loss of the family you envisioned.

Many people view midwives as health professionals who take care of pregnant individuals and guide them through labor and birth. And that is true, but midwives are trained in all areas of reproductive health, including pregnancy loss. This post will explain signs of miscarriage, treatment options, and ways the Miami midwives at Magnolia are ready to help you through this difficult journey.

What Are the Causes of Miscarriage?

Experts agree that the most common reason for miscarriage is genetic abnormalities. More than 50 percent of the time, there’s an abnormality with the egg or the sperm, or anomalies occur as the cells start dividing. In some cases, the abnormalities cause the embryo or fetus to stop growing, and the result is a miscarriage.

Other possible causes can be related to the gestational parent’s health. These include uncontrolled diabetes, hormonal problems, infections, uterine or cervical abnormalities, or thyroid disease. In addition, several factors increase the risk for miscarriage: Being age 35 or older, having previous miscarriages, smoking or taking illicit drugs, or being underweight or overweight.

What Are the Signs of Miscarriage?

The most common symptoms of miscarriage are spotting or bleeding, abdominal cramping, lower back pain, and fluid or tissue passing from the vagina. Because we begin prenatal care around 10-12 weeks at Magnolia, it’s possible you could experience these symptoms before your first visit. If that’s the case, we are still here for you. Just call our office, and we will talk through your symptoms and what steps might come next.

In some cases, there are no symptoms even if the fetus has stopped developing. This type of loss is referred to as a missed miscarriage and is often discovered at a routine prenatal appointment when there is no heartbeat detected via handheld Doppler ultrasound. In this situation, we refer clients for an abdominal ultrasound, which can confirm that the baby is no longer growing and estimate when the development stopped.

What Are the Treatment Options for Miscarriage?

Once a miscarriage starts, there is no way to stop it. If you’re already having bleeding or cramping, it’s highly likely that the reproductive tissue will pass spontaneously and you won’t need treatment. This is what’s called expectant management.

For a missed miscarriage in the first trimester, you can also choose expectant management, which means doing nothing. Because this can take up to four weeks, some people find it too tortuous to wait and instead choose one of the following two options.

1. Medication management: Taking misoprostol, a prostaglandin that causes the uterus to contract and expel the tissue.

2. Surgical management: Undergoing a dilation and curettage (D&C), during which a surgeon dilates the cervix and removes the tissue.

For a miscarriage in the second trimester, we typically do not recommend expectant management because of possible blood loss at the time of delivery. However, care should be individualized, and the treatment options depend on how far along the baby was when development ceased.

How Does My Midwife Support Through Pregnancy Loss?

Even if it’s early in pregnancy, we want to know if you have miscarriage symptoms. It’s also important to note that some people have spotting or cramping during pregnancy, and they go on to have a healthy baby. If you do have symptoms or we have concerns during prenatal appointments, we will give you the option to have blood drawn or go for an ultrasound. Sometimes both are appropriate.

At Magnolia, we have educational resources about pregnancy loss that are available to you. We review warning signs during and after miscarriage that could indicate there’s an infection. These include fever, chills, foul-smelling discharge, excessive blood loss (soaking through a pad in less than an hour), and cramping that lasts longer than two weeks.

Finally, we support you emotionally and mentally by checking in with you periodically. Depending on the type of care you received during your pregnancy loss, we may see you for a follow-up appointment, or it may be necessary for you to follow up with another provider.

Most people who experience pregnancy loss go on to have a healthy, full-term pregnancy if they choose. We offer preconception counseling if you’d like to talk through any concerns about getting pregnant again. During a subsequent pregnancy, we understand you may have anxiety and fear. We are ready to help you through those challenges as well as refer you to mental health professionals in the area who can provide therapy.

For more information about Magnolia and the care we provide, contact us.