By Jessica Zucker, PhD*
Clinical psychologist, author, and creator of the #IHadaMiscarriage movement
Miscarriage is an experience that continues to be shrouded in silence.
Though approximately 1 in 4 pregnancies results in loss1, people tend to feel isolated and alone in its aftermath based on the hush-hush nature of miscarriage combined with cultural stigma. Moreover, research has found that a majority of women report feeling a sense of shame, self-blame, and guilt following pregnancy loss2. These feelings often stem from the fact that women don't have answers to basic questions, the most common being: Why did this happen? In the absence of straightforward answers, people often take medical situations personally, thinking that somehow they did something — or didn't do something — that created this unwanted outcome. However, when medical facts can be obtained, the mystery behind this painful experience diminishes. The mind no longer needs to expend energy making sense of things and can instead grieve and consider trying to conceive once again. It is time we speak more openly about miscarriage to get the information and support we deserve in its wake.
Here are five questions you can address with your doctor that may assist you in getting the answers necessary to understand what you've been through and what the future holds:
1. Why did I have a miscarriage?
This ubiquitous question is an important one. It makes sense to want to understand why you lost a pregnancy unexpectedly. A majority of miscarriages occur within the first trimester and are due to chromosomal abnormalities3. Pregnancy loss can also be due to medical conditions, egg or sperm related problems, or other issues taking place in the body. Although your doctor might not be able to provide a definitive answer for why a loss occurred, s/he may be able to advise if there are any recommended follow-up tests or evaluations that can be done to identify possible causes for miscarriage. This information may help you better understand how best to proceed.
2. Is it my fault that I had a miscarriage?
The simple answer to this complex question is: no. You did nothing wrong. A majority of miscarriages have nothing to do with what someone did or didn't do. As you reflect on your loss and prepare for your future, you may want to consider talking with your physician about potential risk factors, including hormonal and lifestyle issues, history of diabetes, familial genetic history, chronic medical conditions, abnormal uterine configuration, and medications taken during pregnancy. Additionally, if something physically traumatic happened during your pregnancy (like a car accident), talk with your doctor about the details.4
3. Is something wrong with my body?
A majority of miscarriages are due to chromosomal abnormalities. We do not have direct control over our chromosomes, and a pregnancy loss does not necessarily indicate that something is wrong with your health or your body. Infection, autoimmune disorders, implantation issues, hormonal, cervical, or uterine challenges, fibroids, exposure to workplace hazards, and maternal age can contribute to your risk for pregnancy loss4. As you speak with your physician about your health history, be sure to include anything that stands out to you. Often, if your healthcare provider team identifies a medical issue, steps can be taken to address it so that you can plan your fertility future with assuredness.
4. How can miscarriage affect my mental health?
Loss and grief affect people in different ways, but it's crucial to know that your feelings matter and deserve to be explored. Our culture tends to put arbitrary timeframes on grief and yet it is important to remember that the loss of a pregnancy can stir all sorts of feelings and might persist over time. Your mental health matters. If learning more about this aspect of loss is of interest to you, be sure to ask your provider for referral options — clinicians who specialize in pregnancy loss and/or tailored support groups. Conceiving, or not conceiving, after loss can potentially bring about many feelings that are worthy of exploring in the context of therapy or among peers who understand. Getting solid support during the process of building a family can help you feel more emotionally connected during an otherwise challenging time.
5. Will I have another miscarriage? What could my fertility journey look like moving forward?
Miscarriage testing options cannot only be informative, but can help alleviate some of the emotional burden often associated with pregnancy loss. One such reliable test is Anora. Anora is a genetic test that can determine why a miscarriage occurred by testing for chromosomal abnormalities of the tissue from a pregnancy loss. Anora is the most comprehensive miscarriage test on the market – trusted by doctors for more than a decade - and can help illuminate a path forward for you.
- Have you wondered why you had a pregnancy loss?
- Would knowing or ruling out potential causes of your miscarriage help you?
- Would knowing it was not your fault help?
- Do you worry a miscarriage could happen again?
- Have you had more than one miscarriage?
If you answered yes to any of these, genetic testing of the tissue from your miscarriage could be beneficial. Advocate for yourself. Discuss genetic testing with your healthcare provider.
Visit natera.com/anora-kit/ to learn more about Anora and request a test kit.
*Jessica Zucker is a Los Angeles-based psychologist specializing in reproductive and maternal mental health. Jessica's writing has appeared in The New York Times, The Washington Post, The Guardian, New York Magazine, and Vogue, among others. Dr. Zucker is the creator of the #IHadaMiscarriage campaign. Her first book I HAD A
MISCARRIAGE: A Memoir, a Movement came out in Spring 2021 (Feminist Press + Penguin Random House Audio).
1Practice Committee of the American Society for Reproductive Medicine. Fertil Steril. 2012;98(5):1103-11.
3Hyde and Schust. Cold Spring Harb Perspect Med. 2015;5(3):a023119.
4https://my.clevelandclinic.org/health/diseases/9688-miscarriage. Accessed September 2021.
*Anora has been developed and its performance characteristics determined by the CLIA-certified laboratory performing the test. The test has not been cleared or approved by the US Food and Drug Administration (FDA). CAP accredited, ISO 13485 certified, and CLIA certified. © 2021 Natera, Inc. All Rights Reserved.