Miscarriage can also happen due to infection, maternal diseases like lupus, diabetes, and thyroid problems, and abnormalities with the anatomy of a woman's reproductive tract. Sometimes it happens to the same couple more than once, prompting evaluation for known causes. But it's frustrating that most of the time there is no known cause, and the couple feel they are being sent away with only an invitation to return to the obstetrician for the next try—as if finally pulling it off tomorrow would undo today's tragedy.
Treating the Loss
Most couples will feel that the loss is their own private catastrophe. And they are somewhat left on their own, because there are no rituals for this type of human loss. There are no funerals or memorial services. Friends and relatives, often misguided into thinking that mentioning the miscarriage will only be upsetting, are instead seen as uncaring in their silence. The grieving couple have only each other, and that may not be enough for the feelings of guilt and self-examining retrospection. And anger.
After all, this isn't just some tissue that was discarded, like an appendix or a gallbladder. This was their son or daughter. There were dreams of seeing Little League events, helping with homework, attending dance recitals, walking down an aisle. And the whole sense of what might have been is lost to a clinical world of procedures, blood tests, and insurance forms. As an obstetrician, I can assure any couple that their miscarriage is not just any clinical event. I've been delivering babies long enough to see some that I delivered wearing a mortarboard. In a way I grieve with the parents, too, because I know what is being lost in a miscarriage. I'm right there in the middle of it as well. I put it on a different level from the clinical protocols I employ to deal with it.
Perhaps it is fortuitous that the majority of miscarriages go unnoticed, for we would be one bummed out species. Even the 20 percent rate is overwhelming—just ask someone it's happened to. I think people who experience a miscarriage really do appreciate how special each person is. After all, it lands in their faces when the rug gets pulled out from under them. It takes about three months before a couple can deal effectively with their loss. This requiem only underscores the importance of what has been lost. My advice for those who know such mourners is to ask them how they're doing, acknowledge the loss, don't leave them alone in all of this. At the appropriate time they'll file their tragedy away for safe keeping and get on with the rest of their lives. Until then, let them share their grief.
I manage the complication of miscarriage, but that doesn't reduce my feelings for what might have been. So I do not merely send a couple on their way with an invitation to return for the next try. Instead, I applaud them for going back into the world to once again to play by the biological rules. They will have that baby not to replace the permanent little hole in the heart left by a miscarriage, but because they want a baby.
Risks for Miscarriage
Soap opera babies usually don't stand a chance. Miscarriages there occur easily and frequently. The loss of a baby is one of the most powerful misfortunes, and these programs are all about the human condition in all of its tragic splendor. Thank goodness real pregnancy isn't like pregnancy on the daily dramas. An actress falls and she has a miscarriage. A character discovers that her husband is having an affair with her best friend's Tupperware distributor and the stress causes her to lose the pregnancy. Overworking may put her in the hospital for tests that take weeks of prime-time daily viewing. There is no managed care on soap operas.
So just how tough is your baby anyway? First, we must consider that the human race has survived a big disadvantage in reproduction—we generally only have one at a time. For other species nature guarantees survival by allowing multiple births, so that the most vulnerable of life, the infant, is exchangeable for the next that may survive where the first did not. This protection is taken to an extreme with insects, in which reproduction involves thousands of offspring in a very short time, so that even if most die during this vulnerable period, still there are many that survive to keep the species going. Human beings have not only survived but thrived in spite of only having one at a time.