“I am so sorry,” I say. Then I wait.
“You did nothing that caused this miscarriage and there is absolutely nothing you could have done differently.” I make sure that my patient not only hears me, but acknowledges what I’m telling her.
As an ob/gyn, most days I’m certain I have the best job in the world. I spend my days (and nights…and weekends) with women, bringing life into the world—and helping others avoid pregnancy when they’re not ready, thanks to the remarkable birth control options on the market. But there are also days when my job is to counsel patients about issues when it comes to getting—or staying—pregnant. And, unfortunately, one part of that discussion includes miscarriage. Miscarriages are extremely common, rarely talked about, and wrought with misinformation. Here are some of the most common and persistent myths I encounter as an ob/gyn.
But first, what exactly is a miscarriage?
A miscarriage is a non-viable pregnancy in the uterus, or an embryo or fetus without a heartbeat, up to 20 weeks along. Early pregnancy (or first trimester) losses account for 80 percent of all miscarriages. The American College of Obstetricians and Gynecologists (ACOG) estimates that 10 percent of known pregnancies end in miscarriage, and this doesn’t account for the miscarriages that occur when a women doesn’t even realize she is pregnant, which makes the real rate closer to 20-25 percent.
But despite how common they are, many people aren’t aware of the facts. A survey published in 2015 found that public awareness of miscarriages is fraught with misconceptions. A whopping 55 percent of survey respondents across 49 states believed that miscarriages are uncommon, defined as less than 5 percent of pregnancies. More so, a significant percentage of survey respondents believed that lifestyle choices caused miscarriage. (If you take one thing home from this piece: they do not.)
About half of miscarriages are directly related to fetal chromosomal abnormalities. Chromosomes are the structures inside cells that contain genetic material. So, biology has a way of identifying cells that are abnormal and will not go on to be viable—a built-in “quality control” of sorts.
Age can also play a role. According to ACOG, 10 percent of women have a miscarriage when they are younger than 30 years old, and this rate doubles to 20 percent between 35 and 39 years old. It goes up to 40 percent at age 40, and 80 percent at age 45. Reassuringly, most chromosomal problems are not inherited, so at baseline, one miscarriage does not mean that another one is around the corner. Other common causes are poorly controlled medical problems like diabetes, thyroid issues, and uncontrolled hypertension, as well as abnormalities of the uterus. So reproductive health planning and pre-conception health care are really important.
Now that we’ve gone over what a miscarriage is and what can cause them, let’s go over some common misconceptions:
Myth 1: I must have done something, like exercising too much or drinking coffee, to cause the miscarriage.
Here are a few things that are not causally related to miscarriages: exercising, using tampons, lifting heavy things, feeling anxious, morning sickness, drinking a cup of a coffee a day, and working.
While lifestyle choices like alcohol consumption and smoking have been investigated as a cause of miscarriage, the data is less clear that they are a direct cause. There is some data that points to smoking or alcohol increasing the risk of miscarriages, however, the interpretation of these studies is complicated by the difficulty of making accurate adjustments for the many confounding factors. Though the link to miscarriage directly is unclear, both smoking and alcohol should be avoided during pregnancy for their developmental risks and links to poor pregnancy outcomes.
Another concern many of my patients have is that a fall can cause a miscarriage. During the first trimester, the position of the uterus (the walls of which are strong, thick muscle designed to protect your growing baby), the cushion of the amniotic sac, and the small size of the fetus make it unlikely that a fall will do any harm. However, if you suffer a fall later in your pregnancy and you notice vaginal bleeding, severe pain in your abdomen, or your baby’s movements slow or stop, call your doctor right away.
Myth 2: My stress level caused the miscarriage.
In the same U.S. survey mentioned earlier, 76 percent of respondents believed that a stressful event could cause a miscarriage, while 74 percent believed a longstanding stressor could, and 21 percent believed an argument could lead to a miscarriage. Rest assured: There is absolutely no biological basis for any of these.
Myth 3: Having sex caused the miscarriage.
A normal pregnancy is implanted in the uterus on a supportive layer of cells called the endometrium. During intercourse, the uterus is never entered. Studies investigating the relationship of sexual intercourse and adverse pregnancy outcomes have not observed any association between pregnancy complications, including miscarriage.
Many women in the first trimester report that fear of injury to the fetus affects the freedom of their physical response (aka their enjoyment) during intercourse. It shouldn’t. So, unless you have a specific complication of pregnancy that your doctor has recommended pelvic rest for, enjoying sex while pregnant should be encouraged.
Myth 4: My prior birth control use caused the miscarriage.
Generally, birth control pills work by stopping ovulation, stopping the possibility of your egg meeting with sperm after sex, and stopping the fertilization that’s required before a pregnancy is implanted. When you stop using birth control pills, ovulation resumes. In some cases, like with IUDs (which generally work by stopping fertilization and implantation), it’s possible to get pregnant pretty much as soon as you stop using the method.
If there has been contraceptive failure leading to an unplanned pregnancy or you’ve recently stopped using contraception, you are at no increased risk of miscarriage or major birth defects as demonstrated by large registry studies. More so, women who have had prolonged use of contraceptives should be reassured that they have no delay in the resumption of ovulation and are at no increased risk of miscarriage.
Myth 5: Getting the flu shot caused a miscarriage.
Despite what you might have read in some corners of the internet, it is safe to receive the flu vaccine during pregnancy. This is particularly important because pregnant women are at a heightened risk of death from flu compared to non-pregnant women. Vaccination of the mother is the most effective way to protect the fetus and will not put the pregnancy at risk.
The ACOG recommendation that all pregnant women get the flu shot is based on a safety profile and data that is tracked by the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services (HHS). With the support of a large body of literature, they found the flu vaccine (at any point in pregnancy) to be a safe and effective way to reduce maternal morbidity and mortality, and to protect the fetus in-utero and after birth without risk of pregnancy loss.
So why is there so much misinformation out there about miscarriages?
We’re intelligent and curious creatures, and it’s natural to want an explanation for something out of our control. Even if nothing can be done to prevent a subsequent miscarriage, 78 percent of people in that previously-mentioned survey wanted to know the underlying cause of miscarriage.
The good news is that isolated pregnancy loss in the first trimester is usually a one-time event and, if desired, women go on to have a successful pregnancy. Recurrent pregnancy loss is rare—estimates show that fewer than 5 percent of women will have two consecutive miscarriages and just 1 percent will experience three or more.
If desired, there is no medical reason to wait before trying to conceive again after a miscarriage, and you often ovulate two to three weeks after a miscarriage. Though not medically necessary, some doctors recommend waiting until you have one regular period before trying again. This helps give you a more precise due date for a subsequent pregnancy, as this date is calculated by your period. And if you don’t want to become pregnant again, you can start using contraception immediately.
Miscarriages are very difficult and people often feel very alone after experiencing one. Talk to your gynecologist or health care team. Support groups and counselors can also provide resources, like SHARE: Pregnancy and Infant Loss Support, Inc., which provides a list of online resources and support groups.
And remember, it’s not you. You did nothing to cause the miscarriage. Repeat it again: You did nothing to cause the miscarriage.
Dr. Yalda Afshar is an ob/gyn at the Ronald Reagan ULCA Medical Center.
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