Ep.26: Common causes of miscarriage

Welcome back to the Woven Well Podcast. Today we’re talking about miscarriage — not a fun topic at all, which is why it’s often not talked about at all. But the hard reality is that as many as 1 in 4 pregnancies end in miscarriage, so it’s important to talk about it. To bring awareness. To provide education. And to acknowledge the pain that possibly 25% of couples experience at some point. 

No one ever wants to think that miscarriage will happen to them. When you get a hoped for positive pregnancy test, your mind goes to due dates and gender reveals and tiny little clothes. As it should! But we know that our fertility journeys aren’t always what we envision for ourselves - whether that’s in timeline or in pregnancy complications. 

A miscarriage is when a baby still in utero passes before the 20th week of pregnancy from natural causes. The definition alone gives a hint at how vastly different the experiences can be - a loss at 5 weeks will be physically very different than a loss at 19. But in each scenario, the loss and the pain are real and valid. 

And yet, like I said, people don’t often talk about it, for a variety of reasons. That’s okay. It’s up to each couple whether they feel comfortable sharing, and who they share with, and what they choose to share. But what I hate to see is a couple suffering alone because they feel ashamed or that there’s no safe place to share their loss and suffering. 

Like with so many things in the world of fertility, talking about it matters. 

Plus, like with many other areas in the world of fertility, if it’s not talked about, it can feel really mysterious. What happens? How do you know? What causes it? 

There is some mystery involved, of course - we may not *always* be able to know exactly why it happens. But when we can identify a cause, it helps us to address it for any possible future pregnancies. 

So let’s start there, with the most common causes of miscarriage. The information I’m sharing today can of course be found on your own, and I am particularly utilizing work from Dr. Alan Beer, who specializes in one of these causes I’m about to mention. 

There are 6 major categories for the medical reasons miscarriages occur: 

chromosomal abnormalities, abnormal maternal anatomy, hormonal imbalances, infection & illness, environmental factors, and immune system problems. 

I’ll briefly break down each one. 

Chromosomal abnormalities can cause the DNA to not match up right, not grow correctly, or not be able to continue to mature in a way that’s compatible with life. With a few exceptions, these losses often occur before 10 weeks of gestation. For many pregnancies that end extremely early, it’s believed to be because the abnormalities prevented the embryo from developing beyond an initial stage.  

Abnormal maternal anatomy refers to issues with the reproductive organs of the mother that may hinder the ability to carry a pregnancy. Common ones deal with variations in the shape of the uterus, like having a septet, which reduces blood flow to the baby, or being bicornuate or extremely small. All of these uterine conditions restrict the ability of the baby to grow. The presence of large uterine fibroids could also prevent implantation of an embryo or cause an issue with the sustaining of a pregnancy. And then there could be issues with the cervix itself, especially if it is unable to hold up against the pressure of a growing baby throughout pregnancy. 

Hormonal imbalances may seem like a vague statement, but it’s intentionally meant to cover a broad range of possibilities. Because hormones are pretty critical to the success of a pregnancy. Estrogen and progesterone do not go away during a pregnancy, they greatly increase! And if you’ve been listening to the podcast, then you may already know that progesterone plays an important role in preparing the uterine lining for implantation with the nutrition a budding pregnancy would need. Progesterone remains important, as does estrogen. Other hormones, like those involved in the thyroid, are critical to pregnancy success, as well. Some women who have never had thyroid issues in their lives experience extreme thyroid fluctuations or even gain specific thyroid conditions like Hashimoto’s disease, that can cause miscarriage. 

Infection and Illness can refer to conditions like Epstein Barr, STIs like chlamydia, gonorrhea, or syphilis, which are all well known to cause miscarriage, toxoplasma gondii, which you may have heard of if you have cats, as it can be passed through the air or ingestion when cleaning a cat’s litter box, and then uncontrolled diabetes or thyroid disease. There are also bacterias that can cause miscarriage, if left untreated. 

Environmental factors that can contribute to miscarriage risk are use of drugs (including tobacco), alcohol, and certain strong pesticides and chemicals. These are not the ones that we find in common products, but more like commercial grade items or excessive levels of common pesticides. 

Finally, there are immune system issues. One common one is blood clotting disorders. You may have had these your whole life, but they never caused a problem because the clots they create arent’ large enough to be an issue for adult sized blood vessels. Tiny, budding embryos are a different story, though. 

Or your body could have an oversized immunological reaction to the DNA of the baby. Our bodies are trained to fight off invaders to the body and while most immune systems recognize an embryo as an allowable exception, not all systems do. 

You may also have a very aggressive immune system that attacks first and asks questions later, constantly fighting against the pregnancy trying to establish itself and continue to grow. 

All of these can feel like a lot. Where do you start? How do you know if you have any of these risk factors? 

Well I have good news. If you’re already charting with Creighton - which many of our listeners are - then you’re already being proactive in identifying some of these issues. 

Charting with Creighton allows you to spot possible issues in hormonal strength and balance, cervical infection, thyroid disease, diabetes or insulin resistance, and signs of uterine fibroids. That’s a lot! And it’s just by using the Creighton and working with a napro doctor to identify and treat these issues. So, that’s really something, and a great place to start. 

But notice I said Creighton charting and working with a trusted Napro doctor. Working with someone you trust in the medical field can be a game changer to your experience trying to conceive and during pregnancy. They’re going to prioritize optimizing your health before you start trying to conceive, partner with you in your journey to conceive, and provide immediate support at your first positive pregnancy test instead of waiting 8 or 9  weeks for an ultrasound. 

You can even talk with them about doing some additional preventative measures, if you think you’re especially at risk for any of the common categories. 

For instance, You may choose to have an 

• u/s of pelvic organs to look for abnormalities, fibroids, etc

• have hormone panels done to ensure proper levels, including thyroid panels

• test for blood clotting disorders

But hear me, I’m not trying to say you need to have all of these things done before you try to ever have a baby. Most do not do all of these things before trying to conceive. But it’s up to you. You have the choice. 

And If you’ve had a miscarriage, and you’re searching for what caused it as you prepare to conceive again, you can: 

• have an u/s of pelvic organs to look for abnormalities, fibroids, etc

• have hormone panels done to ensure proper levels, including full thyroid panels

• test for blood clotting disorders

• test for infections like Epstein barr, STIs, etc

• test for immunological issues through a reproductive immunologist

• test for thyroid issues during your next pregnancy

And note: many insurance companies will not cover these tests until you’ve had 3+ miscarriages. Which is, of course, outrageous. But you can still ask for what the price would be and you can talk with your napro doctor about which would be most worth it to start out with. It may not actually be that expensive. 

The journey is hard. And it’s scary. So much of it can feel totally outside of our control. 

If you’re listening to this because you’ve recently had a miscarriage, or because you’ve had one in the past and are returning to trying to conceive, I want you to know you’re not alone. And we hate, so much, that this is a part of your story. No one chooses it. No one wants this path. 

And no matter if your loss was right after you got a positive, or well into your first or second trimester, your loss matters. Your baby was real and precious and made in the image of God. 

The time anticipating the loss, walking through it physically, and afterward as you grieve can be some very dark times. And it’s made worse by the fact that it can feel so incredibly lonely. But you’re not actually alone. You are seen. Your tears are counted. Your grief is God’s grief. 

I’m not offering any generalized positivity or cheap words of encouragement. It’s devastating. Raw. Unfathomable. 

And even if we find out exactly why it happened medically, it never seems to explain why it happened spiritually. Why does God allow such deep suffering, that something as beautiful and innocent and hopeful as a budding life would not be left untouched? 

I don’t know. I just know that God doesn’t abandon you during the suffering. That Jesus himself suffered loss and experienced true grief. He felt physical pain. He watched blood flow from his body. He felt the loss of beauty and hope and innocence. 

God knows more than I do. And I haven’t been given the reasons why. But man if it’s not encouraging that God doesn’t leave us alone to face the suffering. 

And that means we can walk with God honestly and vulnerably. We do not have to have it all together, or keep it to ourselves. Now, mourning a miscarriage doesn’t look like one particular thing. Some choose not to think about an early loss as a pregnancy, for instance. Some find out gender, if they can, and name each baby, and others do not. Some choose to bury and some do not. How you react, how you grieve, what you think, and how you move forward - it’s all unique to each person. Don’t compare yourself to others. Don’t worry about what the “right” thing is to do - just consistently go to God, and walk honestly. 

You decide who you tell. If you had already announced, then it may look different and you may fell pressured. But you always get to decide what you share and how much you share. Find one safe person. Find support through your church, counseling, etc

And as you do that, choose to turn to one another, your spouse, as you grieve. your grief may look different - that’s okay. Allow each other to grieve alongside one another. Give each other the space to express it in whatever way feels right. 

Next week we’re going to continue to talk about this topic, but focus in on the practical aspects of what to expect during and after a miscarriage, and what choices you have during that process. Again this isn’t something often talked about, and few prepare to have a miscarriage, so it can feel like a whirlwind when the time comes. We’re hoping that this episode will help prevent that and we’ll have guest to help us do that. 

Thanks for sticking around today. As always, thanks for listening as we continue to explore together what it means to be woven well.