Caitlin Whyte (Host): Welcome to Flourish, the podcast brought to you by Prisma Health, where we bring you the latest on health and healing. I'm your host, Caitlin Whyte. And today, we have a poignant episode as OB-GYN Dr. Kendreia Dickens-Carr joins us to discuss the delicate and often challenging topic of miscarriage. Dr. Dickens-Carr will provide insight into what might cause a miscarriage, as well as guidance on risk factors and the healing process. Well, to begin our conversation, Doctor, I would love to know how common is miscarriage and what causes it.

Dr. Kendreia Dickens-Carr: Miscarriages affect what people think about 10-20% of pregnancies. It could possibly even be more than that because some happen even before a person even knows they're pregnant. So, it seems like it's more or less a late period. But more times than not, the cause generally is thought to be due to some chromosomal abnormality that happened that did not make that embryo viable, or that connection between the egg and sperm was not a viable embryo so it doesn't implant is usually what they think the cause is. But the majority of them, we don't really sometimes even know what the cause is.

Host: Wow. Well, what are some early signs of miscarriage, and what should you do if you see any of these signs?

Dr. Kendreia Dickens-Carr: Early signs of miscarriage can be from spotting, meaning having just a little bit of maybe pinkish -ype brownish discharge to heavy bleeding. Sometimes, it's abdominal pain or cramping. Those probably would be some of your bigger signs, just not feeling pregnant anymore, or passing tissue-like material from your vagina when you had a documented positive pregnancy test. Those sometimes can be some of the symptoms. If you do have those things, you should immediately contact your provider. If you're having heavy bleeding or anything that's emergent, make sure you go into the hospital.

Host: Well, on that note, what happens when there is a miscarriage?

Dr. Kendreia Dickens-Carr: When there's a miscarriage, what happens is the pregnancy does not implant, doesn't, you know, attach and stay in for mom to grow to a viable pregnancy. And so then, what happens is your body is basically evacuating those products of conception, is what we would call it at that point. And so, what ends up happening is your body is delivering those contents. And so, your cervix opens up, your uterus begins to contract and do things like that. That's why you feel pain, and then the bleeding starts.

Host: Well, are there any factors that put someone at a higher risk for miscarriage?

Dr. Kendreia Dickens-Carr: Factors that can put people at a higher risk generally would include age. Obviously, being older can predispose to more chromosomal abnormalities within the egg, so that you see more miscarriages. There are other kinds of different thrombotic-- they're just things that basically an OB-GYN or fertility doctor or an MFM doctor would be concerned about, but like antiphospholipid syndrome or some of these kind of disorders, which cause clotting type issues that can predispose. And sometimes things like lupus or some different rheumatologic disorders can increase risk of that as well as people who have uncontrolled diabetes and different medical conditions. Sometimes this can predispose, but lots of times there's nothing that the mom did, like I said, because the majority are due to some form of a genetic abnormality.

Host: So you're saying, it's a lot about genetics, but is there anything that someone can do to prevent a miscarriage?

Dr. Kendreia Dickens-Carr: Because when we're talking about miscarriage, we're saying things that are less than 20 weeks. And so, lots of times if you're going to miscarry, if it's earlier in the first trimester, the ones that are usually genetically predisposed to have abnormal genetics, if you're going to have a miscarriage at that point, there's not much you can do to prevent it.

As we go further along, and get closer to the 20-week stage, sometimes there are things like an incompetent cervix that wouldn't be a miscarriage. It would be that mom's cervix is a little weaker in opening early sometimes we can help those folks out, and put things like a cerclage in their cervix, which is a stitch to kind of keep it closed if we realize that a person is having painless dilation.

Host: Well, in the event of a miscarriage, what should someone do to heal both physically and emotionally?

Dr. Kendreia Dickens-Carr: To heal physically, there's not a whole bunch to do except just to kind of, you know, take it easy, give yourself at least one to two periods in between trying to get pregnant again, is what I tell folks, unless you have some exacerbating medical problems that you need to optimize before you get pregnant again, meaning if you're an uncontrolled diabetic, perhaps you get your diabetes under control before you get pregnant, perhaps if you thought maybe you wanted to get more in shape or lose weight, do different things that will make a pregnancy easier on your body. Then, do start doing some of those things before you decide to get pregnant again. But otherwise, there's not much to do physically except that and maybe continue to take vitamins.

The other thing I would recommend as far as after you have a loss, because regardless of the age of a loss, that's still a pregnancy. And I have five children. So as a mother, that is still a child. That was yours. So, I would seek out whatever kind of counseling or support that you need in that realm in order to help you move forward from that. Because lots of times, it's very scary for women to even want to get pregnant again if they have a really traumatic miscarriage where they're really bleeding or they have trouble around a pregnancy that they lost, any loss. So, I would say move forward in any form of capacity with grieving through that, then preparing yourself for the next one.

What I will stress is majority of the time, there's nothing that the woman has done, could have done, to change what those outcomes were. It's nothing that she did to cause it. And that's one of the things that I think needs to be stressed. If you've had a miscarriage, the beautiful thing to think about is that you can get pregnant. There are some people who never get pregnant. So from there, we just have to work with sustaining a pregnancy. But you know that you do produce eggs and you can get pregnant and that's a blessing in and of itself.

Host: Well, you mentioned waiting one to two periods to try to conceive again. Is there anything else that you should wait for or think about when conceiving after a miscarriage?

Dr. Kendreia Dickens-Carr: If you've had multiple, like two to three miscarriages, then you might warrant seeing a physician and having a full workup for recurrent losses. But after just one, I would say any medical problems you have, if they're optimally controlled and managed, if you are taking vitamins, you've had a regular period or two, there's nothing in the book to tell you to not get pregnant. There's no guidelines as to you have to wait six months, eight months there. There's nothing out there like that.

Host: All right. And you touched on my last question here already, but what can be done for people who experience multiple miscarriages?

Dr. Kendreia Dickens-Carr: If you've experienced multiple miscarriages, like I said, they do a workup for some of these other more uncommon causes for miscarriages. And then if there's something that can provide some forms of treatments that we have that have been shown to potentially help with getting pregnant, they'll do that.

But if not, and we get down to a road that, you know, it's just very difficult every time to lose a baby, one, two, three, four. I mean, I've seen as many as eight to ten miscarriages. Then, at that point, you have to see if maybe a reproductive endocrinologist might be a viable option in order to secure a pregnancy. That's a specialist, an OB-GYN, who takes further training and does a lot with assisted reproductive technologies and things of that nature.

Host: Well, thank you so much, Doctor, for your time today and for your compassion and your care. And thank you for tuning in to Flourish. We hope that this episode has offered valuable insights and support. For more information and resources, please visit prismahealth.org/flourish. I'm Caitlyn Whyte.