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Prakash Chandran: Miscarriage is when a fetus or embryo dies in the earlier stages of a pregnancy and can be one of the most difficult experiences that a woman and her partner go through. Today, we're going to learn about how miscarriages occur and how to cope with one if it happens. Let's talk about it today with Cristy Schier. She's a certified nurse midwife at Tenet Health Central Coast.

This is Healthy Conversations, a podcast from Tenet Health Central Coast. My name is Prakash Chandran. So Christie, thank you so much for being here today. We truly appreciate your time. Can you start by telling us a little bit more about what a miscarriage is and how common they are?

Cristy Schier: My pleasure. Thank you for having me. So miscarriage is really any loss of an embryo or a fetus in the earlier stages of pregnancy, most commonly in the first 12 weeks, which is the first trimester. But on some cases, we do see them between 12 and 20 weeks, which is the second trimester of pregnancy.

How common is it? It's a difficult thing to answer because not all patients seek care whenever they experience these losses. So if you were to go by that information anecdotally plus clinically, it looks like it could be as high as 30% of all pregnancies result in an early loss. But if you go by what's diagnosed in an office, it's actually like less than 10%.

Prakash Chandran: That 10% feels low to me because, as you stated, anecdotally, I have lots of friends that have had them and they don't necessarily go to seek care. So yeah, that makes sense.

Cristy Schier: Yeah. Absolutely. I would say most women have experienced it at least once in their reproductive years.

Prakash Chandran: Yeah. So how does a woman know if she's having a miscarriage?

Cristy Schier: Most of the time, they'll have some bleeding and maybe even some lower abdominal cramping. Other times they'll just experience a sudden loss of pregnancy symptoms. With that said, all bleeding and cramping and loss of symptoms doesn't necessarily mean that you're having a miscarriage, but those are the first clues usually.

Prakash Chandran: Right. And I think that when it happens, a common question is why did the miscarriage happen? Is it something that I, as a woman, did to make it happen? So could you talk to us a little bit about the main causes of a miscarriage?

Cristy Schier: Yeah, absolutely. And it is a common question. People want to know all the time and I feel so bad for women, because they are looking to blame themselves and they want to know if it's the cocktail they had last weekend or because they worked out too hard or they ran a marathon. And there's a lot of self-blame and it is very unfortunate because almost half the time it's some kind of chromosomal mismatch. So an embryo, a fertilization happens and cellular division gets started, but an embryo just doesn't ever develop or it ceases development at a certain stage because the chromosomes are not compatible.

There's other reasons too. Like for example, some women have some anatomical things or they've had some trauma to their abdomen that can cause early pregnancy loss. And some of that trauma is really related to interpersonal violence or, you know, like gunshot wounds, penetrating wounds. Some of the maternal anatomy can be multiple fibroids in the uterus or adhesions from previous surgeries or what's called uterine septum, which is where the uterus is more shaped like a heart, and that can cause a little bit of difficulty with implantation. But those are less common. Like I said, most of the time it's a chromosomal mismatch.

Prakash Chandran: Yeah. So outside of what you just mentioned, it seems like most of the time it's completely out of a woman's control when miscarriage has happened, right? They can't control that chromosomal mismatch. And so I think I know the answer to this, but this leads me to another question. Can a woman do anything to prevent a miscarriage from happening? Are there certain activities that they should avoid?

Cristy Schier: Unfortunately, it's not something that women can prevent. Just as much as they can't control when it's happening, they can't really control the prevention of it happening. I would say that, in some women who have recurrent miscarriages or maybe they're seeing an infertility specialist, they will be placed on a low-dose aspirin. And there's some data to support that taking a low-dose aspirin can reduce the chance of a loss. But that's it.

Prakash Chandran: What about age? You know, does a woman's or man's age in a partnership increase the risk of having a miscarriage?

Cristy Schier: Absolutely. You're going to find women in their 20s and 30s have miscarriages less frequently. It does start to increase slightly over 35, but we see a bigger increase over the age of 40 and then more than half in women over 40. Although the paternal age, there isn't really a clear correlation and that's usually just maternal.

Prakash Chandran: Okay. And you also talked about that chromosomal mismatch a few questions ago, but I'm curious about if any of this is hereditary. Like if someone's mother or sister experienced a miscarriage, should that woman also expect to have the miscarriage as well?

Cristy Schier: I think that's a really fascinating question and it can be difficult to answer too, just because. Every generation, there's so many things that change and evolve. For instance, I feel like now most women wait until later in life to have pregnancies. And also larger families are less common than they might've been during our parent's or our grandparent's reproductive years. So it's difficult to say, but there has been a lot of anecdotal feedback and maybe even a study or two that has shown that a lot of women who experienced miscarriage, say that their mother did too. I haven't heard so much about sister, but about their mother, for sure. But like I said, it's hard to say because there's barriers to contraception for some people in certain generations in certain areas, and so there's a lot of variables.

Prakash Chandran: Yeah. Earlier, you talked about the timing, which miscarriages typically happen in that first and sometimes in the second trimester. Is there a certain point in the pregnancy where a woman is considered safe from having a miscarriage?

Cristy Schier: I mean, I think the safety profile increases the higher the gestation is. So once we see an embryo with a heartbeat on ultrasound in an office, the chance of miscarriage at that point is less than 10%. And then once someone is out of the first trimester, it actually is even less. It's like a 4% chance. So a lot of people, I think they'll either wait until they have this ultrasound done in our office and others even choose to wait until they reach that 12-week mark before they let people know that they're pregnant, especially in women who've had a loss in the past. I tell people that, once they see things on ultrasound, you know, the heartbeat, the growth of the baby, that they could feel good about telling people if they're ready.

Prakash Chandran: So if a woman were to have a miscarriage, should they seek medical care or medical attention right away?

Cristy Schier: So that's a good question too, because sometimes like I was saying before women can experience bleeding or abdominal pain in the first trimester of pregnancy, that doesn't mean it's miscarriage. I would say any woman who is experiencing bleeding in pregnancy should definitely contact their doctor's office. Does that mean they have to seek treatment? Do they have to go to the emergency room? Not necessarily, but I think it's a really good idea to speak to a nurse or a physician to get some further information or advice, because sometimes bleeding in pregnancy can be something a little more dangerous, like an ectopic pregnancy and other times it's something as simple as like, "Oh, you just have a yeast infection that needs some treatment."

Now, if someone's actively miscarrying and that's what they know is happening, they can absolutely do that at home. They don't need to seek medical treatment as long as their bleeding, isn't too heavy. And by too heavy, I usually tell them if they're soaking through more than a pad in an hour, that they should call someone.

Another reason to maybe talk to a nurse or a doctor is If you don't know your blood type, because some people have a negative, like A negative or B negative or O negative blood type. And if they have bleeding in pregnancy, they'll require an injection called RhoGAM, which has to be given at a doctor's office or an ER.

Prakash Chandran: That's helpful. So if a woman does have a miscarriage, you know, one of the things that I was opening up with is just the fact that it can be such an emotional experience and something that is really hard to prepare for. So how does one cope with having a miscarriage afterwards?

Cristy Schier: This does take an emotional toll on women, for sure, especially women who've experienced some type of trauma in the past. Sometimes those feelings can resurface. So you can experience anything from extreme sadness, grief to even relief. There's just a whole range of emotions. And the partners can experience a lot of these emotions as well.

So, I would say take the time and space that you need. And I often will write people out of work so that they can grieve in the space of their own home and they can surround themselves by people that love them and support them. And they have open dialogue with their partners so that they're both on the same page with sharing their feelings with one another. If somebody gets to the point where they're feeling just overwhelmingly sad or profoundly upset, it could be depression and I would like for them to come in for an evaluation, if that's persisting over several weeks.

Prakash Chandran: So you mentioned the importance of having an open dialogue with a partner, and that just led me to wonder how a partner can support a woman after going through a miscarriage. I know that they may be experiencing their own emotional turmoil after a situation like this. But I imagine they also want to be as supportive as possible. How might they do that?

Cristy Schier: Being there, being that shoulder to cry on, being that listening ear. Helping the woman with pain medication, if that's what she would like, or if that's what she feels like she needs. Making some phone calls to doctor's offices for her. Things like that, I think are the most helpful and also reassurance and reminding her that this is completely out of her control and that she is not going down, that self-blame rabbit hole.

Prakash Chandran: So let's talk about a decision after a miscarriage to try and get pregnant again. If a couple decides that that is something they want to pursue, is that a possibility after miscarriage?

Cristy Schier: Oh, absolutely. With miscarriage being so common, a lot of women are actually able to conceive with the very first oscillation that happens after a pregnancy loss. And so, there's no reason for them to necessarily wait. They don't need to regulate or anything like that. I usually tell them once their bleeding has stopped, they can resume sexual intercourse. There's no ideal time or window to conceive again. And if they want to try again, they should. And I also tell people that if they have two or more miscarriages in a row, that they should probably have an appointment with their doctor or their midwife or their nurse practitioner to discuss some testing that they can do to make sure that there isn't something like diabetes or thyroid disease that's undiagnosed that could be contributing to these losses.

Prakash Chandran: Well, Cristy, this has been a really informative conversation. I really appreciate your time. Just before we close here today, is there anything else you'd like to share?

Cristy Schier: Just that I think women should listen to their bodies and definitely give themselves some grace and know that their bodies are designed to have babies and to carry babies. And one loss doesn't always mean that you're going to have another one. And if you're ready to try again, you absolutely should. And this doesn't mean you have to stop exercising or doing any of the things that you enjoy doing and just keeping open conversations with your partner and your family members and friends that are close to you. Stay on your prenatal vitamins and just taking care of your body physically and emotionally.

Prakash Chandran: Well, I think that's wonderful advice. I really appreciate your time today. Thank you so much, Cristy.

Cristy Schier: Okay. Thank you.

Prakash Chandran: That was Cristy Schier, certified nurse midwife at Tenet Health Central Coast. Thanks for checking out this episode of Healthy Conversations. For a referral to Christie or another provider, you can call the Tenet Health Central Coast physician referral line at 866-966-3680. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

This has been Healthy Conversations, the podcast from Tenet Health Central Coast. Thanks again for listening, and we'll talk next time.