Health Topics

Understanding miscarriage


August 22, 2017

Answers to common questions about the difficult time of miscarriage.


Why me? Why now? What should I have done differently?

These are common questions I get from patients who I see in the clinic and reveal the difficult news that, unfortunately, this pregnancy is a miscarriage.

Miscarriage is defined as a pregnancy loss before 20 weeks gestation. In the first trimester, pregnancy loss rates can be as high 20 percent or one in five women. It’s much more common than you think and most of the time, the reason why it happened isn’t something that you did or didn’t do.

Here are some common questions and explanations as you navigate one of the most difficult times for families.

What are my greatest risk factors for miscarriage?

The older you are at the time of delivery increases the possibility of miscarriage, along with history of previous miscarriage and tobacco use.

What’s the most common reason for miscarriage?

Chromosomal anomalies account for miscarriages 50 percent of the time. Sometimes when the sperm and the egg meet, the resulting embryo doesn’t have the genetic make-up compatible with life and Mother Nature takes measures into her own hands.

What are the most common symptoms of a miscarriage?

Typical signs of a miscarriage include vaginal bleeding, spotting, cramping. Although, sometimes, women won’t have any symptoms at all and don’t find out until the first ultrasound appointment.

How is miscarriage diagnosed?

Miscarriage is usually diagnosed with blood work (quantitative hCG and a Blood Type and Antibody Screen) and by ultrasound.

What is done to treat a miscarriage?

Depending on the type, miscarriage can be managed by waiting to see what happens, taking a tablet by mouth or by undergoing surgery. This decision for management is a joint decision that you would make with your healthcare team to see which option is best for you, as all treatments pose their own risks.

What can I expect physically?

If you choose expectant or medicinal management, it’s common to have heavy bleeding (similar to a heavy period) and cramping – sometimes even passing clots. If you undergo a surgical option those women are kept comfortable and bleeding is minimal.

What can I expect emotionally after a miscarriage?

Everyone processes this news different and at different times. It can hit you in waves. Some days are harder than others. Some women feel a sense of loss at the time of diagnosis and then again after the tissue as passed. It’s normal to talk about your feelings with your support people and your healthcare provider. It doesn’t matter how far along you are – it’s still very painful.

If you are feeling like the sadness it taking over your life, there are people you can contact to talk to and support groups in the area for women who are walking a path similar to you. You can use these miscarriage resources for more information:

American Pregnancy Association

Hope Clinic for Women (local for Nashville)

Center for Loss in Multiple Birth

M.I.S.S Foundation


How soon can you get pregnant after a miscarriage?

It’s up to you; but we try to tell patients to wait until they are emotionally ready.


This post was written by MaryLou Smith, MSN, CNM, an Assistant Professor of Clinical Ob/Gyn and an Assistant Division Director at Vanderbilt School of Medicine. She sees obstetrical and gynecological patients at Vanderbilt’s new Smyrna Center for Women’s Health location. Raised in upstate New York, Smith earned her Bachelor of Science in Nursing at St. John Fisher College in Rochester. She graduated from Vanderbilt University School of Nursing in 2006 with a Masters in Nursing – Nurse Midwifery.

Vanderbilt Women’s Health provides care for women at all stages of their lives at locations across Middle Tennessee. Learn more here or call 615-343-5700.