Pregnancy Loss: what happens at home
There are scientific articles on miscarriage: the different types, the tissues involved, available testing, but what about the boots on the ground experience?
Fortunately, there are many articles and guidance resources on miscarriage. More support organizations have emerged to address the emotional turmoil, and studies have been conducted to investigate causes and best practices, as evidenced below:
Support Groups
Pregnancy Loss Support Program
Recurrent Pregnancy Loss Association
*therapists and counselors that specialize in pregnancy loss (BetterHelp)
Articles on Causes
New insights into mechanisms behind miscarriage
Early risk factors for miscarriage: a prospective cohort study in pregnant women
Articles on Practices and Treatments:
However, what seems to be missing is an explanation of the actual experience as it’s happening to an individual, particularly for expectant management of a miscarriage. Medical or surgical management of miscarriage likely have additional considerations and warrant more in-depth discussion. Even for patients who plan these interventions, they may miscarry spontaneously before their appointments.
There are articles on when to go to the emergency room: such as when two pads are filled per hour for two hours, but what size pad? What sensations will be felt? How long will the bleeding last? What will be the intensity of the pain? What is the consistency and appearance of what is being released from the body? What is a clot, and what is “product of conception” tissue - the precious tissue someone may want to collect for testing to understand why this has happened?
In this post, I want to highlight those who discuss the experience of miscarrying. Why? Because it’s one thing to tell a patient who wants answers to collect their products of conception and another to give them insight into what that experience will actually be like. They might be reaching into the toilet. They might be shaking at the sight of the amount of blood and tissue coming out of them. They might not know what to collect. They may feel upset because they couldn’t catch what came out before it fell to the bottom of the toilet bowl.
These conversations and even these words can feel graphic. The photos in the Reddit and article posts below may disturb some individuals. However, for some, knowing what to expect can help a great deal. Sometimes, not knowing what to expect can make the experience worse, heightening anxiety.
Boots on the Ground Information:
Sample Collection and Testing
Importantly, for anyone who wants to collect their pregnancy to test it for chromosomal conditions, it’s recommended to collect in a plastic container, similar to those that you use to keep extra food, and to put it in the fridge, not the freezer.
It’s important to know that even with collecting the tissue that there can still be challenges from the lab’s end. It’s possible that the tissue collected do not reflect the embryo’s genetics and instead the genetics of who was carrying the pregnancy. It’s helpful to send a DNA sample from the woman along with the tissue to differentiate between the two. It’s also possible the DNA is too degraded for analysis.
A microarray should be ordered instead of a karyotype because karyotyping requires living cells, which may not be present. However, microarray testing cannot determine whether an identified abnormality is due to a translocation, so parental testing may still be needed to assess for chromosomal rearrangements in either member of the reproductive pair.
Approximately 50–60% of miscarriages are caused by chromosomal abnormalities, but how often is this actually confirmed? For coping and closure, testing the products of conception can be valuable rather than relying on assumptions. It can also provide insight if a recurrent pregnancy loss workup is needed. For example, if one partner has a chromosomal rearrangement, does the recent pregnancy loss corroborate this, or could other factors be at play?
While testing products of conception can provide closure, it can also be a source of distress - for those who wanted to test but couldn’t collect the tissue or didn’t know to collect it. Some may develop a deep emotional connection to the products of conception and may not want to relinquish them to a clinic. Instead, they may prefer a funeral or personal ceremony. Additionally, learning the genetic sex of the pregnancy may be difficult for some or, conversely, may help provide additional context, allowing them to name the pregnancy.
There are many factors to weigh: the desire for information, the need for closure, the trust in one’s body or medical providers. People may feel differently with each miscarriage, if they experience more than one. It is crucial to have healthcare providers who understand these nuances, as pregnancy loss is a deeply personal and difficult experience, both in the moment and in the aftermath.
This is a less conventional post - the sources cited aren’t all medical in nature. But reproduction is only partly medical; it is also communal, visceral, and wondrous.