What Every Pregnant Woman Needs to Know About Pregnancy Loss and Neonatal Death

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Miscarriage . Ectopic pregnancy . Molar pregnancy . Stillbirth . Intrapartum death . Important decisions you will have to make. Grieving . Trying again

What Every Pregnant Woman Needs to Know About Pregnancy Loss and Neonatal Death

Losing a baby can be an incredibly painful experience. Regardless of when your baby dies, you lose all of the hopes and dreams you have invested in that child from the moment you first found out you were pregnant.

Although you may feel, initially, that you are the only person in the world to experience this heartbreak, you will discover—as you begin talking about your loss—that miscarriage, stillbirth, and neonatal death happen far more frequently than most of us are led to believe.

The problem is that there continues to be a conspiracy of silence when it comes to talking about these types of losses—a strange holdover from the Victorian era, given that we're now "out of the closet" on so many other matters. Although most childbirth classes give you some basic facts about miscarriage, they tend to ignore stillbirth, intrapartum loss, and neonatal death altogether. This is true of most pregnancy books. Is it any wonder that the majority of women who experience these types of losses feel terribly alone?

" I hated when people said, 'It's for the best' or 'You are still young; there is lots of time.' I desperately wanted that baby.
—Laura, 21, pregnant after a miscarriage "

This chapter wasn't much fun for us to write, and it might not be much fun for you to read, either. Indeed, you may find it extremely difficult to even think about the possibility that something could happen to the baby you are carrying. But things can and do go wrong during pregnancy, and that's why it's important to arm yourself with the facts about pregnancy loss and neonatal death.

(Just a quick note before we plunge into the rest of the chapter. Ann Douglas, one of the authors of this book, lost her fourth child, Laura, to stillbirth. Laura died at 26 weeks due to a knot in her umbilical cord. Ann has chosen to share her experience at selected points in this chapter.)

The facts about miscarriage
As you no doubt realize, miscarriages are extremely common, occurring in approximately 15% to 20% of all confirmed pregnancies (that is, pregnancies that have been confirmed via a home pregnancy test or visit to the doctor). Although the majority of miscarriages occur during the first 13 weeks of pregnancy (with the lion's share occurring before a woman even suspects that she is pregnant), miscarriages can and do occur up to the 20th week of pregnancy. (A pregnancy loss after that point is classified as a stillbirth.)

The causes of miscarriage
Certain factors are known to cause miscarriages.
These factors include

Chromosomal abnormalities: More than half of miscarriages are caused by chromosomal abnormalities—problems with the structure or number of chromosomes in the embryo or with the genes that the chromosomes carry. Many of these embryos would not have developed normally: scientists believe that the high rate of miscarriage helps to ensure that only 2% to 3% of babies are born with congenital anomalies rather than 12%, as would be the case if these miscarriages didn't occur. Miscarriages caused by chromosomal abnormalities are random occurrences and consequently are less likely to recur during subsequent pregnancies than other causes of miscarriage.