Q: What causes miscarriages? Can I give my character a miscarriage by having someone push her down the stairs?

A miscarriage is often a traumatizing event in a woman’s life. They are also extremely common – nearly 1 in 4 pregnancies end in miscarriage. And yet, miscarriage is a taboo subject, rife with misunderstandings. If you are writing a story where a character miscarries, I hope you do your research, avoid the tropes, and treat the subject with the respect it deserves.

Medical Terminology

            Pregnancy loss before 20 weeks = Abortion

            Pregnancy loss after 20 weeks = Still birth

Miscarriage is the loss of a pregnancy prior to twenty weeks gestation. After twenty weeks, it’s considered a stillbirth. But miscarriage isn’t a medical term – the proper term is abortion.

There are many different types of abortions. A spontaneous abortion occurs when the fetus dies unexpectedly in the womb, then passes out through the vagina. Medical and surgical abortions are triggered by a pill or surgical procedure, respectively. A missed abortionoccurs when the fetus dies in the uterus but does not pass on its own and is usually diagnosed by a lack of heartbeat on ultrasound. An incomplete abortion occurs when part of the fetus passed, but other parts remain inside. If your character has a missed or incomplete abortion, she will need to either take a medication to induce the abortion (the much-vilified “abortion pill”) or get a surgical procedure to clean out her uterus, called a dilation and curettage (D&C).

Most miscarriages occur before the twelfth week of pregnancy. The vast majority of these losses are due to genetic anomalies in the embryo. These genetic anomalies can cause nonviable pregnancies, such as blighted ovum or molar pregnancy– where the gestational sack forms but no embryo develops. Genetic anomalies can also cause a normally developing fetus to suddenly die. This means that nothing the mother did could have changed the outcome. This is an important point, so I’m going to repeat it; in the vast majority of cases, nothing a woman could have done could have stopped her miscarriage from happening.

Causes of miscarriage

Maternal health conditions, such as sexually transmitted diseases, thyroid disease, hormone imbalance, and uncontrolled diabetes, can also cause miscarriages. Problems with the uterus – such as fibroids or endometriosis – and cervix can also lead to miscarriage.

Exercise, sexual intercourse, and mild-moderate abdominal trauma do not cause miscarriage. This is because, during the first and second trimester, the uterus – and the fetus it contains – is protected by the pelvis. It is very difficult to injure them directly; falling down a flight of stairs simply won’t do it.

 During the first two trimesters, the main way a miscarriage can by caused by abdominal trauma is if that trauma causes the placenta to rip free of the uterus, called a traumatic placental abruption. However, this requires severe mechanisms of trauma, such as motor vehicle collisions, falls from great heights, or direct hits to the abdomen, such as domestic abuse.

This all changes in the third trimester, when the fetus sits above the pelvis and the protective layer of uterine muscle stretches thin. After about 24 weeks, even minor abdominal trauma can lead to fetal loss, or stillbirth. The mother is also at higher risk of complications, including death. Think of it this way; if your character has a big ole baby bump, abdominal trauma is more likely to cause fetal loss. The bigger the bump, the bigger her risk.

If your pregnant character is exposed to major abdominal trauma, she’ll need to go to the hospital to monitor and make sure the baby is all right.

Symptoms of Miscarriage

Symptoms of a miscarriage include abdominal pain and vaginal bleeding discharge that lasts anywhere from a few hours to several weeks. Your character’s experience of a miscarriage will vary depending on how far along in the pregnancy they were. Many women miscarry without ever knowing it, and simply experience a longer or heavier period than usual. Women who miscarry later in pregnancy will experience more cramping and heavier bleeding – and I mean bathroom-looks-like-a-murder-scene kind of bleeding. They may even be able to identify fetal parts amongst the discharge.

Unlike you’ve probably seen on TV, miscarriages aren’t a one-and-done event – they take days, weeks, sometimes months for the physical symptoms to abate. Even in the best situation – an early, spontaneous loss – the miscarriage will last about as long as a heavy period (5-7 days, for those of you without a uterus). Under less ideal circumstances – a later miscarriage, an incomplete or missed miscarriage– you could make your character cramp and bleed for several weeks, serving as a daily reminder of what they’ve lost.    

No matter how far along the pregnancy was when it happened, miscarriages are painful and heartbreaking. Besides the physical toll, there is also a substantial emotional toll. One study found that 29% of women experiencing early pregnancy loss developed PTSD from the experience.¹  That number only increases as the pregnancy progresses. As you write your character dealing with miscarriage and stillbirth, please, keep this in mind. 

Citations

1. Farren, Jessica, et al. “Posttraumatic Stress, Anxiety and Depression Following Miscarriage and Ectopic Pregnancy: A Multicenter, Prospective, Cohort Study.” American Journal of Obstetrics and Gynecology, vol. 222, no. 4, 2020, https://doi.org/10.1016/j.ajog.2019.10.102.