As physicians, we care for patients in some of the most frightening and devastating moments of their lives. One such instance is early pregnancy loss, also known as miscarriage. For our patients and their loved ones, it’s a sudden, heartbreaking, and deeply painful experience that many never imagined would happen to them.
But miscarriages are very common. In the U.S., at least 15% of recognized pregnancies end in miscarriage, and many losses happen before someone even realizes they are pregnant. Yet, alarmingly, more than half of U.S. adults admit they don’t know the frequency of miscarriages.
Patients often arrive in emergency departments, obstetric offices, or clinics unsure whether their bleeding or cramping is normal or signs of something more serious. When they learn they have had a miscarriage, they often ask whether they did something wrong. In reality, miscarriage is rarely caused by something a patient did, and one of the most important things we remind patients is a simple truth: this is not your fault. In spite of our best counseling, it is hard to shake patients of this guilt that they may have done something wrong.
Despite how common miscarriage is, especially in the first 12 weeks of pregnancy, there are very few resources available for patients and their loved ones about what comes next. In a recent survey, 38% of U.S. adults reported they have little to no understanding of what a miscarriage is or how to manage it.
When it comes to managing a miscarriage, there are three options. The first, referred to as “expectant management,” allows the body to complete the process without intervention over days or weeks. The next method is the use of prescription medication that helps pass the pregnancy more quickly. Finally, the third option available to patients is procedural management, which can involve a brief procedure in an emergency department, clinic, or operating room to empty the uterus.
All of these options are established parts of modern reproductive care. There is no single “right” choice for anyone, and the best path depends on a person’s medical history, personal circumstances, and preference.
Yet too often, physicians only present patients with expectant management as an option, and patients are left with uncertainty about how the process will end. They leave the encounter not sure if they will be bleeding for days or for weeks, and not sure how long it will be until the miscarriage is complete.
We find that many of our patients have never heard a friend, relative, or public figure talk about miscarriage in concrete, practical terms. Given the prevalence of miscarriage, we know that this is not because their loved ones have never experienced miscarriage, but because of the culture of silence that surrounds pregnancy loss.
Patients may not know the warning signs that should prompt urgent care—such as very heavy bleeding, severe cramping, fever, or feeling faint—or what is considered normal as the body recovers. They may not realize they should feel empowered to ask questions about timing, pain control, follow-up, and emotional support. And they almost never know that they have choices.
We have the power to change this. When miscarriage remains shrouded in secrecy and shame, people experience their loss and grief alone and, too often, in unnecessary fear. When we acknowledge how common miscarriage is, speak plainly about what it is and what it is not, and share accurate information about treatment options, we replace shame with compassion and confusion with understanding.
Health systems and clinicians can and should provide clear, accessible information about miscarriage and its management, long before a crisis, and not just in the moment of loss. Friends, families, workplaces, and communities have a role as well. That means making a concerted effort to share miscarriage education tools in patient education materials, encouraging routine prenatal visits, and highlighting public health education campaigns.
For too long, patients experiencing miscarriage have felt alone and isolated. Patients deserve to know how frequently early pregnancy loss occurs, that it is not their fault, and that they have real choices in how to navigate it. Our job is to make sure no one has to learn all of that for the first time in an emergency.
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