The Mayo clinic defines miscarriage as, "a pregnancy loss before the 20th week of pregnancy that can be both physically and emotional painful." When I (Tiffany) read this definition I was immediately drawn to the part “emotionally painful.” While my miscarriage was physically painful, the emotional pain was far worse and left me with empty questions, empty arms and often no answers. Why did this happen to me? Doesn’t God know I’ve been trying to get pregnant for 10 months? Doesn’t the world know how great we would be as parents? Why does that person get to be pregnant and I don’t? Why, why, why... The questions and thoughts were endless and would sometimes make me feel bitter, alone and confused. My miscarriage occurred in my sixth week of my pregnancy and the cause is still unknown. Though we can most likely assume a chromosomal abnormality.
Though I am a Nurse-Midwife, the week of my miscarriage was one I will never forget and I was shocked at how little I felt like I knew all of a sudden! It’s incredible how you can know so much for everyone else and then you turn around and forget it all for yourself. Even midwives need midwives! I decided that it was time to bring this topic to the front lines. To talk about the pain, anxiety and to give information that may soothe many aching hearts. It’s time we start talking about miscarriage instead of sweeping it under the rug!
1. Miscarriage is not your fault and often cannot be prevented
80% of miscarriages are caused by chromosomal abnormalities which could not have been prevented. Other causes include, lifestyle factors like smoking, drug use or malnutrition, implantation abnormalities, hormonal imbalances, or maternal age and/or trauma. 50-75% of women do not even know they are pregnant or have miscarried as their period starts at the same time it was expected. This is known as a chemical pregnancy. Most miscarriages occur before 7 weeks pregnant though a miscarriage can occur up through 20 weeks pregnant. Factors that do not cause a miscarriage include exercise and intercourse. Many of these factors can be addressed and changed and will decrease chances of a miscarriage but as discussed, many cannot be prevented.
2. You are not alone
Miscarriage is the most common type of pregnancy loss. Studies show that 1 in 4 women have suffered a miscarriage and that approximately 10-25% of all pregnancies end in miscarriage. Many women report feeling alone during a miscarriage and afraid to reach out for help. Women who reach out to one another during this season of loss find they are better able to grieve, cope and recover from the loss knowing they have a network of women willing to share in their grief. Please ask for help, talk to your closest friends and family; you may be surprised who else shares in your loss, I know I was.
3. Whatever you feel during or after your miscarriage is normal
Some women may feel relived as the pregnancy was unplanned or the season of life or timing was not right for them. Some women feel devastation, others bitterness, anger, or even depression. Whatever the emotion, I encourage you to feel it, feel it down deep in your heart, grieve for the loss, allow yourself time to recover. It’s OK to say no to people and activities. After my miscarriage a very dear (and pregnant) friend of mine wanted to spend time together but I knew I could not see her with the emotional state I was in. I explained my feelings and she was kind enough to understand and give me the space I needed to recover. Be honest with your friends and family about your grieving process, there is no timeline that things “get better” by as this is different for each individual. My only advice is TAKE YOUR TIME! The only feeling you should NOT have is GUILT. As mentioned above most miscarriages end due to chromosomal abnormalities and therefore, you have done nothing and could have done little to nothing to prevent the miscarriage.
4. Miscarriage can be physically painful
This was the one area where I was stunned at what I didn’t know. I had never miscarried before so I didn’t know what to expect and the pain was shocking to me. I had been told in textbooks to expect it to feel like a period with cramps but this was nothing like a period. The cramps were intense and left me in bed for over an hour (I never have that bad of menstrual cramps). And even more surprising was passing the products of conception. I was either in denial or just didn’t remember that yes, I would have to pass my baby that was no longer living. This was the most difficult part. Once I passed the baby, my cramps ceased and the bleeding slowed and I could resume normal activity, though it took many months to feel “normal” again. Rarely, some women do not pass their miscarriage and require a procedure to help them move the products of conception whether through surgery or taking medications.
So some things that are important to remember:
- A miscarriage is nothing like a period. Often the cramps are intense and can be compared to early labor contractions at full term, though the process is much faster.
- If you are far enough along, you will pass the products of conception that could vary from vascular tissue to a formed human with placenta and an amniotic sac.
5. You must know that it is OK to feel you lost something great.
No matter how many weeks you are when you miscarry, every women dreams of her new baby. She pictures their new life together and when this is taken away, it can be challenging to know where to start again. You can’t go back to “normal” because that normal no longer exists. You have to find a new normal. Don’t ever let anyone tell you it was just “tissue” or there was hardly anything there. This is a lie and you deserve to know better! That tiny human was once a living life and it is acceptable to grieve over that lost life just as you would grieve over any lost life.
A Second Midwifery Perspective: Miscarriage
I (Jolene) am going to tell a different type of birth story. This happened in 2010, but it’s as fresh to me as if it happened yesterday. Of all my births, this was emotionally the hardest. My own religious beliefs will be mentioned throughout the story, and that’s not to offend – just a part of my own story.
I found out I was pregnant after trying for about a year (and I did have another loss at five weeks just two months prior to this pregnancy). It would be our third baby. To say we were all excited was kind of a huge understatement – my Dad had just died at the age of 55 a month before, very suddenly and unexpectedly. My first thought was that it was my Dad helping out.
I also happen to be a nurse-midwife. So I worked in an office with a lab and an ultrasound machine, both of which I know how to use. I did labs and my hormone levels were rising. I did an ultrasound, and could see a sac where the baby would start growing. Going well! I started to feel sick, again, great! So we had seen a baby and a heartbeat a few times, more great news! My friend Cristy happened to be working one Wednesday when I walked into work (she’s an ultrasound tech), and she excitedly asked if I wanted to peek at baby that morning. So before I saw my first patient of the day, I hopped on the table, expecting to see my 8 week 5 day little bean jumping around. Instead, as soon as the picture came up on the screen, the world stopped. I could plainly see there was no heartbeat. A very bad four letter word came out of my mouth. Cristy didn’t have to say a word.
I hadn’t told everyone at my office yet that I was pregnant, so I couldn’t just leave. I called my husband, my mom, and told my colleague and friend, Deb with whom I shared an office. And then went on to see my patients for the day.
It’s sometimes a strange world we live in as midwives. We truly have to leave the world outside the door when we go in to care for someone. I had to get through the day though, and even though it was like a knife to my heart that day to hear some of the usualpregnancy complaints, I hope I was a still somewhat of a comfort. I also got a call that I had two moms in early labor – one already at the hospital, one would be coming in later. I had work to do. I was sad, but it was strangely comforting that life was just going on, when the life inside me had just stopped. There was nothing I could explain, or do anything about, it just stopped.
This was also the week of Christmas. I knew I couldn’t possibly emotionally handle having my first Christmas without my Dad be the day I miscarried at home, so I chose to proceed with surgery. I went to the doctor I worked with and asked if he would be willing to do a surgery in the office for someone who didn’t want to go to the hospital and who wanted to do this the next day, the day before Christmas Eve. He agreed, and then I told him it was me.
I ended up working that Wednesday, into that night with the two births I had already been anticipating (two little boys), and then two more moms came in before I got to go home as well. My first time alone was a couple hours of attempting to sleep in an empty patient room on the postpartum unit at one of the hospitals. Then the tears finally came. How had my body betrayed me? Was I just too old? So many questions going through my head. No answers to any of them.
I finished with the third birth in that 30 hour marathon. A beautiful 9.5 lb little girl who’s mom had to work so hard because sweet little miss was facing mom’s tummy instead of her back (mom’s next two babies were twins and came out A LOT easier than their big sis!). I finally got to go home for a shower, see my husband for the first time since finding out, cried some more, and then got called for the other baby coming. That mom did great as well – a first time mom with a little boy with red hair. She had a laceration that needed a few stitches. Luckily, my doc came over and did that while I went to the office and got prepped for my own “birth.”
I got a few injections when I got to the office – to sedate me. Christie was my nurse, and she was an angel who held my left hand, while my husband held my right one, through my most emotionally difficult birth. I was ready to be done, but then again not. There was speculum, a numbing shot in my cervix (um, OUCH!), waiting, a little cramping, and it was over. I wasn’t pregnant anymore. It was so, so final.
I would go on to get pregnant again, and to lose that baby too, very early again. As Tiffany mentions, laboring and delivering a 5-6 week baby has some similarities to birth at full term (same physiologic process, smaller uterus and baby) – though thankfully it’s typically much more brief. Finally, I found out through Creighton Model/ Napro Technology and my amazing NP Diane, that I had a problem with my hormones. Diane and I got that corrected, and I went on to have my third and fourth babies - ones I felt so incredibly blessed to get to keep.
I was given the gift of faith back in my life by another little soul and her family that touched my life so briefly but so deeply a little more than a year before all this happened (but that’s another story for another day). That was not a coincidence. I have peace knowing that I will get to meet these children of mine someday. The fact that I know my kids are with my Dad, and my best friend growing up, Holly, all my Grandparents, my uncles, and everyone else dear to me who have left before me – it helps, a lot.
I share this not to make anyone sad, but because miscarriage is something so many of us go through. I made decisions I might not normally have made – like surgery – but that was right for me at the time. Just like with any other birth – we make the best decisions we can with the information and situation we have at the time. And having people there who truly care and who are there to support us making and following through with those decisions is undeniably important.
Grief is such a sea of emotions for me. Sometimes the waves came hard and fast, and as soon as I would think I would surely be overcome, they ebbed. That continues to this day. Losing the babies still isn’t easy to think about, but it gets less hard - not easier – just less hard – the sea becomes calmer – as time goes on.
We do what we need to do and go where we need to go in our souls to carry and birth our children – into this world or to the next– whichever the case may be.
In the end, I think of it as something I needed to go through. I needed to know what that felt like to have that unimaginable pain and feel betrayed by my body, so that I can walk with others through it. Not that anyone else’s’ journey is the same, but having been there I feel more equipped to help. I’m grateful for the experience, and I’m eternally grateful for those little souls.
Jolene Hamann has been a Certified Nurse Midwife and Women's Health Nurse Practitioner since 2007 and has had the pleasure of catching babies and caring for women in New York, Illinois, and now Colorado. She has four wonderful children with her photographer husband, Dave - Josh, Fox, Ryker, and Molly. Helping women on the sacred journey through pregnancy, birth, and life is her calling and her passion. Her hobbies include sleep, yoga, hiking, and watching sunrises and sunsets over the mountains en route to or from births.
You can reach her at:
Tiffany Jorgenson is a Certified Nurse-Midwife (CNM) who has been serving the Front Range as a registered nurse and midwife for the last six years. In March of 2015, Tiffany opened a home birth practice (Mountain Miracles Midwifery, Inc.) to serve those families who desired a home birth and wanted insurance to cover their care under a CNM. Tiffany has been honored to serve these families and hopes to change the way out of hospital birth is viewed in the US and help women empower themselves to be leaders in the pregnancy, birth and postpartum care they desire!
Tiffany has been married since July of 2010 and she and her husband are Colorado natives and proud to call it home! Tiffany graduated with her Bachelor’s in Science Nursing from UCCS and obtained her Master’s in Science Nursing from Frontier Nursing University. Her experience ranges from low risk out of hospital birth all the way through high risk in hospital birth and everything in between; though she only manages low risk clients at this time. In her free time, Tiffany enjoys LONG road trips with her husband exploring the US, walking her puppy and being outdoors in beautiful Colorado.
Tiffany Jorgenson, MSN, CNM
Mountain Miracles Midwifery, Inc.