What's normal, what's not in the first trimester and beyond
I've gotten quite a few emails lately with questions about miscarriage and first trimester bleeding. Nadine had an early miscarriage recently and was advised to wait three months before trying again. Amber had her first OB appointment and was told she wasn't nine weeks along as she thought but six weeks. Her placenta was big and there was no heartbeat. Kerri recently had her first prenatal appointment and reported a little spotting but didn't get any response or advice from her doctor. Though each one of these women have a unique angle on the anxiety surrounding that fragile first trimester, they're all feeling worried, confused and more than a little helpless.
That first trimester really rocks your world. First there's excitement (or fear), then there's anticipation (or dread). Then we move on to worry (or relief) before we scoot over to excitement again, then sometimes on to disappointment and grief. Readers frequently ask what they can do to make sure they don't bleed or miscarry. The really frustrating thing is there's not a whole lot we can do to control any thing that happens in those first months except follow the rules of healthy living and hope for the best.
First trimester bleeding is pretty common but doesn't always mean a miscarriage is on its way. About 20-30% of women bleed a little in early pregnancy and only half of those go on to miscarry. Approximately 15-20% of all pregnancies end in miscarriage though many happen before women even know they're pregnant. Common causes for bleeding are: hormone changes, implantation bleeding and cervical irritation. Doctors/midwives will run blood tests and do ultrasounds to determine if it's "normal" bleeding or miscarriage.
A lot of the time, women just have to wait and see which way it's going to go. In Amber's case, she's not bleeding but there's no heartbeat either. It might be that she's just a lot earlier in her pregnancy than she thought and she'll hear a heart beat next time. It might be, like in Kerry's case, that the bleeding will stop within a few days or weeks and the reason her doctor didn't give her any advice was because he/she didn't have any. It might be, like in Nadine's case that she's going to have a miscarriage and will eventually try again for a healthier pregnancy.
Many doctors/midwives will tell you to "try not to worry about it. It's normal." While that may be true, we all know that any amount of bleeding is scary, normal or not. We worry that pink stripe on the toilet paper is going to turn into heavy flow, cramps and a miscarriage. I practically gave myself toilet paper burns when I experienced a little spotting with a couple of my pregnancies. I had to keep "checking" to see if there was more. One time, it went away on its own despite my obsessive wiping. Another time, I had a miscarriage. Again, I don't think the toilet paper had anything to do with it, it just kept me up to date as to which way things were going.
The reality is, worrying won't change the inevitable. If you're going to miscarry, you're going to miscarry. Yeah, that sucks but instead of "trying not to worry" my advice is: go ahead and experience worry. Worrying is what parents do. Worry gets a bad rap like it's an indulgent and unnecessary emotion. Yeah, well, if we're allowed to experience joy and sorrow, it seems like we ought to be allowed to "do" the unpopular emotions like anxiety and worry too. I don't advise curling up in a ball and allowing your worry to consume you. There's no sense letting it entirely rule your world. Most of us have lives that can't be shut down while we wait out those first vulnerable weeks and months. Give it some time and attention, share it with your family and friends and allow them to comfort you. It's OK to be afraid of losing something so valuable, especially when there's nothing you can do to control it. Then, go on about your life and know that if it's meant to be a healthy pregnancy, then it's meant to be. If not, well, that totally sucks.
Nadine's advice that she wait three months is popular but isn't necessarily an iron-clad rule. Three months gives you time to heal, grieve and stock up on folic acid. It allows you to regain a normal cycle so when you get pregnant the next time, it's easy to tell how far along you are. If you have a D&C after a miscarriage, your uterus might feel a little roughed up and it makes sense to allow it to settle down. If, however, you get a normal period shortly after an early miscarriage and you feel emotionally balanced, trying to conceive is probably fine. There's no guarantee you won't miscarry again but like I've said before: there are no guarantees with anything having to do with children.
Nadine, I hope you write back soon telling me you're pregnant again and all is well. Kerry, chances are good this little bit of bleeding is the normal kind and you'll go on to have a normal pregnancy. Amber, if it turns out that there's no heartbeat next time you see your doctor, I'm truly sorry. I won't tell any of you not to worry about it. I've been there and had the tissue burns to prove it. I'll be thinking about all of you.