I sat on the OBGYN’s table, getting my first transvaginal ultrasound. My husband sat next to me holding my hand. We were 7 weeks pregnant, and we were excitedly awaiting the first time we would see our baby.
And then, the doctor said three words we never expected to hear: “There’s no heartbeat.”
People don’t go into pregnancy preparing for loss. It is a time of birth and renewal. Typically, it’s hopeful and exciting. Preparing for a loss when you are pregnancy would be like preparing for a divorce on your wedding day. We are excited for new life, and death, of the lack of life, is often the last thing on our minds. It makes sense that we are not mentally and emotionally preparing for loss.
Moreover, in general, people aren’t speaking about pregnancy loss. Because we aren’t talking about it, we aren’t preparing women and couples for the potential loss of a pregnancy. And because we aren’t preparing them for this possibility, people aren’t emotionally prepared for it when it happens.
Prior to my first loss, I was completely unaware of all of the different types of pregnancy losses. I thought there were two losses: miscarriage and stillbirth. There are, in fact, many different pregnancy losses that can occur.
What is pregnancy loss?
Pregnancy loss is the loss of any pregnancy at any stage of pregnancy, from the moment of conception to a few weeks after a live birth. Pregnancy loss at any stage can lead to feelings of grief, depression, trauma, and heartbreak.
Here are a few definitions for the various types of pregnancy losses that can occur. Please keep in mind, this is a simple overview. Each of these definitions warrants much more space and time than what we are reviewing in this article.
Miscarriage: the spontaneous natural loss of an embryo or fetus before the 20th week of pregnancy. Depending on what source you read, the rate of miscarriage ranges anywhere from 10%-40% of pregnancies (not women!) ending in miscarriage.
Recurrent Miscarriage: having two or more spontaneous miscarriages.
Stillbirth: the death or loss of a baby before or during delivery. Stillbirth, in the United States, is defined as the loss of a baby at or after 20 weeks’ gestation. We can further define stillbirth in stages: early stillbirth occurs between 20- and 27-weeks’ gestation, late stillbirth occurs between 28- and 36-weeks’ gestation, and term stillbirth occurs at 37 weeks and beyond.
Chemical Pregnancy: a miscarriage that happens before the embryo would be visible on an ultrasound, usually before the fifth week of pregnancy. The loss occurs shortly after implantation. Typically, women will have a positive pregnancy test, and then their period will start shortly after. A chemical pregnancy is not a false positive on a pregnancy test (those are rare if not impossible). Sometimes, the loss happens so early, women don’t know they are pregnant.
Abortion: the termination of a pregnancy by medical intervention. Abortions occur for many reasons. Abortion is typically a decision-based loss. Sometimes, women undergo abortions out of medical necessity, or out of ethnical decision making, including, but not limited to, terminating the pregnancy due to genetic conditions. Others elect to have an abortion because they do not want the child for a variety of personal reasons. For whatever reason, abortion can be an emotionally challenging decision.
Termination for Medical Reasons: some couples might choose to terminate a pregnancy due to a variety of reasons, including severe birth defects, life threatening health complications, or genetic conditions. Also called therapeutic or selective abortion, this is a delicate issue, and a heartbreaking matter for parents.
Ectopic Pregnancy: when a fertilized egg implants somewhere other than the uterus, such as in one of the fallopian tubes. This is also called a tubal pregnancy. Approximately 1 out of every 50 pregnancies in the United States is ectopic. This can be life-threatening for the pregnant individual.
Molar Pregnancy: a rare condition in which pregnancy tissue grows abnormally and excessively. This can occur without the presence of fetal cells, and it is a non-viable pregnancy. While most miscarriages are caused by chromosomal abnormalities that develop as the fetus grows, a molar pregnancy is a chromosomal abnormality that occurs at the time of fertilization. This requires close follow-up by your doctor to ensure that all pregnancy tissue is removed.
Premature Rupture of the Membranes (PROM), or Preterm Premature Rupture of the Membranes (PPROM): PROM is the rupture of the membranes, or your water breaking, beyond 37 weeks’ gestation, prior to the onset of labor. PPROM is the rupture of the membranes prior to 37 weeks’ gestation. While infants can survive PPROM (over 80% between 20 and 23 weeks of gestation), 78% of surviving newborns had severe morbidities at the time of discharge.
Neonatal Infant Loss: the death of a newborn younger than 28 days.
Infertility: infertility can be defined in a few different ways. One definition is not being able to conceive after one year or longer if you are under 35 years old, and 6 months for couples over 35 years old. Another definition is not being able to carry a pregnancy to term. Approximately 6% of women between the ages of 15-44 in the United States are unable to get pregnant after one year of trying. And 12% of women have difficulty carrying the pregnancy to term. This can be a challenging diagnosis for people to receive, as infertility is often unexplained.
Conclusion
It is so important to educate ourselves on the various losses that can occur. It is also important for us to talk about these types of losses, and help bring awareness to the all of the feelings that can come with those losses: trauma, fear, anxiety, depression, grief, disconnection from others, and a host of other emotions. All of these definitions are not meant to frighten people; rather, it’s meant to educate so we can balance our excitement of being pregnant and bringing new life into this world, without the possibility of being blindsided if something tragic does occur.