Miscarriages: Why they occur, the mental health impact and the support available

Alexandra Thompson
·4-min read
Prince Harry, The Duke of Sussex with Meghan Markle the Duchess of Sussex meet young people from a number of mental health projects operating in New Zealand, at the Maranui Cafe in Wellington, New Zealand October 29, 2018. Ian Vogler/Pool via REUTERS
The Duchess of Sussex has revealed she endured a miscarriage in July. She is pictured in Wellington, New Zealand in October 2018. (Reuters)

Meghan Markle has opened up about a miscarriage she endured in July.

Writing in The New York Times, the Duchess of Sussex described how she felt a “sharp cramp” that made her “drop to the floor” with her one-year-old son Archie in her arms.

As Meghan and her husband the Duke of Sussex endured “the pain of their loss”, it dawned on them “in a room of 100 women, 10 to 20 of them will have suffered from miscarriage”, but yet “the conversation remains taboo, riddled with (unwarranted) shame”.

Amid the duke and duchess’ loss, experts explain why miscarriages occur, the emotional toll they take and the support available.

Read more: Meghan Markle praised for breaking miscarriage taboo

Watch: Duchess of Cambridge opens up about her miscarriage

Why do miscarriages occur?

A miscarriage is defined as losing a pregnancy in the first 23 weeks. Beyond that, the loss is considered a stillbirth.

Most miscarriages occur before a woman knows she is pregnant. Among those who are aware they are expecting, around one in eight pregnancies end in miscarriage.

Losing three or more pregnancies in a row, defined as recurrent miscarriages, affects around one in 100 women.

Many factors likely contribute to a miscarriage, however, the cause is not usually identified.

The vast majority of cases are not linked to anything the mother has done.

“The most asked question about miscarriage is ‘why did it happen?’,” said Dr Matthew Prior from Dr Fertility.

“The honest answer is we don’t know.

“Most miscarriages are likely due to a randomly-occurring genetic problem which is not compatible with life.”

Read more: The question Meghan Markle wants you to ask your friends

Abnormal chromosomes are often to blame, with a baby being unable to develop if it has too many or not enough. Chromosomes contain tightly-packaged bundles of a person’s DNA.

Miscarriages tend to be a one-off event, with the majority of women going on to have a healthy pregnancy.

“Certain medical conditions have an increased risk of miscarriage, such as thyroid disease, diabetes and obesity,” said Dr Prior.

“Female age is the strongest predictor of miscarriage and the risk increases faster for women in their forties.”

Not smoking, drinking alcohol or using illicit drugs while pregnant helps to reduce the risk.

Eating a healthy diet with plenty of fruit and vegetables can lower the odds, while warding off infections thorough hand washing can also help.

CAPE TOWN, SOUTH AFRICA - SEPTEMBER 25: Prince Harry, Duke of Sussex, Meghan, Duchess of Sussex and their baby son Archie Mountbatten-Windsor meet Archbishop Desmond Tutu and his daughter Thandeka Tutu-Gxashe at the Desmond & Leah Tutu Legacy Foundation during their royal tour of South Africa on September 25, 2019 in Cape Town, South Africa. (Photo by Toby Melville - Pool/Getty Images)
The Duke and Duchess of Sussex are parents to one-year-old Archie. They are pictured on their royal tour of South Africa in September 2019. (Getty Images)

The emotional toll of a miscarriage

A miscarriage can be a challenging occurrence, with many experiencing guilt, shock and anger.

“During a miscarriage, women’s physical and emotional experiences vary greatly,” said Dr Prior.

“Symptoms usually include pain and bleeding. These can be distressing, but often the emotional aspect of miscarriage outweighs the physical symptoms.”

It is not just the mother who feels the impact, however.

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Recent research by Imperial College London found one in 12 (8%) partners experience post-traumatic stress disorder (PTSD) three months after their other half goes through a miscarriage, while one in 25 are still experiencing symptoms nine months on.

PTSD symptoms can include flashbacks, nightmares, insomnia and angry outbursts.

“Baby loss can have a deep and lasting impact on both parents, and this [Imperial] study gives a voice to many who have suffered in silence, highlighting the profound consequences that can have for their mental health and wellbeing,” said Jane Brewin, chief executive of the baby loss charity Tommy’s.

“The message is clear; partners are vulnerable to the same psychological problems as mothers and specialist support must be made available to either or both bereaved parents.”

The support available

The Duchess of Sussex felt, as she was holding her husband’s hand in hospital, “the only way to begin to heal is to first ask, ‘are you OK?’”.

Fertility nurse consultant Kate Davies – also from Dr Fertility – agrees, adding: “Opening up conversations around baby loss and not being fearful to talk, is what we need to foster more of.

“Only by creating a safe environment for women and men to share their stories, and ultimately their grief, will we ever get rid of the taboo that surrounds baby loss”.

For people enduring the loss of a pregnancy, support is available from hospital counselling services.

Numerous charities also have helplines offering support:

Some also like to have a memorial for the baby they lost, like The Miscarriage Association’s stars of remembrance.

Watch: John Legend and Chrissy Teigen describe ‘utter grief’ of miscarriage