Surprisingly, infertility, miscarriage – defined as pregnancy loss before 20 weeks – and stillbirth is extremely common. Estimates state that 1 in 4 current pregnancies will end in miscarriage, and some suggest as high as 1 in 3. (This is about 670,000 per year!) If you include pregnancy loss that occurs before a doctor-ordered positive pregnancy test (also known as a chemical pregnancy), most estimate that 40-50% of all conceptions result in loss. 75-80% of all miscarriages occur in the first trimester, before 13 weeks. Approximately 1 in 160-200 (sources vary) of those women currently pregnant will lose their child to stillbirth. (This is about 26,000 per year!)
- An estimated 80% of all miscarriages are single miscarriages, and these women have a normal pregnancy next time. Reoccurrence of stillbirth is extremely rare.
- However, around 15% of women, who have suffered child loss, have admitted to suffering from significant depression 3 years later. Many of these women also had a healthy child during that time, leading to the conclusion that grief must be addressed for healing to occur – a change in circumstance is not the answer. (Proof that one child cannot replace another one.)
- This also leads to the conclusion that men are being affected as well, if not through the loss itself, through the unaddressed grief and/or depression in the lives of their partner.
There are approximately 6 million reported pregnancies every year throughout the United States (60,000,000 women in the childbearing years of 15-44):
- 4 million +/- live births
- 2 million +/- pregnancy losses
- an additional 8 million couples +/- deal with infertility
Every year in the United States:
- 670,000 women experience pregnancy loss through miscarriage
- 26,000 women experience pregnancy loss through stillbirth
- 1,200,000 women experience pregnancy loss through termination (this number is not included in the 1 in 4 statistic)
- 154,051 children are born with birth defects
- 19,000+ infants die in their first month
- 35,000+ infants die before their first birthday
Every year in the United States:
- 11% of pregnant woman are diagnosed with Post Partum Depression
- 820,000 woman smoke cigarettes while pregnant
- 221,000 women use illicit drugs during pregnancy
- 757,000 woman drink alcohol while pregnant
These statistics are staggering! We offer counseling for everything…except this. Most pregnancy centers are beginning to offer recovery classes to help those who have had prior abortions, but what about those couples struggling to cope with a choice they did not make? Our desire is to bring awareness to this issue of child-loss and begin reaching out with the everlasting hope and joy that only God can give.
What is infertility?
Not able to get pregnant after one year of trying, or in six months, if 35 years of age or older. The inability to stay pregnant may also be an infertility issue.
Common methods of ART (assisted reproductive technology) include:
•In vitro fertilization (IVF) means fertilization outside of the body. IVF is the most effective ART. It is often used when a woman’s fallopian tubes are blocked or when a man produces too few sperm. Doctors treat the woman with a drug that causes the ovaries to produce multiple eggs. Once mature, the eggs are removed from the woman. They are put in a dish in the lab along with the man’s sperm for fertilization. After 3 to 5 days, healthy embryos are implanted in the woman’s uterus.
•Zygote intrafallopian transfer (ZIFT) or Tubal Embryo Transfer is similar to IVF. Fertilization occurs in the laboratory. Then the very young embryo is transferred to the fallopian tube instead of the uterus.
•Gamete intrafallopian transfer (GIFT) involves transferring eggs and sperm into the woman’s fallopian tube. So fertilization occurs in the woman’s body. Few practices offer GIFT as an option.
•Intracytoplasmic sperm injection (ICSI) is often used for couples in which there are serious problems with the sperm. Sometimes it is also used for older couples or for those with failed IVF attempts. In ICSI, a single sperm is injected into a mature egg. Then the embryo is transferred to the uterus or fallopian tube.
ART procedures sometimes involve the use of donor eggs (eggs from another woman), donor sperm, or previously frozen embryos. Donor eggs are sometimes used for women who can not produce eggs. Also, donor eggs or donor sperm is sometimes used when the woman or man has a genetic disease that can be passed on to the baby. An infertile woman or couple may also use donor embryos. These are embryos that were either created by couples in infertility treatment or were created from donor sperm and donor eggs. The donated embryo is transferred to the uterus. The child will not be genetically related to either parent.
Women with no eggs or unhealthy eggs might also want to consider surrogacy. A surrogate is a woman who agrees to become pregnant using the man’s sperm and her own egg. The child will be genetically related to the surrogate and the male partner. After birth, the surrogate will give up the baby for adoption by the parents.
Women with ovaries but no uterus may be able to use a gestational carrier. This may also be an option for women who shouldn’t become pregnant because of a serious health problem. In this case, a woman uses her own egg. It is fertilized by the man’s sperm and the embryo is placed inside the carrier’s uterus. The carrier will not be related to the baby and gives him or her to the parents at birth.
Recent research by the Centers for Disease Control showed that ART babies are two to four times more likely to have certain kinds of birth defects. These may include heart and digestive system problems, and cleft (divided into two pieces) lips or palate. Researchers don’t know why this happens. The birth defects may not be due to the technology. Other factors, like the age of the parents, may be involved. More research is needed. The risk is relatively low, but parents should consider this when making the decision to use ART.
Courtesy of the National Women’s Health Information Center – http://www.cdc.gov/reproductivehealth/infertility/
What is miscarriage?
Spontaneous abortion (SAB), or miscarriage, is the term used for a pregnancy that ends on its own, within the first 20 weeks of gestation. The medical name spontaneous abortion (SAB) gives many women a negative feeling, so throughout this article we will refer to any type of spontaneous abortion or pregnancy loss under 20 weeks as miscarriage. Most miscarriages occur during the first 13 weeks of pregnancy.
Miscarriage is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. The woman may not realize that she conceived when she experiences a chemical pregnancy.
Why do miscarriages occur?
The reason for miscarriage is varied, and most often the cause cannot be identified. During the first trimester, the most common cause of miscarriage is chromosomal abnormality – meaning that something is not correct with the baby’s chromosomes. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell, or are due to a problem at the time that the zygote went through the division process. Other causes for miscarriage include (but are not limited to):
- Hormonal problems, infections or maternal health problems
- Lifestyle (i.e. smoking, drug use, malnutrition, excessive caffeine and exposure to radiation or toxic substances)
- Implantation of the egg into the uterine lining does not occur properly
- Maternal age
- Maternal trauma
Types of miscarriage:
Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.
Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.
Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
Blighted Ovum: Also called an anembryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.
Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.
Molar Pregnancy: The result of a genetic error during the fertilization process that leads to growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.
Current Obstetric & Gynecologic Diagnosis & Treatment Ninth Ed. DeCherney, Alan H., et al, Ch. 14.
MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 23]. Pregnancy Loss; [updated 2006 Feb 22; reviewed 2006 Feb 7; cited 2006 Feb 23]. Available from: http://www.nlm.nih.gov/medlineplus/pregnancyloss.html
Planning Your Pregnancy and Birth Third Ed. The American College of Obstetricians and Gynecologists, Ch. 15.
Williams Obstetrics Twenty–Second Ed. Cunningham, F. Gary, et al, Ch. 9.
What is stillbirth?
Stillbirth is when a baby dies prior to being born. Technically it is after 20 weeks of gestation. It happens about 1 in 160 pregnancies. In the majority of cases, the stillbirth happens before labor about 85% of the time.
Giving birth to a stillborn baby is every pregnant woman’s worst nightmare. When it does happen, it’s natural to want to understand why. Unfortunately, answers are rarely to be found — more than 70% of stillbirths are never explained. Doctors theorize that the majority of stillbirths probably have something to do with the placenta not functioning correctly, and they have some other specific theories on what causes this devastating type of pregnancy loss.
Chromosomal or Congenital Conditions
Just as chromosomal abnormalities cause the majority of miscarriages, certain chromosomal and congenital conditions can increase the risk that a baby will be stillborn. According to the March of Dimes, birth defects are a factor in about 15 to 20% of stillbirths.
Chromosomal abnormalities are usually determined at conception, but congenital problems can be caused by environmental influences. For example, low levels of folic acid — an important nutrient found in fortified grains and leafy green vegetables — can increase risk of having a baby affected by neural tube defects such as anencephaly.
Intrauterine Growth Restriction (IUGR)
Intrauterine growth restriction is a condition in which the baby is significantly smaller than expected for the number of weeks of pregnancy. In severe cases, this condition can cause stillbirth or increased risk of newborn loss, perhaps due to the baby not getting enough oxygen or other important nutrients.
In standard prenatal care, doctors closely monitor a baby’s growth in order to have the best chance to intervene if a baby seems at risk. Health conditions and lifestyle factors in the mother can also increase the risk of intrauterine growth restriction, and doctors screen for these problems in prenatal care, too. Some specific risk factors are preeclampsia, pregnancy-induced high blood pressure, or smoking in pregnancy.
Placental abruption is a condition in which the placenta suddenly separates from the wall of the uterus during pregnancy, while the baby is still in the womb. It can happen because of maternal health conditions, trauma to the abdomen in later pregnancy, or because of congenital uterine malformations. Certain lifestyle factors, such as smoking or substance abuse, can also increase risk. Symptoms include abdominal pain, contractions, and vaginal bleeding. Any woman worried about the condition should see a doctor immediately.
Getting certain bacterial and viral infections later in a pregnancy can increase the risk of stillbirth; infections are a factor in 10 to 25% of stillbirths.
The March of Dimes states that random cord accidents play a role in about 15% of stillbirths. Cord accidents during pregnancy, such as a tight knot in the cord or the cord becoming too tightly wrapped around the baby’s neck, are rare.
Rare Stillbirth Causes
Abdominal trauma, such as from a car accident or falling down stairs in later pregnancy, can also potentially cause a stillbirth. Studies also show that pregnancies past 42 weeks gestation are at increased risk for stillbirth, perhaps due to the placenta losing its ability to support the baby. Doctors usually recommend inducing labor in these pregnancies for this reason.
American Pregnancy Association, “Placental Abruption : Abruptio Placentae.” Nov 2006. Accessed 8 Jan 2008.
American Pregnancy Association, “Stillbirth: Trying to Understand.” Apr 2006. Accessed 8 Jan 2008.
March of Dimes, “Stillbirth.” Quick Reference and Fact Sheets. Nov 2005. Accessed 8 Jan 2008.
What is early infant death?
Any baby that is born alive and dies before its first birthday is considered an infant death. Even if the baby only takes a few breaths or only has a heartbeat for less than a minute, that baby was alive.
Causes of early infant death:
- Birth defects are the second leading cause of infant death in the nation.
- Most birth defects happen within the first three months of pregnancy, often in the first couple of weeks and before a woman even has missed a period.
- Some of the most common birth defects are 1) problems with the heart or 2) neural tube defects like spina bifida.
- A woman’s body can sometimes tell early in a pregnancy if her fetus has a very severe birth defect. These pregnancies often end early in a miscarriage.
What is SIDS?
- SIDS stands for Sudden Infant Death Syndrome. It is the sudden and unexplained death of a baby under 1 year of age.
- Because many SIDS babies are found in their cribs, some people call SIDS “crib death.”
What causes SIDS?
Groundbreaking new research sheds light on SIDS (October 2006)
SIDS may not be a “mystery” disease after all, but it has a specific biological cause.
- New research shows that many babies who have died from SIDS had a disorder in how their bodies responded to the brain chemical serotonin.
- In an infant brain with a serotonin problem, the brain cells that tell the body “turn over because I’m not getting enough oxygen” or “wake up because I’m overheating” simply might not be getting through.
- Safe sleeping for infants can help reduce the risk of SIDS. Remember to always put healthy babies on their backs to sleep; keep cribs free of toys, pillows, and comforters; and avoid overheating the baby or the room baby sleeps in.
- Respiratory Distress Syndrome – Babies with this syndrome are often born so early that their lungs don’t work properly yet.
- Complications of the pregnancy or the birth – A number of babies die from umbilical cord complications or are born much too early because of complications the mother may experience during her pregnancy. Starting prenatal care early allows health care providers to monitor pregnant women throughout their pregnancies and hopefully prevent many complications.
- Abuse and Neglect – Some infants are intentionally or unintentionally killed each year by their parents or care providers. Parents might roll over on a baby while sleeping, might shake a baby and cause life-threatening brain damage, or might simply neglect the child, failing to provide for its basic needs.