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Signs of a Miscarriage

July 17, 2017
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Did you know that miscarriage is the most common pregnancy complication? If not – that’s not on you! Miscarriage isn’t commonly talked about. But once a woman experiences it, she begins to realize (thanks to stats and Google), that she’s not alone. Miscarriages occur in 15-20% of pregnancies, and most commonly occur within the first 8 weeks of pregnancy. After 8 weeks, rates decline to about 3%. Another truth is that miscarriage is no one’s fault – and once it’s happening, there’s often nothing that you can do to stop it. 

Causes of Miscarriage

Miscarriage can happen for a variety of reasons including: factors associated with baby, factors associated with mom, factors associated with dad, chromosomal abnormalities, age, environmental exposure, hormonal disorders, immune factors, coagulation disorders and nutritional deficiencies. 

Signs and Symptoms

The most common sign associated with miscarriage is vaginal bleeding. Bleeding at any point during pregnancy can indicate serious problems. Bleeding may be accompanied by the passing of clots, tissue or a gush of fluid. There may be cervical dilation. Abdominal cramping, pain or contractions may also occur and become regular. Lastly, you may notice diminishing signs of pregnancy such as nausea and vomiting and breast tenderness. Depending on the type of miscarriage you are experiencing, a pregnancy test may reveal a negative result. 

Diagnosis

Unfortunately, you can’t self-diagnose a miscarriage. You may see the signs and symptoms that are occurring, but diagnosis depends on an ultrasound and determining if there’s cervical dilation.  

Types of Miscarriage & Treatment

Threatened Miscarriage

This occurs when a woman notices vaginal bleeding within the first 20 weeks of pregnancy. She may also experience backache, abdominal aching or cramping. The cervix will appear closed upon vaginal inspection. The fetal heartbeat may be found via the ultrasound. Essentially, we treat this as a viable baby until we’re concerned that there’s no heartbeat.

Medical Treatment: Watch and wait, bed rest, possibly supplementing with progesterone and administering uterine muscle relaxants. 

Naturopathic Treatment: Watch and wait, assessing for stress, dehydration and malnutrition. UTIs should also be ruled out. Acupuncture may help to harmonize the different pathways in the body. In TCM terms, this is considered a kidney yang deficiency, and the uterus must be kept warm (think of warm foods, heat over the abdomen, stimulating the appropriate acupuncture points, etc.) Botanicals may also be introduced such as Viburnum opulus (Crampbark) and Dioscorea villosa (Wild Yam) as they are both uterine antispasmodics. 

Inevitable Miscarriage

Presentation of bleeding which may range between minimal to severe, along with some lower abdominal cramping. The cervix appears dilated. At this point, treatment should not include strategies to help prevent miscarriage. Diagnosis will depend on ultrasound. 

Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, dilation and evacuation to empty the uterus. 

Naturopathic Treatment: Emotional support, addressing blood loss, physiological and psychological stress. Supporting the menstrual cycle. 

Incomplete Miscarriage

Includes vaginal bleeding, contractions, cervical dilation and incomplete passage of conception products. Sadly, the baby has passed on or is part of the tissue that has yet to pass. Both methods of treatment will support emotional and physical wellbeing of the mother and partner. 

Medical Treatment: Pain medication if required, ultrasound for diagnosis, treatment for substantial blood loss, blood work, dilation and evacuation to empty the uterus. 

Complete Miscarriage

All uterine contents of the pregnancy are passed. Cramping and abdominal pain may subside shortly after. The cervix will return to an undilated state, and a pregnancy test will read as negative. Both treatments will support emotional and physical wellbeing of the mother and partner. 

Missed Miscarriage

Unfortunately the baby has passed, but is still present in the uterus with no signs of miscarriage. This may continue for a few weeks before a miscarriage occurs, or it may be found at a routine checkup. Because it may lead to a serious maternal infection, medical care must be obtained. 

Medical Treatment: Confirmation by ultrasound, and evacuation of the products of conception. 

Naturopathic Treatment: Emotional support, regulation of the menstrual cycle. 

Recurrent Miscarriage

‘Recurrent’ is diagnosed if there is a history of 3 or more pregnancy losses. At this point, it’s advices that both partners undergo genetic testing to determine a possible cause of miscarriage. Moreover, the couple may need undergoing care if a chronic problem presents. Typically hormonal causes are the most prevalent and may involve the ovary, placenta or thyroid. Diseases also involved with recurrent miscarriage include: hypothyroidism, hyperthyroidism, PCOS, type 2 diabetes, gynecological disease (ie. endometriosis) and intestinal disorders (ie. IBS). It’s recommended that couples stop trying for about 3-6 cycles – to determine a cause and seek treatment for it. 

Medical Treatment: Determine a cause, chromosomal evaluation of both parents. 

Naturopathic Treatment: Determine a cause, prevent future miscarriages, supplement with a botanical like Vitex agnus-castus (Chaste Tree) if there is an issue with HPA axis and progesterone. In TCM terms kidney yin deficiency is the most common cause of recurrent miscarriages – this means that the uterine environment is hot and dry, the endometrial lining may not be thick enough to accept an embryo. 

Next Steps

It’s evident with many of the types of miscarriage – there’s nothing you can do to prevent them. That said if you’ve experienced a miscarriage, it’s best to wait a couple of menstrual cycles before trying again. For couples experiencing recurrent miscarriages – there is a lot that you can do to support your health before trying again. Now is a great time to look at your diet and lifestyle and work with a Naturopathic Doctor to make fundamental changes to support a healthy pregnancy. Moreover, if you are looking to supplement with herbs or vitamins – get an expert to assess them and educate you on what to look for and how to choose a product. Just because something is on sale or is the second cheapest one (you’re not choosing a bottle of wine here!) doesn’t mean it’s going to be high quality or even the right dose that you need. 

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Supportive Resources

Sunnybrook Resources for Grieving Parents – They have compiled a huge database of web resources and chat rooms. This site is definitely worth a visit. 

Nausea and Vomiting in Pregnancy

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July 10, 2017
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Nausea and vomiting in pregnancy is common as up to 85% of pregnant people experience it. Symptoms usually begin around weeks 6-8, peaking around week 9 and Subsiding before 20 weeks. A more severe condition, Hyperemesis gravidarum, can last throughout your entire pregnancy.

We don’t exactly know why this condition happens, but but it’s thought to be due to rising estrogen and HcG levels. Other factors that can affect it are: an empty stomach, low blood sugar, strong smells, nutritional deficiencies, lack of sleep and even stress!

For most, the nausea and vomiting will eventually go away, but in the meantime it’s important to address because it can impact your quality of life. 

Treatments for Morning Sickness

Medication

The common medication you might be offered is called Diclectin (doxylamine/pyridoxine). This medication comes with its controversies however, and its side effects include diarrhea, disorientation, epigastric pain, insomnia, headache, and palpitations.

Natural Therapies

Did you know that a study put out in 2016 listed ginger, acupuncture/acupressure, and Vitamin B6 as first line treatments for nausea and vomiting?

Ginger

Ginger has been compared against placebo in multiple studies, and showed a significant anti-nausea effect, as well as a decrease in vomiting. Some studies have shown ginger to be more effective than vitamin B6 at reducing nausea. When compared to doxylamine/pyridoxine, there was no significant difference between the two. 

Vitamin B6

Compared to placebo, vitamin B6 had a greater anti-nausea effect, with no difference in vomiting. While in another study compared to ginger, Vitamin B6 had a greater anti-vomiting effect. Over a longer period of treatment, vitamin B6 was shown to be more effective than ginger. 

Acupuncture/Acupressure

Acupuncture, as well as acupressure, has been shown to reduce symptoms of nausea and vomiting.
One study demonstrated that women receiving weekly acupuncture treatments, experienced less nausea after 3 weeks compared to sham and no acupuncture.

Next Steps

Other things you can do is avoid foods and smells that nauseate you, get plenty of rest, go for walks and if you can keep some food down make sure you’re getting in some protein and complex carbs. Because dehydration is an issue, be sure to carry around water or tea!  

Interestingly enough, a recent study has shown that nausea and vomiting during pregnancy were associated with a reduction in the risk of pregnancy loss. Suggesting nausea and vomiting is actually protective. And while that’s good news – feeling as well as you can in the first few weeks is key. If you’re looking to use a natural product and avoid side effects, I would recommend working with a ND to ensure that you’re using a high quality supplement at an optimal dose.

If you have natural tips for dealing with morning sickness during pregnancy, be sure to post them below. And if you have any questions or are interested in learning how naturopathic medicine can help during pregnancy book an appointment!

References

Khorasani, F., Aryan, H., Sobhi, A., Aryan, R., Abavi-Sani, A., & Ghazanfarpour, M. et al. (2019). A systematic review of the efficacy of alternative medicine in the treatment of nausea and vomiting of pregnancy. Journal Of Obstetrics And Gynaecology, 1-10. doi: 10.1080/01443615.2019.1587392

McParlin, C., O’Donnell, A., Robson, S., Beyer, F., Moloney, E., & Bryant, A. et al. (2016). Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy. JAMA316(13), 1392. doi: 10.1001/jama.2016.14337

Updated Oct. 2019

Why Aren’t You Getting Pregnant?

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You might think that you can get pregnant at any time during the month – but that isn’t true. There are about 6 days in your cycle when you’re actually fertile. So it’s important to figure out if your body is ovulating, and aim to have sex around that time (including up to 5 days before). Some people become concerned if they don’t get pregnant on the first shot, but it’s actually not that common to do so. About 84% of couple get pregnant within their first year of trying, while 92% of couples get pregnant after 2 years of trying. Depending on your age, there’s a certain time period where you might want to do some investigating if you haven’t become pregnant.

Types of Infertility

Primary Infertility (also known as Subfertility)

This happens when you’re younger than 36, and haven’t gotten pregnant within 1 year of having regular, unprotected sex, or you may not be able to carry a pregnancy to term. If you’re 35 or older, you might have primary infertility if you haven’t become pregnant within 6 months of having unprotected sex, or you may not be able to carry a pregnancy to term. This might be due to the declining egg quality as you age.

Secondary Infertility

This happens if you haven’t been able to get pregnant after 1 year of having regular, unprotected sex, or you can’t carry a pregnancy to term, DESPITE being able to have done so at least once. Women who are experiencing irregular or absence of periods, endometriosis, PCOS, painful periods, pelvic inflammatory disease, more than one miscarriage, should seek care before the 6 month or 1 year mark. 

What Causes Infertility?

Female Factor

You need to be ovulating and have unobstructed fallopian tubes for conception to occur. Keep in mind that this may not account for unexplained infertility if both those factors are normal. When you aren’t able to ovulate, this is known as anovulation. Some conditions that can affect ovulation are:
  • PCOS: A condition that may cause anovulation in women, or irregular periods
  • Diminished ovarian reserve: Fewer eggs remaining in the ovaries than normal
  • Hypothalamic functional amenorrhea: Symptoms include low body weight, excessive stress and exercise
  • Premature ovarian insufficiency: Decline of ovarian function at a younger age (ie. before your 40s).
  • Menopause: A decline in ovarian function, usually when you are in your 50s
An egg needs to pass through a fallopian tube to be fertilized by semen. But some conditions may cause obstruction. These include:
  • History of pelvic infection
  • History of sexually transmitted infections like chlamydia and gonorrhoea
  • Endometriosis
  • History of abdominal surgery

Male Factor

Men may also contribute to infertility, and it’s commonly based on sperm parameters. These parameters include: sperm count, how the sperm is moving, if the sperm is moving in the right direction, the size and shape of the sperm, total semen volume, and if sperm can transition from a gel-like to liquid state after ejaculation. Causes may also include testicular trauma, chemotherapy, hernia surgery, or infertility with another partner.

Unknown Factor

Sometimes we don’t know why infertility happens. This is known as unexplained infertility.

Risks of Infertility

In women, risks include:
  • Age
  • Smoking
  • Excessive alcohol intake
  • Extreme weight gain or loss
  • Excessive physical or emotional stress

Fertility Tests

A diagnostic workup can include:
  • Hysterosalpingogram: an X-ray investigating the shape of your uterine cavity and fallopian tubes, as well as investigating if there are any obstructions within your fallopian tubes.
  • Sonohysterography: ultrasound exam that will create images of your uterine lining. It uses fluid (administered into the cervix) and sound waves to do so.
  • Laparoscopy: The insertion of a thin telescope-like instrument vis a small incision in your belly button. It allows doctors to visually examine your abdominal and pelvic organs (uterus, fallopian tubes, ovaries), and determine if you have endometriosis, scar tissue, fibroids, or any other ‘defects’.
  • Lutenizing Hormone: This is the hormone that triggers ovulation. If there is no LH surge mid-way through your cycle, it’s suggestive of anovulation. It can also provide information about your ovarian reserve, and if your ovaries are functioning normally.
  • Hysteroscopy: Examining your cervix and the inside of your uterus using a thin, tube called a hysteroscope.
  • Transvaginal Ultrasound: Examining a your uterus, ovaries, tubes, cervix and pelvic area, using a ultrasound probe inserted in your vagina.
  • Ovarian Reserve Time: Estimating the supply of remaining eggs within your ovaries.
  • Other blood tests
In men, a work-up includes: a semen analysis and blood work to evaluate testicular function. These usually include: testosterone, follicle stimulating hormone (supports sperm production), lutenizing hormone (prompts testosterone production), and sex hormone binding globulin.

Final Thoughts

Trying to get pregnant and not being able to do so can be isolating and frustrating. You might be trying to do all the things on this fertility journey, like tracking cervical mucus and temperature, using LH strips. You might even be cutting back on smoking, drinking alcohol, or trying to lose weight. Sometimes treatment can be as easy as reducing toxic exposure (like smoking or alcohol), decreasing stress, or losing weight. It really all depends what you’re ready to do. If you’re looking for support getting pregnant, let’s work together to make the process less stressful, figure out what’s going on if there are any changes can you and/or your partner can make now, to help in the longterm. If you found this information helpful, be sure to sign up for my monthly newsletter called The Flow for more informative articles like this!