Not all pregnancies end with a baby. Nearly half of all pregnancies in the United States are unintended; and in 2011, 19 percent of pregnancies in the U.S. ended in abortion, according to a study published in the New England Journal of Medicine in 2016. Additionally, an estimated 10 to 20 percent of pregnancies end in a miscarriage. (The actual number is likely much higher, since many miscarriages happen so early in pregnancy the woman might not yet realize she's pregnant, or they occur at home and go unreported.)
Even during early pregnancy, big changes take place in your body—from tidal waves of nausea to knock-you-out fatigue. When a pregnancy ends during those early weeks, no matter the reason, you go through a post-pregnancy state.
An estimated 10 to 20 percent of pregnancies end in a miscarriage.
The two biggest physiological changes that occur in the aftermath of a pregnancy—regardless of its duration—are the uterus shedding its lining and hormonal levels dropping. In early pregnancy, the lining of the uterus becomes thicker and plusher so that the embryo can implant and a placenta can begin to form. Just as the lining is shed each month with your period, with a natural miscarriage or medical abortion (rather than surgical), you’ll experience bleeding as the uterus empties out.
"Physiologically, depending on how far along you were in your pregnancy, you might still have quite a few postpartum symptoms," says Erica Chidi Cohen, a doula, author, and co-founder and CEO of Loom, a new pregnancy, parenting, and reproductive wellness community in Los Angeles. "No matter what type of loss it was, there will be some blood loss after the fact. And that can continue for a few weeks, sometimes even up to six weeks."
A surge in hormone levels, particularly progesterone, is the cause of many early pregnancy symptoms like fatigue, nausea and sore breasts. "It can make you feel sluggish, tired, and even cause constipation and headaches due to its relaxation effect on the smooth muscles in the body," says Cohen.
"Emotional ups and downs may be common as your body copes with the cascade of having those pregnancy hormones and then not having them."
Hormones return to pre-pregnancy levels gradually. "Breast tenderness and headaches may persist for a while," says Iffath Hoskins, MD, clinical associate professor in the Department of Obstetrics and Gynecology at NYU Langone Health. "Hormone levels decrease over a couple of weeks, therefore emotional ups and downs may be common as your body copes with the cascade of having those pregnancy hormones and then not having them."
Surgical abortions or a miscarriage that requires a D&C (dilation and curettage), a procedure that removes the uterine lining surgically, may also leave you groggy from anesthesia. So you're groggy, hormonal, tired, and wearing a thick pad, since tampons and menstrual cups are a no-go following a miscarriage or an abortion, regardless of the specific medical circumstances. How do you take care of yourself?
Keep reading for advice on staying healthy after a miscarriage or abortion.
Pay attention to your nutrition
"It's important to be eating high iron foods, or taking an iron supplement if you need to, to compensate for the blood loss that’s happening," says Cohen. (Iron-rich foods include lentils, spinach, and brown rice.) It's also a time during which you should eat and rest well.
Cohen also suggests sipping on nettle tea and red raspberry tea during this time to help tone and shrink the uterus back to its non-pregnant state, which is about the same size and shape as a pear. This process, known as involution, takes longer following a full-term pregnancy, when the uterus has stretched to accommodate a 7- or 8-pound baby, but it's still important following a miscarriage or abortion because the uterus grows rapidly during the first trimester. "Red raspberry leaf can help with hormonal balance and toning the muscles of the uterus and pelvic floor. Nettles also help ease muscle spasms, cramping, and pain, which can help with the involution process," Cohen says.
Don’t push yourself physically
When it comes to physical activity, "don't hold yourself to any standard," says Dr. Hoskins. "Go with whatever you feel physically and emotionally." If exercise feels good to you, and your doctor has okayed it following any surgical procedures, go for it! But if not, give yourself a break.
"It’s about finding a balance," says Cohen. "If your loss occurred in your first trimester, your physical body may recalibrate quickly. Unless given explicit instructions by your provider, there is no reason why you can't return to your regular exercise routine, if you feel up to it. That said, if you find that you’re still experiencing light bleeding and feeling bloated and crampy, stick with gentle exertion like walking or gentle yoga like Forrest Yoga or yoga nidra. If you had a late term loss, your provider may advise waiting a few weeks to allow your uterus proper time to heal."
Connect with friends or a support group
Understand that no matter how and why the pregnancy ended, you may have an unexpected emotional response. "It's important to talk to people about it," says Cohen. "Reach out in your community and find spaces where you can share what's going on with you." She suggests the Instagram account @Ihadamiscarriage, started by Loom's community advisor, Jessica Zucker, Ph.D. "There's a lot of different women sharing about miscarriages," Cohen says. "There are also women sharing about abortions."
If you had a miscarriage, keep in mind that the chances of getting pregnant again and carrying a baby to term are very good, according to Dr. Hoskins. "Remember that this does not mean that you cannot have another healthy baby down the road," she says . "The chances of that are very high, 90 percent or more, if there were no underlying medical issues."
As you reinvest in your self-care, try these simple rituals. And here's how visual journaling can help you channel and process your emotions.
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