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Home / Pregnancy / Why do miscarriages happen?

Why do miscarriages happen?

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For many people, the sudden end of a pregnancy gives rise to a thousand thoughts and feelings. Suddenly, you’re not sure what this means about your body or your ability to have a healthy pregnancy, and you certainly aren’t sure what might happen next. Of the questions that patients ask me, the first is almost always, “Why did this happen to me?”

A person having a miscarriage joins a club that they never intended to sign up for. This club is full of amazing people from all different walks of life who are bonded together by this similar experience. Everyone’s miscarriage journey is different, but you and the others that came before you all experience the physical and emotional loss of a pregnancy ending.

This is a bigger club than you realize. Around 1 in 4 recognized pregnancies ends in a miscarriage — and it may be as many as half the pregnancies, since many people miscarry before they realize they are pregnant. At those rates, about a quarter of women will experience a miscarriage during their lifetimes.

This means you absolutely know at least one person who has had a miscarriage, even if no one has told you they’ve had one. Miscarriages happen to people in every country and every situation in life. Healthy or sick. Young or old. Happy or sad or unsure about the pregnancy. There are risk factors for miscarriages, but it’s important to know that most pregnancy losses happen to completely healthy people.

Here are the most common risk factors for pregnancy loss:

Who you are:

• Age.  Being over 35 or having a male partner over 40.
• Weight.  Being underweight or overweight is associated with miscarriage, but it’s unclear if weight itself directly increases the risk.

What you do:

• Lifestyle factors.  Smoking 10 cigarettes or more a day, drinking alcohol, or using nonprescribed substances, particularly cocaine.
• Exposure to radiation and toxic substances.  Having a job that exposes you to toxins, like pesticides, heavy metals (lead, mercury, arsenic), solvents (toluene and benzene), ionizing radiation and some chemotherapy agents.
• Extensive lifting at work.  Regularly lifting over 220 pounds a day. If your job or workplace poses a risk to you during pregnancy, your doctor can write a letter to your employer. Your employer should make accommodations for you.

Pregnancy complications:

• Multiple gestation.  Twins, triplets, or more.
• Pregnant with an IUD in place.  Intrauterine devices (IUDs) are highly effective forms of birth control, but if the device fails, the pregnancy is at a higher risk of loss.
• Invasive pregnancy testing.  Chorionic villus sampling (CVS) and amniocentesis tests to determine if the baby is healthy can uncommonly cause miscarriage.
• Infections.  Rubella, chickenpox, foodborne infections (listeriosis, salmonellosis).
• High-velocity trauma,  like a serious motor vehicle accident or major fall; or low-velocity trauma, like getting hit in the belly during a low-speed motor vehicle accident in the second or third trimester.

Unclear associations, due to poor or conflicting data:

• Night shift work.  Some studies (but not all) have shown that working a night shift affects long-term health and increases the risk of miscarriage.
• Taking medication.  Certain drugs, including oral medication used to treat a yeast infection, may increase early miscarriage risk. Ask your doctor if there are drugs or supplements you shouldn’t take while pregnant.

The average person who wants to be pregnant and have more than one child may be pregnant many times in a lifetime. The odds are actually higher that you’re going to have at least one miscarriage than that you won’t have any. It’s especially sad when a miscarriage happens in a first pregnancy because of all the doubts it might raise. But you’re no more or less likely to have bad luck on your first pregnancy than your fourth.

There are also plenty of things that do not cause a miscarriage. Here’s a short but by no means definitive list:

Exercise, heavy lifting or physical exertion Don’t worry about the fact that you vacuumed your house, moved a few heavy boxes, or lifted your niece or nephew. Even if you have a job that involves lifting mattresses or pushing heavy carts. Even if you bench-pressed 150 pounds on a few occasions or ran a marathon (which is amazing). No amount of typical physical activity can cause a miscarriage.

Working There’s no link between miscarriage and full-time employment, standing more than six hours a day, or an average amount of lifting. While some jobs may be associated with a higher risk, it’s unlikely your job had anything to do with your miscarriage.

Screen time Working at a computer all day or spending a lot of time on your social media accounts is not associated with miscarriage. The electromagnetic fields from computer screens are weak. While staring at a screen all day may not be good for your eyesight or your relationships, it doesn’t threaten your pregnancy.

Air travel Cabin pressurization isn’t associated with higher miscarriage risk. However, if you do fly while you’re pregnant, be sure to regularly get up and walk the aisle to prevent blood clots in your legs. Pregnancy does increase your risk of those.

Frights There are myths about a shock or fright causing a miscarriage. That’s not true, either. Enjoy all the horror movies you want.

Sex I don’t care how vigorous the sex was, how athletic or in what position. In fact, I hope all those things were superfun. No amount of sex (or an orgasm, with or without intercourse) can disrupt your pregnancy.

Caffeine Moderate caffeine consumption (2 cups of coffee or 3 to 5 cans of soda a day) is OK while pregnant.

Tampons Tampons stay in your vagina and go nowhere near the baby inside the uterus.

Hormonal birth control Hormonal contraception doesn’t fundamentally change your ovaries, your eggs or your uterus, and it has no impact on the health of your pregnancies. While the injection can delay your periods from returning for up to a year, you’ll still be able to have a healthy pregnancy once the hormonal effects wear off. If your hormonal birth control failed and you became pregnant while using it, there is no increased risk of miscarriage.

An intrauterine device (IUD) Similarly, having used an IUD in the past doesn’t increase your risk of miscarriage. The only association with an IUD and miscarriage is in the rare instances when you become pregnant with an IUD in place. These pregnancies have a high risk of miscarriage, especially if the IUD is not removed.

A past abortion It isn’t uncommon for people to feel that their decisions about past pregnancies are the reason for a present-day miscarriage. Medically, a past abortion — even if you’ve had more than one — has no impact on your pregnancies in the future. You made the best decision for yourself that you could at the time, and an abortion does not damage your uterus so that you can’t get pregnant again. The universe is not sending you a message.

Morning sickness My patients have asked me if their babies were nutritionally deprived because they were nauseous all the time and couldn’t eat or were vomiting throughout the day. No matter how much you vomited or how little you ate, morning sickness does not lead to miscarriage. In fact, it’s associated with high pregnancy hormone levels that tend to indicate healthier pregnancies.

A flu shot The effects of flu vaccines on pregnancies have been heavily researched. Despite what you may have heard, getting the flu vaccine during pregnancy is not only safe, but also highly recommended. If you were to get the flu while pregnant, you would have a higher risk of serious illness — and even death — than getting the flu at any other time. Getting the flu vaccine won’t cause a miscarriage and will keep you and your baby safe, both before and after birth.

Bottom line: You did nothing wrong. You did nothing to make this happen.

Relevant reading

Mayo Clinic Guide to a Healthy Pregnancy, Second Edition

Mayo Clinic Guide to a Healthy Pregnancy, Second Edition is an authoritative, yet practical reference manual from the pregnancy experts at the #1 ranked hospital in America. There are few events in life that rival the significance and the joy of childbirth. Your interest in this book reflects your eagerness…

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What Does and Doesn't Cause a Miscarriage

Can stress cause a miscarriage? What about sex, exercise, or certain foods? We spoke with experts about what causes a miscarriage—and what doesn't.

What Causes Miscarriage

The most common causes of miscarriage.

• What Doesn't Cause Miscarriage
• Is Miscarriage Ever the Pregnant Person's Fault?

Miscarriage is common. In fact, it's estimated that as many as 26% of all pregnancies end in miscarriage with the likelihood increasing with advancing age. While common, there is still a lot that people don't know about what causes a miscarriage. "Much misinformation is shared among women or passed down from older generations," says Jonathan Schaffir, M.D. , an assistant professor of obstetrics and gynecology at Ohio State University College of Medicine.

While most miscarriages are caused by things that are beyond the pregnant person's control like chromosomal abnormalities and underlying health conditions, many people continue to worry about inadvertently causing a miscarriage. Here's what you should know about what causes a miscarriage—and what does not.

The majority of miscarriages, especially in the first trimester, are caused by chromosomal abnormalities in the developing embryo or fertilized egg, explains the American College of Obstetricians and Gynecologists (ACOG). Beyond chromosomal abnormalities, there are other known causes of miscarriage.

Known Causes of Miscarriage

Known causes of miscarriage include:

• Chromosomal abnormalities
• Genetic factors
• Certain health conditions
• Hormonal disorders

Drug and alcohol use

• Uterine abnormalities
• Cervical abnormalities

Despite all that's known about what can cause miscarriage, there is still a lot that experts don't know. Even after a fertility evaluation for pregnancy loss, up to 50% of miscarriages are attributed to unknown causes.

Because the majority of people who conceive again after experiencing a miscarriage go on to have a healthy pregnancy, it's common to remain in the dark about what caused the miscarriage. Things may look a little different when you're dealing with recurrent miscarriage (two or more back-to-back pregnancy losses), at which point a health care provider may be more likely to recommend doing some testing to pinpoint a possible cause and determine the best course of action.

While it may be hard to pinpoint an exact reason behind a pregnancy loss, here's what experts do know about the most common causes of miscarriage and some of the factors that may increase a person's risk of having one.

Chromosomal abnormalities in the fetus

Research suggests that at least 50% of first-trimester miscarriages are caused by chromosomal abnormalities in the fetus.

"When the chromosomes of the egg and those of the sperm fuse to form an embryo, they usually pair up correctly," says Henry Lerner, M.D., an OB-GYN at Newton-Wellesley Hospital in Newton, Massachusetts. "But sometimes they get scrambled; if they're paired incorrectly, the embryo stops developing."

Chromosomal abnormalities don't mean that anything's wrong with the parents or their genes , and because chromosomal abnormalities in embryos are often random, one-time events, they're unlikely to happen again.

Certain health conditions in the pregnant person

Certain health conditions can cause miscarriage, especially those that restrict blood flow to the uterus. Chronic conditions that are associated with a higher risk of miscarriage include hypertension, diabetes, thyroid disease, lupus, and heart disease. Hormone-related disorders and autoimmune disorders like antiphospholipid syndrome (APS) have also been linked to miscarriage. Certain types of uterine infections and sexually transmitted infections (STIs) can also play a role.

Problems with the uterus or cervix such as fibroids and cervical insufficiency (when the cervix dilates too soon during pregnancy) can also lead to miscarriage.

Other health-related factors include certain medical procedures such as amniocentesis and chorionic villus sampling (CVS), which carry a very small risk of miscarriage (one of the reasons why these procedures are reserved for cases where the benefits outweigh the risks).

Caffeine is one drug that comes up a lot in the context of pregnancy. Let's be clear: One daily cup coffee during pregnancy is perfectly fine. It's when caffeine consumption gets higher that there may be a risk.

Much of the conversation about caffeine and miscarriage is based on a 2008 study that found that people who consumed 200 milligrams or more of caffeine a day had twice the miscarriage risk as those who didn't have any.

Since then, additional studies have demonstrated a connection between excessive caffeine consumption and miscarriage, but there isn't consensus about the nature and strength of the connection. The official stance of the ACOG is that it's safe for pregnant people to drink up to 200 milligrams of coffee per day, which is the amount of caffeine in about two 8-ounce cups of regular coffee.

While the research about caffeine and miscarriage risk is incomplete, the evidence is clear that drug and alcohol use can lead to miscarriage. "Exposing a fetus to large amounts of these chemicals on a regular basis can cause miscarriage because they have a poisonous effect on all those developing cells," says Dr. Schaffir. Substances that can lead to miscarriage include alcohol, illicit drugs, nicotine and tobacco products, and even certain prescription medications.

Researchers note that the risk of stillbirth is raised by 1.8 to 2.8 times with tobacco use, 2.3 times with marijuana use, 2.2 times with stimulants or prescription drug use, and even 2.1 times greater risk of miscarriage from passive exposure to tobacco.

What Doesn't Cause Miscarriage

While we know what things can cause or increase the risk of miscarriage, there are still plenty of myths surrounding miscarriage. We asked Dr. Schaffir to debunk some major misconceptions about miscarriages.

"It's important for [people] to understand that these are just old wives' tales—and not only are they not true but in some cases, believing them can affect your health and well-being," he says. Here are four things that don't cause a miscarriage.

Moderate exercise

Exercising or picking up a (reasonably) heavy object—such as a grocery bag, a toddler, or the like—are extremely unlikely to cause a miscarriage. In fact, the ACOG notes that exercise during pregnancy, with your doctor's approval, can have benefits during pregnancy.

That's because exercise reduces stress, relieves aches and pains, lowers your risk of pregnancy-related conditions like gestational diabetes , gestational hypertension, and preeclampsia , improves your overall fitness, and even builds up stamina for labor. As long as you're continuing exercises that you did pre-pregnancy and not suddenly taking on Olympic weightlifting, exercise during pregnancy is perfectly safe.

Everyday stress

While some studies on stress and miscarriage are conflicting, Dr. Schaffir says that everyday tension or anxiety—such as tight deadlines at work or worrying about what labor will be like—have not been linked to pregnancy loss. What's more, no studies have ever linked excessive bad moods to miscarriage, Dr. Schaffir adds.

Things get murky when dealing with major stress, though. "We're talking big things, like the death of a spouse or parent," he explains, and even then, the link is not well established. Plus, pregnant people who are under extreme stress may be more likely to smoke, drink, or do drugs to cope, which can also affect their risk of miscarrying.

Food that's properly cooked

While foods themselves don't cause miscarriage, certain foods come with higher risks of food-borne illnesses like listeriosis (an infection caused by the bacteria Listeria monocytogenes ).

The Food and Drug Administration (FDA) explains that cases of listeriosis and other food-borne illnesses have been linked to miscarriage and pregnancy complications, which is why experts recommend avoiding certain foods during pregnancy. For instance, pregnant people should avoid raw meat and fish, unpasteurized cheeses, and deli meat, all of which carry a higher risk of food-borne illness.

In general, all kinds of sex and sex acts including the use of sex toys are considered safe during pregnancy. The fetus is protected not only by amniotic fluid but also by the powerful muscles of the uterine walls. As long as the pregnancy is low risk, the fetus is developing on a typical track, and there are no concerns about pre-term labor or other complications, sex during pregnancy is likely safe. If you're concerned, however, don't hesitate to ask a health care provider.

Is Miscarriage Ever the Pregnant Person's Fault?

The vast majority of miscarriages occur because of chance chromosomal or genetic abnormalities in the embryo or fetus or, less commonly, hormonal imbalances or problems with the uterus or placenta, says Dr. Schaffir. These factors are nothing that a pregnant person has control over. It's natural for people experiencing loss to try to explain it in some way, even if that means blaming themselves. "But all [people] need to know that most of the time, a miscarriage is completely random," he says.

Dr. Schaffir adds that if you eventually want to try again, odds are you will conceive and have a healthy pregnancy. Of course, that being said, if you have any concerns, have had two or more losses in a row, or are over the age of 35, it's always a good idea to speak with a doctor who can help you plan your next steps.

Key Takeaways

The majority of miscarriages are caused by chromosomal abnormalities, which cannot be predicted or prevented. Most people who have had a miscarriage are able to conceive again and have a healthy pregnancy. If you experience repeated miscarriages or have any underlying health conditions, it's best to speak to a doctor about making a plan for pregnancy.

Miscarriage . Stat Pearls . 2022.

Early Pregnancy Loss . The American College of Obstetricians and Gynecologists. 2018.

Chromosomal instability in first trimester miscarriage: a common cause of pregnancy loss? . TP Translational Pediatrics . 2018.

Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study . American Journal of Obstetrics and Gynecology . 2008.

Relationship between maternal caffeine and coffee intake and pregnancy loss: A grading of recommendations assessment, development, and evaluation-assessed, dose-response meta-analysis of observational studies . Frontiers in Nutrition . 2022.

Association between stillbirth and illicit drug use and smoking during pregnancy . Obstetrics & Gynecology . 2014.

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Miscarriage: Why It Happens And How Best To Reduce Your Risks

A conversation with Dr. Henry Lerner

Q: How common are miscarriages? Do you see it a lot in your practice? A: Unfortunately miscarriages are extremely common.  They occur in one of every five pregnancies.  So although there are 4 million babies born in the United States each year, another one million couples undergo the emotional trauma of having a miscarriage. Having practiced obstetrics over the last 22 years I have seen thousands of couples go through miscarriages.  They occur so commonly, I generally see to 2 to 3 such couples a week.  No matter how sophisticated a woman and her partner may be, no matter how many healthy children they might already have, a miscarriage is always an extremely upsetting event. Q: Are there different types of miscarriages? A: Yes. The majority of miscarriages--60 percent or so--come about because of a miscombination of the chromosomes of the egg and sperm when they fuse at conception.  Four out of five times when the egg and sperm fuse a healthy embryo results.  One out of five times, however, the chromosomes of the egg and sperm don't combine correctly resulting in the embryo having abnormal chromosomes.

But there are other causes for miscarriage as well.  These range from abnormalities of a woman's reproductive organ--such as a uterus that has large fibroids--to hormonal inadequacy, infection, or harmful environmental influences. Q: Is it useful to try to detect the specific cause for every miscarriage? A: Since 60 percent of all miscarriages occur because of the accidental event of chromosomal miscombination, trying to find the "cause" of this random event will not help a couple avoid a similar outcome in a future pregnancy.  However, if there is some reason to suspect that another factor is at work--such as an anatomic, hormonal, environmental, infectious, or genetic abnormalit--then further testing is appropriate.  Such testing may enable a treatment to be found that can significantly increase the chances of the next pregnancy being successful. Since women who have had three or more miscarriages are more likely than others to have a specific, nonrandom cause for their miscarriages, it is worthwhile for such women to undergo a comprehensive evaluation.  By so doing, a treatable cause for these recurrent miscarriages can often be found. Q: Is there anything a woman can do during pregnancy to reduce her risk? A: First of all, she should take several steps to prepare for becoming pregnant.  This means getting medical problems attended to, having dental work done, and making sure immunizations are up to date. Second, she should make sure that while trying to get pregnant she is eating a healthy, well balanced diet and is getting some source of folic acid.  Taking a standard over-the-counter multivitamin tablet most easily does this.  Folic acid decreases the risk of spinal cord defects developing in the baby. Third, a woman trying to conceive should reduce the amount of alcohol she consumes and stop smoking.  She should of course stop the use of all recreational drugs and consult her doctor before taking any medications other than Tylenol or antacids. Fourth, all woman and their partners should inquire of family members about their genetic and family health histories.  In this way the possibility of any inheritable diseases can be uncovered and professional genetic counseling obtained if necessary. Fifth, while trying to get pregnant and during pregnancy it is important to make sure that the environment in which a woman lives and works does not contain any noxious substances that might be harmful to the pregnancy.    While there are many more factors that contribute to reduced risk for miscarriage and that are discussed in my book, these are the most important ones. Q: Will doctors ever find a way to prevent miscarriages? A: The answer to this question depends on what kind of miscarriages we are discussing.  As far as the spontaneous, common miscarriage that occurs randomly because of miscombination of the chromosomes of the egg and sperm, the answer is probably no. On the other hand, miscarriages caused by anatomic problems, hormonal inadequacy, medical illnesses, or environmental factors are certainly amenable to being reduced or eliminated. Q: What advice can you offer women who have suffered a miscarriage and are now scared about it happening in another pregnancy? A: Your fears and concerns are entirely normal and appropriate. However as you learn more about miscarriages you will come to understand that the vast majority of women who go through 1, 2, or even more miscarriages do eventually go on to have as many healthy children as they want.  My advice to you is to find out as much about miscarriages as possible, consult with your doctor as to whether or not further testing makes sense for you, and then move on with the assurance that your next pregnancy is overwhelmingly likely to be a normal one resulting in the birth of a healthy baby. Henry Lerner, M.D., OB/GYN is the author of Miscarriage: Why It Happens And How Best To Reduce Your Risks, and a graduate of Harvard Medical School. He has been an obstetrician/gynecologist for more than twenty years. He has appeared on "Nightline," "Larry King Live," and "Firing Line" and has been interviewed for magazines including Time and People. He lives in Newton, Massachusetts. Whether it occurs in the first trimester or later in a pregnancy, a miscarriage is always an emotionally traumatic event, sometimes a physically daunting one, and all too often an isolating experience. Adding to the frustration and disappointment of the 800,000 women who miscarry every year, busy obstetricians often lack up-to-date or specific knowledge about the causes and consequences of this profound event. Into this fact-vacuum comes Miscarriage, a book that every physician will confidently recommend and that women hungry for information will seek out. From the chromosomal, illness-related, immunological, and genetic reasons for miscarriage to the diagnostic tests and surgical procedures now available, this authoritative guide reflects the latest medical information on why miscarriages do and don't happen and the best methodologies known for recovery and preparing to conceive again. Complete with stories from women who have miscarried and reassuring input from a female doctor, Miscarriage also provides substantive advice for coping with the anxiety and depression that often accompany the loss of pregnancy.

Please check-out You've Had A Miscarriage - What Now? by Henry Lerner, M.D., OB/GYN author of "Miscarriage: Why It Happens And How Best To Reduce Your Risks"

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Truths About Causes of Miscarriage

A Reality Check for Common Claims About Miscarriage

People hear a lot of things about what does and does not cause miscarriages, and much of the information available is confusing at best and harmful at worst. The truth is that while some miscarriages have a known cause, most don't and experts still don't fully understand all the complexities of pregnancy loss. Often, what research reveals are miscarriage risk factors , or things that are correlated with miscarriage and may increase a person's risk of experiencing one.

But it's important to note that correlation is not necessarily causation, meaning that while something might be associated with miscarriage , it does not necessarily cause it. Here is what the research tells us.

There Is No Evidence That Video Display Terminals Cause Miscarriage

There was one study in the 1980s that found an increased risk of miscarriage in women who used video display terminals for a lengthy period of time on a regular basis. But subsequent research has not found a link between video display terminals and miscarriage.

It's been noted that there are potential biological effects associated with electromagnetic fields that raise some concern over their role in miscarriage, but the lack of data does not reveal any clear causal link.

Abortion Doesn't Increase Risk of Miscarriage in Future Pregnancies

While there are a couple of studies that have suggested an increased risk of miscarriage in people who had previously terminated a pregnancy, the evidence overwhelmingly indicates that elective abortion is safe and not linked to future pregnancy loss.

Any increased risk of future miscarriage appears to be limited to people who experienced post-surgery complications such as severe infection or uterine scarring after a surgical abortion via dilation and curettage ( D&C ). And there is no evidence that medical abortion, or an abortion using medications rather than surgery, is associated with future miscarriages.

In fact, a large study published in The New England Journal of Medicine found that elective medical abortion was not associated with any increased risk of subsequent miscarriage.

Severe Stress May Increase Miscarriage Risk, But it's Complicated

There is some evidence that stress during pregnancy may elevate miscarriage risk . There have been several studies that found evidence of a link between stress and miscarriage or stillbirth, although the evidence doesn't prove that the stress is what caused the miscarriages in those cases.

It is very difficult to evaluate the role of stress in miscarriage, and while many studies have investigated this relationship, the answer is still unknown.

Everyone experiences stress. It's important to note that we all process stress differently. For example, one person may feel "very stressed" by relatively minor stressors, while another may feel only "moderately stressed" when faced with greater obstacles.

That said, there is some biological evidence pointing towards the role of stress in miscarriage. Stress leads to the release of "stress hormones" such as cortisol in the body. Elevated cortisol levels, in turn, have been associated with an increased risk of miscarriage in some studies.

Looking at population studies, ordinary stress has not often been associated with an increased risk of miscarriage, but "major stress," such as the economic downturn in Denmark was linked with a greater risk of miscarriage. Evidence suggests that it's that unusual or chronic stress may be more important when considering miscarriage risk.

One of the most comprehensive studies to date published in 2017 suggested that stress increases the risk of miscarriage by around 42%.

The Relationship Between Aspirin and Miscarriage Risk Is Complex

There is some research that taking aspirin during pregnancy may increase miscarriage risk . However, evidence of causation is unclear, as some studies show no such link.

Additionally, some doctors even prescribe ​ low-dose aspirin as a part of recurrent miscarriage treatment, although evidence of the efficacy of this treatment is mixed. Daily low-dose aspirin is also recommended to prevent preeclampsia in high-risk pregnant people.

For people who have recurrent miscarriages due to antiphospholipid syndrome , a type of clotting disorder, low-dose aspirin may lessen the risk of miscarriage. For people without a history of recurrent miscarriages, some research has shown an association between aspirin use in early pregnancy and an increased risk of miscarriage, although other studies have shown no such link.

Using non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) and Aleve (naproxen), however, may slightly increase the risk of early miscarriage. But more research is needed to understand the link, as it's possible that some may be taking NSAIDs to treat pain caused by an impending miscarriage (in which case the NSAIDs aren't the cause of the miscarriage).

Additionally, the Food and Drug Administration (FDA) only recommends taking NSAIDs before 20 weeks of gestation due to rare but serious (and potentially fatal) complications that can occur when taken in the latter half of pregnancy.

Birth Control Pills and Emergency Contraception Don't Cause Miscarriage

Although taking a large dose of birth control pills within a few days of intercourse can work as emergency contraception, there is no evidence that birth control pills will cause a miscarriage in an established pregnancy or that taking birth control pills will increase the risk of future miscarriage.

You Can Safely Breastfeed While Pregnant

There's no evidence that continuing to breastfeed an older child during a new pregnancy causes miscarriage or any harm whatsoever to the developing baby.

Pregnant people who want to continue breastfeeding an older child while pregnant can do so without worry.

Moderate Exercise Is Safe and Recommended During Pregnancy

No one knows for sure whether strenuous exercise increases miscarriage risk , but most obstetricians recommend exercise during pregnancy. There was a large study in 2007 that indicated women who engaged in ​strenuous exercise were more likely to have miscarriages, but there have been several other studies that found no link between exercise and miscarriage.

Light and moderate exercise during pregnancy are almost certainly beneficial. Some doctors advise keeping your heart rate under 140 beats per minute (bpm) to be on the safe side.

High Body Temperature May Increase Miscarriage Risk

Hot tub use during pregnancy may increase the risk of miscarriage according to a 2003 study. In that study, the risk of miscarriage was doubled on average with early first-trimester hot tub use and increased further with greater frequency of use.

The problem with hot tubs, saunas, and hot baths isn't the devices themselves but rather the increase in body temperature associated with their use. Allowing your body temperature to get too high during pregnancy has also been linked with neural tube defects and is not recommended.

For those who desire to spend some time in a hot tub or hot bath, program your hot tub to a lower temperature, don't allow your body temperature to exceed 101 degrees F, and spend no longer than 10 minutes in the tub.

Some Food-Borne Infections Are Associated With Miscarriage Risk

The advice that you should avoid soft, unpasteurized cheese and cold deli meats while pregnant is valid but incomplete. The risk associated with certain cheeses and deli meats isn't limited to these food items.

In practice, pregnant people should do their best to avoid common sources of food-borne illness, including unpasteurized cheese and cold cuts. Not only are you more likely to develop food poisoning while pregnant , but some of the organisms that cause food poisoning are linked with an increased risk of miscarriage. These include:

• Toxoplasmosis

It's important to note that you don't have to avoid all cheese or deli meats during pregnancy.

Most cases of food poisoning linked to miscarriage are related to dairy products (such as soft cheeses) that have not been pasteurized, meats that have not been thoroughly cooked, or vegetables that haven't been washed.

Having Sex During Pregnancy Does Not Cause Miscarriage

There's no evidence that sex during pregnancy poses any risk of miscarriage. Sex doesn't even seem to be able to trigger labor in people with full-term pregnancies, so you should definitely not worry about orgasms or related uterine contractions causing miscarriage.

Sex is generally considered safe during all phases of pregnancy, but there are a few exceptions such as after your water has broken or if you are experiencing vaginal bleeding. Be sure to discuss any concerns with your provider.

In Most Cases, Getting Pregnant Again Right After a Miscarriage Doesn't Increase Your Chances of Another Miscarriage

There's always a risk of miscarriage in any pregnancy, but there's no real evidence that you need to wait any set period of time after a first-trimester miscarriage before you try again in order to prevent another miscarriage. There may, however, be other reasons for waiting.

In the past, it was often recommended that people wait a few months before trying again. One of the reasons behind this recommendation was that it can be more difficult to date a pregnancy that occurs immediately following a miscarriage , but with the advent of early ultrasound, this is rarely a concern today.

An older study also suggested a higher rate of miscarriage when a person becomes pregnant right away after having a pregnancy affected by a neural tube defect, but this may be related to low folate levels prior to the first pregnancy that persist for the second pregnancy.

Doctors may still advise waiting for different reasons for individual people, so be sure to check with your doctor about their recommendations for you.

For example, if a person has a miscarriage related to a medical condition such as uncontrolled diabetes, it's important to stabilize the medical condition before trying again.

Progesterone Cream Is Not a Universal Solution for Miscarriage Prevention

Don't rush out and buy that cream yet. Some doctors do believe that progesterone supplements might help certain people with a history of recurrent miscarriage but the opinion is controversial. There's no strong evidence that progesterone supplementation helps prevent miscarriage with the exception of people who are undergoing in vitro fertilization (IVF) and a small subset of people with recurrent miscarriages.

As for over-the-counter progesterone creams , the dosage varies heavily and some of the creams don't even contain any active progesterone. If you would benefit from progesterone supplementation during your pregnancy, it's best to get a prescription from your doctor.

Having a Bicornuate Uterus Doesn't Cause Miscarriage

A bicornuate uterus can mean an increased risk of preterm labor , but there's no evidence that it increases the risk of miscarriage. However, a uterine septum can mean an increased risk of miscarriage, and the two malformations look similar on imaging tests.

Learn more about the different types of uterine abnormalities and miscarriage risk .

Minor Abdominal Injury Isn't Linked to First-Trimester Miscarriage

Minor trauma such as falling , being hit in the abdomen , or having a fender bender is not likely to cause a first-trimester miscarriage, but it can cause placental abruption in the second or third trimester and potentially lead to late pregnancy loss.

In contrast, high-velocity trauma, such as a motor vehicle accident or major fall can significantly increase the risk of miscarriage. Plus, the risk of a fall or trauma of any kind is much greater later in pregnancy.

The Research About Roller Coasters and Miscarriage Is Lacking

No one has researched the safety of riding roller coasters during pregnancy , or the effect of other amusement park rides. There is a theoretical risk that the jerking motions could lead to placental abruption later in pregnancy, and although riding a roller coaster in very early pregnancy is most likely not going to cause problems, no one really knows where the cut-off point lies for safe versus risky.

Due to the uncertainty over the effect of roller coasters on pregnancy, some experts recommend avoiding these rides no matter how far along you are in your pregnancy.

Obesity May Increase the Risk of Miscarriage

Obesity does appear to increase the risk of miscarriage , but the relationship between body weight and miscarriage is still not well understood.

Though obesity is linked with miscarriage and recurrent miscarriages, it's not known if being overweight is actually a cause of miscarriage.

Certain Illnesses During Pregnancy Are Associated With Increased Risk of Miscarriage

Certain bacterial and viral infections can increase the risk of a miscarriage . Examples include:

• Fifth disease
• Rubella (German measles)
• Bacterial vaginosis

That said, the chance that these infections will result in miscarriage is usually much lower than the chance that a baby will be fine. If you become ill while pregnant, it's always a good idea to contact your provider.

Pregnant People Over the Age of 35 Have a Higher Risk of Miscarriage

The risk of miscarriage is slightly higher for moms over 35 and is almost 50% for pregnant people in their early 40s.

It's important to note, however, that for a pregnant person who is 35 years old, the chances of a healthy pregnancy are still higher than the chances of miscarriage.

Miscarriage Is Almost Never the Pregnant Person's Fault

Miscarriage almost never happens because of something that a pregnant person did or did not do. It is important to emphasize this point, as many people wonder what they may have done to cause their miscarriage.

Chromosomal abnormalities in the baby are the most common reason for a miscarriage , and these abnormalities are not caused by anything a pregnant person does or does not do, but happen by chance alone.

Goldhaber MK, Polen MR, Hiatt RA. The risk of miscarriage and birth defects among women who use visual display terminals during pregnancy . Am J Ind Med . 1988;13(6):695-706. doi10.1002/ajim.4700130608

Shaw GM. Adverse human reproductive outcomes and electromagnetic fields: A brief summary of the epidemiologic literature . Bioelectromagnetics . 2001;Suppl 5:S5-18. doi:10.1002/1521-186x(2001)22:5+<::aid-bem1020>3.3.co;2-c

Virk J, Zhang J, Olsen J.  Medical abortion and the risk of subsequent adverse pregnancy outcomes .  N Engl J Med.  2007;357(7):648-53. doi:10.1056/nejmoa070445

Xu Z, Zhao J, Zhang H, et al. Spontaneous miscarriages are explained by the stress/glucocorticoid/lipoxin A4 axis . J Immunol . 2013;190(12):6051-8. doi:10.4049/jimmunol.1202807

Bruckner TA, Mortensen LH, Catalano RA. Spontaneous pregnancy loss in Denmark following economic downturns . Am J Epidemiol . 2016;183(8):701-8. doi:10.1093/aje/kww003

Qu F, Wu Y, Zhu YH, et al. The association between psychological stress and miscarriage: A systematic review and meta-analysis .  Sci Rep . 2017;7(1):1731. doi:10.1038/s41598-017-01792-3

Keim SA, Klebanoff MA. Aspirin use and miscarriage risk . Epidemiology . 2006;17(4):435-9. doi:10.1097/01.ede.0000221693.72971.b3

Levine LD, Holland TL, Kim K, Sjaarda LA, Mumford SL, Schisterman EF. The role of aspirin and inflammation on reproduction: The EAGeR trial . Can J Physiol Pharmacol . 2019;97(3):187-192. doi:10.1139/cjpp-2018-0368

Demers S, Roberge S, Bujold E. The use of aspirin during pregnancy . Am J Obstet Gynecol . 2013;208(2):161-162. doi:10.1016/j.ajog.2012.11.024 

Di Prima FA, Valenti O, Hyseni E, et al. Antiphospholipid syndrome during pregnancy: The state of the art .  J Prenat Med . 2011;5(2):41-53.

Daniel S, Koren G, Lunenfeld E, Levy A. NSAIDs and spontaneous abortions - true effect or an indication bias? .  Br J Clin Pharmacol . 2015;80(4):750-754. doi:10.1111/bcp.12653

Food and Drug Administration. FDA recommends avoiding use of NSAIDs in pregnancy at 20 weeks or later because they can result in low amniotic fluid .

Madsen M, Jørgensen T, Jensen ML, et al. Leisure time physical exercise during pregnancy and the risk of miscarriage: A study within the Danish National Birth Cohort . BJOG . 2007;114(11):1419-26. doi:10.1111/j.1471-0528.2007.01496.x

Parad A, Leonard E, Handler L. FPIN's Clinical Inquiries.  Exercise and pregnancy loss . Am Fam Physician . 2015;91(7):437-8.

Li DK, Janevic T, Odouli R, Liu L. Hot tub use during pregnancy and the risk of miscarriage . American Journal of Epidemiology , 2003;158(10):931–937. doi:10.1093/aje/kwg243

Carmi R, Gohar J, Meizner I, Katz M. Spontaneous abortion--high risk factor for neural tube defects in subsequent pregnancy . Am J Med Genet . 1994;51(2):93-7. doi:10.1002/ajmg.1320510203

Stephenson MD, McQueen D, Winter M, Kliman HJ. Luteal start vaginal micronized progesterone improves pregnancy success in women with recurrent pregnancy loss. Fertil Steril . 2017;107(3):684-690.e2. doi:10.1016/j.fertnstert.2016.11.029

Heazell AEP, Newman L, Lean SC, Jones RL. Pregnancy outcome in mothers over the age of 35 . Curr Opin Obstet Gynecol . 2018;30(6):337-343. doi:10.1097/GCO.0000000000000494

By Krissi Danielsson Krissi Danielsson, MD is a doctor of family medicine and an advocate for those who have experienced miscarriage. 

Miscarriage

• What is a miscarriage? |
• What causes a miscarriage? |
• What are the symptoms of a miscarriage? |
• How can doctors tell if I've had a miscarriage? |
• How do doctors treat a miscarriage? |
• How can I prevent a miscarriage? |
• How can I feel better after a miscarriage? |

What is a miscarriage?

Miscarriage is when your pregnancy ends before 20 weeks of pregnancy. Most miscarriages happen in the first 12 weeks of pregnancy.

Bleeding and cramping are common signs of miscarriage

If you were pregnant and didn't know it yet, you can have a miscarriage and think it was just your period

To tell if you’ve had a miscarriage, doctors will check your cervix (the lower part of your uterus)

Doctors will also do an ultrasound (moving pictures of the insides of your uterus, also called your womb)

Many women who’ve had one miscarriage get pregnant again and deliver healthy babies

However, your chances of miscarriage go up each time: the more miscarriages you have, the more likely you are to have another one

If you’ve had several miscarriages, you may want to see a doctor before you get pregnant again

Doctors can try to make your next pregnancy more successful

What causes a miscarriage?

Doctors don't always know what causes you to miscarry. Miscarriage is not caused by a sudden emotional shock, such as getting bad news. Also, minor injuries like slipping and falling do not cause miscarriage. However, major injuries like a bad car crash can cause miscarriage.

Causes in the first 12 weeks of pregnancy

A problem with the fetus, such as a birth defect or an inherited disorder

Sometimes the fetus has a defect that is so severe that the fetus can't live more than a month or two inside you. A severe defect causes most miscarriages in the first 12 weeks of pregnancy.

Causes in weeks 13 through 20 of pregnancy

Often, doctors never figure out the cause of miscarriage at this stage. But sometimes they can pinpoint one of these as the cause:

Problems with your reproductive organs, such as fibroids , scar tissue, a double uterus, or a weak cervix

Rh incompatibility (when you have Rh-negative blood and the fetus has Rh-positive blood)

Severe injuries

Infections, such as cytomegalovirus or rubella

Certain health problems that aren’t taken care of during pregnancy, such as diabetes , an underactive thyroid gland , or high blood pressure

Causes of repeated miscarriages

If you have had several miscarriages, doctors will look for problems such as:

Blood that clots too easily in the woman

Abnormal chromosomes in the fetus from either parent

What are the symptoms of a miscarriage?

A miscarriage early in pregnancy may just seem like a normal period. If you didn't know you were pregnant, you probably wouldn't think you were having a miscarriage.

Other times there are obvious symptoms:

Bright or dark red blood

Passing large clots and bits of tissue

At first you may have only a small amount of bleeding, similar to having your period. As the miscarriage continues, the bleeding usually gets worse. The blood may be bright or dark red. Sometimes you'll also pass blood clots. You'll have cramps that may get worse as your uterus (womb) pushes out bits and pieces of the pregnancy.

Call your doctor right away if you have any bleeding during your pregnancy. Not all bleeding during pregnancy means you're having a miscarriage. About half the time, the pregnancy continues just fine. However, your doctor needs to check to see whether you had a miscarriage or not. If you pass large clots or bits of tissue, put them in a container or wrap them in a towel for the doctor to look at.

How can doctors tell if I've had a miscarriage?

If you've had bleeding or cramping during the first 20 weeks of your pregnancy, doctors will:

Do a pelvic exam: They look inside your vagina (birth canal) to check your cervix (the lower part of your uterus where your baby comes out)—if your cervix is open, a miscarriage is likely

Do an ultrasound : This test uses sound waves to create moving pictures of the inside of your uterus—it can show if the fetus is still alive

Do blood tests: Doctors check your levels of the pregnancy hormone hCG

How do doctors treat a miscarriage?

If the fetus and the placenta (the organ that feeds the fetus) are no longer in your body, you won't need any treatment. The bleeding and cramps will stop soon.

If bits and pieces of the pregnancy are still in your body, doctors might:

Watch to see if your uterus will empty itself, as long as you don’t have a fever or seem sick

Do a procedure to remove the rest of the pregnancy

If doctors need to remove pieces of your pregnancy from your uterus, they'll give you medicine to make you sleepy. The procedure you have depends on how far along the pregnancy is:

In the first 12 weeks of pregnancy: Remove pieces using a suction instrument put into your uterus through your vagina

Between 12 and 20 weeks of pregnancy: Remove pieces using surgical instruments put into your uterus through your vagina

If close to 20 weeks of pregnancy: You may be given a medicine to start labor to pass the rest of the pregnancy

How can I prevent a miscarriage?

You can't really prevent a miscarriage. If you've had some bleeding or cramping during the first 20 weeks of your pregnancy, your doctor may tell you to avoid too much physical activity and stay off your feet. But there's no proof these things help.

How can I feel better after a miscarriage?

It's normal to feel grief, anger, and guilt after a miscarriage.

Consider talking with another person if you feel sad and are grieving your loss

If you’re worried about having another miscarriage, talk to a doctor who can discuss possible tests

Remember that many women who miscarry get pregnant again and give birth to healthy babies

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What causes miscarriages, and disproving common myths

• Chromosomal abnormalities can cause a miscarriage. 
• Other factors can increase your risk for a miscarriage, such as having uterine problems or getting pregnant after age 35. 
• Having sex, too much stress, and getting a UTI while pregnant will not cause miscarriages alone. 
• This article was reviewed by  Olivia P. Myrick , MD, who is a clinical assistant professor with the Department of Obstetrics and Gynecology at  NYU Langone .
• Visit Insider's homepage for more stories .

Miscarriages affect an estimated 10% to 20% of all pregnancies, according to the Mayo Clinic . However, there are a lot of myths surrounding what exactly can cause a miscarriage. 

Here's how you can separate fact from fiction when it comes to a miscarriage. 

What causes miscarriages

Most of the time, a chromosomal abornamility will cause a miscarriage, while other factors like age, health issues, or unhealthy behaviors can all increase your risk. 

• Abnormal chromosomes: Normally, an embryo should contain 46 chromosomes, but sometimes this isn't the case . "Usually these are due to a random sporadic mutation such as an extra or missing copy of a chromosome," says Alexander Chiang, MD, OB-GYN chief of Obstetrics and Gynecology at UCLA Medical Center, Santa Monica. When that happens, "the body realizes there is an issue and stops the pregnancy in the form of a miscarriage," Chiang says. This type of miscarriage will usually happen within the first 10 weeks of pregnancy. Sometimes doctors can perform genetic testing on the pregnancy tissue to determine if this is the reason for miscarriage, but this is not always possible.
• Problem with the uterus or cervix: Sometimes the uterus can have growths like fibroids or polyps that don't always cause miscarriage, but they can increase your risk. Other issues include abnormal tissue like in the case of a uterine septum (which women can be born with) or scar tissue in the uterus, from prior infections or surgeries. Additionally, a weakened cervix can sometimes cause miscarriage later in pregnancy. Women who have had previous surgeries on their cervix or have a history of preterm birth are at higher risk for a weakened cervix.
• Health problems while pregnant: Medical issues such as thyroid disease , diabetes , and serious infections like influenza , malaria, and HIV can lead to a higher risk of miscarriage. It is always preferable to make sure any chronic diseases are well controlled prior to getting pregnant.
• Age: Getting pregnant at an older age increases miscarriage risk. For example, in a large 2019 study published in the British Medical Journal, pregnant women aged 45 years and older had a 53% risk of miscarrying whereas women aged 25 to 29 had a 10% risk. The eggs of women in their forties are much more likely to have abnormal chromosomes than eggs of women in their twenties. This is one of the reasons why there is increased risk for miscarriage as a woman ages.
• Common habits to avoid while pregnant: Smoking, drinking, and illicit drug use have all been found to increase a person's risk of miscarrying. 
• Physical trauma or a major injury: Trauma or injury can cause the placenta to separate from the uterus, which can lead to bleeding, cramping, and ultimately, miscarriage.

Myths: What doesn't cause miscarriages

However, acute stress, having sex, taking birth control, and urinary tract infections don't cause miscarriages alone. 

• Stress: Acute stress alone doesn't cause miscarriage. "Acute stress such as from work, losing a loved one, or relationship problems are unlikely to cause a miscarriage," says Chiang. Chiang does suggest there may be a connection between miscarriage rates and long-term stressors, such as poverty with food or housing insecurity, risk of violence, and perhaps racial disparities in connection with socioeconomic status.
• Sex: Having sex while pregnant doesn't cause miscarriage. Sometimes if the placenta is in an abnormal location or too close to the cervix, women may be told to refrain from intercourse, but, in general, "sex is safe throughout pregnancy, although it can cause spotting or bleeding for 24-72 hours from mostly the cervix," says Chiang.
• Birth control pills: Taking birth control while pregnant doesn't cause miscarriage. "If [the pill] fails and the pregnancy is established, the birth control pills do not disrupt the ongoing pregnancy. Some women actually are given progesterone in the first 10 weeks to support a pregnancy," Chiang says. However, if someone gets pregnant with an intrauterine device (IUD) in place, then a doctor may advise removal to reduce the risk of miscarriage. 
• Urinary Tract Infections: A UTI alone doesn't cause a miscarriage, but complications might. "If [a UTI] is not treated and the infection ascends into the kidneys, it can cause a very serious full-body infection called sepsis which can cause a miscarriage," says Chiang. 

The 5 main types of miscarriage

"In general, a miscarriage is when there is a detachment of the embryo from the uterine wall, often with the [shedding] of the endometrial lining that has built up to support the pregnancy," says Chiang . 

However, sometimes the endometrial lining, which helps nourish the embryo, doesn't always leave completely, which may mean a woman needs medical or surgical treatment. Here are the five main types of miscarriage:

• Complete miscarriage: A complete miscarriage means all of the tissue — including the pregnancy and the placenta — has passed out of the uterus. This can happen spontaneously, and the body should recover naturally without medical treatment. If bleeding hasn't subsided after two weeks, though, see a doctor. This type of miscarriage usually happens before week 12 of pregnancy. 
• Incomplete miscarriage: An incomplete miscarriage happens when some of the pregnancy tissue remains in the uterus. In this case, a woman might have heavy bleeding for a longer period of time, and an ultrasound will show that there is still blood clot or placenta in the uterus. To remove the remaining tissue, the woman will likely need medication or a surgical procedure.
• Missed miscarriage: This is when the embryo has died (or wasn't able to form properly) but remains in the uterus. Many times the woman may not have symptoms, and this may be found on an ultrasound. In this case, it's possible for this pregnancy tissue to pass on its own, but the timing can be unpredictable, so the woman may want to discuss medical or surgical options with a doctor. 
• Septic miscarriage: A septic miscarriage happens when harmful bacteria infect the uterus . If you have a septic miscarriage, this is an emergency. The woman would have very high fevers and abdominal pain. Doctors will need to remove any, and all, pregnancy tissue as quickly as possible, and it would be important to take antibiotics until the infection subsides.
• Threatened miscarriage: Spotting early in pregnancy is common and can be normal, but bleeding at that point can be considered what's called a  threatened miscarriage. For most, the bleeding will subside and the pregnancy will continue to term. However, if the bleeding increases, it can lead to a miscarriage. Any time there's heavier bleeding early in pregnancy, notify a doctor.

Additionally, if a miscarriage happens very early, a woman might not realize she had a miscarriage or even know she was pregnant. "When [a miscarriage is] very early, less than 5 weeks from the last period, it can present as just a period, which would be considered a biochemical pregnancy  and miscarriage," Chiang says. In these cases, the pregnancy does not form enough to be visible on an ultrasound.

It is important to recognize that miscarriages are extremely common and largely due to factors outside of anyone's control. If you are one of the many women who have suffered a miscarriage,  reach out to your doctor for support. 

The body will physically recover quickly from a miscarriage, but it is important that families allow time for emotional recovery as well. If a woman has had more than one miscarriage, your doctor may recommend further testing to determine the cause and guide pregnancy planning for the future.  

Related stories about  miscarriage :

• You cannot prevent a miscarriage but there are steps you can take to reduce your risk
• A chemical pregnancy is a miscarriage, but doctors say it's a good sign if you're trying to get pregnant
• You've had a miscarriage. Here's how long doctors recommend you wait before trying again
• What is a molar pregnancy and how to treat it
• What is an ectopic pregnancy and how to treat it
• You can get pregnant with an IUD but it's extremely rare

Watch: Pathologists debunk 13 coronavirus myths

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Miscarriage and questions of fitness to fly

Medical matters: the issue of when it is safe to travel by air when pregnant was brought into sharp focus last week when the….

MEDICAL MATTERS: THE ISSUE of when it is safe to travel by air when pregnant was brought into sharp focus last week when the authorities planned to deport a Nigerian asylum seeker who had recently suffered a miscarriage.

Olayinka Ijaware, who was eight weeks pregnant when she miscarried, was taken to the Rotunda Hospital from Dublin airport when she complained of vaginal bleeding. She was discharged with a letter stating “the above named patient is unfit for air travel if she is actively bleeding per vagina”, and subsequently returned to Dublin airport when, for reasons that remain unclear, the flight was cancelled.

Would the Garda National Immigration Bureau have been correct if it had gone ahead and flown her back to Nigeria while she actively bled in the weeks following a miscarriage? In general, travel in pregnancy is “low risk”. But the risks do vary with the stage of pregnancy. The second trimester is considered the safest in which to travel.

A doctor assessing the fitness of a pregnant woman to fly will pay specific attention to blood-pressure readings and ultrasound findings. He will look for any acute symptoms or signs, such as vaginal bleeding or abdominal pain.

Whether the woman is at increased risk of premature labour, pre-eclampsia (a potentially dangerous rise in blood pressure) or of having a pre-delivery haemorrhage must also be assessed.

Does the expectant mother have pre-existing medical conditions such as diabetes or asthma and if so are these likely to deteriorate during travel? And where is she travelling to? There is a big difference between arriving in a large western city with state-of-the-art obstetric facilities and medical expertise and heading into the bush or a jungle with nothing more than a first-aid box.

The risks of air travel during pregnancy include miscarriage, premature birth and deep-vein thrombosis. According to a review published in the British Medical Journal the miscarriage rate is 3-30 per cent for women who experience vaginal bleeding in the first trimester. There is no evidence to suggest air travel increases a woman’s risk of miscarriage; however, being airborne when a miscarriage occurs increases the difficulty of safely managing the situation. And there are studies showing female flight attendants have higher miscarriage rates than their peers.

In the latter stages of pregnancy, the main concern when flying is the risk of premature birth. It is often unpredictable, although women with a history of delivering prematurely and those expecting twins do have a statistically greater chance of premature labour. In recognition of this, most airlines will not permit a woman with a multiple pregnancy to fly after 32 weeks of gestation.

Deep-vein thrombosis is more common in pregnant women and is estimated to complicate about one in 1,000 pregnancies. Travel adds additional risk because of immobility, lower oxygen concentrations and low humidity, leading to more sluggish blood flow in veins.

While most exotic infectious diseases are uncommon, traveller’s diarrhoea is not: it affects up to 60 per cent of visitors to tropical and semi-tropical regions of the developing world. A bad dose can cause severe dehydration and may increase the risk of premature labour. And while oral hydration salts mixed with filtered water will settle the majority of cases, severe diarrhoea in a pregnant woman should hasten the use of intravenous fluids.

So where does that leave Olayinka Ijaware and the actions of the Garda? Probably the most important determinant of her fitness to fly was the nature, quantity and intensity of her vaginal bleeding. Bright red blood in copious amounts is a greater cause for concern than a trickle of older, brown-coloured blood. The decision of the Garda doctor who examined her and declared her fit to fly suggests she may have been experiencing a lighter form of bleeding, which may persist for weeks after miscarriage.

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Florida says people getting abortions will not be penalized, clarifies medical exceptions

As of Wednesday, May 1, Florida joined several other states in banning nearly all abortions after six weeks . Critics have pointed out that many people don't find out they're pregnant by then, and say the medical exceptions provided in the law to save the pregnant person's life or avoid irreversible damage in cases of dire need are intentionally vague and confusing.

“This ban is putting lives at risk,” said state Sen. Bobby Powell , D-West Palm Beach. “People are going to die. ... That’s what it’s going to lead to for the women in the state of Florida.” 

The state is fighting back. In a post on X , formerly Twitter, the Agency for Health Care Administration released some clarification Wednesday to "combat the lies and misinformation surrounding Florida’s Heartbeat Protection Act."

Notable among the items listed in the "Myth vs. Fact" flier the agency posted are that a pregnant person seeking or getting an abortion will not be subject to criminal penalties and that abortions for ectopic pregnancies, premature rupture of membranes or miscarriages are not prohibited.

None of these facts are explicitly mentioned in the new law or Florida statutes, although Democrats tried and failed to have similar clarifications added to the bill last year.

Cases of women nearly dying due to doctors and hospitals, afraid of repercussions and ill-defined rules, delaying care or turning them away have sprung up in other states with similarly restrictive laws. In Florida, a doctor told a woman in Miramar who was experiencing premature rupture of the membrane (PROM) that he couldn't deliver the fetus because of the state's 15-week ban. She delivered it herself alone in a hair salon bathroom last April and lost half her blood before EMTs arrived.

In 2022, a woman in Lakeland was forced to give birth to a baby with no kidneys or lungs  that died shortly afterward. A Planned Parenthood doctor turned away a 14-year-old rape victim trying to terminate her pregnancy because of Florida's abortion ban, according to a lawsuit  challenging the law.

Early reports from a University of California San Francisco study found that recent abortion bans have contributed to "preventable complications, such as severe infection" because healthcare providers "reported their 'hands were tied.'"

The day the 6-week ban went into effect, the Florida National Organization for Women (NOW) issued a travel advisory warning pregnant people to avoid travel or relocation to Florida due to "significant concerns regarding the availability of essential healthcare services for pregnant individuals with both wanted and unwanted pregnancies."

“Florida works to ensure the health and safety of mothers and babies by continuing to hold medical providers accountable to the standards of their oath to protect and ensure the health and well-being of their patient,” the AHCA flier said.

In November, Florida voters will be able to decide if they want to return state abortion laws back to something resembling previous federal law under Roe v. Wade.

What is Florida's abortion law?

Following the Florida Supreme Court decision on the constitutionality of a 2022 15-week abortion ban in April, a more restrictive 6-week ban passed last year went into effect on May 1. Abortions after six weeks of gestation (with some exceptions) are prohibited and anyone performing one or assisting someone to get one is subject to criminal charges, fines and/or loss of medical licenses.

'We’ll be getting involved': Could a special session bring lawmakers back to Florida Capitol for abortion, immigration?

What are the exceptions to Florida's 6-week abortion ban?

According to Florida Statutes and the new ban created by SB 300 , abortions after six weeks are only allowed:

• If necessary to "save the pregnant woman’s life or to avert a serious risk of imminent substantial and irreversible physical impairment of a major bodily function of the pregnant woman other than a psychological condition"
• If "in reasonable medical judgment, the fetus has a fatal fetal abnormality"

The decision must be certified in writing by two physicians. Even then, abortions are banned under the new bill if the pregnancy has "progressed to the third trimester." Medical abortions are also prohibited unless performed in person by a healthcare professional which bans home use of so-called "abortion pills" mifepristone and misoprostol ,

According to the AHCA, pregnant people will not be forced to give birth if their life or health will be in jeopardy.

Abortions also may be performed in Florida up to 15 weeks if the patient is pregnant due to rape , incest or human trafficking but only if the pregnant person has copies of "a restraining order, police report, medical record, or other court order or documentation" to provide evidence that they are a victim of rape or incest.

What is an ectopic pregnancy?

In an ectopic pregnancy, a fertilized egg implants outside of the uterus, usually in the Fallopian tubes, according to information from the Mayo Clinic , When that happens the egg cannot survive and the growing tissue may cause life-threatening bleeding.

"Treatment to remove an ectopic pregnancy is not prohibited under Florida law," the AHCA flier said.

What is premature rupture of membranes (PROM)?

Commonly referred to as "water breaking," PROM normally occurs when the protective amniotic sac around the fetus bursts before or during labor. If it happens prematurely (considered to be before the 37th week of pregnancy) it can cause serious infections and complications.

"Florida law does not prohibit treatment for women who experience premature rupture of membranes (PROM)," the AHCA said, "and as such, physicians in Florida should follow established standards of care regarding the most appropriate course of action for PROM."

What is a miscarriage?

"Miscarriage is the sudden loss of a pregnancy before the 20th week," the Mayo Clinic says , and up to 20% of known pregnancies end in miscarriage although that number is likely much higher. Miscarriages often happen when the fetus does not develop properly.

"Florida law does not prohibit the removal of a pregnancy for women who experience a miscarriage in any circumstance," the AHCA said.

When do most people find out they're pregnant?

Most people find out they're pregnant before six weeks, but one in three do not and one in five won't know till after seven weeks, according to a  2021 study from ANSIRH  at the University of California San Francisco. The percentage is even higher — almost two in three people — for teens between ages 15 and 19 who become pregnant and don't find out until six weeks or later, the study found.

Symptoms vary wildly between individuals and even between different pregnancies for the same person, and irregular menstrual cycles can make it difficult for a person not actively trying to get pregnant to notice in time.

The AHCA responded to this issue by mentioning pregnancy tests , which detect the presence of a hormone called human chorionic gonadotropin, or hCG. The agency said "pregnancy tests have evolved substantially over the years. Trace levels of hCG can now be detected as early as eight days after ovulation."

However, while some pregnancy tests advertise earlier detection, medical experts say a week after the first day of a person's missed period is more accurate. According to a clevelandclinic.org  post in 2022, "If you take a test too soon, it could be negative even if you're pregnant."

Can I go to jail for getting an abortion after 6 weeks in Florida?

Florida law prohibits anyone from willfully performing or actively helping someone get an abortion outside of the six-week gestational period or the legal exemptions. Doing so is considered a third-degree felony, punishable by fines and imprisonment of five years.

"Florida's criminal abortion penalties do not apply to pregnant women," the AHCA said. Florida law only states that a person upon whom a partial-birth abortion is performed, which is illegal, may not be prosecuted.

What would Amendment 4, Florida's abortion amendment do?

The proposed amendment submitted by  Floridians Protecting Freedom  that will  appear on November's ballot  reads:

“No law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient’s health, as determined by the patient’s healthcare provider. This amendment does not change the Legislature’s constitutional authority to require notification to a parent or guardian before a minor has an abortion.”

Fetal viability has been put at about 24 weeks.

For the amendment to pass it must win by a supermajority, or at least 60% of the vote. According to an  exclusive USA TODAY/Ipsos poll  of more than 1,000 Floridians, half said they would vote in favor.

Rumors of a special legislative session to consider stricter immigration laws have been floated but Gov. Ron DeSantis said he was unaware of any plans to address the abortion amendment.

"That would be news to me if there were to happen in terms of any other amendments being added to the ballot," he said during a press conference Thursday in Jacksonville. "There may be people in the Legislature talking. Not coming from me."