From the Midwife’s Desk: When Pregnancy Ends in Miscarriage

From the Midwife’s Desk: When Pregnancy Ends in Miscarriage

The Messenger of Allah, peace and blessings be upon him, said, “By the One in Whose hands is my soul, the miscarried fetus will drag his mother to paradise by his [umbilical] cord if she was patient [with the miscarriage], hoping to be rewarded.” 


A miscarriage is the spontaneous loss of a pregnancy prior to 20 weeks gestation. It can be both physically and emotionally painful and is a relatively common experience. Approximately 10-15% of pregnant women will experience a miscarriage in the first trimester, which lasts until the completion of the 12th week of pregnancy.  It is much more uncommon to experience a miscarriage in the second trimester; only 1-5% of women experience miscarriage between the 13th and 19th week of pregnancy. When women experience a loss before 120 days, which equals to about the 20th week or 5-month mark, they do so before the soul has been blown into the fetus by the angels directed to do so. 

There are varying reasons as to why a miscarriage may occur, the most common cause is a chromosomal abnormality in the embryo. In short, a chromosomal abnormality means that something in the DNA of the embryo did not lay down correctly and the abnormality interrupts the advancement of the pregnancy.  Other causations of miscarriage include, but are not limited to, maternal age over 40, infection, and improper implantation of fertilized egg into the uterine lining.

Even with this knowledge, couples faced with pregnancy loss will experience mourning. With positive coping behaviors and the support of family and friends, they can move to reconciliation and acceptance. If Allah tests you or the people you love with a loss of a wanted and beloved pregnancy, here are a few pieces of advice that may help you or them to get through the moments of difficulty.

Whatever The Outcome, Lean on Allah 

As Muslims, we accept La Ilaha il Allah, There is no God but Allah.  We know from Allah we come and unto Him we return, Inna ilahi wa inna ilayhi raajioon. Holding onto this deep belief and faith can assist us when we are faced with the trials of this dunya. Holding onto this however, does not make us immune to disappointment, pain and grief that may be experienced with a pregnancy loss.  

There are generally three different types of miscarriages, and depending on the type and the experience that comes with it, couples may experience varying levels of emotional hardship.  

  1. A spontaneous miscarriage is a miscarriage in which everything that was in the uterus to develop the pregnancy is expelled on its own. When this happens on its own and is complete, there is less risk for infection and complications.  
  2. An incomplete spontaneous miscarriage occurs when there is bleeding and a drop in pregnancy hormones, however, not everything is expelled from the uterus on its own natural course. This type of miscarriage can lead to excessive bleeding, infection, and/or more medical procedures in order to reduce the risk of infection and manage bleeding.  
  3. The third type is a missed miscarriage. This is often diagnosed by the absence of fetal heart activity in the office during a prenatal appointment or during an ultrasound. In this instance, the fetus is at a gestational age where a heart rate would be expected. A fetal heartbeat can be detected from 5 ½ weeks to 6 weeks; however, it is often better assessed between 6 ½ to 7 weeks. If it is not detected at the later timeframe, a missed miscarriage may be diagnosed. 

It is important to note that it may be diagnosed only if it is really clear that the pregnancy is dated correctly. Sometimes, pregnancies are not as advanced as a mother may think based on her cycle, so a provider may have her come back for an additional ultrasound in a week or two to confirm whether the pregnancy is advancing or not before making a final diagnosis. 

A missed miscarriage can often be managed in three different ways:

  1. Expectant management – waiting for the body to naturally expel the pregnancy.
  2. Medication management – the provider may offer medication that can cause contents to expel from the uterus.
  3. Surgical management – a surgical procedure is performed to empty the contents of the uterus to protect from infection and risk that some products may be retained through the two other types of management.

These are all decisions the woman will make with her health care provider. 

While any one of these outcomes can be jarring, shocking and distressing, the family should be encouraged by the words of our beloved Prophet Muhammad, peace and blessings be upon him. Umm Salama reported Allah's Messenger said: 

“If any Muslim who suffers some calamity says, what Allah has commanded him, ‘We belong to Allah and to Him shall we return; O Allah, reward me for my affliction and give me something better than it in exchange for it,’ Allah will give him something better than it in exchange.”

(Sahih Muslim Book #004, Hadith #1999)  

For those who have patience through trial, Allah promises reward, and part of that reward can be ease of distress and protection from despair.  

While a woman who is experiencing bleeding with a miscarriage, may not be able to pray tahajjud for herself, this is a good opportunity for family or friends who are aware of the situation to pray for her.  The deep disappointment and worry the expecting grandparents and aunties and uncles may feel can be channeled into supplication to Allah on behalf of the couple and remembrance that this is the qadr or preordainment of Allah. While we know that one way Allah expiates our sins is through trial in this life to protect us from punishment in the next, this is not the time to look at the couple and blame them for the loss. If anything, remind them of Allah’s wisdom and mercy.  Perhaps Allah has protected them from something whether in this life or the next. 

Turn to Your Partner – Sharing My Story 

“And of His signs is that He created for you from yourselves mates that you may find tranquility in them; and He placed between you affection and mercy. Indeed, in that are signs for a people who give thought.” 

(Surah Ar-Rum, 30:21)

Praise be to Allah, my husband and I have been blessed with four children and six pregnancies, two of which ended in miscarriage, one diagnosed in the first trimester, the second diagnosed in the second trimester. Early in our marriage, we became pregnant with our first child.  The beginning of the pregnancy was not easy. I experienced the common discomforts of fatigue and morning sickness, but also the very upsetting symptoms of cramping and bleeding, which can occur in the first trimester of pregnancy without miscarriage. Sometimes when a woman experiences this it is called a threatened miscarriage. 

I have to admit that I was full of anxiety and tears and vividly recall, all these years later, falling into my husband’s arms crying and fearful that I would not hold on to this very desired child. I do not remember everything about how we handled that situation, however, I do remember the comfort he offered me. I recall the safety I felt with him and the fact that he reminded me of Allah and His Qadr. 

I mention this for two reasons. The first is to mention that bleeding and cramping can occur in the first trimester without ending in miscarriage. In this instance, we went on to have a healthy full-term pregnancy. The second is to remind you that Allah has given us a spouse to help give us peace of mind and love and comfort and it is important to lean into each other during times of hardship. Those moments can strengthen your bond and serve as a point of reflection for you later on in the marriage. You’ll remember, we were there for each other when we need each other at just the right time. Allah knows best.

Our first miscarriage occurred after we already had two children. I was in the middle of the workday when it occurred. My husband and I only had inclinations that maybe we were expecting another, but hadn’t confirmed it yet. We had our hands full with our other children and there was no rush. The pain and sudden nature of it all was shocking and I had to be assisted home by one of my colleagues. She was sympathetic and comforting and made duaa for us. When I arrived home, my husband was there with our children and we called our health care provider.  We were given instructions about what to look for and what would be abnormal occurrences that should prompt a call or a visit to the emergency room.  

Before my husband had to go to leave for work, I remember lying in his lap, watching cartoons with our children and feeling grateful to Allah for all the support I had received from my Muslim colleagues who were there to help me and my little family. We never announced to extended family that we had been expecting. I told my sister of the miscarriage, because I can share most things with her, and she comforted me by reminding me that miscarriages are common and reminded me to be grateful for the children I have and look forward to having more. I told my best girlfriends because we worked together and they wondered where I disappeared to that day. Everyone was kind. 

I mention this to remind you that there is no shame in miscarriage. It is something that happens to you, not something that you make happen. We are all but humans and our bodies have rights over us. After a good night’s sleep, I felt back to normal and hopped back into my daily routine. Having toddlers will make you do that. This will not be every woman’s experience, especially if the first miscarriage occurs before having other children. This is just an example of how support from family and friends can carry you through a hard time, inshaAllah, Allah willing.  Also, knowing how commonplace miscarriages are and that they are often followed by successful pregnancies can bring a bit of ease to an anxious mind.

Our second miscarriage occurred after we had had our third child. I was terribly excited for this pregnancy because my best friend was pregnant, too, and our dates lined up. We had other children of similar age and I thought the fun would continue. I also thought that perhaps after this one, I would be done having babies for a time and could just focus on raising our kids.  

None of my pregnancies were easy and all had taken a toll on my body. As I had three children all under the age of four I thought I was a pro at pregnancy. I spaced out my appointments because it was difficult getting around with three toddlers in tow. At my next appointment, I found out that somewhere between week 8 to 9, when I had last been seen at week 16, when I was being seen next, the baby’s heart had stopped beating and the pregnancy had ended without my knowledge. 

To be transparent, I was devastated. I was not too far from being halfway through a pregnancy and learned that I would not be meeting this baby that I had dreamt of and had already made some plans for. I had taken a leave from my job so I could be home with all of the kids. I had started to think about how I would have to rearrange the kids’ rooms eventually to make space for another one. I was trying to stay fit and strong and when I found out, I crumpled. 

This was over 19 years ago and I still get a bit teary-eyed when I think about that little one. Truly, looking back I probably went through an episode of depression. I kept thinking how could I not know something was wrong? And some who knew about the pregnancy actually had the nerve to ask me, “how didn’t you know” or even asked if I had done something that could have caused the miscarriage. I would advise all readers at this time, do not do that to your sisters, your daughters, your cousins, your nieces. Do not cast blame. Allah does as He wills.  

Due to the fact that the pregnancy was a bit more advanced and that they couldn’t determine how long ago the pregnancy had ended, I was advised to have surgical management of the missed miscarriage. The decisions made around that time are a little hazy. I know my husband was there and he helped to speak for me when I could not. I remember going to the hospital, getting prepped for the procedure, and being terrified. I held onto my husband tight, asking him to pray for me. I asked him to promise that if Allah took my soul while I was in the procedure, for him to make sure he found a good mother for my children. I repeated a lot of tashahhud. I woke up afterward to the face of a kindly nurse telling me everything was “all done” and “ok” and soon my husband was bundling me up in the car and then settling me into bed. Seriously, that one hurt and when we could sit and talk about it, we thought we were done with our reproductive journey. Perhaps Allah was letting us know we were done. We had three little ones to focus on and we were still building careers. So that is what we did.  

Have Hope and Do Not Despair 

One of my most beloved quotes from the Qur’an is: 

“For indeed, with hardship [will be] ease [i.e., relief].

(Surah Ash-Sharh, 94:5)

So I looked for my ease. We coped by throwing ourselves into the children in front of us and into the direction we wanted our life together to take.  I remember telling my husband that if Allah would not give me another baby at the time, I would make midwifery my baby and started on that journey. It is a journey I do not regret. I homeschooled my children and my nephews, I started nursing school, and we moved to a larger home. And when our hearts were mostly healed, we tried again and Allah gave us number four.  Was that pregnancy even sweeter and even more cherished because of our previous experiences? Yes, I think so.  

Turn to Others 

Allah blessed me with a husband who could be supportive through these challenges, but some of us will be challenged not only with loss, but lack of support from those we love.  I benefited from family and friends who could understand or at least empathize with my loss. Their gentle hugs, smiles and reassurances comforted me through what can feel like a disaster.

If you find yourself surrounded by those who do not offer you the loving support you need, remember Allah, He is the Loving and the Comforter. Remember that even when He tests you, it is due to mercy for you. With patience you can forbear. If Allah does not provide you with assistance in those closest to you, there is help for you out there amongst your practitioners  and mental health providers. Hold onto the prayers. There is another resource you may find helpful, Share - Pregnancy and Infant Loss Support Center.

I share my experiences with you because I see you in the office, unaware that a miscarriage could happen to you. I want you to know that it happens more than it is reported so that 10-15% statistic of miscarriage in the first trimester for “known” pregnancies is probably underreporting the number of miscarriages that truly occur. If you gathered five of your closest female friends or family members of reproductive years in a room together, it has likely happened to at least one of you. 

I share my story with you because I see you fearful that you will never have a healthy pregnancy.  Just because a miscarriage can occur, obviously doesn’t mean that it will happen to you and if it does happen to you, it doesn’t mean you will never have a successful pregnancy. Being pragmatic at the beginning of a pregnancy can help with coping with a possible negative outcome. Often women are given the advice to wait until after the completion of the first trimester to share with others that they are pregnant, because perhaps they will have a miscarriage and don’t want the burden of others knowing what has occurred. It is up to you whether you share or not, just know that the outcome of a pregnancy is not determined until either the loss or the birth of the baby. This should not make us shrivel in fear, place talismans around our bodies, nor believe every other woman will give us the evil eye so we should not tell anyone about the pregnancy to protect ourselves. We should live in hope that Allah will provide us with the child we desire and live in the knowledge and comfort that Allah will do as He pleases.  

I share my story with you because I think my own experiences brought me closer to Allah and made me realize on an even deeper level the acceptance of His Qadr. I am not claiming to be the most adept at acceptance, but I am better than from where I started. I am reminded through these and other experiences to start my waking moments with dhikr of Allah, keep the prayers, do what is good, and stay away from what is evil. This is some of what we do as Muslims to prepare ourselves for the good and the bad. When we share our stories with each other we can help each other grow through shared knowledge and help each other prepare for what may be yet to come. 

As open as I am to sharing my story with you, as a practitioner I want to be sure you understand that this detailed information is not a replacement for medical advice from your personal health care provider. If you are having or have experienced a miscarriage, it is important to seek counsel and care from a trusted provider. If you or someone you love has experienced proven recurrent miscarriage, talk to your prenatal provider about genetic testing if possible. 

Melissa Fleming is a Muslim wife, mother of four, daughter, sister and auntie. She is a Certified Nurse-Midwife and Lactation Consultant in Maryland and has had the pleasure of attending to women and their babies in both birth center and hospital settings. She is a founding board member and health services director for Faith Families of African-Descent Meeting for Marriage & Parenting Support (FFAMM, INC.), a service organization focused on helping Africans of the diaspora connect with the African continent through travel and service. She has been working on increasing maternal/child and women’s health care in The Gambia through this collaboration. You can learn more about this project here: FFAMM Projects. Melissa is active in her local community with service and youth groups.  


Add new comment