# Breastfeeding and miscarriage, 3 miscarriages total



## JBH (Apr 14, 2008)

Hi
I rarely post but would like some advice. Part of me needs to vent too. IN January I gave birth to a healthy baby girl (I feel blessed). I am 34 going on 35 at the end of July.
In November of 06 we had a miscarriage, it was a blighted ovum, missed miscarriage, empty sac, however its named, its still a miscarriage. No tests were done. I had the suppositories at 7 weeks to induce the miscarriage and boy did that hurt like hell.
I was told to wait a cycle before trying again. We ended up getting pregnant before that first period-but he pulled out so I thought no way. I tested early, like 9 DPO b/c I spotted. It was positive and this time I had a blood test. I ended up getting the results the day I started spotting brown. I was pregnant but the HCG was low and the day I was supposed to get my period, I did. It was so early I would never have known I was pregnant had I not taken an early test. The dr. did not want to consider this miscarriage as a reason to test because she felt it was related to a thin uterine lining and not giving the body a chance to heal.
4 cycles later I got pregnant again and everything was fine. It was uneventful, progesterone ok, etc.
Now, fast forward....
I have been breastfeeding 6 months but supplementing with formula and also solids. Due to my age and also our careers it is in our best interest to begin for #2. I got pregnant this past month and at 6 weeks and 2 days began bleeding like a moderate period. That was Monday and Tuesday of this past week.
I miscarried, again early. I went to a midwife this time instead of a doctor and she mentioned that genetic testing wouldnt be really an issue since I had a healthy baby recently and the miscarriages werent consecutive.
I then had bloodwork and called in the next day and the midwife said other tests were normal except hcg was very low and miscarriage probably imminent. I had told her I already passed some tissue. But then another midwife called me the day after and said my hcg was low and also my progesterone. I dont know if she knew I had already called in but I just got 2 conflicting stories about my results. I have questions and will go back Friday to do more bloodwork and can ask then.
I never had progesterone deficiencies, but is that something that waxes and wanes, or may vary from cycle to cycle?
I am also breastfeeding. I cant help but wonder if that contributed. I know there is no evidence to support that claim but something inside me questions that. I was having very mild contractions while I would breastfeed. Maybe its just coincidence.
The difference between this miscarriage and the other 2 was that I previously spotted brown whereas this one was more like a late period.
The midwife also said that if you have a pregnancy in the first year it is not unheard of to have miscarriages because the uterus isnt in prime shape for another pregnancy. I dont know. She suggested to wait a full year.
(I had a vaginal birth before)
I am just not sure why I had the miscarriage(s) but I do wish I had answers. I hate not knowing why.
I also felt the midwives were abrupt in their discussion with me about this issue. Not rude, but I wasnt feeling the empathy. When the midwife called asking for me and when I said, yes this is her, she said "So are ya still passing clots?". On one hand it was amusing but on the other it came out of left field, not "how are you feeling, etc". I thought midwives were supposed to be different than doctors.


----------



## RunnerDuck (Sep 12, 2003)

Sorry you are going through this.









Progesterone is somewhat subjective. I believe the lab normal value for it is anything over 10. However many doctors have their own opinions on normal - ie some like to see it above 15 for a normal cycle and 20 for a medicated (fertility treatment) cycle, some like it over 20 no matter what, etc. If you knew that the number was it would be more useful but it could be the number was in the gray area and one midwife thought it was OK and one thought it was not.

Low progesterone can cause lining issues and this can result in miscarriage. Progesterone can be supplemented easily - you can take it orally, vaginally, or by injection. Vaginal or injection is best - and vaginal is easiest, though messy. (The shots are intermuscular which wigs me out for some reason... sub-q shots don't phase me)

The flip side of the coin is, low progesterone may be a sign of bad egg quality so it's an effect of the miscarriage rather than the cause, if that makes sense. But there is no harm to supplementing in the hopes of sustaining a pregnancy. At worst, you'll be postponing the inevitable.

If you are having regular cycles, how long is your luteal phase (the time from ovulation to period)? It should be between 12 and 16 days - if you are less than this it points to luteal phase defect which basically means the corpus luteum (where the egg popped out of) is dying off early. The CL produces progesterone and if it dies off too early, the pregnancy can't establish itself. A short luteal phase would indicate progesterone might help. How does the length compare to your past cycles - ie is it shorter now that you are nursing? It could be the nursing is affecting things - though that is not a popular theory in some circles.









As for whether or not progesterone can vary from cycle to cycle... if it's a luteal phase problem I think these tend to be fairly consistant at lp tends to be the same for a given women. Of course we all have screwy cycles from time to time. It's also possible for any women to throw out a bad egg now and then which would mean yes she could have low progesterone one cycle and not another. So yes it's possible progesterone issues are transient. My progesterone was always low during m/c cycles whereas with my son it was 27 (natural cycle) and 187 with the twins (medicated, started at triplets) - whether or not the low progesterone caused the miscarriage or was the result of a bad egg, I don't know.

There are a number of tests that can be done for repeat loss. If the pregnancy has progressed far enough, the embryo/fetus can be tested for abnormalities, but most losses seem to be early losses like you experienced. Often repeat loss testing involves looking for clotting factors and immune factors in the mother that might be causing the loss. I have had 3 losses, I had the testing done after the 2nd loss, I think. I came back as having some clotting factors (MTHFR) and a light elevation in one of the antiphospholipid antibodies - was told to take a daily baby aspirin and a prescription b vitamin. There are other thing that can be wrong and other ways to address them but to a certain extent many miscarriages are just caused by bad luck. (I am not even sure I believe I have issues... just because the tests found those things does that mean that they caused the miscarriage?)

It can't hurt to pursue the repeat loss testing, though. It's just blood work and 3 losses is when most people start pursuing testing.

Find out about that progesterone level, for starters.

Hope things work out for you next time!


----------



## JBH (Apr 14, 2008)

Wow, thanks for your post. I just got some very useful information here.
I had absolutely no idea that bad egg quality could be coupled with low progesterone-very interesting.

I do have regular cycles, and my LP is about 14 days. I do have cysts on my ovaries, but do not have PCOS. I think that varies from cycle to cycle also.
Since I've only had 2 cycles since breastfeeding, they have been about 34 days long. That was another question my midwife had, how long are my cycles and the possibility of an older egg being released. Im still waiting for the antibody test to come back, but a part of me feels that because Ive had one healthy baby recently, that this could be a stroke of bad luck or just bad egg quality. Also, the fact that my hormones are probably not as stable as they are when Im not breastfeeding, plus giving birth 6 months ago. My gut feeling is that it could be one or more or a combination of these factors.
I think for those of us who have suffered early losses, the causes are sometimes unknown and that is the hardest part, not knowing why, and having to experience it.
Im still on the fence whether I should see an ob or stick with the midwife practice.


----------



## moonglowmama (Jan 23, 2002)

not wanting to sidetrack the thread, but RunnerDuck, can you share some links or resources about luteal phase length and miscarriage and also progesterone?

I've been reluctant to ever do progesterone, thinking that if there was a problem with the egg or the fertilization, it would be better to allow nature to take its course, even if it meant a miscarriage. But you mentioned it not doing any harm except to prolong the inevitable. Where can I read more about that?

And, would a longer luteal phase cause an increase in miscarriage?

Thanks!

JBH- I am sorry for your loss. I think that for me, breastfeeding does contribute to pregnancy loss, though no one at LLL would want me believing that. But any pregnancy I was nursing in, I lost. And that was with super vitamins and good nutrition. I don't know for sure that's the reason, but I highly suspect there's some connection, even if not the cause.


----------



## RunnerDuck (Sep 12, 2003)

I spent a few years in infertility/mc hell... picked up things from doctors, books, message boards, other women - so a lot of this is stuff I carry around in my head that I have reason to believe is true but who knows, someone could prove me wrong. Google "luteal phase defect miscarriage" and see what comes up. I think "Taking Charge of your Fertilty" explains the progesterone/lp defect but it's been a while since I've read it. An excellent book explaining causes of miscarriage, treatments that might help, treatments that aren't proven, and why there's hope for the future is "Coming to Term" - the author is a man whose wife has had miscarriages. Last name is Cohen or Cohon. It's really great - it's packed with scientific knowledge but written so any idiot can grasp it.

As for progesterone prolonging the inevitable - there's a slight catch. You might need to be closely monitored for that. If there is something wrong with the embryo that is not compatable with life, it simple won't develop normally - progesterone will just keep you from bleeding and physically losing the baby. Ultrasound would show if things are developing or not. Blood work would show if HCG levels are rising appropriately. With no monitoring, though, it's possible progesterone would just keep bleeding from happening indefinately leading you to think things are OK when really they aren't (although some women bleed despite progesterone).

Most infertility doctors give progesterone as a preventative regardless of how your progesterone turns out on a given cycle - but there are also docs who don't believe in giving it without good reason. Personally I don't see any harm in it, other than it being messy as hell. (It oozes out over the course of the day...)

A longer luteal phase... I would almost wonder if it was a miscarriage. You can have a REALLY early loss called a chemical pregnancy where your blood levels of HCG barely rise - it might not even show on a home pregnancy test - and your period is delayed by just a few days. Blood work will show the slight rise in HCG but in most cases women never know they have this kind of loss and just chalk it up to a period being a few days late. If your luteal phase is consistantly longer than 16-18 days - I really don't know what that would mean. Could mean you're thinking you're ovulating in a different day than you actually are... could mean you produce super corpus luteums that just don't die... could mean you metabolise progesterone more slowly? (It has to be gone from your system for the bleeding to start) Sorry, don't really have an answer to that one!


----------



## Earthy Elf (Jul 14, 2008)

I did have a nursing induced miscarriage. But I don't think it's as much of a risk as mainstream medicine implies. Of the percentage of women who do actually breastfeed older babies and children, so many of them continue to nurse while pregnant without any issues. I hope your body heals and gets on the right track for you soon.


----------

