by NZINGHA SHABAZZ

Reproduced with permission from Islam and Infertility

Miscarriage is a very difficult event to deal with. Many women not only have to deal with the physical issues that arise, but also emotional issues. One of the most common emotional responses is "what did I do?" Self blame is not an unusual reaction and something that should be addressed rather than put aside. One of the numerous ways to positively walk through this traumatizing event is to find out what went wrong. I will attempt to share some information below, however, this is not to be substituted for medical advice from your doctor. 

One of the many things a woman may hear is that miscarriage is just Allah’s will and the body's way of rejecting a deformed fetus. While it is true that over ½ of miscarriages do occur due to genetic abnormalities in the fetus. The question arises as to the other ½ and what causes the miscarriages? 

If a woman does miscarry, it is very helpful if the passing tissue of the fetus is kept and presented to the hospital or doctor. Usually this tissue is recognized as a "blood clot", not uncommon in resemblance to uterine lining that is shed each month in a woman. This will, with the help of lab tests, determine if the fetus in fact had any genetic abnormalities that caused it to abort. Not all genetic abnormalities results in a miscarriage, many continue with a healthy pregnancy and results in physical as well as mental handicaps. 

Genetic Problems With The Parents

Though a genetic problem may be ruled out with the fetus. The problem can lie with the parents themselves. A Blood test called "karyotyping" can easily, but not cheaply, be performed to determine this factor. 

Endometriosis

43% of women diagnosed with Endometriosis have had miscarriages. It is not exactly known how Endometriosis causes miscarriages, but theories tend to attribute it to hormonal imbalances. Having Endometriosis myself, I have heard the often quoted "pregnancy helps Endometriosis" unfortunately this is not the whole truth. 

During the first two to three months of pregnancy, Endometriosis often gets worse before it gets any better. In order for pregnancy to help Endometriosis a woman must carry to full term. This is due to the increase of estrogen levels which causes Endometriosis to grow. 

Luteal- Phase Defects

This is a common hormonal cause of spontaneous abortion. This happens when the corpus luteum, which forms on the ovaries after ovulation, does not produce the proper amount of progesterone. The progesterone is necessary for the fertilized egg to implant itself in the uterine lining. If the corpus luteum fails the uterine lining will not be able to carry the attached fetus and a miscarriage will occur. This happens in the early months of pregnancy for after the second month of pregnancy the placenta takes over the production of progesterone. 

Malformations In The Uterus

There are several malformations of the uterus that can contribute to miscarriage, such as unicornuate uterus, septate uterus, and bicornuate uterus. 

1. Unicornuate uterus

This is the name for a woman that has a half of uterus, which can be diagnosed with and HSG. There are many women who go on to carry and deliver babies with this condition. Just because one has this condition does NOT mean that they will miscarry, although their chances do increase. What is said to happen is that the uterus is smaller and weaker due to the malformation. Which leads to not only miscarriages but premature births. 

2. Septate Uterus

This is when the woman’s uterus is partially or totally separated by a wall known as a "septum" Again this condition can be diagnosed with an HSG and many women go on to carry and deliver babies. When miscarriages do occur, it is usually attributed to the fertilized egg implanting itself on the septum. The septum has a very poor blood supply and the fetus aborts due to being undernourished. 

3. Bicornuate Uterus

A woman who has a uterus that looks like a heart, from the inside and out. And is attributed to higher rate of miscarriage, twice that of the general population. 

Several of these conditions can be treated with a surgical procedure. And they can be easily diagnosed with an HSG. Most women with such conditions don’t have any infertility problems, but may increase their chances of Endometriosis. 

Adhesions

Adhesions are a common infertility problem, from the tubes to the ovaries. There are also problems with adhesions in the uterus itself, occurring from several different factors. Procedures such as a D&C can cause adhesions as well as the surgical procedure to remove fibroids. The adhesions themselves can be cut away from the uterine wall enabling women to carry to full term. Figures as high as 85 % success rate after such a surgical procedure 

Fibroids

Fibroids are muscular tumors inside the uterine cavity, although benign, can interfere with conception as well as cause spontaneous abortion. If the fertilized egg implants itself over a fibroid, the food supply will be to low and the fetus will miscarry. Even fibroids that tend to be small before pregnancy can enlarge due to the increase of estrogen and progesterone. 

There is a major medical procedure called myomectomy which can remove the fibroids from the uterus. Success figures as high as 41% miscarriage rate among women with non treated fibroids fell to 14% after surgical treatment, makes for a great option. 

Incompetent Cervix

This is the term used to describe a woman whose cervix is incapable of holding together for a full term pregnancy. The baby literally falls out of a woman unless the problem is noted and dealt with. The doctors will generally sew the cervix together to hold the baby inside, and highly recommend bed rest. 

There are other causes of miscarriages such as infections, chemical hazards in our daily lives. But these are some of the main reasons why women miscarry. Many doctors, Insha'Allah this thought is changing, generally don’t look into the reason why a woman miscarries until her third consecutive miscarriage. If you find that your doctor is not receptive to your concerns about your miscarriage, remember you are in control, simply find another doctor that will address your concerns. 

What I find most upsetting, in an Islamic standpoint, is that women are blamed for miscarriages as a "play-back" of some evil thing she did or has within her. Being pregnant if have heard the sayings of the cultures, don’t walk this way you will miscarry, don’t get upset you will miscarry, don’t eat this you will loose your baby, and the tales get wilder as they continue. What this tells me is that culturally women have been conditioned to believe and accept that it is strictly her fault, and something she can avoid. This ties in with the overwhelming worth that is placed an a woman as an individual by how many children she has. And, Allah forbid, a woman has repetitive miscarriages the cultural views are to blame the women for their evil fault which endued the miscarriage. This would, perhaps, not affect me as it does, if it were not passed off as an Islamiclally sound view of miscarriage. 

How many of our sisters have been made to feel bad for having a miscarriage. Something they could have possibly avoided by not doing certain daily things that do not cause miscarriage at all. A sister recently had a miscarriage, of course the normal stages of blaming herself, due to our normal feelings as well as mixed cultural thought. I reassured her as best I could that such things happen, that it was not some inherently evil thing from her. I saw the relief on her face when I reassured her, all to have it undone by a well meaning sister in the next room. I however, controlled myself from "flipping out", if you will, and realized I had to rid her of her cultural hang ups as well. 

This lead me to find out exactly what our prophet s.a.w. said concerning miscarriage, if anything at all. I found the following: 

Abu Huraira reported that Allah’s Messenger s.a.w. said "The miscarried fetus that I send before me is dearer to me than a rider whom I leave behind." [Ibn Majah] 

"Mu’adh b. Jabal reported on the authority of Allah’s Messenger s.a.w. who said "By him in whose Hand is my life, the miscarried fetus will drag his mother towards the paradise, with his navel string if she had shown the patience for the sake of reward from Allah."