Some have said: A family without children is incomplete. A woman who has never been a mother will never truly become a woman. Some cannot become mothers because they are unable to conceive. Others conceive but repeatedly fail to carry a pregnancy to term. In a way, the latter brings greater pain than the former, for it inflicts not only emotional anguish but also physical torment.
Our editorial office frequently receives letters from women who have experienced miscarriage. Pain and tears intertwine between the lines, their sorrow palpable on the page. These women, repeatedly shattered in body and spirit, cry out the same anguished plea: "My child, what can I do to hold onto you?"
Married for five years, she conceived four times, only to lose each pregnancy. Her tender maternal longing was shattered by relentless reality. Under the pseudonym "Refusing Tenderness," she sent this heart-wrenching letter to our editorial team—
Why Can't I Be a Mother?
I married at the end of 1999. Two months later, I became pregnant.Initially, I felt no discomfort and continued commuting by bicycle. At three months, I noticed dark yellow discharge and rushed to the hospital. The doctor diagnosed threatened miscarriage. Despite taking medication to prevent miscarriage, excessive bleeding forced a D&C procedure.
A year and a half later, I became pregnant again. Learning from my previous experience, I strictly adhered to bed rest, even using the bathroom in my bedroom. But by the third month, bleeding started again. I took medication and received injections to prevent miscarriage, yet the bleeding didn't subside. One night, I found myself lying in a pool of blood. My husband urgently called the doctor, who advised me to stop trying to save the pregnancy. Blindly pursuing it wouldn't necessarily lead to a good outcome.Thus, my second pregnancy came to an end.
A year and a half later, in April 2003, due to contraceptive failure, I became pregnant once more. As before, intermittent vaginal bleeding began around the three-month mark, and the baby was lost again.
At this point, I couldn't help but wonder: was it my body, or my husband's? To find the cause, we underwent every possible test available in the city. The results showed no abnormalities in either of us.
After a year and a half of careful preparation, I became pregnant again in November 2004. I quit my job for this pregnancy.My mother tended to me day and night, and I took medication and injections daily. After two and a half months of relative calm, my worst fear materialized. Vaginal bleeding started, growing heavier and heavier until it became uncontrollable. Even the doctors stopped giving me pregnancy-sustaining injections. After four or five days of continuous bleeding, clots began appearing, and my abdominal pain intensified. I took a taxi to the hospital in the middle of the night. Due to the excessive bleeding, the doctors recommended a D&C procedure.
Lying once more on the cold operating table, I numbly allowed the doctor to "manipulate" me, yet my heart was torn by waves of pain and spasms... The sound of firecrackers grew louder and louder in my ears. The empty, quiet hospital bustled with activity because of my arrival.By the time the procedure ended, it was already 8:30 PM. The 2005 Spring Festival Gala was airing on TV. The laughter and joy filling every household felt utterly foreign to me. On this warm and festive New Year's Eve, my fourth pregnancy ended once again in heartbreaking despair...
Five years ago, I was a healthy, confident young woman. Today, I am a frail woman, physically and mentally exhausted, utterly drained. I still cannot understand why, with both my husband and I having perfect health checkups, pregnancy keeps failing? Did the doctors make a mistake, or did I?Why can't I be a mother?
——Refusing Tenderness
"To become a mother, I gave everything I could—I quit my job, sacrificed my health, and ended up scarred..." In a letter to the editor, "Refusing Tenderness" wrote these heartbreaking words. Many readers share similar experiences, viewing the causes of miscarriage as an eternal mystery.However, experts see it differently—
Recurrent Miscarriage: Causes Identified in 90% of Cases
Professor Gao Meiyang (Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Guangzhou Medical University) explained that cases like "Refusing Tenderness's" are clinically termed recurrent miscarriage—defined as three or more consecutive spontaneous abortions, often occurring at the same gestational stage.Numerous factors contribute to habitual miscarriage. Common causes of early miscarriage (termination before 12 weeks of gestation) include embryonic chromosomal abnormalities, immune system issues, and maternal endocrine disorders. For late miscarriage (termination between 12 and 28 weeks), common causes include uterine malformations or underdevelopment, cervical incompetence, and uterine fibroids.
In the 1980s, limited by the scientific and technological capabilities of the time, it was often difficult to identify the exact cause of recurrent miscarriage. However, with continuous improvements in diagnostic techniques and increased medical understanding, the situation has greatly improved. "Currently, the cause can be identified in most cases of recurrent miscarriage," said Chen Quannang (Professor of Obstetrics and Gynecology, First Affiliated Hospital of Guangzhou Medical University).
Embryonic chromosomal abnormalities are the primary factor considered in early miscarriages and the most common cause of recurrent miscarriage. Among chromosomal abnormalities, the most prevalent is "balanced chromosomal translocation."
"Balanced chromosomal translocation" is a medical term. Carriers of balanced translocations themselves show no abnormalities, and their semen or eggs appear normal. However, their offspring are highly susceptible to "chromosomal segment deletions," which can cause fetal malformations and trigger spontaneous miscarriage.
Another common cause of early miscarriage is "couple discord.""Couple discord" is a vivid metaphor coined by Professor Gao Meiyang, referring to immune factors. Since half of the embryo's genetic material originates from the father, the embryo is considered a semi-allogeneic transplant to the mother, potentially triggering an immune rejection response (similar to organ transplantation). When this immune rejection reaches a certain threshold, the embryo is rejected by the mother, resulting in miscarriage.
Maternal endocrine factors, including systemic endocrine disorders (hypothyroidism, diabetes, etc.) and gynecological endocrine issues (luteal insufficiency, elevated prolactin levels), are also common causes of miscarriage.
Some readers may wonder: with so many potential causes of miscarriage, isn't it overwhelming and complicated to pinpoint the specific reason for one's own miscarriage?
In practice, during consultations, physicians typically establish a preliminary diagnostic direction based on the patient's medical history—such as menstrual patterns and the clinical course of the miscarriage—to guide targeted investigations.
For instance, miscarriages due to cervical incompetence generally occur in the later stages of pregnancy and progress extremely rapidly. This is because cervical laxity allows the fetus and amniotic fluid to descend with minimal resistance.Since the fetus can be expelled without strong uterine contractions, the pregnant woman may not experience intense abdominal pain. Simultaneously, with minimal vaginal bleeding, the fetus is already "expelled." Professor Chen Quannang describes the speed of this process as "like a hen laying an egg."If a woman's past miscarriages resemble this pattern, doctors will focus their investigation in this direction. Once confirmed through examination, surgical "tightening" of the cervical os can prevent recurrence. In contrast, miscarriages caused by uterine hypoplasia have a distinct characteristic: as the number of miscarriages increases, the uterus gradually develops, causing the gestational age at miscarriage to progressively increase. Over time, this often culminates in the mother giving birth to a premature infant.
The distinct characteristics of miscarriages caused by different factors serve as key clues for physicians in identifying the underlying cause.
However, not all miscarriages yield a clear diagnosis. Wang Zhixin (Associate Professor, Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University) notes that approximately 10% of recurrent miscarriage cases remain unexplained.Professor Chen Quannang believes this is only temporary, and with advances in science and technology, these mysteries will eventually be unraveled. Vaginal bleeding: a sign of impending miscarriage? I've had light spotting for a few days now—just a tiny bit that leaves a faint trace on my pad. Could it be from friction during intercourse?What if the hospital checkup shows it's not a threatened miscarriage, but just bleeding from intercourse? That would be so embarrassing... Plus, I've heard that if it were a miscarriage, there should be symptoms like lower back pain or abdominal cramps. But aside from the bleeding, I felt no discomfort, so I didn't think much of it.Unexpectedly, one night a few days later, I suddenly experienced heavy vaginal bleeding and abdominal pain. My family panicked and rushed me to the hospital... The baby was gone. I deeply regret my carelessness back then... I would like to ask the expert: Does sudden vaginal bleeding during pregnancy always indicate a threatened miscarriage?
—A reader's phone consultation