In The Rules Don’t Apply, a new book by New Yorker writer Ariel Levy, the author tackles the gut-wrenching topic of miscarriages. The memoir was inspired by Levy’s 2013 New Yorker essay about her own harrowing miscarriage in a Mongolian hotel room when she was 19 weeks pregnant.

“Very little had ever truly gone wrong for me before that night on the bathroom floor,” Levy writes. “And I knew, as surely as I now knew that I wanted a child, that this change in fortune was my fault. I had boarded a plane out of vanity and selfishness, and the dark Mongolian sky had punished me.”

Now, Levy’s highly-anticipated new book thrusts a taboo subject into the national spotlight, and highlights the self-blame and misunderstanding surrounding miscarriage, or the loss of a pregnancy within the first 20 weeks. Dr. Rebecca Brightman, a New York City-based OBGYN, says that many women don’t really understand how common miscarriages are, and for this reason are very hesitant to talk about them. As a result, women often blame themselves, as Levy originally did. With this in mind, here’s what you need to know about this awful experience:

Miscarriage is incredibly common. Although many women suffer the experience alone, the rate of miscarriage is between 8 and 20% of pregnancies. “I am in a practice where we deal with people miscarrying every week,” Brightman said. “I think a lot of people out there just don’t realize how common it is, and they don’t think that it will happen to them, it’s just not on people’s radar screens, especially my younger patients.”

The risk depends on maternal age. Unfortunately, the explanation for miscarriage is sometimes as simple as the age of the mother, and the risk increases as women get older. “Under 30, the risk is 10% to 20%, after 35 the risk is as high as 20%, and after 40, it’s more like 40%. After 45 it is an 80% risk of miscarriage,” Brightman said.

Miscarriages are your body’s way of protecting you and the baby. Most miscarriages occur because there was something fatally wrong with the fetus. “I would say, 60% of miscarriages are caused by chromosomal abnormalities that are not compatible with life,” Brightman said. To provide patients with more information and reassurance, she often suggests testing to determine the possible cause.

You didn’t do anything wrong. Self-blame is a common reaction, but it is misplaced. “The overwhelming majority of early miscarriages occur not because anyone did anything wrong, but again, because something is chromosomally abnormal,” Dr. Brightman said. “A lot of people think oh my gosh I didn’t know I was pregnant I had one drink or I ate this, I went to a concert and the music was loud, but there’s very little you can do yourself to influence a pregnancy.”

The behavior that is linked with miscarriage is pretty extreme. Research has suggested some risk factors for miscarriage, but they are typically linked with unhealthy lifestyles. “There is some suggestion that heavy smoking, large amounts of alcohol consumption, cocaine, and use of non-steroidal anti-inflammatory drugs, and excessive amounts of caffeine are risk factors,” Brightman said. Extremes of body weight, high fevers, and certain viral infections also have been linked with the loss of pregnancy.

It’s healthy and normal to grieve. Hormonal fluctuations combined with the loss, can produce extreme emotions that can require a lot of emotional support. “I think the most important thing, honestly, is to tell people it’s ok to be sad, that’s normal, and to reassure them that they were able to get pregnant, and you should be able to get pregnant again,” Brightman said. Plus, patients can often start trying again soon: “Depending on how far along somebody is, we have them wait just one or maybe two cycles before they try again.”

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