Early pregnancy loss, also known as miscarriage, is more common than most people think. Defined as a loss of pregnancy before 20 weeks gestational age, about 1 in 5 pregnancies will end in a miscarriage. The majority of miscarriages will happen early, often in the first trimester. Early pregnancy can be a time of uncertainty and ambivalence and complications or pregnancy loss can add overwhelming feelings of shame, disappointment or sometimes even relief. We’re here to meet you where you are and walk you through this vulnerable time, together.

One of the most challenging aspects of a miscarriage is that it’s often difficult to make a diagnosis or treatment plan with a single lab result or ultrasound. Sitting with this uncertainty is often one of the hardest parts of the entire experience – the not knowing. We will be in close communication with you to help you anticipate what might come next and what your options are at each point in your journey.

What causes a miscarriage 

We don’t always know what causes miscarriages, but it is almost never caused by something you did as the pregnant person. Having sex, minor injuries such as falling, working out, stress, and most medications do not affect a normally developing pregnancy, and they do not cause miscarriage.

Things we do know that can cause early miscarriage include:

• Chromosomal abnormalities apply to about half of all miscarriages. This is when the embryo has an abnormal number of chromosomes (genes).
• Certain illnesses, such as severe diabetes, are more likely to cause a miscarriage.
• A very serious infection or a very major injury may cause miscarriage.
• If you’ve had more than 2 miscarriages in a row you are at higher risk of miscarriage.
• Advanced maternal age > 35 can put you at higher risk of miscarriage.  

How would I know if I was having a miscarriage?

Bleeding is the most common sign of miscarriage. Sometimes you will have cramping too. Your pregnancy test will likely still be positive. If you did feel pregnant, you might not anymore. Sometimes you may have no symptoms, but find out during an ultrasound that the embryo or fetus is no longer growing.

What are the different ways miscarriage is referred to?

“Missed” miscarriage (also known as missed abortion) — You have no cramps or bleeding. But ultrasound shows an embryo without a heartbeat, measuring smaller than expected, or an empty pregnancy sac without an embryo.

Spontaneous miscarriage (also known as spontaneous abortion) – You have symptoms of miscarriage (bleeding, cramping) that start without any medical intervention.

Incomplete miscarriage — Some pregnancy tissue passes out of the uterus but some stays inside. Sometimes treatment is needed to remove the remaining tissue.

Inevitable miscarriage — Your bleeding increases, and the cervix (the opening to the uterus) begins to open. In this case, miscarriage is certain while the timing can remain uncertain.

Complete miscarriage — All the pregnancy tissue is passed. Treatment is usually not needed.

Your care provider may also use the term “threatened miscarriage”. You have bleeding, with or without mild cramps, but the cervix is closed. Sometimes this is a sign that a miscarriage may occur, but the pregnancy could also continue normally. This is a particularly challenging space where you must watch and wait to see how things will evolve.

What usually happens during a miscarriage?

You will most likely have bleeding and cramping. Bleeding may be similar to a heavy period. You may pass large blood clots the size of a lemon or some tissue from the pregnancy. If bleeding continues, the pregnancy will often pass on its own. The bleeding usually decreases after the pregnancy tissue has passed. It’s normal to have some bleeding or spotting for 4-6 weeks after a miscarriage.

Cramps are also a normal part of miscarriage. Some people feel stronger cramps than others. Cramping will ease after the pregnancy tissue has passed. We’ll share some comfort measures and medication options with you for managing your pain.

You might experience nausea, vomiting, and diarrhea while having a miscarriage. This will usually self-resolve. You may also have mild fever, chills, dizziness, headache, back pain, and a general sense of exhaustion.

A miscarriage can cause a wide range of emotions. You may feel sadness, guilt, fear, anxiety, relief or have other vulnerable emotions. A sense of grief is a normal experience after early pregnancy loss. Sometimes the feelings are so strong that you may have trouble going about the normal activities of your day. Call us if this happens. We can help or refer you to someone who can.

Warning Signs and When to Call Us

If you have:

• A fever of 100.4°F or higher
• Abdominal pain or cramps that don’t get better with pain medicine or pain so severe that you are unable to manage it at home
• Bleeding that is heavy, soaks 2 maxi pads an hour for more than 2 hours, any clots larger than the size of a lemon passed for more than 2 hours, moderate or heavy bleeding that does not abate, or any bleeding associated with feelings of dizziness, shortness of breath, fainting or loss of consciousness
• If you are weak or have nausea, vomiting or diarrhea for more than 24 hours

All of these could be signs of a serious complication or infection and need immediate medical care in an emergency room.

Will I see the embryo during the miscarriage?

You may or may not. Before eight weeks (two months), the embryo is small and may look white or tan in color. You may not notice it amid bleeding and clots passing through the vagina. If the pregnancy is eight weeks or more, you may see the embryo. At eight weeks, it is about 1/4 to 1/2 an inch long. Cramping and bleeding will slow down after it comes out.

How will I feel after the pregnancy comes out?

Bleeding — After the pregnancy tissue passes, it’s normal to have bleeding like a menstrual period for 1 or 2 weeks but it should get lighter and lighter over time. You may have little or no bleeding for a few days or weeks. Bleeding may be intermittent, stop and then start again and could continue this way for 4 to 6 weeks. You should have your normal period again 4 to 8 weeks later.

Cramping — You will cramp less and less as the hours and days go by.

Tiredness — You may feel tired for 1 or 2 days. You should feel a return to normal energy levels soon.

Breast changes — Tenderness should go away in a few days. It is less common, but you may leak a milky discharge. Wear a snug-fitting bra if you do. This should stop in 1 or 2 days.

Medication reactions – If you took medication called misoprostol during your miscarriage, you may notice some side effects.  It is common to have a low grade fever and chills the day you take the misoprostol prescription. It is not normal to have a fever that lasts more than 24 hours – a persistent fever may be a sign of infection. The medication can also cause nausea or diarrhea.  These effects should go away in 1 or 2 days after you take the misoprostol.

When can I return to my normal activities after a miscarriage?

Plan on resting the day the pregnancy comes out. Most people return to their normal activities the next day, but don’t plan to do hard physical work or heavy exercise for several days.

You may have sex as soon as you feel ready. Remember there is no rush of when that might be. Be open with yourself and your partner about how that feels. Know that if your sexual activity includes contact with sperm, you may be able to get pregnant again within 2 weeks of passing the pregnancy.

If you want to get pregnant again, we will offer you personalized counseling and can talk with you about the best timing for trying again. If you have had two or more miscarriages in a row, or a miscarriage at ten weeks gestation or greater, we can talk with you about the possibility of referring you to a fertility partner for further testing.

If you don’t want to get pregnant again, we can talk with you about birth control methods and when to start those. When you will get your next period depends on the birth control method you use. If you are not using birth control, you should have a period within 8 weeks of the miscarriage. If you are not using birth control and you do not get a period within 8 weeks, please reach out to our care team.

What can I do to prepare for having a miscarriage?

Stop by the pharmacy to buy maxi pads and over-the-counter pain medicine such as acetaminophen (Tylenol) and ibuprofen (Motrin) to use during and afterwards. Don’t take aspirin, because it could make you bleed more. Fill any prescriptions you were given by our care team and take according to the directions.

Use comfort measures. Put a hot water bottle or heating pad on your lower belly. Take a warm shower. Sit on the toilet and read a magazine. Have someone you feel nurtured by and safe with rub your back. Binge a TV show or favorite movie. Wear cozy comfortable loose-fitting clothing.

Plan for your family or friends to be with you and to check in on you during the process. Talk to someone about how you’re feeling. Reach out to our care team if you are feeling overwhelmed, scared, or alone – we are here for you and with you throughout this experience.

READ MORE about early pregnancy loss care options