Miscarriage: Signs, Causes and How to Heal Afterwards

Perhaps you are going through a miscarriage right now. Perhaps you fear one, or are trying to understand what has just happened. Before anything else, one thing: a miscarriage is common, and in the vast majority of cases it is not caused by anything you did or did not do.

It is still an ordeal, physical and emotional, often lived through in silence. What follows explains what is happening in your body, the treatment options, and how to get through the weeks after, as a couple or with the people around you.

What is a miscarriage, and how common is it?

It is the spontaneous end of a pregnancy before the baby could live outside the womb. In France, the limit is set at 22 weeks of amenorrhoea, that is, counted from the first day of the last period; an early miscarriage happens before 14 weeks, which is the most common case, and a late miscarriage after that. The United Kingdom uses 24 weeks, and the WHO 28 weeks: the definitions vary, but the experience is the same.

According to France’s national health insurance (Assurance maladie), about 15% of pregnancies end this way. Quebec’s Mieux vivre guide speaks of one pregnancy in six, and says that most miscarriages happen in the first 12 weeks. The risk rises with age: according to the Assurance maladie, it goes from about 12% at 25 to 50% at 42.

Sometimes nothing shows. This is called a missed miscarriage: the ultrasound shows a sac with no embryo, or an embryo measuring more than 7 mm whose heart is not beating. If the embryo is smaller, the Assurance maladie advises waiting at least a week before concluding, with a new scan.

What are the signs of a miscarriage?

The main sign is vaginal bleeding, from a few spots to heavy bleeding, brown or bright red, continuous or on and off. It often comes with:

• cramps in the lower abdomen, similar to period pain, or pain in the lower back;
• clots or small pieces of tissue, pink, grey or whitish;
• sometimes a sudden loss of fluid.

Bleeding on its own does not necessarily mean a miscarriage: our article on bleeding during pregnancy explains the other possible causes. According to the Assurance maladie, bleeding with pain makes a miscarriage more likely.

Severe pain on one side only, pain at the tip of the shoulder or feeling faint should make you think of an ectopic pregnancy, which needs care the same day.

Why did it happen? It is not your fault

Most early miscarriages come from a major genetic abnormality in the embryo. It does not develop, or its heart stops. The Mieux vivre guide is clear: these abnormalities happen by chance, and they do not mean that you are infertile or that you have a health problem.

The same guide lists what does not cause miscarriage: stress, tiredness, physical activity, sex, diet, lifting heavy loads. People around you may each have their own explanation: the housework the day before, a meal, an upset. Medicine accepts none of them.

Some factors raise the risk across a population, such as age, smoking, alcohol, obesity or certain illnesses. They matter mainly for prevention and for tests after several miscarriages. The WHO notes that advice focused on lifestyle can lead women to believe they are to blame for their miscarriage. Guilt is common. It is not deserved.

How is a miscarriage managed?

The doctor examines you, then an ultrasound, often done vaginally, confirms the miscarriage and checks that it is not an ectopic pregnancy. A blood test (measuring the hormone hCG) is sometimes useful. The NHS says it plainly: once a miscarriage has started, it cannot be stopped.

If the womb is already empty, no treatment is needed, only a check-up. Otherwise, there are three options before 14 weeks, to discuss with your doctor:

If tissue remains after two weeks of waiting, treatment is offered. After 14 weeks, management is different and the team will talk it through with you: sometimes it means giving birth, naturally or after induction.

If you are Rhesus negative, you may be offered an injection of anti-D immunoglobulin, depending on how far along you were and the team’s practice.

After a miscarriage: looking after your body

The pain usually eases within a few days, and the bleeding or spotting within about two weeks. A few pointers help during this time:

• pads rather than tampons, to reduce the risk of infection;
• postponing sex for about two weeks, or until the bleeding has stopped;
• rest, and a painkiller if needed, chosen with your doctor or pharmacist;
• time off work if you need it: talk to your doctor.

Your period usually comes back within eight weeks, and your cycle may take a few months to settle.

Grief, even very early on, is real grief

Emotional recovery often takes longer than physical recovery, the NHS notes. Sadness, helplessness, anger, denial, confusion, a feeling of emptiness: all these reactions are described. For some women, the bond began with the positive test, or even with the plan to have a baby. The Mieux vivre guide puts it this way: losing an unborn baby can bring grief comparable to losing a person who has lived.

The father can also be deeply affected, often in a different way and at a different time. Talking together, accepting that the other may not feel the same thing at the same pace, avoids each of you being left alone with your pain.

Many couples wait until the end of the first trimester to announce a pregnancy. When the loss comes before that, it sometimes stays secret, and so does the grief. You have the right to talk about it, to whoever you want, whenever you want.

If the sadness or guilt will not let go, if you can no longer sleep or cope, talk to your doctor or gynaecologist: psychological support can really help, and there is no shame in asking for it.

And the next pregnancy?

Most women who have had a miscarriage go on to have a pregnancy that goes well, the NHS stresses. A single miscarriage is most often a one-off event.

There is no compulsory wait before trying again: when you feel ready, once the symptoms have passed, or after a first normal cycle according to the Quebec guide. A pre-conception appointment lets you take stock, and folic acid continues. To find your most fertile window, see our article on ovulation and fertile days.

After several miscarriages, tests are offered: from two in a woman under 40 in France, from three in the United Kingdom. They look for treatable causes, even if they do not always find one.