Miscarriage: The facts and Practicalities

In this two-part series, we've touched on the emotional aspects of miscarriage in our Support after a miscarriage | Lil-Lets blog. However, becoming familiar with the physical experience of miscarriage can also make this time feel a little less daunting, equipping you to navigate it with greater clarity and confidence.

Whether you’ve experienced an early miscarriage (first trimester before 12 weeks), a late miscarriage (2^nd trimester between 13 and 24 weeks) or you are supporting someone who has experienced a miscarriage, I hope this information gives a deeper understanding of your own experience and helps with your future plans.

First and Foremost, please know that this is not your fault.

Whilst there are of course some precautions you can take to reduce the risk of a miscarriage, it's so important to understand that, in most cases, miscarriages are beyond your control.

Miscarriages are very common and can happen for many different reasons, with the cause often not known, but it’s important to know that it is very unlikely to be due to anything you did or didn’t do. Although we don’t have exact statistics, experts believe that around 1 in 4 pregnancies end in miscarriage with most of those happening in the first 13 weeks of pregnancy.  

Miscarriage In The First Trimester

It is believed that nearly all reported miscarriages occurring before 12 weeks are due to issues with the baby’s chromosomes, meaning they can get too many or not enough at conception, which can disrupt a healthy developing embryo.

But How Will You Know If You’re Miscarrying? 

Firstly, everyone is very different and understandably, in early pregnancy, we are more aware of our body changes and worry that some symptoms, or lack of them are an indication that something is wrong. It doesn’t always mean there’s an issue as symptoms do change regularly and can include things like nausea and vomiting, extreme fatigue and sore, tender breasts.  Some women experience very few pregnancy symptoms, others experience a lot, while some notice different symptoms with each pregnancy. However, a noticeable loss or reduction of strong pregnancy symptoms well before 12 weeks can sometimes signal a miscarriage, indicating a drop in pregnancy hormones. For reassurance you may want to contact your health care provider, maybe do another pregnancy test or arrange a scan to check if the pregnancy is still progressing.

Early signs of pregnancy can vary, but some of the most common symptoms include:

Bleeding is the most common symptom of miscarriage and can present in many ways, from light spotting or brownish discharge to heavy, bright red bleeding and clots, which may last a few days.  However, bleeding in early pregnancy is quite common and doesn’t always mean you’re miscarrying. It’s always best to get any bleeding checked out, so contact your GP or midwife who should be able to guide you on the next steps to take. And just to give a little reassurance, around half of those presenting with bleeding will go on to have a healthy pregnancy.

Cramping or pain in your lower abdominal area or period type pain can be a sign of miscarriage, especially If you are experiencing this along with spotting or bleeding. And just like bleeding, pain can also be normal in early pregnancy. Commonly many women experience stitch type pain as the uterus grows and the ligaments stretch, or back ache as the pregnancy progresses, but again symptoms can vary so it’s always best to get advice.

If you are showing signs of miscarriage, reaching out to your midwife or GP is essential. They can assess your symptoms, provide guidance, and help determine the best next steps for your health and peace of mind.

Seek urgent help if you are experiencing.

• Continuous and severe tummy pain, on one side.
• Bleeding after the pain has been noticed.
• Shoulder tip pain.
• Diarrhoea and vomiting.
• Feeling faint and lightheaded.

This could indicate an Ectopic pregnancy, where the pregnancy is developing outside of the womb, and comes with a risk of internal bleeding. If you are worried you may be experiencing symptoms of an Ectopic pregnancy, please visit your A&E Department immediately.

When a natural miscarriage begins, unfortunately, there isn’t a way to prevent it from progressing. You may experience period-like cramps that, even early on, can be quite painful, as the uterus contracts to expel the pregnancy.

Some women in my care describe these cramps as similar to labour contractions. Don’t hesitate to take pain relief to help manage the discomfort, and wearing a period pad can be useful to monitor your bleeding, as it can become quite heavy. Passing large clots or tissue is common, and it’s possible that some of this may be recognisable as the pregnancy sac or foetus, which can understandably be very distressing.

Having someone with you during this time can be incredibly valuable, offering both emotional and practical support. Some people find they’re able to manage at home, but it’s important to stay in touch with your midwife or maternity unit in case you need further guidance. If the pain or bleeding feels unmanageable, or if you’re unsure about what to do next, your local Early Pregnancy Unit, Maternity Bereavement Suite, or even the 111 service can advise you on where to go if you prefer to be seen at the hospital. Alternatively, you can always go to your nearest A&E for support.

If a miscarriage is suspected to be very early in the pregnancy, it’s common practice to schedule a repeat scan after about a week. This follow-up scan is important to determine whether the pregnancy has developed or to confirm if it has unfortunately ended. While the waiting period can be incredibly distressing, it allows healthcare professionals to avoid prematurely diagnosing a healthy pregnancy that is still ongoing.

In addition to the scan, you may also be offered a blood test at one or both appointments to measure the levels of HCG (Human Chorionic Gonadotropin) in your blood. Typically, a decreasing HCG level can indicate that a pregnancy has ended. These steps are crucial in providing you with accurate information and ensuring you receive the appropriate care during this difficult time.

Is There Treatment For An Early Miscarriage?

 Yes, there are treatments available for an early miscarriage, and the best option often depends on the individual situation, including the size of the pregnancy and your medical history. Generally, there are three main options to consider unless emergency treatment is required: the treatment that is available to you will depend on the size of the pregnancy.

In the early stage of pregnancy there are generally 3 options open to you, unless of course you need emergency treatment: 

3. Letting Nature Take Its Course: This involves allowing your body to begin the process of miscarriage naturally. Many women choose this option, as it can be less invasive and may feel more natural.
4. Using Medication: Medication can be prescribed to help start or speed up the miscarriage process. This is usually done when the body hasn’t started the process on its own, or to ensure it progresses more quickly and completely.
5. Surgical Intervention: In some cases, a minor surgical procedure may be necessary to remove the pregnancy tissue. This option may be recommended if there are concerns about an incomplete miscarriage or if there are complications.

Ultimately, the choice of treatment is yours, but it's important to discuss your options with your healthcare provider. They can help you understand the implications of each choice and recommend what might be best suited to your individual circumstances

To help you with your decisions, you can read more about each of these here The physical process 

Most miscarriages, regardless of when they occur, are typically attributed to issues related to the baby’s development and are usually one-off experiences and do not necessarily indicate ongoing fertility issues. 

There are other causes which are more common as the pregnancy progresses and as you enter your second trimester, which I’ll share with you here, but please know that some of these can also occur in earlier and later miscarriages too!

Chromosomal abnormalities: 

The baby receives half its chromosomes from each parent at conception, so this is the time the baby’s own chromosomes are formed. It’s an intricate process and sometimes there can be problems with the formation of these chromosomes, that may cause an abnormality.  This unfortunately can result in miscarriage in the early or later stages of pregnancy, but that may not always be the case. In some cases, like Downs Syndrome for instance, a baby can have abnormal chromosomes and still be born healthy and live a fulfilling life, alongside varying disabilities. In most cases chromosomal or genetic abnormalities happen purely by chance, but on rare occasions they can be inherited, but there are blood tests that can check parent’s chromosomes.

Structural abnormalities:

Nearly half of all miscarriages occur when the baby does not develop properly from the very beginning of the pregnancy. These abnormalities can affect various parts of the body, including the heart, brain, and spine. Conditions such as congenital heart defects, neural tube defects like spina bifida, or other critical structural issues can lead to pregnancy loss.

In some cases, these abnormalities are detected during the mid-trimester scan (typically between 18-22 weeks of pregnancy), which allows for early identification of potential issues. However, not all structural abnormalities are apparent during this scan and may go undetected until after the baby is born

Cervix or uterus: If the cervix (the lower part of the uterus) is weak or damaged, it may not be able to support a pregnancy, and this weakness can lead to premature dilation and cause the cervix to open.  

Additionally, in later pregnancy and as the uterus becomes heavier, or if the uterus has an irregular shape, such as in cases of a septate uterus or fibroids, there may not be enough space for the baby to grow properly.

Both cervical and uterine abnormalities can pose significant risks during pregnancy. If you have a history of these conditions or experiences symptoms like pelvic pressure or unusual discharge, it's essential to consult with your GP or healthcare provider. Monitoring and interventions, such as cervical cerclage (a stitch placed around the cervix to support it), may help manage these risks and improve outcomes for future pregnancies.

Infection: Whilst common coughs and colds are not harmful to your unborn baby, some infections can affect the amniotic fluid surrounding the baby, or indeed the baby directly causing a second trimester miscarriage, preterm labour or serious illnesses to newborns.

• Bacterial Vaginosis is an example of an amniotic fluid infection causing pre-term birth.
• Parvovirus B19, is spread by coughs or sneezes of an infected person, or by touching contaminated objects.
• Listeria often contracted from contaminated foods such as unpasteurised dairy products or undercooked meat.
• Toxoplasmosis caused by a parasite often found in cats, or undercooked meat, can cross the placenta and cause serious issues in a developing foetus, including neurological problems.
• German Measles or rubella as it is sometimes called in pregnancy can lead to miscarriage or severe birth defects.

Let me reassure you however that having an infection like these in one pregnancy, does not increase the risk in subsequent pregnancies.

Blood-clotting problems: APS Antiphospholipid Syndrome sometimes known as  Hughes’s Syndrome is a condition where the blood clots more than it should and obstructs blood flow to the placenta, depriving the foetus of necessary nutrients and oxygen. Sometimes referred to as ‘Sticky Blood’, the condition can cause both early and late miscarriages; to lessen risks associated with APS your doctor may prescribe Aspirin or blood thinners to reduce the risk of blood clotting during your pregnancy. 

What Happens When A Miscarriage Has Been Identified?

Many expectant parents anticipate their mid-trimester scan, which is around the 20-week mark, as an exciting milestone to see their baby and confirm the progress of the pregnancy. Unfortunately, for some, this scan may reveal serious issues that were previously undetected, such as severe congenital conditions or even foetal demise.

Discovering that your baby has died during a mid-trimester scan or that your sonographer has discovered a severe condition or abnormality that is not compatible with life can be devastating. The latter in particular, can be extremely distressing, when faced with the decision to end or continue with the pregnancy and can be one of the most challenging and heartbreaking experiences a person can endure.

The ‘Foetal Medicine’ or ‘Maternity Bereavement’ team at your local hospital will mostly likely take over your care at this point and will provide and talk through all options available to you which will enable you to make a choice that is right for you, as well as prepare you for what’s to come. 

It’s natural to feel overwhelmed, and for some even guilty about your choices going forward and decisions regarding your pregnancy can be incredibly emotional. Take your time to absorb the information and consider your options carefully there is no rush. Consider going home and take some time to work through the information you have been provided with.

If you feel uncertain or want additional reassurance, you can always ask for second opinion and do your own research in relation to a particular condition, this can often help you feel more confident when making your final decision. Help lines available at Tommy’s and the Miscarriage Association can be extremely helpful talking things through with you.

Navigating the complexities of a difficult pregnancy diagnosis can be incredibly challenging. Trust in the expertise of the foetal medicine or maternity bereavement team, take your time in making decisions, and lean on available resources for support. Remember, you are not alone, and there are people and services ready to help you through this difficult journey.

Labour And Birth 

Experiencing a loss during pregnancy is profoundly challenging, and the decisions surrounding how to proceed can be incredibly emotional. If your loss doesn’t start spontaneously, you may be offered the option to wait for the labour to start naturally, or alternatively you may be recommended to have medication to start off the labour process, which is called an induction.

These are very difficult decisions to make, as well as being extremely upsetting, with you most likely wondering why you can’t have a caesarean section, instead of having to go through the process of labour and birth at all! Your health is very important during this time and for this reason it’s rare that a C-Section is offered.  Going through the labour and birth process poses a lower risk to your health in comparison to having a C-section. It also results in a faster recovery allowing you to begin the healing process both physically and emotionally. 

You may be cared for in a Gynaecology or Maternity suite setting with some hospitals having a special Bereavement Suite, and so it may even be possible for you to choose.  This varies a great deal from one hospital to another and I would urge you to discuss this with the team taking care of you.

What I Have Learned.

Many of those that I have cared for who have experienced a vaginal birth in the 2nd Trimester, have found the giving birth experience to be deeply meaningful, providing a sense of closure, allowing them to bring their baby into the world before saying their goodbyes.

But if you really do feel a C-section is the route you want to follow, you can of course talk this through with those caring for you. 

Investigations

After a second trimester loss, hospitals typically provide a range of investigations to help identify potential underlying causes. This could be the offer of blood tests for you and perhaps your partner, to check for any possible relatable issues.  Tests of the baby may also be offered which may include carrying out a post-mortem or testing the placenta. 

I appreciate these can feel intrusive but knowing the potential causes of the loss can often offer reassurance and help manage risks in future pregnancies, allowing for more informed decisions and better care.

You should be offered a follow-up appointment with your hospital consultant a few weeks after your loss, and this is when you can hopefully find out the results of any investigations. This is also a good opportunity to ask any questions as well as find out about any treatment or recommendations for recovery or subsequent pregnancies.

Sadly though, sometimes there can be no explanations, which means you may come away without any answers or a reason for your loss. This can make the visit and experience even more difficult so maybe reach out to the numerous support networks that are there to offer help and support. You’ll find a list at the end of this post. 

What Happens To My Body After A Miscarriage?

Bleeding

Physical recovery following a miscarriage is very different for everyone but after a second trimester loss, you are likely to have some bleeding and perhaps period type pain. This might go on for several weeks, with the pain and bleeding gradually getting less over that time. Some of the women in my care think this bleeding in the first few weeks is their period, but it’s actually Lochia, a mix of blood, and uterine tissue.

Menstrual Cycle

If you normally have a regular cycle, you can expect your period to return after around 4-8 weeks based on factors such as hormone levels and your own natural recovery process.

Breasts

Your breasts may feel tender and uncomfortable, and it may upset to hear that your breasts may produce milk. This does depend on how many weeks pregnant you were, but your care providers will most likely suggest tablets to reduce the production of milk. If you have been in hospital, you will be able to take before being discharged home, otherwise your GP can prescribe it for you. Your GP can also give you a sick note/fit note if you need one for your employers. 

Hormones

Your hormones will fluctuate after a miscarriage but usually settle once you have stopped bleeding. You may notice that you feel emotional and have mood swings as well as feeling a desperate sadness for your loss. Allow yourself time to process these feelings and seek support if needed.

A Midwife Visit After a Miscarriage

Your midwife may offer to visit you at home to support you in your recovery, addressing both physical and emotional aspects of healing. Some people find this a comforting option, while others may prefer to focus on their recovery privately. Remember, it’s entirely up to you—do what feels right, and please don’t worry about your midwife’s feelings. They completely understand if you’d prefer not to have a visit and will respect your choice.

When To Seek Medical Advice After A Miscarriage

After experiencing a miscarriage, it's important to monitor your body for any signs that may require further investigation. While some bleeding and discomfort are common, there are specific symptoms that warrant contacting your healthcare provider. Please reach out to your GP or midwife if you notice any of the following:

• Increased Bleeding or Pain:
  • If you find that the bleeding becomes heavier or if you experience significant increases in abdominal pain, this could indicate a potential complication that needs to be assessed.
• Foul-Smelling Vaginal Discharge:
  • A vaginal discharge that appears unusual in colour (such as green or yellow) or has a foul odour could signal an infection. It's crucial to seek medical advice if you notice these changes.
• Concerns About Other Physical Symptoms:
  • If you experience any other symptoms that cause you concern, such as high fever, chills, severe fatigue, or any new or unusual symptoms, don’t hesitate to reach out to your healthcare provider for guidance.

When Can I Try To Conceive Again?

It’s only natural to have questions or even concerns about conceiving again after experiencing a miscarriage. The good news is that having a miscarriage typically does not affect your chances of a successful future pregnancy.

I would recommend chatting about this with your healthcare provider as there may be personalised advice for your particular case. However, here is some general information you may find useful:

• It's essential to allow your body time to heal after a miscarriage. Your healthcare provider will typically recommend you do not have sexual intercourse until all bleeding has stopped, to reduce the risk of infection.
• Waiting for at least one menstrual cycle before attempting to conceive again, can be helpful. It makes calculating dates easier too, as your first period may possibly be longer or shorter than usual. Allowing your menstrual cycle to return to a normal pattern can help identify when ovulation is taking place.
• If you do conceive before you have a period, it doesn’t make you more likely to miscarry.  There is in fact,good evidence that indicates there may be a lower risk of miscarriage for those who conceive within the first six months after a miscarriage.
• The best time to try is when you and your partner feel physically recovered and emotionally ready to embark on another pregnancy.
• Focus on optimising yours and your partners health. This includes maintaining a balanced diet, optimum gut health, taking regular exercise, good sleep patterns, reducing stress, managing chronic conditions (like diabetes or thyroid disorders), and avoiding harmful substances such as alcohol, tobacco and recreational drugs.

What Increases The Risk Of Miscarriage?

There are several things that increase the risk of miscarriage but, even if you did any of these things in your last pregnancy, it doesn’t necessarily mean that any one of them actually caused your loss.  The chances of a second miscarriage happening are low but it’s good to be aware of the risk factors:

• Maternal Health Factors: Certain health conditions in the mother, such as diabetes, thyroid disorders, autoimmune diseases, and infections (like rubella or cytomegalovirus), can increase the risk of miscarriage.
• Lifestyle Factors: for both biological parents. Smoking, alcohol use, drug abuse, and exposure to environmental toxins (like chemicals or radiation) can increase the risk of miscarriage.
• Advanced Maternal Age: Women over 35 have a higher risk of miscarriage compared to younger women, largely due to increased likelihood of chromosomal abnormalities in eggs.

Support 

There are many baby loss support services that share evidence-based information around miscarriage, and also guidance and support for the months after. I’ve listed some below with links to helplines, services and websites.

Speaking to others that have experienced loss, and sharing your own experience is something I always recommend. There are many local baby loss charities that offer face to face support groups, with ongoing support to families like the Lily Mae Foundation  who also offer counselling and pregnancy after loss support. Navigating a subsequent pregnancy can be filled with worry and anxiety, so having individual or group support at this time can really help. 

Commemorating Your Baby 

Your hospital may offer communal cremation and funeral services, or this may be something you’d like to arrange yourself. It may be important to you and your family to commemorate your pregnancy; to not just acknowledge it but to help you through the grieving process, you may find the first part of this blog series Breaking The Silence useful to read.

I hope you’ve found the information here useful, and that it has given not only reassurance but hope for your future family plans. 

Support services and contacts

Tommy’s baby loss support group https://www.facebook.com/share/g/1iNucD79yVzkbDRQ/?mibextid=K35XfP

https://www.tommys.org/baby-loss-support/miscarriage-information-and-support

Tommys helpline

0800 0147 800

Mon-Fri 9am-5pm

midwife@tommys.org

The Miscarriage Association leaflets 

Helpline 01924 200799

Mon, Tue, Thu 9am-4pm | Wed, Fri 9am-8pm

Info@miscarriageassociation.org.uk

sands.org.uk

Helpline  0808 164 3332 

10am to 3pm Monday to Friday and 6pm to 9pm Tuesday, Wednesday and Thursday evenings.

helpline@sands.org.uk

The Lullaby Trust  

Helpline 0808 802 6868

Mon to Fri, 10am – 5pm | Weekends and Public Holidays, 6pm – 10pm

British Association for Counselling and Psychotherapy

Hold a therapist directory.

01455 883 300

Samaritans | Here to listen

24-hour helpline: 116 123 (freephone) 

jo@samaritans.org

ARC - Antenatal Results and Choices (ARC) 

Offering support and information following diagnosis of anomaly 

The Lily Mae Foundation

Websites and Resources

Request a baby loss certificate - GOV.UK

Miscarriage - NHS

The Miscarriage Association:Pregnancy Loss Information & Support

Saying Goodbye - support for miscarriage and baby and infant loss

Still Parents Podcast Podcast Series – Apple Podcasts

Miscarriage information and support | Tommy's

www.petalscharity.org

The Ectopic Pregnancy Trust

The Molar Pregnancy Support & Information - The Complete Resource

Bereavement care after baby loss - learning for all

https://portal.e-lfh.org.uk/Component/Details/589351

Pregnancy loss at work

https://www.sands.org.uk/sites/default/files/Pregnancy%20and%20Baby%20Loss%20at%20Work.pdf?_gl=1*15d9g6i*_gcl_au*NzkyODc2MjY3LjE3Mjg0NTg1MTQ.*_ga*MTA1MjU5MTI2Mi4xNzI4NDU4NTA1*_ga_RXE8QR4HHG*MTcyODQ1ODUwNC4xLjEuMTcyODQ1OTYxMy40OS4wLjA.