Early Pregnancy Loss

October is Pregnancy and Infant Loss Awareness Month. It is estimated that 10-20% of all pregnancies end in miscarriage, which is defined as a pregnancy loss before the 20th week. Most miscarriages occur in the first trimester. As midwives, it is a vital part of our work to support our clients through miscarriage.

First, it is important to know that miscarriage is not typically something that can be avoided by behavior or lifestyle changes. In most cases, there is an unknown cause for a miscarriage – it could be a chromosome abnormality or something else beyond your control, such as an implantation or hormonal problem, or unexplained intrauterine fetal demise. While you will likely encounter quite a bit of advice in early pregnancy about how to prevent miscarriage (such as not jogging or avoiding sex), for most people, normal activities are safe in pregnancy, and not at all related to miscarriage. That being said, there are some health conditions that may contribute to a higher incidence of miscarriage, so if you have recurrent pregnancy losses, your healthcare provider may be able to work with you to help manage these conditions to reduce the risks of future losses.

Warning Signs of Miscarriage

Contact your pregnancy care provider if you experience the following:

  • Bleeding from the vagina
  • Cramping in the lower abdomen (like menstrual cramps)
  • Intense or dull lower back pain
  • Fluid or tissue passing from the vagina
  • Loss of pregnancy symptoms in the first trimester

If you were to contact us with these symptoms, we may advise you to watch and wait (sometimes, you may have some of these symptoms that end up resolving without miscarriage), or we may send you for an evaluation in the hospital or for an ultrasound to figure out what is going on. If it is clear that there is a miscarriage in progress, we will talk through the process with you, and stay available to communicate as you weather this loss.

Complications to watch out for

A miscarriage may happen quickly, or may take a few days to complete. In a typical scenario, there will be a few hours of intense cramping that may even feel like contractions, and there will be a short period of heavy bleeding, during which some large clots and tissue will be passed. In most cases, the body will complete a miscarriage on its own without complications, but if you experience the following, contact your healthcare provider or go to the hospital:

  • Very heavy bleeding that soaks two regular pads in an hour
  • Feeling lightheaded with bleeding, or fainting
  • Symptoms of uterine infection, such as fever, chills, abdomen that is tender to touch, or foul smelling discharge

Stay in communication with your provider, especially if your symptoms do not appear to be progressing normally. Sometimes, the body has trouble completing the miscarriage without intervention – in these cases, medications or a D & C (dilation and curettage) may be needed.

What comes after

In most cases, after the initial period of heavy cramping and bleeding, the bleeding will taper off to similar to a period, and may continue for a week or more. If you have passed tissue, and the symptoms progress on a normal trajectory, you can be reasonably sure that the body completed the miscarriage. However, if there is any doubt, you can be referred for an ultrasound for definitive answers.

So, that’s a short overview of what to expect from a clinical standpoint. We do want to address how you may feel emotionally after a miscarriage. There is a wide range of normal – some people take it in relative stride, and try again. Many people experience moderate to severe grief. Also, remember you will be experiencing similar hormone changes to those that are experienced in the typical postpartum period, which can bring emotional ups and downs. We want to encourage you to acknowledge and normalize your own response to your loss. We are here to cry with you, and we hope you feel free to communicate your grief to those in your family and social circles. Some people would also benefit from speaking to a therapist who is familiar with grief and postpartum mental health – we have some great people to refer you to for this service.