What happens when you miscarry: what to expect

How is my miscarriage confirmed?

The most accurate way to confirm a miscarriage is by ultrasound scan – often a transvaginal (internal) one.

If you’ve noticed signs of miscarriage (such as bleeding and/or abdominal pain) and your GP or midwife has referred you to an Early Pregnancy Unit, you will probably be given an internal ultrasound scan.

However, as Ruth Bender Atik from the Miscarriage Association, points out, it’s not always possible to confirm the miscarriage straightaway.

"If you’re at least 6 weeks pregnant," says Ruth, "your doctor is likely to send you for a scan to see what’s happening. But it’s not always possible to see the pregnancy sac or the heartbeat in those first weeks of pregnancy, even with a transvaginal scan.

"In some cases, you may be offered an internal examination or blood tests to check levels of the pregnancy hormone, beta-human chorionic gonadotrophin.

"But even then, you may still be asked to come back in another week or even 2, when things should be clearer."

If you are less than 6 weeks pregnant, you are likely to have to wait for your scan referral, as it’s very hard to confirm a miscarriage this early on.

If you found out, at a routine (or additional) NHS scan or at a private scan that you may have had a ‘missed miscarriage’ (where your baby dies or doesn’t develop but you haven’t had any physical signs of miscarriage), you may have to return for further scans before anyone can confirm anything for definite.

If you find yourself in any of these situations, we know the wait can feel interminable. Please also know that it’s normal to feel optimistic, pessimistic, scared, empty of emotion – or all four (and maybe other feelings completely) in quick succession.

Once the doctors feel able to make a diagnosis, you’ll probably find they use 1 of the following terms:

Threatened miscarriage: This means the bleeding and pain you’ve been experiencing may eventually lead to miscarriage but there is no sign of miscarriage yet. You will probably be told to go home and return if the bleeding gets heavier and/or the pain gets worse.

Missed (or silent) miscarriage: This is when your baby has died but is still in your womb (so you may not have had any spotting or bleeding or pains). You may still feel pregnant and have positive pregnancy tests. Often, you don't know anything has happened until you have a routine scan and the sonographer has to break the news that they can't find a heartbeat.

Early embryonic demise: This cold medical phrase is another way of saying a 'missed miscarriage' and means your baby has died or stopped developing and is still in your womb. You will go on to lose – or officially miscarry – your baby in due course.

Incomplete miscarriage: This means you are miscarrying and have lost most of your pregnancy but there is still some tissue left in your womb.

Complete miscarriage: This means you have miscarried and your womb is empty.

If it is a miscarriage, what happens next?

There are medical and surgical treatment options but generally, with incomplete miscarriage or missed miscarriage, doctors will first advise something called "expectant management" – which is all about allowing the miscarriage to take its natural course without the need for medical treatment, other than painkillers.

If you are bleeding very heavily, in more pain than you can manage, you may be advised to stay in the hospital for care and pain relief.

Otherwise, you may prefer to leave hospital and let your miscarriage "complete" at home.

In some cases, or if expectation management doesn’t work, you will be offered tablets or a pessary (inserted vaginally) containing a drug (often misoprostol or mifepristone) that should start or speed up the miscarriage process.

Once you’ve taken the tablets (or had them inserted), you can go home to wait for the miscarriage to complete. If you don’t experience heavy bleeding after 24 hours, you should contact your doctor/the EPU as you may need another dose.

How much will I bleed?

"The amount of bleeding during a miscarriage can vary greatly," says Ruth, "but, generally, light spotting that may be brown or light pink in colour develops into heavier red bleeding, which may contain blood clots and bits of tissue.

"While this is happening, you can feel strong period-like cramps. You may find that having a warm bath, using a hot water bottle and/or taking ibuprofen or paracetamol can help."

If you’ve been given medicine to start or speed up the process, you may also feel sick and have diarrhoea. Your doctor may prescribe you something to help with the sickness.

You’ll be advised to wear sanitary pads until the bleeding stops as using tampons may carry a higher risk of infection.

"But, if at any stage, you experience very heavy bleeding (filling more than one sanitary towel in an hour) or if you feel very unwell or feverish," says Ruth, "it would be best to seek urgent medical advice."

How long will it take to miscarry completely?

You will probably have bleeding for 2 to 3 weeks in total, says Ruth, although it may only be heavy bleeding for a few days.

How long it all takes, and when the heavier bleeding happens, does vary from person to person. But we think this post on our MadeForMums Chat forum from hershymom (who, as you can probably guess from her screen name, lives in the US) is a useful one to read:

“So in May I had a miscarriage," she posted. "I searched the internet for a detailed schedule on the cycle of a miscarriage and what to expect and couldn't really ever find what I wanted to see. So I kept track of the cycle of my miscarriage and hopefully it will help calm some nerves for someone out there! Obviously this is going to be different for everyone, but this is just my experience. I had a normal, healthy ultrasound the day before the baby's heartbeat stopped, so that's how I knew when the miscarriage began.

Day 1: baby’s heartbeat stops, brown discharge starts
Day 2: brown blood in the am. Turns bright red in the pm, light in flow
Day 3: light flow, bright red until 8am. Then turns heavy with clotting. Ultrasound at 10 am reveals no heartbeat. Bleeding stays heavy and clotting for the next 3 days.
Day 6: bleeding and clotting starts to decrease at certain times during the day.
Day 8 to 11: bleeding is light to moderate with no clots
Day 12: heavy cramping in the morning and lost the "pregnancy tissue" at 8 am."

What happens next?

After 3 weeks, assuming bleeding’s stopped, you’ll probably be advised to do a pregnancy test. If it’s negative, that means the miscarriage is complete.

If the test is positive or you are still having bleeding and cramps after 3 weeks, you may need another scan to see if you need further treatment.

Further treatment options include waiting another 7 to 12 days, taking medication to speed up the miscarriage process or having surgery.

Will I need surgery?

Surgery (now called surgical management of miscarriage or SMM; it used to be called ERPC) is usually only advised if you have continuous heavy bleeding, infected pregnancy tissue, or if waiting and medication hasn’t enabled the tissue to pass.

It’s done under either local or general anasethetic and doesn’t involve any cuts to your tummy. Instead, a small suction tube is inserted into your womb through your vagina.

Read more about the procedure

The pregnancy tissue that’s taken out will be sent off for testing but should then be disposed of respectfully, and in a way that you have discussed with hospital staff before the procedure.

Afterwards, you’ll have some light vaginal bleeding for 14 to 21 days. And, if your blood group is rhesus negative, you’ll have an anti-D injection (to stop your body developing antibodies that could be harmful to another baby if you get pregnant again).

Why did my miscarriage happen?

Unfortunately, you’re unlikely to find out the exact reason why you miscarried.

"You may have to suffer 3 early miscarriages in a row before you and your partner are referred for NHS tests," says Ruth.

But it may help to know that the vast majority of miscarriages happen because the embryo had abnormal chromosomes and didn’t develop normally. This is not preventable and it is not caused by anything you have done during your pregnancy.

Very rarely, miscarriage is caused by problems with your uterus or a condition which causes your immune system to reject your pregnancy.

There is no evidence that early miscarriages are caused by infections.

Where to get more help and info

The Miscarriage Association has a forum, a Facebook page, an online Live Chat and a helpline on 01924 200799 that's open Monday to Friday, 9am to 4pm). Read more about how the Miscarriage Association can help.
The Stillbirth and Neonatal Death Society (SANDS) has a helpline on 0808 164 3332 and you can also email helpline@sands.co.uk
Babyloss also offers support and information

About our expert: Ruth Bender Atik

Ruth Bender Atik has been National Director of the Miscarriage Association since 1993. She is a qualified social worker and has written guidance for NHS staff on Caring for Patients with Pregnancy Loss.

Images: Getty Images