Health - PREGNANCY and BABY GUIDE - Miscarriage

Introduction 

A miscarriage is the loss of a pregnancy during the first 23 weeks.

The main sign of a miscarriage is vaginal bleeding, which may be followed by cramping and pain in your lower abdomen.

If you have vaginal bleeding, contact your GP or midwife. Most GPs can refer you to an early pregnancy unit at your local hospital straight away if necessary. You may be referred to a maternity ward if your pregnancy is at a later stage.

However, bear in mind that light vaginal bleeding is relatively common during the first trimester of pregnancy (the first 12 weeks) and doesn't necessarily mean you're having a miscarriage.

Read more about the symptoms of miscarriage.

What causes a miscarriage?

There are probably many reasons why a miscarriage may happen, although the cause isn't usually identified. The majority aren't caused by anything the mother has done.

It's thought most miscarriages are caused by abnormal chromosomes in the baby. Chromosomes are genetic "building blocks" that guide the development of a baby. If a baby has too many or not enough chromosomes, it won't develop properly.

If a miscarriage happens during the second trimester of pregnancy (between weeks 14 and 26), it's sometimes the result of an underlying health condition in the mother.

For most women, a miscarriage is a one-off event and they go on to have a successful pregnancy in the future.

Read more about what causes a miscarriage.

Can miscarriages be prevented?

The majority of miscarriages can't be prevented. If a woman has suffered from more than three miscarriages, some women can be helped to keep their pregnancy with medication under the care of a specialist.

However, there are some things you can do to reduce the risk of a miscarriage. Avoid smoking, drinking alcohol and using drugs while pregnant. Being a healthy weight before getting pregnant, eating a healthy diet and reducing your risk of infection can also help.

Read more about preventing miscarriages.

What happens if you think you're having a miscarriage?

If you have the symptoms of a miscarriage, you'll usually be referred to a hospital for tests. In most cases, an ultrasound scan can determine whether the pregnancy is ongoing or you're having a miscarriage.

When a miscarriage is confirmed, you'll need to talk to your doctor or nurse about the options for the management of the end of the pregnancy.

In the majority of cases, the pregnancy tissue will pass out naturally in a week or two. Sometimes medication to assist the passage of the tissue may be recommended, or you can choose to have minor surgery to remove it if you don't want to wait.

Read more about diagnosing a miscarriage and what happens if you have a miscarriage.

After a miscarriage

A miscarriage can be an emotionally and physically draining experience. You may have feelings of guilt, shock and anger.

Advice and support is available at this time from hospital counselling services and charity groups. You may also find it beneficial to have a memorial for your lost baby.

You can try for another baby as soon as your symptoms have settled and you've had one period, although you should ensure you're emotionally and physically ready first.

Having a miscarriage doesn't necessarily mean you'll have another if you get pregnant again. Most women are able to have a healthy pregnancy after a miscarriage, even in cases of recurrent miscarriages.

What happens after a miscarriage 

A miscarriage can have a profound emotional impact, not only on the woman herself, but also on her partner, friends and family.

Advice and support is available during this difficult time.

Remembrance 

It's usually possible to arrange a memorial and burial service if you want one. In some hospitals or clinics, it may be possible to arrange a burial within the grounds.

You can also arrange to have a burial at home, although you'll need to consult your local authority before doing so.

Cremation is an alternative to burial and can be performed at either the hospital or a local crematorium. However, not all crematoriums provide this service and there won't be any ashes for you to scatter afterwards.

Unlike a stillbirth, you don't need to formally register a miscarriage. However, some hospitals can provide a certificate to mark what has happened if you want one.

Emotional impact

Sometimes the emotional impact is felt immediately after the miscarriage, whereas in other cases it can take several weeks. Many people affected by a miscarriage go through a bereavement period.

It's common to feel tired, lose your appetite and have difficulty sleeping after a miscarriage. You may also feel a sense of guilt, shock, sadness and anger – sometimes at a partner, or at friends or family members who have had successful pregnancies.

Different people grieve in different ways. Some people find it comforting to talk about their feelings, while others find the subject too painful to discuss.

Some women come to terms with their grief after a few weeks of having a miscarriage and start planning for their next pregnancy. For other women, the thought of planning another pregnancy is too traumatic, at least in the short term.

The father of the baby may also be affected by the loss. Men sometimes find it harder to express their feelings, particularly if they feel their main role is to support the mother and not the other way round. It may help to make sure you openly discuss how both of you are feeling.

Miscarriage can also cause feelings of anxiety or depression, and can lead to relationship problems.

Getting support

If you're worried that you or your partner are having problems coping with grief, you may need further treatment and counselling. There are support groups that can provide or arrange counselling for people who have been affected by miscarriage.

Read more about dealing with loss and counselling, and find bereavement support services in your area.

Your GP can provide you with support and advice. The following organisations can also help:

• The Miscarriage Association is a charity that offers support to people who have lost a baby. They have a helpline (01924 200 799, Monday to Friday, 9am to 4pm) and an email address (info@miscarriageassociation.org.uk), and can put you in touch with a support volunteer.
• Cruse Bereavement Care helps people understand their grief and cope with their loss. They have a helpline (0844 477 9400, Monday to Friday, 9am to 5pm) and a network of local branches where you can find support.

Having sex and trying for another baby

You should avoid having sex until all of your miscarriage symptoms have gone. Your periods should return within four to six weeks of your miscarriage, although it may take several months to settle into a regular cycle.

If you don't want to get pregnant, you should use contraception immediately. If you do want to get pregnant again, you may want to discuss it with your GP or hospital care team. Make sure you are feeling physically and emotionally well before trying for another pregnancy.

The Miscarriage Association has written a leaflet called Thinking about another pregnancy (PDF, 207kb) that you may find helpful. It's important to remember that most miscarriages are a one-off and are followed by a healthy pregnancy.

Although it's not usually possible to prevent a miscarriage, there are some ways you can reduce the risk. See preventing miscarriage for more information and advice.

Finding a cause

It's natural to want to know why a miscarriage happened, but unfortunately this is not usually possible. Most miscarriages are thought to be caused by a one-off problem with the development of the foetus.

Read more about the causes of miscarriage.

How common are miscarriages?

Miscarriages are much more common than most people realise. Among women who know they're pregnant, it's estimated one in six of these pregnancies will end in miscarriage. Many more miscarriages occur before a woman is even aware she has become pregnant.

Losing three or more pregnancies in a row (recurrent miscarriages) is uncommon and only affects around 1 in 100 women.