If you were rejoicing over a positive pregnancy test just weeks ago, coping with a sudden and unexpected miscarriage can be difficult. You may feel a range of emotions: sad and disheartened over the loss, angry and resentful it happened to you and possibly withdrawn from friends and family.
You may have trouble eating and sleeping. You may cry a lot, or you may not cry at all. These are all among the many natural, healthy responses to a pregnancy loss. Remember: Your reaction is what’s normal for you.
Feeling in the dark about what happened and what your next steps should be can make the situation even tougher. Learn more about what to expect both physically and emotionally during this time.
What is a miscarriage?
A miscarriage is when an embryo or fetus is expelled from the uterus before 20 weeks gestation. Often, the first sign this is happening is heavy bleeding accompanied by abdominal or back pain and cramping.
Depending on how far along your pregnancy was, these symptoms can last for just a few days — like a normal period — or up to three or four weeks. If you experience any of these symptoms, see your doctor right away.
What happens after a miscarriage
Your practitioner will confirm the miscarriage using an ultrasound and possibly perform a pelvic exam to check your cervix. He or she may also draw blood to check your hCG levels, your blood count (to determine blood loss) and your Rh factor (to check for Rh incompatibility). If your Rh factor is Rh-negative, you may also receive a shot of Rh immunoglobulin to prevent serious problems in later pregnancies.
Emptying the uterus
Once the miscarriage has been diagnosed, your uterus will need to be empty so your normal menstrual cycle can resume and you can try to get pregnant again, if you choose to. If your first sign of a miscarriage was heavy bleeding — especially if it was just a few weeks into pregnancy — then it’s possible that the miscarriage was “complete,” meaning all the fetal tissue has already been cleared out of your uterus.
More About Recovering From a Pregnancy Loss
But sometimes — especially the later in the first trimester you are — a miscarriage isn’t complete, and parts of the pregnancy remain in the uterus (known as an incomplete miscarriage) that need to be removed.
There are a number of ways this can happen:
- Expectant management. You may choose to let nature take its course and wait until the pregnancy is naturally expelled. Waiting out a missed or incomplete miscarriage can take anywhere from a few days to, in some cases, three or four weeks before your body takes care of things and you resume normal menstrual cycles.
- Medication. If there’s no sign of your body expelling the embryo on its own, your practitioner might instead give you the option to take miscarriage medications — usually misoprostol, or misoprostol combined with mifepristone — to help speed things along. Within a few hours of taking a pill or receiving a vaginal suppository, you should start to bleed and expel fetal and placental tissue. Just how long this takes varies from woman to woman, but most will pass the tissue within 24 to 48 hours. These medications cause some of the same side effects that you might have experienced when you were just letting nature take its course: cramping, bleeding, nausea and diarrhea.
- Surgery. Another option is to undergo a minor surgery called dilation and curettage (D&C). During this procedure, a doctor will gently remove the fetal and placental tissue from your uterus. Bleeding following the procedure usually lasts no more than a week. Though side effects are rare, there is a slight risk of infection following a D&C.
How should you decide which route to take? Some factors you and your practitioner will take into account include:
- How far along the miscarriage is. If bleeding and cramping are already heavy, the miscarriage is probably already well under way. In that case, allowing it to progress naturally may be preferable to a D&C. But if there is no bleeding (as in a missed miscarriage), misoprostol or a D&C might be better alternatives.
- Your emotional and physical state. Waiting for a natural miscarriage to occur after a fetus has died in utero can be psychologically debilitating for a woman and her spouse or partner, if she has one. It’s likely that you won’t be able to begin coming to terms with — and grieving for — your loss while you're still pregnant. Completing the process faster will also allow you to resume your menstrual cycles sooner, and when and if the time is right, try to conceive again.
- Risks and benefits. Because a D&C is invasive, it carries a slightly higher (though still very low) risk of infection. The benefit of having a miscarriage complete sooner, however, may greatly outweigh that small risk for most women. With a naturally occurring miscarriage, there is also the risk that it won’t completely empty the uterus, in which case a D&C may be necessary to finish what nature has started.
- Evaluation of the miscarriage. When a D&C is performed, evaluating the cause of miscarriage through an examination of the fetal tissue will be easier.
What not to do after miscarriage
Whether or not you had a surgical procedure to treat your miscarriage, your doctor will let you know when it’s okay resume normal activities like exercise and sex. While you may be able to get back to your usual routines right away, your practitioner will recommend that you don’t put anything in your vagina — which means abstaining from sex and not using tampons — for two weeks to avoid infection.
Make sure to see your health care provider for a follow-up appointment a few weeks after your miscarriage.
What to watch for after miscarriage
Even if your miscarriage progresses naturally and is relatively pain-free, your practitioner will likely want to check in with you for a few weeks or months to make sure you don’t develop any complications (don’t worry, these are all very rare).
If you keep bleeding for more than seven days, this excessive bleeding can signal that there’s still placental tissue in the uterus or that you’ve developed an infection. Other signs of an infection can include foul-smelling discharge, fevers, chills and abdominal pain. If your practitioner suspects an infection, he or she will likely treat it with a course of antibiotics.
In extremely rare cases, retained products of conception (the technical term for any embryo or fetal or placental tissue left in your uterus) can start abnormally growing and form a type of tumor called a choriocarcinoma.
After a D&C, you’ll also have a slight risk of complications from the surgery. In around 16 percent of first D&Cs women develop scarring, called Asherman syndrome, inside their uterus or around their cervix. It can take a second surgery to get rid of those scars, but luckily, you’ll recover and be able to get pregnant again.
Your emotions after miscarriage: The stages of grief
Whenever a pregnancy loss happens, you’re likely to experience many feelings and reactions. Though you can’t wish them away, understanding them will eventually help you come to terms with your loss.
Many people who suffer a loss of any type go through a number of steps on their road to emotional healing. These steps are common, though the order in which the first three occur may vary and so, too, may the feelings you experience.
- Shock and denial. There may be numbness and disbelief, the feeling that “this couldn’t have happened to me.” This is a mental mechanism designed to protect your psyche from the trauma of loss.
- Anger and guilt. Desperate to pin the blame for such a senseless tragedy on something, you may blame it on yourself (“I must have done something wrong to cause the miscarriage” or “If I’d been happier about the pregnancy, the baby would still be alive.”). Or you may blame others — God, for letting this happen, or your practitioner, even if there is no reason to. You may feel resentful and envious of those around you who are pregnant or who are parents, and even have fleeting feelings of hatred for them.
- Depression and despair. You may feel sad most or all of the time, cry constantly or be unable to eat or sleep. You may also have no interest in anything or be unable to otherwise function, and may wonder if you’ll ever be able to have a healthy baby.
- Acceptance. Finally, you’ll come to terms with the loss. Keep in mind that this doesn’t mean you’ll forget the loss — just that you’ll be able to accept it and get back to the business of life.
Miscarriage support
The grief you're feeling is real — and no matter how early in pregnancy you experienced the loss of a baby, you may feel that loss deeply. Some well-intentioned friends and family may try to minimize the significance with a “Don’t worry, you can try again,” not realizing that the loss of a baby, no matter when it occurs during a pregnancy, can be devastating.
Still, if you’ve suffered a miscarriage or an ectopic or molar pregnancy, it’s important to remember that you have the right to grieve as much — or as little — as you need to. Do this in any way that helps you to heal and eventually move on.
Turn to your partner for support, if you have one. Remember that he or she is mourning the loss of a baby too but may show that grief in a different way. Sharing your feelings openly with each other, rather than trying to protect each other, can help you both heal.
If you're religious, ask your pastor, priest, rabbi or spiritual leader for guidance. Perhaps you’ll find closure in a private ceremony with close family members or just you and your partner. Sharing your feelings — through a support group, with a friend or online — with others who experienced a miscarriage can also be a comfort. Ask your practitioner to recommend a therapist or bereavement group to help you through this difficult period.
Since so many women suffer a miscarriage at least once during their reproductive years — at least 10 to 20 percent of pregnancies end in miscarriage — you may be surprised to find how many others you know have had the same experience but never talked about it with you, or maybe never talked about it at all. If you don’t feel like sharing your feelings — or don’t feel you need to — don’t. Do only what’s right for you.
When will you feel normal again?
No matter what you’re feeling — and given your situation, your feelings may be all over the emotional map — give yourself time. Accept that you may always have a place in your heart for the pregnancy you lost, and you may feel sad or down on the anniversary of the due date of your lost baby or on the anniversary of the miscarriage, even years later.
If you find it helps, plan on doing something special at that time — at least for the first year or so — that will be cheering yet allows you to remember: planting some new flowers or a tree, having a quiet picnic in the park or sharing a commemorative dinner with your partner.
While it’s normal to mourn your loss — and important to come to terms with it your way — you should also start to feel gradually better as time passes. If you don’t, or if you have continued trouble coping with everyday life (you’re not eating or sleeping, you’re not able to focus at work, you’re becoming isolated from family and friends) or if you continue to feel very anxious (anxiety following miscarriage has been shown in studies to be even more common than depression is), professional counseling can help you to recover.
Getting pregnant again after a miscarriage
Health care providers used to recommend waiting a number of months before trying to get pregnant again after a miscarriage. They’ve learned, though, that the uterus is remarkably good at recovering from a miscarriage. Most doctors now say it’s okay to try again as soon as you’ve had one normal menstrual cycle.
But check with your practitioner about your specific situation. If there’s scarring in your uterus or pieces of placenta left behind, he or she might recommend a longer wait. Even among women who have had two or three consecutive unexplained pregnancy losses, about 65 to 75 percent have a successful next pregnancy that ends in a live birth.
Try to remind yourself that you can — and most likely will — become pregnant again and give birth to a healthy baby. For the vast majority of women, a miscarriage is a one-time event — and actually, an indication of future fertility.
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