Miscarriage accounts for the end of a significant minority of pregnancies. It is important to know that – barring certain conditions that, in the case of recurrent loss, a doctor can help you diagnose – you probably won't have one. Even if you have had one or multiple already. As a young person with unexplained recurrent loss, the worst percentage ever given to me by the miscarriage reassurer was 35.4% – still less likely than success.
When I miscarried my first pregnancy, there was a certain amount of surprise within the family. Neither of Fish's grandmothers had ever miscarried, and Fishfather's mother in particular was especially surprised.
However, as soon as this silenced topic had been broached, it appeared everywhere... all of Fishfather's mother's friends had experience with it. I mentioned the topic at synagogue and all three other adults in the room had experienced miscarriage in their own families. One month after my loss, Fishfather's sister experienced a miscarriage at the same stage of gestation. Like other misfortunes, miscarriage is everywhere. Unlike others, it's hushed up, marginalized, private; you're grieving, you feel like a failure. Before any of my pregnancies or miscarriages, I dislocated my left kneecap three separate times; after the last time, I had surgery to repair the issue. It was physically and emotionally difficult to manage the injuries and face down my first surgery at 22. But at least there weren't people around me explaining how my insufficiently positive visualizations had brought the dislocations on myself.
The earliest type of miscarriage. If you are tracking and testing, you may catch an early positive pregnancy test followed by your period on time, or only slightly delayed. This is "chemical": the pregnancy hormones in your body are legible to testing (especially with the modern extremely-sensitive tests), but there is no growth visible to an ultrasound ("clinical" losses). The good news about these is that you get them over with quickly, and your pain and bleeding will resemble a normal to heavy period. The bad news is the obvious. The "minor" nature of these can also make them feel less "legitimate" than other types of miscarriage. Your pregnancies are all pregnancies, no matter how far they develop, and you should not be afraid to take the time and space you need to heal physically and emotionally from the loss you are experiencing.
The further you get into pregnancy, the heavier the symptoms of miscarriage will generally get. At the six-seven week point you will not labor or pass the unusually large clots that accompany later miscarriages: this loss will still probably resemble a period, albeit the period of a lifetime. Closer to eight or nine weeks, the bleeding and tissue will be heavier. The hormone crash may also be more severe: after two days of workable light bleeding including some glop, my 6w5 loss felt like my worst PMS ever times about fifteen, and I missed two days of work. The good news is you can take Advil. There is no other good news.
By this point, depending on where you live, you may have had your first ultrasound and discovered at the doctor's, rather than at home, that you are going to miscarry. This is called a "missed miscarriage", on the grounds that your body "missed" it, and may need to be helped along. (Miscarriages are usually for chromosomal reasons – essentially genetic copy errors – and it is in your body's best interests to clear these out as soon as possible to save you time and energy, but your body occasionally takes longer to catch on.) My first miscarriage fell into this category, as a scan at 9w5 revealed that fetal growth had stopped at 8w4. If a missed miscarriage is discovered at the doctor, you will be offered options – a D&C to remove the tissue through minor surgery; pills to induce the miscarriage rather than waiting for the body to clue in on its own; or you can wait for your body to miscarry on its own, aka "expectant management" (which can take a long time, and include additional tissue growth in the meantime).
In a D&C, or "dilation and curettage", you will receive anesthesia, and your obstetrician will go into your uterus through your cervix and get the miscarriage tissue out. I had mine under general anesthesia; I was happy to sleep through it and happy that when I awoke the miscarriage was over. This is a higher intervention option, but will resolve the problem quickly and save you from the labor.
If you manage with medication, you will be given pills which stop the growth of the pregnancy (mifepristone) and induce uterine contractions (misoprostol), or misoprostol alone. You may take these by mouth, vaginally, or in some combination. These will cause the miscarriage to occur promptly and quickly, rather than waiting for the body to sort itself out. These have a fairly high success rate, but not 100%, so you will want to follow up with the doctor. Heavy and prolonged bleeding or cramping after the first few days can be a sign that some of the pregnancy tissue did not successfully pass; if you experience these, you definitely want to contact your doctor and ensure the miscarriage is complete.
Your third option is waiting for the body to miscarry on its own. This can take several weeks; when I opted to wait after the doctor discovered the missed miscarriage, I was told to call back if four weeks went by and the miscarriage still had not begun. This is the lowest-intervention option and therefore the most "natural", but you may feel this to be a situation in which man has improved upon nature. I chose this option with my first because I was somewhat ignorant of the miscarriage experience and nervous about the hospital; but after experiencing the long wait, labor and clots of the 11-week loss and ending up in the ER anyway, I would certainly choose the D&C if I experienced this a second time. As in the case of using pills, heavy and prolonged bleeding and cramping can indicate pregnancy tissue left over; you should follow up with a doctor no matter what, but especially in the possibility of incomplete miscarriage.
Each of these options has its pros and cons, and I am grateful to certain aspects of my first miscarriage for the preparation those experiences gave me for later pregnancies. I got a "dry run" of my hospital's ER and L&D department, which showed me a respect and compassion that allowed me to confidently seek OB care there later on. I also experienced a miniature labor, as my cramping transitioned to a shockingly strong but instructive pain, like a lattice of hot wires pushing down and precisely outlining for me every uterine muscle. I couldn't talk through those small contractions, but I could bear them, knowing that after three or four seconds each allowed me to push out a (disgustingly large) clot which would relieve the pain.
These labors can go on for hours; you can find accounts online of people who have miscarried at home at this 9 to 12 week point in their pregnancies, and it is truly an ordeal. I got an emergency D&C partway through and was more than happy to bail on the pain.
Your hormones will crash pretty bad after this one. What I remember best, three years out, is being extremely sweaty at night.
Something you should know about miscarriage at this stage is that, by this point in pregnancy, your placenta has hooked up to your own blood supply. What this means is that, in rare cases, you can hemorrhage from a miscarriage even in the first trimester. Because this was not made totally clear to me by my first doctor (we switched practices after this) I lost consciousness from blood loss before it occurred to Fishfather and I that bleeding so much into the toilet it sounded like peeing was not the "heavy bleeding" typical of miscarriage, but rather a life threatening complication. What can I say – I'm a tough guy who doesn't like to tap out, and I'm very bad at estimating volume. Learn from my mistakes. If you bleed through more than one maxi pad an hour, you need to go to the ER! The "heavy bleeding" of miscarriage refers to period-like bleeding interspersed with lots of clots and tissue – not large amounts of red, liquid blood.
These losses are painful with long labors and often recognizable embryonic/fetal sacs.
Well, it happened. You had your first miscarriage, and everyone was very kind, and reassured you how very unlikely it was to happen again. And yet here we are.
After two clinical (6 weeks and later) losses, you may be offered a referral to a fertility specialist. If you are not offered this, you may want to ask after it anyway. The doctor I left only does those referrals after 4 clinical losses; the doctor I ended up with refers after 2, which was much better for me. Several things can cause recurrent first-trimester miscarriages, including:
A specialist will test you extensively, for anything you're willing to have tested, and let you know if any of these problems show up. Anatomical issues pertaining to the ovaries, fallopian tubes or uterus can be detected via transvaginal ultrasound with saline (SHG), an experience which, after pregaming with Advil, was not painful for me, but extremely uncomfortable physically and mentally, like the vaginal equivalent of dental work where both the doctor and nurse are up in your teeth. Other issues can be detected via bloodwork. The good news is that many causes of recurrent pregnancy loss are treatable via various avenues and none of them should conclusively rule out future successful pregnancies.
If you have enough miscarriages (or even just one), you may find yourself a superstitious object as people rationalize how miscarriage is really caused by emotional unreadiness, fate, too much stress, negative visualization, working, coffee, doomscrolling... This kind of thing, while inaccurate and deeply offensive, is usually a person trying to reassure you that things will be better for you this time (?!), or convince themselves that your fate will not afflict their own pregnancies. I find that the best approach is assertive but merciful.
Meanwhile, needless to say, these things do not cause miscarriage. Coffee drinkers, employees, negative Nellies, people who become aware of pregnancy later on, and people who do not want their pregnancies nonetheless carry to term all the time. Miscarriage is a subject of profound ignorance. Carry your convictions and research-based beliefs with you, talk to your OB, and tune out the peanut gallery.
This is a great tool which can tell you the statistics of miscarriage at any given point: https://datayze.com/miscarriage-reassurer