What really happens during a miscarriage

WARNING — This article contains some graphic descriptions of what you might see during a miscarriage.

What does a miscarriage feel like?

A miscarriage usually starts with vaginal bleeding. This could range from light spotting or heavy bleeding. In most miscarriages, you will also experience lower abdominal pain, which may feel like period pain or severe cramps. As a miscarriage progresses, you may also pass fluid and blood clots from your vagina.

Spotting or bleeding during pregnancy doesn't necessarily mean you are having a miscarriage, but if you notice bleeding, it's important to speak to your doctor or midwife.

In some types of miscarriage, you might not have any symptoms, and the miscarriage will only be discovered at your next ultrasound. Some people may notice only mild symptoms such as changes in their pregnancy symptoms, such as less morning sickness and breast tenderness.

It is normal to feel very upset if you think you are having a miscarriage. Everyone reacts differently. It can take a while to process what is happening. Your partner can support you, even as they experience their own feelings.

What should I do if I think I’m having a miscarriage?

A miscarriage requires prompt medical care. If you think you are having a miscarriage, call your doctor or midwife for advice and support. Go to your nearest hospital emergency department if:

• you have heavy vaginal bleeding (soaking more than 2 maxi pads per hour or passing clots larger than golf balls)
• you have severe pain in your abdomen (tummy) or shoulder
• you have a fever (a temperature above 38°C)
• you are dizzy or fainting
• you notice fluid coming from your vagina that smells bad
• you have diarrhoea or pain when you have a bowel motion (poo)

What happens during a miscarriage?

Unfortunately, nothing can be done to stop a miscarriage once it has started. Any treatment given is to reduce the chance of heavy bleeding or infection.

How long the miscarriage process takes depends on how you and your doctor or midwife decide to manage the miscarriage. Options include:

• a 'wait and see' approach (expectant management)
• taking medicines to help your body pass the pregnancy tissue (medical management)
• a surgical procedure to empty your uterus (surgical management).

Expectant management

Expectant management is when you wait to see what will happen naturally. Often, the pregnancy tissue (the baby, pregnancy sac and placenta) will pass naturally. When it starts, you will notice spotting and cramping and then start bleeding more heavily. The cramps will usually become stronger as you pass the pregnancy tissue.

The process may take up to 2 weeks. Some amount of bleeding can continue for up to 2 weeks after you pass the pregnancy tissue.

It can be emotionally difficult to wait for the miscarriage, because you don't know when it will happen.

Medical management

Some people choose to have medical management because they don't want to wait for up to 2 weeks for all the pregnancy tissue to pass naturally. Your doctor can prescribe medicine, so the process is over more quickly. The medicine will cause you to have pain and bleeding like what you would experience with a miscarriage. The pregnancy tissue is likely to pass within 4 to 6 hours, however sometimes you will need more doses of medicine.

Surgical management

If some tissue remains in your uterus, or you don't want to experience the pain or bleeding of miscarriage, you may choose to have a surgical procedure called a 'dilatation and curettage' (D&C). You may need to wait some time for your surgery. The operation only takes 5 to 10 minutes under general anaesthetic, and you will usually be able to go home the same day.

While you are waiting for a miscarriage to finish, it's best to rest at home and do what feels right for you. You can use paracetamol for your pain. If you are bleeding, use sanitary pads rather than tampons to reduce the chance of infection.

What does a miscarriage look like?

In the first month of pregnancy, the developing embryo is the size of a grain of rice so it is very hard to see. You may pass a blood clot or several clots from your vagina, and there may be some white or grey tissue in the clots. The bleeding will settle down in a few days, although it can take up to 2 weeks.

At 6 weeks

Most women can’t see anything recognisable when they have a miscarriage at this time. During the bleeding, you may see clots with a small sac filled with fluid. The embryo, which is about the size of the fingernail on your little finger, and a placenta might be seen inside the sac. You might also notice something that looks like an umbilical cord.

At 8 weeks

The tissue you pass may look dark red and shiny — some women describe it as looking like liver. You might find a sac with an embryo inside, about the size of a small bean. If you look closely, you might be able to see where the eyes, arms and legs were forming.

At 10 weeks

The clots that are passed are dark red and look like jelly. They might have what looks like a membrane inside, which is part of the placenta. The sac will be inside one of the clots. At this time, the developing baby is usually fully formed but still tiny and difficult to see.

At 12 to 16 weeks

If you miscarry now, you might notice water coming out of your vagina first, followed by some bleeding and clots. The fetus will be tiny and fully formed. If you see the baby it might be outside the sac by now. It might also be attached to the umbilical cord and the placenta.

From 16 to 20 weeks

This is often called a 'late miscarriage'. You might pass large shiny red clots that look like liver as well as other pieces of tissue that look and feel like membrane. It might be painful and feel just like labour, and you might need pain relief in hospital. Your baby will be fully formed and can fit on the palm of your hand.

What happens after a miscarriage?

After a miscarriage, you will have some cramping pain and bleeding after the miscarriage, similar to a period. It will get lighter over time and will usually stop within 2 weeks.

Signs of pregnancy, such as nausea and tender breasts, usually fade in the days after the miscarriage. If you had a late miscarriage, your breasts might produce some milk. You will usually have your next period in 4 to 6 weeks.

Remember, it is normal to feel very many different emotions at this time and support is available.

Resources and support

Talk to your doctor or midwife for information and advice on what do and how to look after yourself if you experience a miscarriage. There are often social workers available through your hospital.

Miscarriage Australia has resources about what to expect from a physical and emotional perspective after miscarriage.

Red Nose Grief and Loss provides support for people affected by pregnancy loss, stillbirth, baby or child death. You can call them on 1300 308 307 – 24 hours a day, 7 days a week.

NSW Health has a booklet about miscarriage in many community languages.

The Pink Elephants provide information and peer-support for anyone impacted by early pregnancy loss.