Am I having a miscarriage?

We know that experiencing a miscarriage can be devastating. Here is what you need to know if you’re concerned you may be having one. Our other article explains what a miscarriage is.

What are the signs?

Some women or birthing people have no obvious signs of a miscarriage, and it is only discovered during a routine antenatal scan.

The most common sign is vaginal bleeding or discharge. Bleeding can be light, heavy, and include clots. Spotting or light bleeding doesn’t necessarily mean you will miscarry, but you may want to check with your midwife.

Pain can also vary. Continuous low abdominal pain and/or backache that isn’t resolved by normal pain relief is a good reason to contact your midwife (NHS, 2022; Miscarriage Association, No date a).

A sudden, sharp and intense pain, vaginal bleeding or spotting, pain in the shoulder, diarrhoea and vomiting, feeling dizzy, lightheaded or fainting, are possible signs of an ectopic pregnancy. This is when a fertilised egg implants outside the womb, such as in the fallopian tube.

If you are experiencing these symptoms go to your nearest emergency department immediately. If you can’t get there yourself, call 999 (NHS, 2022).

Other signs can include no longer being aware of previously strong pregnancy symptoms (Miscarriage Association, no date a).

How will I know for certain?

If you’re less than six weeks pregnant your midwife may suggest you watch and wait. Otherwise, you’ll usually be referred to an early pregnancy unit, or maternity unit, depending on how far along the pregnancy is. Diagnosis and management of miscarriage could take a few weeks (RCOG, 2016).

An ultrasound scan will look for a heartbeat and check development. The most accurate scan is done via the vagina. You may also be offered blood tests. If these tests are inconclusive, you may have them repeated after a couple of weeks (NHS, 2022).

What happens next?

There is a National Bereavement Care Pathway used in England and Scotland, and this is expected to roll out to Wales and Northern Ireland.

If the scan shows no remains of pregnancy or surrounding tissue left in the womb, then it is likely the miscarriage is complete and there is no need for further treatment. However, the early pregnancy unit may wish to carry out blood tests to check your pregnancy hormones are dropping, to rule out an ectopic pregnancy.

If there are remains, your options are:

Expectant management is waiting for the remaining tissue to pass naturally while at home. If the pain and bleeding doesn’t start within that time or either are getting worse, you can discuss your options again.

Medical management – medication to cause the remains to pass out of your womb.

Surgical management under general or local anaesthetic – which may be advised if you have continuous heavy bleeding, infected pregnancy tissue, or if waiting and medication hasn’t enabled the remains to pass.

(NHS, 2022)

Afterwards

Miscarriage is an emotionally difficult event for the whole family. Information and support is available from a range of organisations, who can help with remembrance and dealing with grief. These include The Miscarriage Association and The Ectopic Pregnancy Trust, which offers specialist support after an ectopic pregnancy.

Since February 2024 an optional Baby Loss Certificate is available in England for babies lost before 24 completed weeks of pregnancy.

Finding the cause

There is normally no investigation of a single miscarriage, as they are common. However, if a woman or birthing person has experienced three miscarriages, then they will be referred to a Recurrent Miscarriage Clinic and offered tests to look for a possible cause. This can include blood tests, genetic tests, and a scan of the uterus (RCOG, 2023).

Depending on the results of the tests some treatment may be offered, but it is common for miscarriage to remain unexplained (RCOG, 2023).

Having sex again

Whether you wish to get pregnant again, or simply want to regain some intimacy, waiting until the bleeding has stopped reduces the risk of infection (Miscarriage Association, No date b).

If there is any chance you could get pregnant again and you don’t wish to, you need to consider contraception as soon as you start having sex (NHS, 2022).

If you do wish to get pregnant no waiting period is necessary (RCOG, 2016). Having a negative pregnancy test will confirm the miscarriage is complete, and having a period again will help you calculate your dates for the next pregnancy (Miscarriage Association, No date c).