Miscarriage: What It Is, Why It Happens and How to Deal
By medical definition, a miscarriage, also called “spontaneous abortion,” is a pregnancy that naturally ends (all by itself, without anyone doing anything to make it happen) before twenty weeks—before the fifth month —of pregnancy.
Believe it or not, miscarrying is just as normal and as common as not miscarrying is. Reproductive health experts believe that as many as half of all fertilizations or conceptions do not result in a viable pregnancy.
Considering that many people who become pregnant choose to terminate their pregnancies with medical or surgical abortion, it may even be more common for a pregnancy to end in miscarriage than in birth. Miscarriage is rarely about anyone doing anything wrong; if it has happened to you, you can rest assured that it is highly unlikely to have been your fault or doing.
Often, miscarriage occurs so early and so uneventfully that a person won’t even know they’ve had one or that they were even pregnant in the first place. Many of those incredibly early miscarriages aren’t even technically considered miscarriages but rather pregnancies that just didn’t complete through the implantation stage.
It’s estimated that of people who have become “fully” pregnant and know of their pregnancies—so, those who have been pregnant at least a couple weeks—around 15–20 percent will miscarry. Most miscarriages are not preventable once pregnancy has taken place, and they occur when the body is simply unable to sustain a healthy pregnancy—they don’t happen because anyone did anything wrong. Miscarriage is the body’s natural way to safeguard against an embryo or fetus that will be stillborn (that will not be alive), or has a significant congenital birth defect, or in the case of a pregnancy that will put the pregnant person’s health or life at risk. It’s understood that problems with chromosomes in genes that occur by chance are what cause most miscarriages and that’s nothing anyone can do anything about.
Early miscarriage is most common and accounts for about 75 percent of all miscarriages. Very early miscarriage is rarely even noticed, nor does it have any visible symptoms; although some spotting or mild cramping may occur, those are often easily mistaken for a period. You often can’t have a very early miscarriage verified, so it’s one of those situations where you simply may never know whether you had a miscarriage or not. A lot of people who miscarry very early never knew they were pregnant or that they miscarried.
When miscarriage occurs after the first few weeks and is usually noticeable, symptoms often include mild to severe pelvic and abdominal cramps that may persist for more than a day, vaginal bleeding or spotting, sometimes including a passage of tissue from within the vagina, or a clear fluid drainage.
Early miscarriage rarely requires prompt medical attention or hospitalization. For most people, it is physically no different than a crampy period. It’s smart to see your doctor or gynecologist after a suspected miscarriage, however, to check up on your health and be sure you did fully miscarry. Often after miscarriage, a healthcare provider will want to perform a D&C, dilation and curettage, a surgical procedure that clears the contents of the uterus, in this case to be sure nothing is left after miscarriage that could cause infection or other health complications. If very heavy bleeding occurs after miscarriage or spotting lasts more than two weeks, if large clots are passed or a foul-smelling discharge is present, or if cramps are severe or a fever develops, they should seek immediate medical attention. Failing to get medical care after miscarriage can create risks with both your short-term and long-term health, including your fertility.
No matter how someone may have felt about a pregnancy, whether it was planned or unintentional, it is normal and common to experience all kinds of feelings, some of which may seem in conflict with each other.
You may feel grief, regret, relief, happiness, anger, loneliness, or gratitude. You may have a strong experience of loss, or you may feel no sense of loss at all. You may feel like your body horribly betrayed you; you may feel like your body miraculously did exactly what you’d hoped it would do. You may find yourself in denial about either miscarrying or being pregnant in the first place. You may feel hard feelings like shame or guilt, even though a miscarriage wasn’t your fault. You may feel literally elated; you may want to throw a party. You may be very upset, or depressed, even to the point of feeling like you may self-harm or become suicidal. You may want to keep it a secret, and may have feelings about that. You may also find yourself having very different feelings than you expected to: for instance, if the pregnancy was unwanted, you may expect to feel relieved but wind up experiencing sadness instead.
Depending on how long someone was pregnant for, some of these feelings may also be due to, or influenced by, postpartum depression, which is something that can happen to someone any way a pregnancy ends, be it by birth, abortion or miscarriage. A pregnancy ending can create hormonal changes that can have some big emotional impacts.
These feelings can be tricky when you’re a young adult: friends, family, or partners may not have been happy you were pregnant in the first place and may not be sympathetic. For people of all ages, grief and upset after miscarriage is usually worse if there’s a lack of support or understanding from those around them, so seeking out support and doing plenty of emotional self-care are key.
If you want or need support, you’re certainly welcome to come talk with one of our staff in any of our direct services. Unmoderated internet forums or social media often aren’t great places for this kind of support, as so many people are ignorant about miscarriage, both about how it happens and how hard some people can struggle with it. Offline, people you trust and know to be supportive, who can just be there for you and listen to you when you need that, are the usual good bet. Extra points for anyone in that group who you know to be open-minded and easily corrected if and when they’re wrong about something. You may find it helpful to talk with other people who have had miscarriages, even if you haven’t had the same experiences.
If you are deeply struggling; if you are depressed, if you are thinking about or engaging in any kind of harm to yourself or others, if you are having suicidal thoughts or urges, or even just if you have been feeling bad about this for a while and cannot seem to shake it, please seek out qualified help. You do always have the option of calling for emergency care (mental health emergencies are also emergencies) through a local hospital. You also may use crisis care lines, be they general, suicide hotlines, or focused on pregnancy and its outcomes (like All-Options in the United States). You can ask your gynecologist/obstetrician or a general doctor for support resources or counseling referrals; you may also have the option of a support group. If you need big help, please ask for big help.
If you’re involved with the other person who was part of creating your pregnancy, they may be a good support for you in this if you need it and you want to turn to them for it (you don’t have to: it is okay if you’d rather talk to someone else). They may also have their own feelings and needs, and you may need to work together to figure out how to get both of your different needs met. If it turns out they need a lot more support than you want or are willing to give, especially as the person who has themselves experienced the miscarriage in your own body, please know it is both okay and healthy for you to have limits. You can let them know what they are and they can seek out the additional help they need from other sources, be that from a friend or a counselor.
Please remember that if miscarriage happens to you or to someone you know, it is not your or their fault.
Most of the time, just as our body often makes us throw up bad food we’ve eaten because it knows it’s not good for us, our body miscarries when it knows that a pregnancy is not sound for the person whose body it is happening to, or for a fetus. That fact alone may not make any hard feelings go away, but blaming yourself (or someone else, if you’re not the person who’s miscarried) is often a big player in the toughest feelings, so on top of not being truthful, it’s also something that’s going to make you feel a lot worse.
If you are pregnant and want to remain so — or are considering pregnancy and thinking about any of this — please understand that most of the time, miscarriage is something that is simply outside your control. It may feel scary to know that, but it’s important to accept, especially if and when it happens. However, there may be some things you can do to decrease your changes of miscarrying.
Some factors that may increase the possibility of miscarriage are:
- Lack of full sexual maturity or growth (in other words, becoming pregnant when very young)
- Poor nutrition
- Cigarette, drug, or alcohol use
- Hormonal imbalances
- Sexually transmitted infections or conditions
- Other reproductive or general medical conditions, like PCOS, uterine malformation, fibroids, lupus, congenital heart disease, severe kidney disease, diabetes, thyroid disease, or exposure to environmental hazards or radiation
- Stress or injury from sexual or domestic abuse
No one can rely, for the record, on any of these things to cause a miscarriage. Someone who wants to terminate a pregnancy safely and effectively must seek out a safe abortion procedure.
Should you want to remain pregnant and do what you can to assure a healthy pregnancy, your best bet is to access good and regular prenatal care early on in a pregnancy. An obstetrician, midwife or doula can help you with things like improving your nutrition, ditching bad habits like smoking, getting out of any unsafe relationships, or managing a pregnancy while also managing other existing health conditions.
If you're reading this because someone you care about has had a miscarriage:
Since miscarriage is such a unique experience, everyone won't want or need the same things. If you have the ability, you can offer practical help to your friend, partner or family member who has experienced miscarriage; like finding or accessing counseling or other healthcare, including transportation to or from any appointments, or even just keeping them company on public transit. You can bring them things they may want or need for a day of downtime-self-care, like snacks, books or some comfy pajamas. You can also offer them help with a distraction, like going on a walk together, watching a movie or doing other thimgs where they don't focus on the miscarriage or talk about it, if that's what they'd prefer.
Instead of assuming anything about their feelings, it's ideal to listen and respond to what they're telling you, and to do so without judgment. You may have ideas about how they should feel, maybe even based on how you think you would feel or know you have felt with a miscarriage, but this is about them, not you. Ask them to find out how they're feeling, and try to accept what they tell you.
Ask how you can give them emotional or other support or help, and let them know if and how you can be available to do that. If they don't have any ideas, you can always make a couple basic offers, like to come by and see them and just hang out, to check in with them with a text each day, or just to sit and listen to them talk about their feelings. If they feel unsupported or vulnerable around anyone -- like, for example, family members who don't know they were pregnant, or a partner who isn't being great about this -- you can ask what you can do to have their back in that regard.
Ultimately, supporting someone with a miscarriage is a lot like being supportive with anything else: you just want to do your best to center that person, letting them decide what they need, while still honoring your own limits and boundaries.
Excerpted and adapted from s.e.x.: the All-You-Need-to-Know Sexuality Guide to Get You Through Your Teens and Twenties by Heather Corinna (DaCapo Press, 2016).