What It's Really Like to Have a Miscarriage
On my youngest daughter's birthday, I wrapped up a special poem and in front of family and friends, read the words aloud, breaking the happy news to everyone that her last "gift" was a new baby brother or sister on the way. We recorded all of the kids' reactions, amid excited shouts and jumps for joy. My husband's grandma hugged me and I smiled down at my loose pink tank top concealing the teeniest of bumps already.
Miscarriage wasn't even on my radar. But weeks later, I started bleeding.
Like a lot of people, I had no idea what having a miscarriage would really be like. I would go on to have two consecutive miscarriages that couldn't have been more different. Here's what I learned along the way about what having a miscarriage is really like.
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Most miscarriages happen in the first trimester.
Both of my miscarriages happened in my first trimester—defined as before 13 weeks—which J. Daniel Woodall, DO, MPH, FACOG, an obstetrician and gynecologist at Spectrum Health Pennock in Hastings, Michigan, explains is when the majority of miscarriages (around 80 percent) occur.
Overall, somewhere between 10-30 percent of all pregnancies will end in miscarriage, notes Dr. Woodall. And in some cases, the loss happens so early that they aren't even clinically identified—meaning that the loss could have happened before the pregnancy was even discovered, and the menstrual cycle just starts like normal, or is a few days late.
So how do you know if you had a miscarriage? Dr. Woodall explains that if you are in the first trimester and have bleeding like a heavier, painful period and pass obvious tissue, you most likely had a miscarriage. However, even in those cases, he recommends evaluation by an obstetric provider to make sure you have miscarried and if any further testing is needed. "Whenever you suspect miscarriage, even if you're confident you passed everything, notifying your OB provider is always indicated," he says.
Some miscarriages may hurt, but some may not.
As the American College of Obstetricians and Gynecologists (ACOG) explains, there are two basic types of early pregnancy loss: 1) either a gestational sac that is empty or 2) a gestational sac that has an embryo or fetus but no fetal heart activity.
The type of miscarriage you experience can determine the route your loss will take; an empty gestational sac, for instance, can be a less physically intense process because there is no embryo present that has to be passed. If you have a fetus that is close to 12 weeks gestation, it can be a more painful and intense process because there is more tissue that has to be passed.
I experienced both kinds of miscarriage. With my first miscarriage, I began bleeding, so I went to my provider for an ultrasound, and discovered that I had an empty gestational sac. She explained to me that an empty gestational sac can occur when an egg is fertilized, implants, and the sac forms, but the embryo fails to develop correctly.
As far as what miscarriage feels like physically, Dr. Woodall says that miscarriage can be painless if your body has not started the process of passing tissue—called the "products of conception"—or it can be quite painful if your body has started the process of passing the tissue.
"Most of the pain associated with miscarriage is extreme cramping, [which can feel contraction-like] in nature, as the uterine muscle functions to get the products of conception out," he explains.
Miscarriage can feel a lot like labor, adds R. Renee Gaiski, MSN, CNM, with Spectrum Health Pennock, in Hastings MI. "The cramping can be very intense, usually in the lower abdomen but sometimes wrapping around to the back or down the thighs," she describes. "The pain often will come and go like contractions, but when the pain is most intense, it can feel constant."
You can have zero symptoms of a miscarriage.
"Some miscarriages occur without symptoms and are found during early an ultrasound during routine prenatal care," Dr. Woodall explains. "In my practice about half of all miscarriages I find during a routine first-trimester ultrasound and the other half present with bleeding before 13 weeks."
With my second miscarriage, I had no physical signs that anything at all was wrong and I had all my normal pregnancy symptoms of nausea, sore boobs, and fatigue. Because of my first loss, my provider did a very early ultrasound around eight weeks, where we were able to see a normal gestational sac and an embryo with a heartbeat. Unfortunately, however, the baby's heartbeat was very low. A heartrate under 100 beats/minute by seven weeks usually indicates a non-viable pregnancy; my baby's was only 60.
I went home that day, just waiting to see if my baby would live or die. Words can't adequately capture how excruciating that time was for me. I hosted a Christmas brunch and tried to slap a smile on my face, even though inside, I was just wondering if I would know the moment my baby died inside of me. At my next check-up, despite the fact I had no bleeding or cramping, the ultrasound revealed an empty sac again—the fetus had disappeared.
Miscarriages can last days, weeks, or even months.
Dr. Woodall explains that in general, when women miscarry and pass tissue spontaneously, the bulk of the process can take about 12-24 hours, followed by normal period type bleeding for several days. However, as Dr. Zev Williams, M.D., Ph.D., director of Columbia University Fertility Center explains, the length of time that it takes for your body to begin that process can vary widely, from a matter of days to weeks long.
My two miscarriages were very different in length. With the first, because I was already bleeding, I elected to see if the pregnancy would pass on its own and it seemed to do that. That weekend, I bled very heavily, similar to a heavy period. I then went in to have my hCG levels drawn to ensure that they had dropped appropriately. That's when my loss took a turn—although my levels dropped initially with my first draw, a few days later, they had risen again.
I would go on to have several exhausting weeks of a cycle of bleeding heavily, my levels dropping, then rising again, before my doctors decided that I must have had a pregnancy that implanted somewhere else in my body that was still growing. Without knowing where it was, it was a hazard to my health, and I eventually had to take a special medication to dissolve the pregnancy.
From start to finish, I bled for two months straight, and the entire process was incredibly physically, mentally, and emotionally draining. In my mind, I had always thought that a miscarriage would be a short yet intense process; I hadn't expected the long, drawn-out experience I had. Instead of any one overwhelming moment of cramping, I had what felt like a heavy period for two months straight.
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You will need time to physically recover.
My second miscarriage was more of what I expected the first time. Because I hadn't started bleeding, my provider prescribed misoprostol, a medicine that can induce contractions, for me to use at home (you place the medicine in your vagina, as close to your cervix as you can get it) to start the process. I placed the medication in on a Saturday morning, but the cramping, for me, didn't really begin until the night and the bleeding didn't start until the following day, on Sunday. I bled on and off initially and then had about a six-hour window where I bled very heavily, with spurts of more thick clots and "clumps" of tissue.
It wasn't overwhelmingly painful for me, but it was an alarming process because the sheer amount of blood and tissue coming out was shocking. I did lose a lot of blood very quickly, which caused some complications for me. I nearly fainted, became delirious, and my husband contemplated taking me to the ER before being able to re-stabilize me with some orange juice and water.
After the initial "big" tissue loss (I never saw an actual fetus in either miscarriage, but many women do), it still took me about three days for the physical symptoms of cramping and heavier bleeding to subside, and I didn't know that would happen—on Monday, my husband went to work like normal and I was left at home, curled up on the couch still in pain, trying to care for my four-year-old. Looking back, I wish I had known to have the kids gone from the house during the weekend and to give myself more time and space to do absolutely nothing but recover even after the initial loss was over.
Gaiski notes that my experience the second time was pretty standard—she says that most of the time, the intense pain and heavy bleeding will last for 3-4 hours. The bleeding will then slow to a heavy period, and often after a couple of days will become just light spotting, which can last from a few days to a few weeks.
But the pain is also emotional—and hormonal.
While the physical pain can be very different depending on the route your loss takes, along with other factors such as how far along you were, if you have to take any medication to induce the process, and your own pain tolerance, it's also very important to mention that the emotional pain of a miscarriage is very individual too. "Add the pain to the mental anguish of losing a pregnancy, it can hurt a lot," says Gaiski. "Physically and emotionally."
For me, personally, with my first loss, because I had an empty sac and never "saw" my baby, I told myself that I didn't have the right to be sad as much as a woman who had lost a baby she could physically see. But then, when I had a second miscarriage and saw the fetus—even with the heart beating—and still had to say goodbye, I realized that the emotional toll I felt for each loss was exactly the same.
My heart didn't care what I saw on an ultrasound screen. I knew and loved each of my babies from the very beginning as if I had already held them in my arms. With each loss, I learned I had to give myself permission to grieve any way I wanted to. It helped me to talk to other women who had miscarried, to share my loss on social media, to write about it, and to honor each baby in a special way. Today, I wear a special gold bar necklace that is engraved with two small circles in remembrance of my losses.
It's also important to remember that even an early pregnancy loss will have a very physical impact on your hormones. The abrupt change in hormones can trigger a lot of hard feelings and for me, it took several weeks before I felt like my emotions stabilized enough that I could safely go out in public without bursting into tears randomly. The emotional and hormonal shifts of a pregnancy loss are very, very real.
Miscarriage is not always a sign that something is wrong.
Like many women, when I miscarried, I worried that something was "wrong" with me, and that I would never be able to have another baby. But most women who have had a miscarriage—and even the majority who have two or more losses, like I did—are able to go on to have a successful pregnancy. This turned out to be true for me, as I was able to get pregnant about a year after the second loss and welcomed my rainbow baby five months ago.
"While having a miscarriage does increase the risk of future miscarriage, the odds are overwhelmingly in favor of the next pregnancy being normal," Dr. Woodwall notes.
In the end, going through my miscarriages placed me firmly into a club I wished I hadn't joined. The two experiences, although physically different, were both incredibly exhausting, draining, and emotionally trying times for me. If I'm being honest, I never would have expected just how much a miscarriage would impact me so deeply and to this day—despite having my rainbow baby sleeping in her crib—the pain has never quite left me. Miscarriage is a deeply personal process and there is no "wrong" or "right" way to get through it.
If you are forced to become "part of the club" with me, just remember that there is nothing you did that could cause a loss, that you have every right to grieve any way you need to, and that there is always help available to you through any step of the process.