Miscarriage

Also called Early pregnancy loss, Recurrent miscarriage

Common, almost never anybody's fault, and treated as a medical event when it is usually a bereavement.

What it is

The loss of a pregnancy before 24 weeks. Around one in five known pregnancies ends this way, and the true figure including very early losses is higher.

The overwhelming majority of single miscarriages are caused by a chromosomal problem in the developing pregnancy that was never survivable. Not by lifting, working, stress, arguing, exercise, sex, or anything anybody did or failed to do. That sentence is the single most important one in this entry, because almost everybody who miscarries searches for what they did wrong.

Investigation is usually offered after three consecutive miscarriages, and in many areas after two. Recurrent miscarriage has identifiable causes in a proportion of cases, including antiphospholipid syndrome, thyroid disease and uterine abnormalities, and those are treatable.

An ectopic pregnancy is different and dangerous, and pain with bleeding in early pregnancy always needs assessing rather than assuming.

Molar pregnancy is rarer again and needs specialist follow-up.

The care around it has improved but remains inconsistent, and people are still commonly told to go home and wait with no follow-up and no acknowledgement that anything was lost.

Signs you might notice

Vaginal bleeding in early pregnancy, which may be spotting or heavy, sometimes with clots or tissue.

Cramping or pain in the lower abdomen or back.

Pregnancy symptoms such as sickness and breast tenderness fading.

Sometimes nothing at all, with the loss found at a scan. This is a missed miscarriage and is particularly cruel because the person had no warning.

Bleeding in early pregnancy is common and does not always mean miscarriage, but it always needs assessment.

999 or A and E: heavy bleeding soaking more than a pad an hour; severe one-sided pain; shoulder-tip pain; feeling faint or collapsing; or fever with pain and bleeding. Shoulder-tip pain in particular suggests an ectopic pregnancy and is an emergency.

How it can affect day-to-day life

Grief after miscarriage is real bereavement and is frequently unwitnessed, because other people did not know about the pregnancy and cannot see what was lost. Partners grieve too and are almost never asked.

The physical process can take days or weeks and is more painful and heavier than most people are warned. Being told what to expect, honestly, changes the experience considerably.

Anniversaries, due dates and other people's pregnancies stay difficult for a long time, and that is normal rather than a failure to move on.

Anxiety in a subsequent pregnancy is close to universal, and early reassurance scanning helps. Recurrent miscarriage clinics and specialist support exist and are worth asking for.

Employment rights around miscarriage are limited and poorly known, and this is a common source of additional harm.

Supporting someone well

Say plainly and more than once that it was not their fault and there was nothing they could have done.

Do not say at least you know you can get pregnant, at least it was early, or everything happens for a reason. Ask what they need and follow their lead.

Ask the partner how they are.

Go to the early pregnancy assessment unit; in most areas these can be contacted directly without a GP referral.

Ask what the options are for management: waiting, medication or a procedure. Being given a choice matters more than which one is chosen.

Ask for anti-D if the person is rhesus negative; it is easily missed.

Ask about investigation after two losses rather than waiting for three, particularly with any other risk factor.

Get bereavement support offered, not just treatment. A certificate of baby loss is available in England for pregnancies lost before 24 weeks and matters to many people.

Where to get help

The early pregnancy assessment unit, GP or midwife.

999 or A and E for heavy bleeding, severe or one-sided pain, shoulder-tip pain, or feeling faint.

Miscarriage UK run a helpline and support groups, including for partners.

Tommy's midwives on 0800 014 7800, and their recurrent miscarriage clinics.

Cruse Bereavement Support for grief support.