What Happens During a Miscarriage–And How to Support Someone Going Through One
By Dr. Janet Jacobson

 

Losing a pregnancy can be devastating–and it’s even harder when you feel like nobody understands what has happened to you and your body.

 

I’ve been an OB/GYN for nearly 25 years and have devoted much of my career to the medical science of managing pregnancy loss, ensuring patient safety during treatment, and helping patients cope with the emotional side of a miscarriage. I’ve presented and contributed to multiple papers on the topic, even writing part of a medical textbook on the subject. As the Medical Director for Planned Parenthood of Orange and San Bernardino Counties, each year, I assist more than 5,000 patients with miscarriage management.

 

However, because so many of my patients have come in frightened because they don’t know what’s happening to their body or are unsure of how to move forward or support their partner, I want to share some of this knowledge more widely and dispel some myths about pregnancy loss.

 

Here is what happens during a miscarriage, why they happen, and what to do if you or your partner experiences one.

 

Types and causes of pregnancy loss

 

There are two types of pregnancy losses: miscarriage and stillbirth. Miscarriage is what we call it when someone loses a pregnancy during the first 20 weeks of pregnancy. After 20 weeks of pregnancy, it’s known as a stillbirth.

 

Miscarriages, especially, are incredibly common. About 1 in 8, or 10-15% of known pregnancies end in miscarriage. That number may even be higher since many patients don’t report or talk about their miscarriages because of cultural stigma or the misplaced belief that their actions caused it.

 

This is the most important thing to know: unless you are heavily drinking or using drugs during your pregnancy, a miscarriage or stillbirth is not your fault. Pregnancy loss is not caused by exercising, working, being scared, stress, arguments, having sex, eating the “wrong” foods, using birth control before pregnancy, thinking bad thoughts, having previously had an abortion, or any of the other culturally ingrained reasons someone might believe.

 

Here are the known medical reasons a person might lose a pregnancy.

• Chromosomal abnormality. This is the number one reason miscarriages occur, especially early in pregnancy–half of all miscarriages occur for this reason. Chromosomes are in each cell of the body and carry the blueprints (genes) for how people develop and function. When a miscarriage happens early, there is a 50% chance that there is a chromosomal abnormality that would not allow the fetus to develop properly or survive outside the womb.
• Injuries. Falls, accidents, and other high-impact events that lead to injuries can induce miscarriage or stillbirth.
• Health conditions–maybe. Certain health conditions can also make miscarriage more likely in certain patients, but every person’s body is different. For example, I have treated many patients with diabetes and obesity who had healthy pregnancies and others with normal body weight and no previous health histories who had multiple miscarriages. Check with your doctor or healthcare provider to assess your risk.
• Ectopic pregnancy. Ectopic pregnancies, which happen in about 1-2% of all known pregnancies, occur when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. This is a life-threatening emergency. When an ectopic pregnancy grows, it can cause a pregnant person’s fallopian tube to burst and cause internal bleeding, which can result in death without prompt medical attention.

 

What happens during a miscarriage

 

Vaginal bleeding, like during your period, is the most common sign that you may be having a miscarriage. Bleeding is common in early pregnancy. About 50% of the time, it is a sign that a miscarriage is happening and your body is attempting to expel the pregnancy.

 

The signs of a miscarriage requiring prompt medical attention are:

• Bleeding from the vagina with or without pain, including light bleeding (also known as spotting)
• Pain or cramping in the pelvic area or lower back
• Fluid or tissue passing from the vagina
• Fast heartbeat

 

If you have passed tissue from your vagina, place it in a clean container if possible and bring it to your health care provider’s office or the hospital. A lab can examine the tissue to check for signs of a miscarriage.

 

If you are experiencing a miscarriage and the pregnancy tissue has not passed completely, your healthcare provider will discuss the three treatment methods used to manage miscarriage.

 

Unless you need emergency treatment, the choice of miscarriage management is up to you:

• “Expectant management,” or waiting for all of the pregnancy tissue to pass out of your body while monitoring you for symptoms. Most nonviable pregnancies will pass out of your body within six weeks.
• Medication management. Your healthcare provider will give you two medications, mifepristone, and misoprostol, to help you pass all of the tissue out of your uterus more quickly.
• Procedural management. A suction aspiration procedure to evacuate your uterus while
  you are under sedation is commonly used for miscarriage treatment. The entire
  procedure takes less than five minutes. This process is also used to treat emergencies
  like heavy bleeding or if expectant and medication management fail.

 

If you are experiencing an ectopic pregnancy, it is even more important for you to get urgent medical care. The signs of an ectopic pregnancy, which require immediate medical attention, are:

• Severe lower belly pain, especially on one side
• Vaginal bleeding or spotting, especially if it’s heavy
• Shoulder pain
• Feeling very weak, dizzy, or fainting

 

If your medical provider determines you are experiencing an ectopic pregnancy, they may refer you to the nearest hospital or offer medical treatment right away. For some people with ectopic pregnancies, emergency surgery to remove the embryo is required in order to prevent or stop any life-threatening internal bleeding.

 

If you are experiencing any sort of cramping or bleeding during pregnancy, time is of the essence. Seek medical care as soon as possible. I work with Planned Parenthood, and our health centers are often a first stop for immediate miscarriage management. This is because it can take weeks for a patient who is experiencing bleeding during pregnancy to get in with her OB/GYN, and emergency rooms might have hours or even day-long waits.

 

If you can’t get in to see your regular doctor, and the emergency room at your local hospital cannot see you in a timely fashion, you can go to your nearest Planned Parenthood health center or equivalent community health provider. The compassionate doctors and nurses at these health centers are experienced in managing pregnancy loss and can get you in quickly. If you need more extensive medical care, they can refer you to a nearby hospital.

 

How to Support Yourself or a Loved One

 

Though more people are speaking out on social media about their experiences, there can still be a lot of social stigma around experiencing a miscarriage or stillbirth. This is why so many expectant parents can feel isolated in their grief or just aren’t sure how to support their partners or loved ones in these situations. The fear in the moment and the loneliness after are some of the hardest things a pregnant person and their family can go through.

 

Here are the ways you can support a loved one who is going through a pregnancy loss.

• Remind them that they are not alone and that this is not their fault. Be sure to tell them that their miscarriage or stillbirth is unlikely to have happened because of anything they did or did not do.
• Follow their lead. Everyone deals with loss differently. For some, a miscarriage can be devastating, while for others, it’s less so. While people deal with grief in different ways, it’s important to acknowledge the miscarriage and validate their feelings. If they don’t want to talk about it, they’ll let you know.
• Help with practical things as they recover. Recovery from a miscarriage can be physically and emotionally painful. Offer to run errands, cook or deliver meals, provide babysitting, or help with other household chores. If you live too far away to help with chores, a simple card is a great way to show you care and are thinking of them.
• Be present and listen. Rather than simply say, “Let me know if you need anything,” proactively let the person know that you are there for them, and reach out in person, online, or by phone call or text. If they share their feelings, listen without interruption or judgment. Being heard can be healing.
• Avoid minimizing their feelings. Though you may mean well, saying things like “at least you can try again,” “it’s for the best,” or “God needed one more angel” can invalidate their emotions. Instead, let them know their feelings are valid and understandable–phrases like “I’m so sorry for your loss” and “This must be incredibly difficult” can go a long way.
• Above all, respect their boundaries. If they say they need time alone, respect their wishes. Avoid asking intrusive questions, and leave space for them to share as much or as little as they need to.

 

And if you are the one who has lost a pregnancy–be kind to yourself. Ask for help at home. Give yourself space and time to heal. Reach out to your healthcare provider, your nearest Planned Parenthood health center, or other trusted resource for guidance and support.

 

The more we know and talk about pregnancy loss, the more we can reduce the unnecessary shame and stigma around it. Above all, if you or a loved one experiences a pregnancy loss, know that this is an incredibly common experience. It does not indicate anything about you as a parent or person. You are not alone, and you have support from medical providers who care.

 

ABOUT THE AUTHOR

Janet Jacobson, MD, is the medical director at Planned Parenthood of Orange and San Bernardino Counties, one of the largest Planned Parenthood affiliates in the nation by patient volume.