Answering your questions about early miscarriage
We are sorry that you have received news that you have miscarried.
Miscarriage is most commonly used to describe the situation where a pregnancy ends unexpectedly
before 24 weeks gestation. Early miscarriage occurs within the first 13 weeks. This includes
pregnancies where the baby has died before 13 weeks but the miscarriage happens later. Late
miscarriage occurs when the baby dies between 14 and 24 weeks.
We hope that this leaflet will help to answer your questions about early miscarriage.
The physical process of miscarriage
In some miscarriages the womb empties itself completely and is called spontaneous or complete
miscarriage. In some cases the baby dies but is not miscarried. This is often called a missed or silent
miscarriage. Sometimes pregnancy tissue is left behind. This is called incomplete miscarriage.
If the miscarriage is not complete or missed and you are physically well you have three choices:
1. You may choose to do nothing and let the miscarriage happen naturally. This process might
take some time.
2. You may prefer medical treatment (tablets) which starts the miscarriage process.
3. You may prefer to have surgical treatment carried out under general anaesthetic to remove
the pregnancy tissue from the womb.
These options will be discussed with you by a doctor or nurse practitioner. You will be given more
detail about each treatment explaining the risks and benefits and given the opportunity to ask further
questions to help you decide what is best for you.
How long will I bleed for?
The amount of pain and bleeding varies but can depend on what stage the pregnancy ended and
which treatment you choose (natural, medical or surgical).
With medical or natural management, some women can have quite severe abdominal cramps as well
as heavy bleeding when the miscarriage happens. This should gradually become less, but can take up
to four weeks to stop.
After surgical treatment you may bleed, perhaps on and off, for up to two weeks and you may also
have cramping pains during this time. It is best to use sanitary pads rather than tampons, and not to
have sexual intercourse until the bleeding stops, to avoid the risk of infection.
If bleeding continues to be heavy or you have an unpleasant vaginal discharge or high temperature
contact your GP as soon as possible as these may be signs of infection.
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If you normally have a period every month your first period following miscarriage will usually occur
within six weeks. It may be heavier than usual. Your periods will return to their normal pattern but
this may take up to three months.
When can I go back to work?
You may feel physically tired for a week or so and need to take it easy during this time. Returning to
work varies from person to person and on the type of work you do as well as how you feel physically
and emotionally. You may prefer to be among colleagues and find it helpful to return to a routine or
you may want to take time off until you feel ready to see people and able to concentrate on work.
What about my emotions?
Loss of a baby at any stage of development can be a devastating experience.
You may have a mixture of emotions which may feel uncomfortable and confusing. For many women
these feelings pass quite quickly and life resumes. For some however, these feelings are more
prolonged and difficult to cope with.
You and your partner may both be upset but in different ways or at different times. For example, one
of you might want to talk, the other may want silence or simply find it hard to express feelings. One
of you may want to try for another pregnancy as soon as possible, but the other may not.
Your partner may feel guilty because you are the one that had to go through the physical experience
of miscarriage. Sometimes partners feel powerless to help. Some concentrate on 'being strong.' The
downside is that they may end up feeling isolated, with no-one to talk to. They may also hide their
feelings so well that they appear not to care.
Children often notice when something is wrong, especially if a parent or someone close to them is
upset. You may want to think about telling them what has happened, even very simply, especially if
they knew you were pregnant.
Friends and family can help but it can sometimes be useful to talk in confidence to someone outside
the family. Your GP may be able to arrange some Counselling support or you can contact the
Miscarriage Association.
Saying goodbye following miscarriage
Many people want to do something to remember their baby or to help them say goodbye. You may
prefer to do this privately with family in your own chosen way.
Each month we hold a short service at the crematorium for the babies that have died. You and your
family are welcome to attend the service which takes place on the first Thursday of the second
month after your miscarriage. (So for example if your miscarriage took place in January, the service
would take place on the first Thursday in March). The service is held at 9am at Saltwell Crematorium
and is conducted by one of the hospital chaplains. After the service there will not be any ashes to
scatter, however there is a Garden of Remembrance which you may want to visit.
We also have a remembrance book in the hospital chapel in which your baby’s name can be entered
and once a year we hold a remembrance service for all parents and their families. Please ask the
nursing staff who can contact one of the hospital chaplains if you would like more information about
these services.
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What happens to the baby?
All pregnancy material will be treated with care and respect. We have in place arrangements for
sensitive disposal. You are unlikely to pass anything recognisable if you were less than 7 weeks
pregnant. However you may see a small sac. If you are at home you can use the toilet as you would
with a heavy period. If you prefer, you can bring the pregnancy tissue to Women’s Health Clinic, in a
clean dry container. It will be sent to the pathology lab for examination. All pregnancy tissue is sent
for cremation to Saltwell Crematorium in Gateshead. If you do not want to be included please speak
to your nurse. She can also provide you with information about the monthly service held at the
Crematorium. If you would like more information about this please ask the nurse
Will I be offered any follow-up treatment?
You may be offered a follow-up appointment at the hospital. If not, you may want to make an
appointment with your GP, midwife or health visitor if you want to ask questions or talk over
anything that may be worrying you.
Why did it happen?
This is the most common question asked and unfortunately the hardest to answer.
Sadly about one in four babies are lost before 12 weeks.
It can be hard to accept that no-one can say for certain why it happened.
It is unlikely to have happened because of anything you did or didn’t do. Unfortunately once a
pregnancy starts to miscarry; there is very rarely anything that can be done to stop it.
The main causes of miscarriage are thought to be:
Chromosomal: causes about half of all early miscarriages. Chromosomes are tiny structures found in
all cells in the body. They carry our genetic information given to us from our parents. In order to grow
and develop normally a baby needs the exact number of chromosomes from each parent. If there are
too few or too many a miscarriage may happen.
Immunological: Problems within the blood vessels which supply the placenta can lead to miscarriage.
Infection: Minor infections like coughs and colds are not harmful, but a very high temperature and
some illnesses or infections, such as German measles, may cause miscarriage.
Anatomical: If the cervix (neck of the womb) is weak, it may start to open as the uterus (womb)
becomes heavier in later pregnancy and this may lead to miscarriage.
An irregularly-shaped uterus can mean that there is not enough room for the baby to grow. Large
fibroids may increase the risk of miscarriage in later pregnancy.
A small number of women who miscarry are found to have had a molar pregnancy (hydatidiform
mole). In this situation, a fertilised egg which is genetically abnormal implants in the uterus (womb)
but the cells of the placenta grow very quickly and prevent it developing further. This is identified
from the pregnancy tissue sent to the pathology lab.
Will this miscarriage affect my chances of having a baby in the future?
After one miscarriage, most women go on to have a normal pregnancy. Research shows that even if
you have several miscarriages, you still have a good chance of having a baby.
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Investigations into why miscarriage has occurred are carried out when a woman has recurrent
miscarriage, defined as three or more consecutive miscarriages.
Factors which increase the risk of miscarriage include:
A woman’s age - the risk of early miscarriage increases with age. At the age of 30, the risk of
miscarriage is one in five (20%). At the age of 42, the risk of miscarriage is one in two (50%).
Health problems – as an example, poorly controlled diabetes can increase the risk of an early
miscarriage.
Lifestyle factors – smoking and heavy drinking are linked with miscarriage.
How long should we wait before trying for another baby?
Usually there is no physical reason why you should wait to become pregnant again. Some women
need to give themselves time to grieve; other women feel that being pregnant again helps them to
cope better with their loss. So the answer to this question is when you and your partner feel ready,
both physically and emotionally.
If I want to wait before trying for another baby, when do I need to start using contraception?
You can ovulate (produce an egg) during the first weeks following your miscarriage. If you have
intercourse you may become pregnant, so it is worth talking about contraception as soon as possible
with your GP or Family Planning Clinic.
Is there anything I should do to prepare myself for another pregnancy?
Try to take care of yourself with a healthy diet and regular exercise. Avoid smoking and alcohol. It is
recommended that you take folic acid supplements while trying for a baby and until 13 weeks
pregnant. Your GP or Chemist can provide up-to-date information.
We hope this information has helped answer your questions. However if you want further help or
information the following contacts are available:
Contacts:
Nurse practitioner
Early Pregnancy Assessment Unit (EPAU)
Tel: 0191 445 2146 Monday to Friday 8:30 am – 4:30pm
24 hour contact telephone
Ward 21 Tel: 0191 445 2021
Hospital Chaplaincy
Tel: 0191 445 2072
Further useful contacts
NHS direct – Tel: 0845 4647
NHS Direct on line www.nhsdirect.nhs.uk
Association of Early Pregnancy Assessment Units www.earlypregnancy.org.uk
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Miscarriage Association Tel: 01924 200799 www.miscarriageassociation.org.uk
SANDS - Stillbirth and neonatal death charity Tel: 02074365881
www.uk-sands.org
Royal College of Obstetricians and Gynaecologists
www.rcog.org.uk
Data Protection
Any personal information is kept confidential. There may be occasions where your information needs
to be shared with other care professionals to ensure you receive the best care possible.
In order to assist us improve the services available your information may be used for clinical audit,
research, teaching and anonymised for National NHS Reviews. Further information is available in the
leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust
website or the PALS Service.
Information Leaflet:
Version:
Title:
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NoIL363
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Answering your questions about early miscarriage
September 2011
November 2015
Linda Snaith and Sue Bedigan – Women’s Health Clinic
This leaflet can be made available in other languages and
formats upon request
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