Having a miscarriage: 3 things you should know

A miscarriage happens when a pregnancy ends in an unplanned way, all by itself, before the start of the 13th week of pregnancy. Miscarriages are also sometimes called early pregnancy losses. They can even happen before you know you’re pregnant.

There are a couple of different ways you might find out you’re having or have had a miscarriage. Sometimes a miscarriage causes cramping or bleeding. Other times, there are no symptoms at all, and the pregnant person finds out about the miscarriage during an ultrasound. Miscarriages can happen to people who want to carry the pregnancy to term and to those who don’t. And how people feel about having a miscarriage varies by person–there is no one emotion or combination of emotions that is “normal” or “right.” Some people feel sad, some feel relieved, some feel angry, some feel something else entirely, some feel a mix of emotions, even contradictory ones, and some may not feel much at all. Any emotion you may feel in response to a miscarriage is totally normal and okay.

As you’re talking with your health care provider, wondering why this miscarriage happened or what happens next, here are three very important things to keep in mind.

1. It is NOT your fault.

Miscarriages happen for different reasons, but most happen because of problems with the pregnancy itself. The egg and sperm may have joined together in a way that doesn’t allow the pregnancy to continue, or the pregnancy may not have had the genetic information needed for it to continue. It’s nobody’s fault—it’s a natural way that the human body ends pregnancies that are not able to last.

Miscarriages do happen more often for people with certain health conditions like diabetes and clotting problems, but these are pretty rare causes of miscarriage. And some behaviors, like drinking a lot during pregnancy, do increase the risk of miscarriage. But miscarriage is rarely caused by something you did or didn’t do—it’s much more likely for it to happen because something wasn’t working as it should in the pregnancy itself.

You did not cause a miscarriage by forgetting to take a prenatal vitamin, eating spicy food, exercising a normal amount and intensity for you, having a cup of coffee, feeling stressed out, having sex, or doing any number of other reasonable, everyday-life things. And using hormonal birth control (like emergency contraception (EC), the pill, the patch, the ring, or the implant) before getting pregnant—or after getting pregnant but before you know you’re pregnant—does not cause miscarriages!

2. Miscarriages are really, really common.

People often feel very alone when they’re miscarrying, because we don’t talk about it much in our society. About 15% of known pregnancies (15 out of every 100 pregnancies where the pregnant person knows they’re pregnant) end with a miscarriage. If you also count people who didn’t know they were pregnant yet, this number is higher.

3. You probably have time to decide what you want to do next.

Always talk to your health care provider if you think you may be having a miscarriage. They will let you know if there is anything you need to do right away. But generally, unless you’re in danger because of heavy bleeding, you have some time to absorb the news and learn about the different treatment options.

If the pregnancy tissue has come out and the bleeding from your vagina has stopped, the miscarriage is over. This is sometimes called a “complete” miscarriage. Usually that means you don’t need any treatment, just some time to recover.

Sometimes though, the pregnancy has stopped growing but the pregnancy tissue hasn’t started to come out yet at all. This is sometimes called a “missed” miscarriage. It is also possible to have an “incomplete” miscarriage, which means that the pregnancy has stopped growing and some of the pregnancy tissue has come out, but some is still inside the uterus. If you’re having a missed or an incomplete miscarriage, your provider may offer you different options to help complete the miscarriage. Each of these options ends in your uterus being emptied of all the pregnancy tissue. There is no one right option. Here are the possibilities:

“Watch and wait” (sometimes also called “watchful waiting” or “expectant management”)

This option means that you and your provider decide to give your body time to expel the pregnancy tissue on its own. Human bodies are pretty good at recognizing when a pregnancy isn’t able to continue, and most of the time, sooner or later, will start the process of pushing that pregnancy tissue out. This causes the cramping and bleeding that people experience during a miscarriage.

Pros: No medicine or procedure is involved. Some may feel this approach is more “natural” and want to try it first before moving to another treatment option if they need to.

Cons: It’s hard to know exactly how long it’ll take for the miscarriage to be complete, especially if there aren’t physical symptoms of miscarriage when the diagnosis is made. Most of the time, all of the pregnancy tissue will be passed within two weeks, but it can sometimes take longer. Some people find it hard to wait, not knowing exactly when the experience will be over. And some don’t like not knowing whether they might end up needing another treatment if their body doesn’t complete the miscarriage on its own.

Medication (mifepristone and misoprostol or just misoprostol)

If bleeding and cramping haven’t started on their own and some or all of the pregnancy tissue is still in your uterus, your provider may be able to give you medicine to help your uterus start the process of passing the pregnancy.

Once you take misoprostol (either by itself or after taking mifepristone), and the process begins, most of the pregnancy tissue should pass within two to four hours. You may continue to have some bleeding for up to six weeks though.

Pros: There’s no procedure involved and you have more control over the timing of when the miscarriage happens than you do with the “watch and wait” option. You can take the pills at home and have your miscarriage in the privacy of your own space, rather than at a provider’s office like you would do with a procedure.

Cons: About 15% to 20% of people won’t pass the pregnancy after taking the pills and will still need a procedure to remove all the pregnancy tissue.

Procedure (also called“aspiration” or “D&C”)

This option involves your provider doing a procedure, sometimes right in the office, to remove any pregnancy tissue that’s still inside the uterus.

Pros: A procedure can be planned on your and your provider’s schedule. Some providers can offer stronger pain control medicines as pills or through an IV. Some offer general anesthesia, which is when you’re completely asleep during the procedure and won’t remember anything about it afterward. If you get a procedure to complete your miscarriage, it’s very unlikely that you’ll need any further treatment for the miscarriage.

Cons: While having a procedure to treat a miscarriage is very safe, there is always a small risk that comes with any kind of invasive procedure. About 1 in 400 people having this kind of procedure have a serious complication.

These are all safe and reasonable options, so talk with your provider about which approach they’d recommend and think about which you’re most comfortable with.

Take good care

If you find yourself dealing with a miscarriage, it’s important to take good care of yourself physically and mentally. That includes making sure you deal with your miscarriage in whatever way you’re most comfortable with.

Some health care providers may feel more comfortable with one treatment than another, so it’s good to know a little bit beforehand about your options. If your provider doesn’t offer the treatment you prefer, it’s okay to ask for a referral to someone who does. (For example, ob-gyns have surgical training and may be more comfortable than other kinds of providers offering all three options.)