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It’s normal to feel a flood of emotions after learning your pregnancy is no longer viable. In addition to any sadness you may have over the loss, you probably have some concerns about your own health. Or maybe you have yet to get a confirmation that what you’re feeling is a miscarriage and find yourself asking, “What does a miscarriage feel like?”
Words can’t always capture the emotional pain and grief, as well as the physical sensation of a miscarriage. As important as it is to feel prepared and understand what your body is going through, you may not fully get what a miscarriage feels like until you experience it yourself.
Still, it’s important to educate yourself and understand your options, for example, if you can’t or don’t want to pass the fetal tissue naturally after a miscarriage (more on this below).
What does a miscarriage feel like?
While miscarriages often feel like isolating experiences, the truth is they are quite common. Up to 26% of pregnancies end in miscarriage, with most occurring during the first trimester, the first 12 weeks of pregnancy. Usually, this is due to chromosomal abnormalities (chromosomes are structures that contain your genes), that cause the fetus to have extra or not enough genetic material. Many chromosomal abnormalities are not compatible with life (Dugas, 2021; American Society for Reproductive Medicine, 2012).
It’s important to remember that every pregnancy, and every body, is different. If you have bleeding or cramping, even if it feels like a past pregnancy loss, it’s important you see your healthcare provider before assuming you lost the pregnancy.
Miscarriage: symptoms, causes, types, risk factors
Miscarriage in the first trimester
What a miscarriage feels like depends on how far along you are. Aside from intense uterine cramping that can feel worse than the cramping you experience during your average menstrual period, other symptoms of miscarriage include (Van den Akker, 2011):
- Mild to severe lower back pain
- Pink-colored vaginal discharge
- Tissue clots and heavy vaginal bleeding
- Mild to severe uterine contractions that come in waves
- Loss of pregnancy symptoms such as sore breasts, morning sickness, and fatigue
- A negative urine pregnancy test for very early pregnancy losses
It’s also possible that you may feel nothing at all. Sometimes you can lose a pregnancy without experiencing any bleeding or cramping. These losses, also known as missed miscarriages, are typically diagnosed at your doctor’s office when there is no fetal growth or heartbeat. Or you might experience a chemical pregnancy, an early miscarriage that occurs between conception and your first missed period and often goes undetected (Dugas, 2021).
Of course, physical symptoms are not the only symptoms many experience when miscarrying. Emotional symptoms are usually present, too. While they can vary, grief and depression are common following a miscarriage. You may feel these symptoms at any time during the process or weeks, months, or even years after your loss.
The stress of a miscarriage can also lead to strained relationships, anxiety, post-traumatic stress disorder, panic disorder, and obsessive-compulsive disorder. These symptoms may be worse for people experiencing recurrent miscarriages or more than one miscarriage (Van den Akker, 2011).
Molar pregnancy: causes, symptoms, and treatment
Pregnancy loss in the second and third trimesters
There are two types of pregnancy losses. Losing a pregnancy before 20 weeks is a miscarriage. After 20 weeks, it’s considered a stillbirth. Because the second trimester includes weeks 13-27 of pregnancy, it is possible to miscarry during the second trimester, but it is rare. About 24% of second-trimester miscarriages are due to chromosomal abnormalities; the rest are due to problems with the uterus, cervix, or placenta; immune issues; physical trauma; infection; drug use; or uncontrolled illness. Regardless of the cause, second-trimester losses before 20 weeks typically present with the same symptoms and require the same treatments as first-trimester losses (Dugas, 2021; American Society for Reproductive Medicine, 2012; Michels, 2007).
If you feel any of the miscarriage symptoms listed above during your second trimester, it is wise to see your healthcare provider. And, if you are in your late second trimester or your third trimester and notice a lack of fetal movement or experience heavy blood loss, reach out to a healthcare provider immediately (Da Silva, 2016).
Diagnosing a miscarriage
If you are pregnant and start bleeding, your healthcare provider will want to check the health of your pregnancy. How they do this depends on how far along you are.
There are two tests medical professionals use when assessing the health of a pregnancy: a blood test checking human chorionic gonadotropin (hCG) levels and transvaginal ultrasound, where they insert a thin probe in the vagina to get images of the reproductive organs, measure the gestational sac and length of the fetus, and check for any cardiac activity (American College of Obstetricians and Gynecologists, 2018).
Sometimes, tests might be inconclusive, and your healthcare provider will ask you to come back in a few days to repeat them. Waiting to know the outcome of your pregnancy can be emotionally painful. Still, it’s important to be 100% certain that the pregnancy is not viable, especially if you plan on taking medication or having surgery to help you pass the tissue (American College of Obstetricians and Gynecologists, 2018).
What is a chemical pregnancy and how does it happen?
Treating a miscarriage
If your healthcare provider confirms that you are miscarrying, they will usually give you the option to pass the fetal tissue on your own (expectant management) or use medical assistance.
While research shows emotional symptoms tend to be the same regardless of the method you choose, some people prefer medical assistance over expectant management, as medications and procedures can make the process faster, with expectant management taking up to eight weeks to completely pass pregnancy tissue (Van den Akker, 2011; Luise, 2002).
If you choose to take medication, your healthcare provider may give you a prescription for mifepristone, which blocks progesterone, a hormone involved in sustaining a pregnancy, and misoprostol, which causes the uterus to contract and the cervix to thin. You will get one to two doses to take either orally or vaginally. Symptoms for this version of medical assistance include vaginal bleeding lasting for up to 16 days, nausea, and diarrhea (Macnaughton, 2021; Coughlin, 2009).
The other medical option is a procedure known as a “D&C” or dilation and curettage. As part of this procedure, your healthcare provider will dilate your cervix and remove the tissue with either sharp instruments or suction. Following the procedure, you may have abdominal pain, uterine cramping, and bleeding (Dugas, 2021).
When to see a doctor
It’s important to see your healthcare provider if you think you may be having a miscarriage. If you have lost the pregnancy, your healthcare team will ensure the process is complete and that there is no fetal tissue left in the uterus.
And just as important as it is to take care of yourself physically, it’s also essential to take care of yourself mentally. If you find yourself struggling—whether it’s days, weeks, or months later—reach out to a trusted loved one or a mental health professional and share your feelings about the loss.
- American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology (2018). ACOG Practice Bulletin No. 200: Early Pregnancy Loss. Obstetrics and Gynecology, 132(5), e197–e207. doi: 10.1097/AOG.0000000000002899. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30157093/
- Annan, J. J. K., Gudi, A., Shah, A., & Homburg, R. (2013). Biochemical pregnancy during assisted conception: a little bit pregnant. Journal of Clinical Medicine Research, 5(4), 269-274. doi: 10.4021/jocmr1008w. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3712881/
- Coughlin, L. B., Roberts, D., Haddad, N. G., & Long, A. (2004). Medical management of first trimester miscarriage (blighted ovum and missed abortion): is it effective?. Journal of Obstetrics and Gynaecology, 24(1), 69-71. doi: 10.1080/01443610310001620332. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/01443610310001620332?src=recsys
- Da Silva, F. T., Gonik, B., McMillan, M., Keech, C., Dellicour, S.,Bhange, S., et al. (2016). Stillbirth: case definition and guidelines for data collection, analysis, and presentation of maternal immunization safety data. Vaccine, 34(49), 6057-6068. doi: 10.1016/j.vaccine.2016.03.044. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5139804/
- Dugas, C., & Slane, V. H. (2021). Miscarriage. [Updated Jun 29, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532992/
- Garcia-Enguidanos, A., Calle, M. E., Valero, J., Luna, S., & Dominguez-Rojas, V. (2002). Risk factors in miscarriage: a review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 102(2), 111-119. doi: 10.1016/S0301-2115(01)00613-3. Retrieved from https://www.sciencedirect.com/science/article/pii/S0301211501006133#BIB65
- Luise, C., Jermy, K., May, C., Costello, G., Collins, W. P., & Bourne, T. H. (2002). Outcome of expectant management of spontaneous first trimester miscarriage: observational study. BMJ (Clinical research ed.), 324(7342), 873–875. doi: 10.1136/bmj.324.7342.873. Retrieved from https://pubmed.ncbi.nlm.nih.gov/11950733/
- Macnaughton, H., Nothnagle, M., & Early, J. (2021). Mifepristone and Misoprostol for Early Pregnancy Loss and Medication Abortion. American Family Physician, 103(8), 473-480. Retrieved from https://www.aafp.org/pubs/afp/issues/2021/0415/p473.html
- Michels, T., & Tiu, A. (2007). Second trimester pregnancy loss. American Family Physician, 76(9), 1341-1346. Retrieved from https://www.aafp.org/pubs/afp/issues/2007/1101/p1341.html
- Pineles, B. L., Park, E., & Samet, J. M. (2014). Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. American journal of epidemiology, 179(7), 807-823. doi: 10.1093/aje/kwt334. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24518810/
- Van den Akker, O. B. (2011). The psychological and social consequences of miscarriage. Expert Review of Obstetrics & Gynecology, 6(3), 295-304. doi: 10.1586/eog.11.14. Retrieved from https://www.tandfonline.com/doi/full/10.1586/eog.11.14?src=recsys
Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.