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What Happens When You Have a Miscarriage?

You can’t believe it. You are finally pregnant with a much- desired pregnancy.  You carefully planned out how you would tell your husband the exciting news and it made your heart explode seeing his reaction.  You are floating on cloud nine and love having this little “secret” that only you and your partner know about.  You have heard stories about not telling anyone until you are out of the first trimester- twelve weeks- in case of miscarriage, and so you don’t tell another soul, but never really thought it would happen to you.

But then it does.

You wake up with a little blood. Fear rushes into your heart. You wish it away and just go about your day, hopeful it was nothing.  Spotting does occur sometimes in pregnancy and it doesn’t always mean something is wrong. 

Then the cramping starts.

In a panic, you call your doctor and are seen that day for an ultrasound.  Unfortunately, your worst fears are confirmed. There is no heartbeat on the ultrasound where it previously had been seen.  The moment feels surreal and a hurt you didn’t know was possible has clamped down with a crushing pressure on your heart.

Your doctor gently explained to you what was happening and what to expect next.  There are options to think about and possible explanations for why this happened.  However, you realize while looking at your husband, whose eyes are brimming with tears and looking straight at the floor, that you don’t hear a word that is being said.

It is too much.  Too much to comprehend.  Too much hurt and disappointment to even grasp and absorb what is being told to you.

As an obstetrician, unfortunately, this is something we see in the office almost every day.  After years of practice, it never gets easier to tell a family that a miscarriage has occurred.  Most patients need time to grieve, reflect, and compose themselves before they are ready to hear about what needs to happen next.

If you are not hemorrhaging, you have time. In case you didn’t hear (or couldn’t absorb due to your emotional state) all the options your doctor discussed with you about your miscarriage, I want to help you remember them now.  I want to be an advocate for you to know what to expect and next steps. Of course, you should always call your own doctor for medical advice pertinent to your unique medical situation, but in general the following advice applies to straightforward miscarriages.

You have 3 basic options:

Watch and wait: If it is all just too much, and you are not ready to take any action, or perhaps you want to give your body time to complete the miscarriage on its own you do have the option to just wait.  Eventually, you will begin cramping and bleeding more.  This usually happens within several weeks, but if it doesn’t you need to follow up.  If it is very early in the pregnancy, you may be able to avoid multiple medical visits and complete the process at home.  It can be comforting this way, but also scary for some.  You may not know when to expect the most bleeding or cramping.  Most can safely have a miscarriage without intervention.  You will of course need to follow up with your doctor to make sure everything is complete and follow up with any questions or if bleeding is heavy.  They will need to check your blood type to make sure you won’t need an important medication called Rhogam for any future pregnancies. 

Medication to initiate the process: Perhaps you don’t want the uncertainty of not knowing when the miscarriage will truly take place, and you feel uncomfortable waiting weeks for it to happen. You have been through a lot already and you want to speed up the process but don’t feel that a procedure is how you want to proceed.  A good option for you may be taking a medication that will induce the cramping that helps you pass the tissue of the nonviable pregnancy from the uterus.  It will usually start the process within 24 hours of taking the medication and you may have more control over the timing of completing the miscarriage.  However, be aware that you may ultimately need a procedure if the miscarriage is not complete or the bleeding is too heavy.  For this reason, it is always important to follow up with your doctor throughout the process as directed. 

Procedure:  A minor surgical procedure called “D & C” is also an option. This may be a welcome alternative if you cannot take a lot of time off work.  Perhaps you may be caring for several other small children and unable to find time to care for yourself in a way necessary when having a miscarriage at home.  Another common reason for having the procedure is to have the painful experience over more quickly.  Often, you are asleep for the procedure and the pregnancy tissue is removed.  This dramatically decreases the bleeding and cramping you can expect, although you may still have a small amount after the procedure.  It gives you control over when and how the miscarriage occurs and is completed.

There is no right or wrong option for how you move forward after a miscarriage (or failed pregnancy) has been confirmed.  However, you should be given all of these options.  If you are not, ask your doctor about it as they may have an explanation why in your particular case one option may be better than the other.

The most important thing to remember when you have a miscarriage is that it is not your fault.  It is out your control when a first trimester miscarriage happens.  Often, it is a very good sign that if you got pregnant once, you will be able to get pregnant again.  Although the hopes and dreams of the current pregnancy that you lost will never be replaced, you can find comfort in knowing that you will likely again one day have the opportunity to have a successful pregnancy.

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