Miscarriage: What Happens, and How to Grieve
Miscarriage is common, rarely anyone's fault, and still too often carried in silence. Here is a gentle guide to the signs, what happens medically, when tests are offered, and how to grieve, for you and for your partner.
TL;DR: About 15 in every 100 known pregnancies end in miscarriage, most often because of a chromosome problem that nobody caused. Bleeding and cramping before 24 weeks are the main signs. Care can mean waiting for nature, medicine, or a small procedure. Tests for an underlying cause are usually offered after three miscarriages. Your grief is valid, however early the loss, and so is your partner's.
If you are reading this because you have just lost a pregnancy, or you are bleeding and frightened, we are so sorry. Whatever you are feeling right now, shock, numbness, guilt, relief, deep sadness or all of it at once, is allowed. Many women go through miscarriage quietly. In many African families a pregnancy is not announced until it is showing, so when a loss comes early, few people even knew there was a baby to grieve. You may be back at work the next week with no one aware of what you carried home. This guide is here to explain what happens, gently and clearly, and to remind you that you do not have to carry it alone.
How common is miscarriage?
Far more common than most people realise. A major 2021 Lancet series found that about 15 percent of recognised pregnancies end in miscarriage, around 23 million losses worldwide every year. About 11 percent of women have had one miscarriage, about 2 percent have had two, and fewer than 1 in 100 have had three or more. A loss before 24 weeks is called a miscarriage; after that, it is a stillbirth.
What are the signs of a miscarriage?
According to the NHS, the main sign of miscarriage is vaginal bleeding before 24 weeks, often with cramping or pain in the lower tummy, and sometimes pink, grey or white tissue passing from the vagina. Some women have no symptoms at all and only learn at a scan that the pregnancy stopped developing. This is called a missed miscarriage, and it can be especially hard because the body gave no warning.
Light bleeding in early pregnancy is common and does not always mean a miscarriage. ACOG notes that a small amount of spotting often settles. If you are bleeding, contact your midwife, doctor or early pregnancy unit, who can check with a scan and sometimes blood tests.
Did I cause my miscarriage?
Almost certainly not. This is the question so many women ask, often in the middle of the night, so please hear it clearly. The American College of Obstetricians and Gynecologists states that working, exercising, stress, arguments, having sex, or having used birth control pills before pregnancy do not cause miscarriage. Lifting your toddler, the long bus ride, the spicy food, the argument with your husband, none of these ended your pregnancy.
The RCOG explains that about half of all miscarriages happen because the pregnancy developed with abnormal chromosomes, usually by chance, even when both parents' own chromosomes are normal. Some factors do raise the risk, including being 35 or older and smoking, and long-term conditions such as poorly controlled diabetes, which we cover in diabetes, periods, sex and fertility. Even then, a risk factor is not blame.
What happens medically after a miscarriage?
A miscarriage cannot be stopped once it has started, but you will usually be offered choices for what happens next. For an early miscarriage, before 14 weeks, the NHS describes three main options:
- Waiting (expectant management). Letting the pregnancy pass naturally, which usually takes about two weeks but can take longer.
- Medicine (medical management). Tablets to help the pregnancy pass. You may be able to go home after taking them, or you may be monitored in hospital.
- A small procedure (surgical management). A thin tube is passed through the vagina into the womb to remove the pregnancy with gentle suction, under general or local anaesthetic.
There is no single right choice. Some women want to wait at home in private; others want it over quickly, or prefer a hospital setting. Ask what each option involves, how much pain and bleeding to expect, and who to call if you are worried. If you were at least 12 weeks pregnant and your blood group is rhesus negative, you may be offered an anti-D injection.
Afterwards, bleeding or spotting can last up to two weeks and cramping a few days. The NHS advises avoiding sex until symptoms have gone to lower the risk of infection, and notes it can take up to eight weeks for a period to return. Most women who have a miscarriage go on to have a successful pregnancy. When you feel ready, our fertility tips for getting pregnant may help.
When are tests offered for recurrent miscarriage?
In the UK, the NHS and RCOG define recurrent miscarriage as three or more early miscarriages, which affects about 1 in 100 women, and that is when referral for tests is usually offered. The 2023 RCOG guideline keeps the threshold at three, but encourages clinicians to use their judgement and investigate after two if there is reason to suspect an underlying cause. If you have had two miscarriages and feel something is wrong, it is reasonable to ask.
Tests can include blood tests for antiphospholipid syndrome, a condition that affects blood clotting, done twice at least 12 weeks apart; checks of thyroid function; a scan to look at the shape of the womb; and sometimes chromosome testing. Often no cause is found. That is hard to hear, but the RCOG says that when recurrent miscarriage is unexplained, most women still have a good chance of a successful pregnancy in future. Our guide on how to talk to your gynaecologist can help you prepare questions.
How do you grieve a miscarriage?
There is no correct way, and no timetable. Some women grieve deeply for months. Others feel they should be "over it" because the pregnancy was early, and then feel guilty for still hurting. A loss at seven weeks can carry the weight of every hope you had already started to build.
Silence makes it heavier. You may hear "it was not meant to be", "at least it was early", or "you can try again". People usually mean well, but these words can sting. You are allowed to say, "I just need you to listen." For women of faith, prayer, scripture, your imam, pastor or priest, and the rituals of your community can be a deep source of comfort, and grief and faith can sit side by side. Some families mark the loss with a quiet prayer, a name, planting a tree or lighting a candle. If you live in England, you can request an official baby loss certificate for a loss before 24 weeks, which some parents find meaningful.
If sadness does not lift, or you have trouble sleeping, eating or functioning, please reach out. Grief after pregnancy loss can turn into anxiety or depression, which we cover in anxiety and depression in women. If talking about this at home feels impossible, our guide to talking about mental health with your African family may help, and affordable therapy in Lagos, Nairobi and London lists places to start.
Partners grieve too
Partners often feel they must be the strong one, holding everything together while their own loss goes unseen. ACOG notes that partners may grieve differently, and that emotional healing often takes longer than physical healing. One of you may want to talk while the other goes quiet; neither is wrong. Try to name the loss together, and let each other grieve in your own way.
When to seek urgent care
Call 999 or your local emergency number, or go to A&E, if you are pregnant and bleeding and you have severe tummy pain, pain in the tip of your shoulder, feel faint or dizzy, or the bleeding is heavy. Shoulder pain can be a sign of an ectopic pregnancy, which is an emergency. After a miscarriage, get help right away if you soak through more than two large pads an hour for two hours in a row, or have a fever, chills or severe pain, which can mean heavy bleeding or infection.
This post is education, not medical advice. Please contact a clinician about your own symptoms and care.
When you feel ready, and only then, Asele can help you notice your body again. Cycle tracking can show when your periods return and settle, symptom logging can capture bleeding, pain and mood, and Amara is there to talk things through in Yoruba, Hausa, Igbo, Swahili, French or English. If you are referred for tests, the Health Brief can turn your history into a short summary for your appointment, so you do not have to retell everything in a hard moment. You can find us at Asele. Be gentle with yourself.
References
- Quenby S, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. The Lancet, 2021. pubmed.ncbi.nlm.nih.gov
- NHS. Miscarriage. nhs.uk
- NHS. Miscarriage: what happens. nhs.uk
- American College of Obstetricians and Gynecologists. Early pregnancy loss. acog.org
- Royal College of Obstetricians and Gynaecologists. Recurrent miscarriage: patient information. rcog.org.uk
- Regan L, et al. Recurrent miscarriage, Green-top Guideline No. 17. BJOG, 2023. obgyn.onlinelibrary.wiley.com
- GOV.UK. Request a baby loss certificate. gov.uk
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