Understanding Early, Late and Recurrent Miscarriage

The term miscarriage refers to the loss of a baby in the first 24 weeks of pregnancy (1, 2). Unfortunately, miscarriages are a common complication of pregnancy, with the majority of miscarriages occurring within the first trimester (first three months of pregnancy) (2,3). Experiencing a miscarriage can be devastating, and we hope that this blog post will provide some support in navigating all of the available information on what you can expect during and after a miscarriage.

This post will explore the differences between early, late and recurrent miscarriages, as well as the investigations you might be offered following a miscarriage and the outlook regarding future fertility. We will also discuss the ways you can access ongoing professional and community support after experiencing a miscarriage.

Early Miscarriage

If you lose your baby in the first 12 weeks of being pregnant, this is called an early miscarriage. The majority of miscarriages are early miscarriages and sadly 1 in 5 women will experience an early miscarriage with no obvious cause. Early miscarriages can sometimes happen before a woman has missed her period or is even aware that she is pregnant (3, 4).

What are the symptoms of an early miscarriage?

The symptoms of an early miscarriage include (2-5):

⭐ Vaginal bleeding that might require a sanitary pad. This bleeding can vary from light spotting and/or a brownish discharge to heavy, bright red bleeding with or without blood clots.

⭐ Discharge of tissue and/or fluid from the vagina.

⭐ Lower abdominal (tummy) pain and/or cramping.

⭐ An end to pregnancy related symptoms that you had been experiencing, such as breast tenderness or nausea.

Occasionally, women can have a miscarriage but experience no symptoms. When this happens, a miscarriage might not be diagnosed until a woman has had her first ultrasound scan (4).

It is important to remember that vaginal bleeding in early pregnancy can be caused by a number of different conditions, and does not necessarily mean that you are having a miscarriage (2,3,5). You can read more about the causes of bleeding in early pregnancy on our blog post.

What are the causes of an early miscarriage?

It is often not possible for a healthcare professional to identify the specific reason why you have miscarried (2-4, 6).

However, the most common cause of early miscarriages is believed to be an abnormality of the baby’s chromosomes. Chromosomes are found within each of your baby’s cells and they contain the genetic information (DNA) inherited from both parents that is necessary for your baby’s growth in the womb. Unfortunately, if there is a problem with any of your baby’s chromosomes, it might lead to developmental abnormalities that are sadly not compatible with life. The good news is that this does not mean that you or your partner have any abnormalities of your own chromosomes. It also does not mean that a future pregnancy will be affected by chromosomal problems (3,4,6).

Early miscarriages can also be caused by problems with the development of the placenta, which is the organ responsible for supplying your baby with oxygen and nutrients essential for normal development (4,6).

There are other factors which increase a woman’s risk of having an early miscarriage, including (3,6):

⭐ Increased age: the risk of miscarriage in women over the age of 40 is approximately 50% (compared to around 20% in women aged 30) (3).

⭐ Medical conditions: including several long-term health problems, such as poorly-controlled high blood pressure, diabetes and an over/under active thyroid gland.

⭐ Lifestyle factors: including smoking, excessive alcohol and/or caffeine intake, obesity and illicit drug use.

How is an early miscarriage diagnosed?

If you think that you might be having an early miscarriage, you must be assessed by an appropriate healthcare professional (e.g. GP or midwife) as quickly as possible (3). You can also be seen at your local Early Pregnancy Assessment Unit (if you are based in the UK, you can find your closest Unit here).

⚠️ If you are experiencing any of the following (3):

• heavy bleeding
• severe tummy pain
• feeling dizzy and/or faint
• collapse
• feeling very unwell

then you must seek urgent medical attention at your local Accident and Emergency department or by phoning your local emergency line (e.g. 999 in the UK).

An early miscarriage is usually diagnosed using a combination of the following tests (3):

👩‍⚕️ Ultrasound scan: this might be trans-abdominal (where the scan probe is moved across your tummy) or trans-vaginal (where the scan probe is placed gently inside your vagina). Neither a trans-abdominal or trans-vaginal ultrasound increases your risk of having a miscarriage.

👩‍⚕️ Blood tests: specifically to check your level of hCG (pregnancy hormone).

👩‍⚕️ Vaginal speculum examination: this might be done to check for other causes of bleeding and/or pain.

What will happen if I am diagnosed with an early miscarriage?

If tests confirm that you have had a miscarriage and your ultrasound scan shows that all of the pregnancy has come away from your womb, you might not need any further treatment (3).

However, if your ultrasound shows that some of the pregnancy remains in your womb, you will require treatment to “complete” the miscarriage. There are usually three options available to women in this situation, and your maternity care professional will be able to discuss the treatments with you that are best suited to your individual circumstance (3,7).

The treatment options for an early miscarriage include (3,7):

👩‍⚕️ Expectant management

This approach involves waiting to see if the miscarriage completes naturally and has a success rate of around 50%. It can take a while for bleeding to begin and it can persist for up to 3 weeks. The heaviness of bleeding varies from woman to woman and you may also experience some cramping. If bleeding is very heavy or you suffer from severe tummy pain or cramping, it might be necessary to admit you to hospital.

👩‍⚕️ Medical management

This involves taking a medication called Misoprostol, which is available as either a tablet or pessary. Misoprostol works by encouraging the cervix to open, allowing the remaining pregnancy tissue to come away from your womb. After taking the medication, you will experience some bleeding, pain and/or cramping (similar to having a heavy period). This bleeding can continue for up to 3 weeks and, similar to expectant management, you might need to be admitted to hospital if it is very heavy or you have severe pain. Misoprostol is successful in treating miscarriage around 85% of the time.

👩‍⚕️ Surgical management

Surgery to treat a miscarriage involves removing the remaining pregnancy through your cervix, and is performed either under general anesthetic (where you are asleep) or local anesthetic (where you are awake but feel no pain). You might be given some medication to take before surgery that helps to soften the cervix. How quickly you need to have surgery will depend on a number of factors, including: how heavy your bleeding is; whether you have any signs of infection; and whether you have previously tried expectant or medical management for your miscarriage. Surgery is successful in treating miscarriage approximately 95% of the time.

Pregnancy remains that are removed during surgery are sometimes sent to the hospital laboratory for testing. These tests can check for any problems with the placenta and also confirm that the pregnancy was developing inside your womb and was not ectopic (where a pregnancy grows outside of the womb). Women who have had expectant or medical management might be able to bring their pregnancy remains into hospital if they would like these tests to be done. You and your partner will be able to sensitively discuss options for disposal of your pregnancy remains with the healthcare team at your hospital (3).

What happens after I have been treated for an early miscarriage?

A miscarriage is an extremely personal experience, and every woman will feel differently in the period following a miscarriage. These are some symptoms that you might experience in the weeks after an early miscarriage (3):

⭐ Continued vaginal bleeding for 1-2 weeks. This bleeding will likely be on the heavier side initially, but should become lighter as time goes on. You should not use tampons following a miscarriage, as these can increase your risk of developing an infection. You can expect to ovulate before your next regular period; this means that you should use contraception if you do not want to get pregnant.

⭐ Mild to moderate abdominal (tummy) discomfort. You will likely experience discomfort that feels like strong period pains on the day of your miscarriage. In the following days, you might have some milder cramps and/or an aching sensation in your lower tummy.

⭐ Emotional distress. A miscarriage can be devastating for you and your partner. Every person feels differently in the period following a miscarriage, and emotions can range from low mood and tearfulness to severe grief. See below for advice on where to access support after a miscarriage, as well as tips for how to cope with your loss.

⚠️ Occasionally, women develop serious side-effects of a miscarriage or treatment for a miscarriage, including infection of the womb and/or damage to the womb. You can also become very unwell if any of the pregnancy has remained in your womb (3).

You must seek urgent medical help (e.g. at Accident and Emergency or the Early Pregnancy Assessment Unit at your local hospital) if you experience any of the following symptoms (3):

❗ Vaginal bleeding that is very heavy and/or bleeding that lasts longer than 2 weeks

❗ Severe abdominal (tummy) pain (e.g. pain that does not get better with over-the-counter painkillers)

❗ Smelly vaginal discharge

❗ Fever

❗ Flu-like symptoms

❗ Loss of appetitie

❗ Severe nausea and/or vomiting

❗ Persistently feeling generally unwell

Will I have another miscarriage?

Women who have had one or two early miscarriages are not at increased risk of having further miscarriages. For the majority of women, a miscarriage is a singular event and you have an excellent chance of having a successful future pregnancy (3).

Very rarely, women have a condition that make them more likely to suffer from miscarriages (3). You can read more information about this below.

Late & Recurrent Miscarriage

What is a late miscarriage?

If you lose your baby after 12 weeks but before 24 weeks of being pregnant, this is called a late miscarriage. Late miscarriages are sometimes called second or third trimester pregnancy losses. They are much less common than early miscarriages, occurring in around 1-2 out of every 100 pregnancies (1-2%) (1,8,9).

What is a recurrent miscarriage?

When a woman has three or more miscarriages in a row, this is called recurrent miscarriage. Around 1 out of every 100 couples trying to conceive (1%) suffer with recurrent miscarriage (1).

What are the symptoms of a late miscarriage?

The symptoms of a late miscarriage include (10):

⭐ Vaginal bleeding that varies in severity, but is often moderate to heavy and can include blood clots.

⭐ Strong, cramping abdominal (tummy) pain that can resemble labour pains.

⭐ Baby movements that change, slow down and/or stop.

⭐ Breaking of your waters; if this happens, you might deliver your baby very quickly.

Some women have no symptoms with a late miscarriage, and sadly only find out that they have lost their baby at their next ultrasound scan (10). The symptoms of recurrent miscarriage will depend on whether the loss is an early or late miscarriage.

What causes late and recurrent miscarriage?

For some women who suffer from late or recurrent miscarriage, there is no specific cause found (1,8). However, other times, there is a reason identified for why a late or recurrent miscarriage has occurred (1,6,8,9,11).

There are numerous factors which may make you more likely to suffer from late and/or recurrent miscarriage, including (1,6,8,9,11):

⭐ Parental age

• Older mothers have a greater risk of late and recurrent miscarriage than younger mothers. For women aged over 40, more than 50% of pregnancies unfortunately end in miscarriage. Couples may also be more likely to miscarry if the father is older.

⭐ Chromosome abnormalities

• Chromosomes are found within each cell of your body, and they contain the genetic information (DNA) that you have inherited from your parents. If you or your partner has a chromosome abnormality, it can make you more likely to suffer from late and/or recurrent miscarriage. One partner is found to have an abnormality on one of their chromosomes in around 2 to 5% of couples who struggle with recurrent miscarriage. Even though this abnormality might not impact the parent, it can sadly be incompatible with life for your baby.

⭐ Structural abnormalities of the baby

• Some structural abnormalities of the baby, such as spina bifida or congenital heart defects, can result in late miscarriage. This is unlikely to be the cause of recurrent miscarriage.

⭐ Anatomical abnormalities

• There is some evidence that an abnormally shaped womb (uterus) can contribute to late and recurrent miscarriage, but exactly how large an effect this can have is unclear. However, small differences in womb shape do not appear to predispose to miscarriage.
• Weakness of the cervix is known to increase a woman’s likelihood of experiencing a late miscarriage.

⭐ Antiphospholipid Syndrome

• Antiphospholipid syndrome is a rare autoimmune disease that means the blood clots more easily than it should. Women with this condition are at increased risk of both late and recurrent miscarriage.

⭐ Thrombophilia

• Thombophilia is an inherited medical blood disorder that causes the blood to easily form clots. Thrombophilia is particularly linked to late miscarriage, but also recurrent miscarriage.

⭐ Infections

• Unfortunately, any infection that makes the mother very sick can cause a late miscarriage.
• Late miscarriages can also be caused by infections that directly affect your baby (e.g. parvovirus or toxoplasmosis) or the fluid around your baby (e.g. bacterial vaginosis). It is currently unclear whether infections also play a role in recurrent miscarriage.

⭐ Diabetes and thyroid conditions

• If you have poorly controlled diabetes and/or problems with your thyroid, this can cause a late miscarriage. However, as long as these conditions are properly managed, they shouldn’t cause recurrent miscarriage.

⭐ Lifestyle factors

• The lifestyle factors that contribute to early miscarriage (e.g. obesity, smoking, excess alcohol use etc.) can also increase your risk of late or recurrent miscarriage.

How is a late miscarriage diagnosed?

If you have any of the symptoms of a late miscarriage (or any concerns about your baby’s movements), it is important that you are seen promptly by a maternity care professional. Late miscarriages are often diagnosed with an ultrasound scan, and this can be either trans-vaginal or trans-abdominal. You will be diagnosed with recurrent miscarriage if you have had three or more confirmed miscarriages (either early, late or a combination) (1).

What will happen if I am diagnosed with a late miscarriage?

If you are diagnosed with a late miscarriage, you will have to go through labour to deliver your baby. This can be an extremely traumatic experience, and it is important to remember that the midwife and/or doctor caring for you will understand this and be there to support you throughout your time in hospital (8,10).

Options on how to deliver your baby may include (10):

👩‍⚕️ Waiting to see if labour begins naturally. You might be given the choice of waiting at home or being admitted to hospital. If you do go home, it might be helpful to have someone you trust stay with you for support.

👩‍⚕️Having your labour induced (started artificially with medication). If your labour is being induced, you will likely be given a few different medications, which can include tablets, pessaries and an intravenous drip.

Once your labour has started, you will be given appropriate pain relief to ensure you are as comfortable as possible throughout the process (10).

What can be done to reduce my risk of future miscarriages?

If you have had a late miscarriage, or been diagnosed with recurrent miscarriage, you might have lots of questions about what can be done to reduce your risk of having further miscarriages. The first step will likely involve a series of tests to determine if a cause can be found for your miscarriage(s). If these tests reveal a possible cause, the second step will involve exploring treatment options with a maternity care professional (1,11).

The tests you might be offered include (1,11):

👩‍⚕️ Blood tests (specifically to check for antiphospholipid syndrome, thrombophilia, infection and/or chromosome abnormalities).

👩‍⚕️ Vaginal swabs to check for infection.

👩‍⚕️ A check of your baby’s chromosomes, to identify any abnormalities.

👩‍⚕️ Post-mortem examination of your baby.

👩‍⚕️ Trans-vaginal ultrasound scan to assess the shape of your womb (uterus). If any abnormalities are found, you might be offered further investigation of your womb, such as a hysteroscopy (where a small telescope is placed through the cervix to enable more detailed assessment of the womb).

The treatment options available to you will depend on the results of your tests and whether any possible cause for your miscarriage is identified. Your maternity care doctor will be able to discuss possible treatment options with you and your partner and explore the management best suited to your individual circumstance (1).

Possible treatment options can include (1,11):

👩‍⚕️ Treatment for Antiphospholipid Syndrome

If you are diagnosed with antiphospholipid syndrome, you will likely be prescribed low dose aspirin tablets and injections of a medication called heparin. These medications reduce your blood’s ability to clot and are safe to take during pregnancy. When used together during pregnancy, aspirin and heparin have been shown to increase the likelihood of successful pregnancy in women with antiphospholipid syndrome. Women with this condition are monitored closely throughout their pregnancy, and will likely have extra antenatal appointments, so that any problems can be handled quickly and safely.

👩‍⚕️ Treatment for Thrombophilia

Women diagnosed with thrombophilia are often treated with heparin injections to reduce their risk of late miscarriage.

👩‍⚕️Genetic Counseling

Couples who are found to have a chromosome abnormality are often referred for genetic counseling. This means you will have an appointment with a specialist called a clinical geneticist who will be able to discuss options with you for approaching future pregnancies.

👩‍⚕️ Surgery

If you are found to have an abnormality of your womb that might be contributing to late or recurrent miscarriage, you might be offered surgery to try and correct this.

👩‍⚕️ Cervical stitch

Women who are found to have a weak cervix and have had a late miscarriage are sometimes offered surgery to have a stitch put in the cervix. This surgery is often performed through the vagina at 13 or 14 weeks of pregnancy. You may be offered the option of being asleep (general anesthetic) or awake (spinal anesthetic) during the procedure. If your doctor is unsure whether a weak cervix caused your late miscarriage, you may be offered frequent trans-vaginal ultrasound scans during your pregnancy. If the scans show that your cervix is shorter than expected before 24 weeks of pregnancy, you might be offered the cervical stitch surgery.

👩‍⚕️ Hormones

Some women are offered treatment with progesterone or hCG hormones early on in their pregnancy to try and reduce their risk of recurrent miscarriage. However, how well this works is currently unclear and more research is needed to determine its effectiveness.

What happens to my baby after a miscarriage?

Once you are stable, you and your partner will be able to decide if you would like to see and spend time with your baby. If you choose, you can be given as much time as you would like to see, hold and/or take photographs with your baby. There is no rush to make this decision; your baby will be cared for until you feel emotionally and physically ready to decide on next steps (12).

When a baby is miscarried in the UK before 24 weeks, you do not legally have to bury or cremate him/her. However, there are numerous options available for you if this is something that you would like to do. Some hospitals will offer burial and/or cremation services for miscarried babies (this might be offered just for late miscarriages, or for both late and early miscarriages). You might also find that your hospital runs larger burial or cremation services, where multiple babies lost to miscarriage are buried or cremated together (9).

You are also free to make your own arrangements for a burial, cremation and/or funeral service if you wish. This can be a very overwhelming thing to plan, and it might be helpful to get support from close friends and relatives, as well as professionals such as the hospital chaplain, a funeral director and/or minister from your personal faith (9).

What does this mean for future pregnancies?

If you have been affected by late or recurrent miscarriage, it is understandable to be concerned about what this means for your future pregnancies. When you next conceive, you and your partner should be seen by a specialist maternity healthcare professional; your local hospital might even have a special clinic for late or recurrent miscarriage. Your doctor will be able to offer individualised support for your particular circumstance and discuss the likelihood of you having a successful pregnancy. If a cause has been found for your miscarriage, treatment options to improve your chance of carrying to term will be discussed (1).

The good news is that most couples who have suffered from late or recurrent miscarriage will have a successful pregnancy at their next attempt. Women who receive regular supportive care from an Early Pregnancy Assessment Unit from the beginning of their pregnancy have an increased likelihood of successfully carrying a baby to term. Reassuringly, for couples with no identifiable cause for recurrent miscarriage, around 75% will have a successful pregnancy with early supportive hospital care (1,11).

Life After Miscarriage

There are few experiences in life that can compare to the emotional torment of losing a baby. Everyone processes grief differently, and there is no right or wrong way to feel after a miscarriage. Some people will process their emotions more quickly, while others may experience a severe grief reaction that can take a long time to work through. Ongoing support is always available from your GP, who can also refer you to counseling services if you would like to talk through your feelings (8-10,12).

Tips & Suggestions for Coping After Miscarriage

Suffering a miscarriage is a uniquely personal experience, and every one will have different methods for coping during this difficult time.

Below we have compiled some tips that you might find helpful in navigating the challenging emotions many face after a miscarriage (8-10,12):

❤️ Receiving baby-related advertisements or newsletters via e-mail (or seeing baby-themed posts on social media) can be extremely distressing. If you signed up to any mailing lists or baby groups before your miscarriage, it might be helpful to unsubscribe from these (or ask a friend or family member to do this for you). You can also register with the Baby Mailing Preference Service to reduce the number of baby-related communications you receive.

❤️ Special occasions, such as family get-togethers, anniversaries of your baby’s due date or holidays (e.g. Christmas, Mother’s/Father’s Day, etc.) can be especially difficult. Some couples find it helpful to plan something special to remember their baby on such occasions.

❤️ After a miscarriage, you and/or your partner might find it difficult to keep up with daily tasks, such as cooking, cleaning, shopping or taking care of pets. It might be helpful to outsource some of these jobs to friends, family and/or professional services (e.g. cleaning or meal delivery services) for a period of time.

❤️ Memory boxes can be a special way to collect and display keepsakes from the time that you spent with your baby. Examples of items you might want to put in your baby’s memory box include: cards from loved ones, a lock of your baby’s hair, foot and/or hand prints, photographs, a blanket your baby was swaddled in and/or a baby-grow or other clothing. You might want to display a memory box in your home or keep it somewhere private where you can bring it out when you want to reminisce about your baby. Some hospitals offer memory boxes, or you can order one free of charge from the Stillbirth & Neonatal Death Charity (Sands) here.

❤️ Some couples find it comforting to take and keep photos of the time spent with their baby. These might be photos of your baby on his/her own, or photos of you and your partner and/or other family members with your baby. You can take these photos yourself or ask a friend, family member or the midwife/nurse looking after you to do this for you. If you are unsure whether you will want to keep photos, a midwife or nurse can take photos and attach these to the mother’s hospital notes; then, if you would like these photos in the future, you can request them from the hospital where you received treatment. You can also ask that photos be placed in a sealed envelope for you to take home and open if and when the times feels right.

❤️ Many crematoriums, hospitals and cemeteries have a Book of Remembrance (memorial book) for babies lost to miscarriage. You might want to enter your baby’s name and/or a brief message in memory of your baby into one of these books.

❤️ You might find it helpful to continue collecting special keepsakes over the years that remind you of your baby. These could be put into a memory box, displayed in your home or kept somewhere private for when you want to look at them. Such keepsakes might include: poems or stories that remind you of your baby, jewellery, artwork and/or a funeral order of service.

❤️ Attending a remembrance event might be a safe and supportive environment in which to meet other couples who have struggled with miscarriage while honoring the memory of your baby. Sands organises two remembrance events each year: one in June and the other in December. You can find more information on these events, as well as other remembrance events held across the UK, on the Sands website. Some couples prefer to organise their own remembrance event (e.g family picnic, planting flowers, walk, hike, etc.) in loving memory of their baby.

❤️ You might consider whether you would like a permanent memorial for your baby that you can visit over the years. A permanent memorial could be anything that you and your partner choose, but popular options include trees, benches, inscribed marker posts and commemorative plaques (available at some cemeteries and crematoriums). Woodland Trust allows parents to plant and/or dedicate an already planted tree (or larger woodland area) to their baby; some of their locations also have the option to dedicate benches or inscribe marker posts with a special message for your baby. The Sands Garden (one of more than 350 special gardens that are part of the National Memorial Arboretum) is dedicated in memory to all babies who have lost their lives; parents can dedicate a small stone in the garden to their baby and visit the garden whenever they would like.

❤️ Parents might find it comforting to take part in Baby Loss Awareness Week, which takes place every year from October 9th through 15th. The Week ends with the International Wave of Light at 7PM on October 15th, which is an opportunity for parents all over the world to celebrate their baby’s memory as a supportive collective. This special Week includes numerous events that you can take part in, including remembrance services, candlelit vigils and ribbon displays. You can find more information about Baby Loss Awareness week and its events here.

Where can I go for support?

There are numerous charities, organisations and community groups that offer ongoing advice and support to anyone affected by miscarriage. It can sometimes be hard to know where to start, but your GP might be able to advise you on the most appropriate support for you that is available in your local area (9,12).

Below we have included links to some of the wonderful support services available to couples who have suffered a miscarriage:

❤️ The Miscarriage Association: offers support to anyone affected by miscarriage via a telephone helpline, online forums, friendly Facebook groups and volunteer support services. The Association also publishes a range of easy-to-read leaflets on a range of topics related to miscarriage.

❤️ The Stillbirth & Neonatal Death Charity (Sands): provides an online chat function called GriefChat, where users can connect privately with a trained bereavement counsellor. Sands also offers a telephone helpline, bereavement support phone app, local community support groups, online community and Facebook groups for bereaved parents and a range of bereavement support literature.

❤️ The British Association for Counselling and Psychotherapy: has an extensive directory of trained therapists across Britain that you can search to find counseling and/or psychotherapy services in your local area.

❤️ The Samaritans: provides telephone support via their helpline 24/7 to anyone who is struggling with emotional distress. If you prefer, you can also contact one of the Samaritans volunteers via e-mail.

❤️ Saying Goodbye: is a UK-based charity that is part of the Mariposa Trust. Saying Goodbye organises remembrance services that can be attended by anyone affected by the death of a child at any stage of pregnancy, at birth or in infancy. You can attend services as frequently as you want and are able to bring other members of your family with you, including children.

❤️ Cruse Bereavement Care: provides free support to anyone struggling with bereavement in the form of a telephone helpline, online chat function and in-person volunteer support.

❤️ Child Death Helpline: a telephone helpline offering free confidential support to anyone affected by the death of a child of any age. The telephone helpline is staffed by volunteers who are bereaved parents themselves.

This list is not exhaustive, and there are a range of excellent support services available to couples bereaved by miscarriage. If you are interested in additional support services, Sands has published a comprehensive list which includes contact information and details on services provided.

What are the rules about returning to work?

Sadly, mothers who have lost a baby to miscarriage (e.g. before 24 weeks of pregnancy) are not entitled to maternity leave or allowance under UK law. However, you might be entitled to sick leave from work and can discuss this with your GP, who should be able to provide you with a sick note for your employer. Many employers are able to record sick leave related to miscarriage in a way that does not affect your sickness record. Your GP can work with you to determine the amount of time you will likely need off work, and can support you to return to work when you are comfortable (12).

When can I try to conceive again?

There is no right or wrong time to start trying again for a baby. Some couples will feel they need considerable time before they are ready for another pregnancy, while others might feel that trying again will help them process their grief. You and your partner can try to conceive as soon as you feel physically and emotionally ready to do so. However, you should wait to have intercourse until your body has fully recovered from your miscarriage (e.g. all vaginal bleeding has settled and/or you have healed from any surgery that you might have had) (3,4,9,12).

Conclusion

Unfortunately, miscarriage is a common complication of pregnancy (2,3). However, if you experience vaginal bleeding during your pregnancy, it does not necessarily mean that you are having or have had a miscarriage (2,3,5). It is important that women with any vaginal bleeding seek medical advice quickly (e.g. from a GP, midwife and/or an Early Pregnancy Assessment Unit), so that they can be assessed and diagnosed quickly and safely (1,3). If you are diagnosed with a miscarriage, there are many services available for ongoing support, advice and assistance during what might be an extremely difficult time (9,12).

The good news is that the majority of women who experience a miscarriage–including late and recurrent miscarriage–will go on to give birth to a happy, health baby in a future pregnancy (1,3).

References

(1) Recurrent and late miscarriage: tests and treatment of couples. Royal College of Obstetricians & Gynaecologists. Published: May 2012. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-recurrent-and-late-miscarriage—tests-and-treatment-of-couples.pdf

(2) Miscarriage–information and support. Tommy’s. Published: February 2020. https://www.tommys.org/pregnancy-information/pregnancy-complications/baby-loss/miscarriage-information-and-support

(3) Early Miscarriage. Royal College of Obstetricians & Gynaecologists. Published: September 2016. https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-early-miscarriage.pdf

(4) Early Miscarriage. Tommy’s. Published: March 2020. https://www.tommys.org/pregnancy-information/pregnancy-complications/baby-loss/miscarriage/types-miscarriage/early-miscarriage

(5) Symptoms: Miscarriage. NHS. Published: June 2018. https://www.nhs.uk/conditions/miscarriage/symptoms/

(6) Causes: Miscarriage. NHS. Published: June 2018. https://www.nhs.uk/conditions/miscarriage/causes/

(7) How Your Miscarriage Will be Managed or Treated. Tommy’s. Published: January 2020. https://www.tommys.org/pregnancy-information/pregnancy-complications/baby-loss/miscarriage/how-your-miscarriage-will-be-managed-or-treated

(8) Late Miscarriage. Tommy’s. Published: February 2020. https://www.tommys.org/pregnancy-information/pregnancy-complications/baby-loss/miscarriage/types-miscarriage/late-miscarriage

(9) Late Miscarriage: Second Trimester Loss. Miscarriage Association. Published: March 2017. https://www.miscarriageassociation.org.uk/wp-content/uploads/2016/10/Late-Miscarriage-Mar-2017-1.pdf

(10) Treatment of Late Miscarriage. Tommy’s. Published: January 2020. https://www.tommys.org/pregnancy-information/pregnancy-complications/baby-loss/miscarriage/how-your-miscarriage-will-be-managed/treatment-late-miscarriage

(11) The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. Green Top Guideline No. 17. Royal College of Obstetricians & Gynaecologists. Published: April 2011. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_17.pdf

(12) Sands Bereavement Support Book. Stillbirth & Neonatal Death Charity. Published: June 2019. https://www.sands.org.uk/sites/default/files/Sands%20Bereavement%20Support%20Book%20-%20web%20version_v1.1.pdf