You may have heard the statistics that miscarriage is common, occurring in about 10 percent of identified pregnancies, and those numbers might make you wonder—will you become one of them? And how can you know if you are having a miscarriage?
Zev Williams, M.D., Ph.D., director of Columbia University Fertility Center, explains that there is no "one way" that someone will experience a miscarriage, and there can be a wide range of symptoms.
"For example, you can have a patient with all the typical symptoms of a normal pregnancy such as morning sickness, and no alarming symptoms at all, but have a pregnancy loss," he says. "Alternatively, we have had patients with significant bleeding and cramping but go on to have a healthy full-term delivery."
The most common symptom of a miscarriage is bleeding or cramping, but not all cases of bleeding or cramping—especially in the first trimester—mean miscarriage. And not all miscarriages will begin with bleeding or cramping.
Dr. Williams adds that one of the most common types of miscarriage he sees at the fertility practice is a "missed miscarriage," which is when the fetal heart stops, but the patient is not yet experiencing any signs of losing the pregnancy, like bleeding or cramping. Ultimately, the only true way to tell if you have had a miscarriage is through an ultrasound to look at the uterus and blood work to see what your hCG levels are.
"Rapidly dropping hCG levels generally indicates a complete miscarriage, as would an empty uterus," describes R. Renee Gaiski MSN, CNM with Spectrum Health Pennock, in Hastings, Michigan.
What to Do First If You Worry You're Miscarrying
J. Daniel Woodall, DO, MPH, FACOG, an obstetrician and gynecologist at Spectrum Health Pennock in Hastings, Michigan, says that the very first thing you should do if you think you might be having a miscarriage is to always notify your pregnancy care provider.
Bleeding and cramping are often the first signs of a miscarriage, says Dr. Woodall, but some women also experience bleeding during pregnancy as a normal symptom, so it can be difficult to tell if you are really having a miscarriage. Your doctor's office can help you figure out what your next steps should be, such as scheduling an appointment in-office for an ultrasound, setting up a blood test to determine your hCG levels, or going to the ER.
And you shouldn't hesitate to reach out for help even after-hours. "All OB practices should have emergency provider numbers where patients can call 24 hours a day to speak to a provider on call," Dr. Woodall notes.
What Your Doctor Will Want to Know
When you do call your doctor, they will ask you certain questions to determine what is going on with you and your pregnancy and help identify what to do next, so it's helpful if you can be prepared to give them the information they need.
According to Dr. Woodall and Dr. Williams, your doctor will want to know the following questions:
- Are you bleeding?
- Are you in pain?
- Are you feeling light-headed or dizzy?
- Are you short of breath?
- Do you have a fever or foul-smelling vaginal discharge?
- When was your last period?
- What is your blood type?
- Have you had a miscarriage before?
The primary symptom that your doctor will be looking for, says Dr. Woodall, is bleeding. Too much blood loss may warrant a trip to the emergency room, so be sure to keep a close eye on how much bleeding you have had.
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"As a general rule, if a woman is bleeding through a pad per hour for more than two to four hours in a row, or has a fever, I always recommend emergency evaluation," he says. Gaiski also points out that it's very important to head to the ER if you are feeling lightheaded, dizzy, or are near passing out, and don't have a lot of bleeding, because those can be signs of an ectopic pregnancy, which is life-threatening if it ruptures.
Dr. Williams also recommends that if you do pass any tissue, that you save it, in case your doctor needs to do any genetic testing.
What If You're Just 'Not Feeling Pregnant' Anymore?
In the beginning of pregnancy, before you are able to feel your baby kick and before you can really tell you're pregnant, you don't really have a way to know how your baby is doing. (The American College of Obstetrician and Gynecologists does not recommend the use of at-home dopplers to monitor your baby's heartbeat.)
Without any other way to tell how your baby is doing in those first few months, you may use the presence of pregnancy symptoms to reassure yourself that everything is going just fine in there. But what about if you experience a sudden drop in symptoms? What if you wake up and the morning sickness is gone and your boobs don't feel as sore? If that happens—don't panic. Pregnancy symptoms can fluctuate and every woman will experience them differently.
"Just as some women have nausea with early pregnancy and some women don't, the loss of pregnancy symptoms is not predictive of miscarriage," explains Dr. Woodall. He adds that sometimes, the loss of some pregnancy symptoms can happen with a miscarriage, but in general, it's not predictive of miscarriage and should not be cause for concern.
However, you should also communicate with your pregnancy care provider about any symptoms that concern you—it's important that you feel comfortable to talk with your doctor or midwife during your pregnancy.
What Happens Next
If you do suffer a miscarriage, Dr. Williams, says that in most cases, careful evaluation and testing can determine the cause of the pregnancy loss and most causes are correctible.
And whether you choose to try to conceive again or not, it's incredibly important that you allow yourself space and time to heal and grieve in a way that you need.
"Whether it was six weeks, 12 weeks, or more, it's a loss that you will never forget, and that is okay," says Gaiski. "Even if the pregnancy wasn't necessarily 'planned or even 'wanted,' it is very normal to have intense sadness."
She recommends seeking professional treatment, counseling, if needed, and talking through your experience—because you are never alone when it comes to miscarriage.