Am I Having a Miscarriage?

Miscarriage has been a taboo subject for far too long, which means that not many pregnant people understand the facts about what pregnancy loss can look like. You may have heard the statistics that miscarriage is common, occurring in about 10% of identified pregnancies, and those numbers might make you wonder. Will you become one of them? And how will you know if you are having a miscarriage? Read on to learn more about miscarriage symptoms and what to do if you think you may be miscarrying.

There Are Many Kinds of 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 vaginal bleeding or abdominal 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 his fertility practice is a missed miscarriage, which is when fetal cardiac activity 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 examine the uterus and blood work to evaluate your hCG levels. "Rapidly dropping hCG levels generally indicates a complete miscarriage, as would an empty uterus," describes R. Renee Gaiski MSN, CNM, a certified nurse midwife with Spectrum Health Pennock in Hastings, Michigan.

What to Do First If You Worry You're Miscarrying

J. Daniel Woodall, D.O., MPH, FACOG, an obstetrician and gynecologist at Spectrum Health Pennock in Hastings, Michigan, says that the first thing you should do if you think you might be having a miscarriage is always to notify a prenatal care provider.

Bleeding and cramping are often the first signs of a miscarriage, says Dr. Woodall, but some people also experience bleeding during pregnancy as a symptom that's within the range of "normal," so it can be difficult to tell if the bleeding is related to a miscarriage or something else. A prenatal health care provider can help you determine your next steps, such as scheduling an appointment in-office for an ultrasound, setting up a blood test to determine your hCG levels, or going to the emergency department.

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 the Doctor Will Want to Know

When you do call a doctor, midwife, or other health care provider, they will ask you a series of questions about your symptoms to help determine what is going on and what to do next, so it's helpful to be prepared to give them the information they need.

According to Dr. Woodall and Dr. Williams, a health care provider will want to know the answers to 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 the first day of your last period?
• What is your blood type?
• Have you had a miscarriage before?

The primary symptom the medical provider will look for, says Dr. Woodall, is bleeding. They'll also likely want to know how long you've been bleeding and how much you're bleeding as too much blood loss may warrant a trip to the emergency department.

"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 emergency department 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, you save it in case you and the doctor decide to do any genetic testing.

What If You're Just 'Not Feeling Pregnant' Anymore?

At the beginning of pregnancy, before you can 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 Obstetricians and Gynecologists does not recommend using 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 pregnant person 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 a pregnancy care provider about any symptoms (or lack thereof) that concern you.

What Happens Next

The most common cause of first-trimester miscarriage is thought to be chromosomal abnormalities in the embryo or fetus that cause it not to develop as expected. In most cases of early miscarriage, however, the cause remains unknown, which can be difficult to grapple with when you want answers.

In the case of miscarriage that occurs later in pregnancy or with recurrent miscarriage (that is, two or more consecutive miscarriages), a health care provider may recommend additional evaluation and testing to try to determine the cause.

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 you need. "Whether it was six weeks, 12 weeks, or more, it's a loss that you will never forget, and that is OK," 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 no matter how isolating the experience can feel, you are never alone when it comes to miscarriage.