The loss of a baby through miscarriage can be very distressing. A miscarriage generally occurs for reasons outside your control and nothing can be done to prevent or stop it from happening. Most women who have had a miscarriage will go on to have a healthy pregnancy in the future.

What is a miscarriage?

A miscarriage is the loss of your baby before 20 weeks of pregnancy. The loss of a baby after 20 weeks is called a stillbirth.

Up to 1 in 5 confirmed pregnancies end in miscarriage before 20 weeks, but many other women miscarry without having realised they are pregnant.

Common signs of miscarriage include:

• cramping tummy pain, similar to period pain
• vaginal bleeding

If you think you are having a miscarriage, see your doctor or go to your local emergency department.

Many women experience vaginal spotting in the first trimester that does not result in pregnancy loss.

What are the types of miscarriage?

There are several types of miscarriage — threatened, inevitable, complete, incomplete or missed.

Other types of pregnancy loss include an ectopic pregnancy, molar pregnancy and a blighted ovum.

Threatened miscarriage

When your body is showing signs that you might miscarry, that is called a 'threatened miscarriage'. You may have light vaginal bleeding or lower abdominal pain. It can last days or weeks and the cervix is still closed.

The pain and bleeding may resolve and you can go on to have a healthy pregnancy and baby. Or things may get worse and you go on to have a miscarriage.

There is rarely anything a doctor, midwife or you can do to prevent a miscarriage. In the past bed rest was recommended, but there is no scientific proof that this helps at this stage.

Inevitable miscarriage

Inevitable miscarriages can come after a threatened miscarriage or without warning. There is usually a lot more vaginal bleeding and strong lower stomach cramps. During the miscarriage your cervix opens and the developing fetus will come away in the bleeding.

Complete miscarriage

A complete miscarriage has taken place when all the pregnancy tissue has left your uterus. Vaginal bleeding may continue for several days. Cramping pain much like labour or strong period pain is common — this is the uterus contracting to empty.

If you have miscarried at home or somewhere else with no health workers present, you should have a check-up with a doctor or midwife to make sure the miscarriage is complete.

Incomplete miscarriage

Sometimes, some pregnancy tissue will remain in the uterus. Vaginal bleeding and lower abdominal cramping may continue as the uterus continues trying to empty itself. This is known as an 'incomplete miscarriage'.

Your doctor or midwife will need to assess whether or not a short procedure called a ‘dilatation of the cervix and curettage of the uterus’ (often known as a ‘D&C’) is necessary to remove any remaining pregnancy tissue. This is an important medical procedure done in an operating theatre.

Missed miscarriage

Sometimes, the fetus has died but stayed in the uterus. This is known as a 'missed miscarriage'.

If you have a missed miscarriage, you may have a brownish discharge. Some of the symptoms of pregnancy, such as nausea and tiredness, may have faded. You might have noticed nothing unusual. You may be shocked to have a scan and find the fetus has died.

If this happens, you should discuss treatment and support options with your doctor.

Recurrent miscarriage

A small number of women have repeated miscarriages. If this is your third or more miscarriage in a row, it’s best to discuss this with your doctor who may be able to investigate the causes, and refer you to a specialist.

What are the signs of a miscarriage?

A miscarriage can occur suddenly or over a number of weeks. The symptoms are usually vaginal bleeding and lower tummy pain. It is important to see your doctor or go to the emergency department if you have signs of a miscarriage.

The most common sign of a miscarriage is vaginal bleeding, which can vary from light red or brown spotting to heavy bleeding. If it is very early in the pregnancy, you may think that you have your period.

Other signs may include:

• cramping pain in your lower tummy, which can vary from period-like pain to strong labour-like contractions
• passing fluid from your vagina
• passing of blood clots or pregnancy tissue from your vagina

What should I do if I think I’m having a miscarriage?

If you are concerned that you are having a miscarriage, call your doctor or midwife for advice and support.

Keep in mind that many women experience vaginal spotting in the first trimester of pregnancy that does not result in a miscarriage.

If you are alone, consider calling your partner or a friend for help and support.

If you have very heavy bleeding, strong pain or feel unwell, call triple zero (000) or have someone take you to your nearest emergency department.

How is a miscarriage managed?

Unfortunately, nothing can prevent a miscarriage from happening once it has begun. What happens now depends on your own health and what is happening to you.

Each approach has benefits and risks. You should discuss these with your doctor.

Expectant or natural management

Also called ‘watch and wait’, expectant management may be recommended in early pregnancy. This involves going home and waiting until the pregnancy tissue has passed from your womb by itself. This can happen quickly, or it may take a few weeks.

Medical management

You may be offered medication that speeds up the passing of the pregnancy tissue. You may be asked to stay in hospital until the tissue has passed, or you may be advised to go home.

Surgical management

You may be advised to have a form of minor surgery called a 'dilatation and curettage' (also called a D&C or a curette). This procedure is often recommended if you have heavy bleeding, significant pain or signs of infection. It may also be recommended if expectant or medical management has failed. You may also decide that you prefer this option.

This procedure is done under general anaesthesia in an operating theatre. It takes 5-10 minutes once you are asleep. The doctor opens the cervix and removes the remaining pregnancy tissue.

How is a miscarriage treated?

Once it is confirmed that you are having a miscarriage, your doctor may offer or recommend treatment. There are many options. All have benefits and risks — discuss these with your doctor.

If the miscarriage is complete

If it seems the miscarriage is complete, you should still see your doctor for a check-up. You may be advised to have an ultrasound to make sure your uterus is empty.

If you go to hospital

If you go to your hospital’s emergency department, you will be seen first by a triage nurse, who will assess how urgently you need to be seen by a doctor. Depending on your symptoms, you will either be taken in to see a doctor immediately, or you will be asked to wait.

If you are waiting to be seen and your symptoms become worse or you feel like you need to go to the toilet, let the staff know immediately.

What happens if I miscarry at home?

Some women miscarry at home before they have a chance to see their doctor or get to the hospital.

If this happens, then:

• use pads to manage the bleeding
• if you can, save any pregnancy tissue that you pass, as your doctor may recommend it is tested to see why your miscarriage happened
• take medications such as paracetamol if you have pain
• rest
• call your doctor or midwife

There is a chance you may see your baby in the tissue that you pass, but often the baby is too small to recognise, or may not be found at all. It is normal to want to look at the remains, but you may decide you do not want to. There is no right or wrong thing to do.

Some women miscarry while on the toilet. This can also happen if you are out and about, or in hospital. There is no right or wrong way to handle this.

Why do miscarriages happen?

Many women wonder if their miscarriage was their fault. In most cases, a miscarriage has nothing to do with anything you have or have not done. There is no evidence that exercising, stress, working or having sex causes a miscarriage.

Most parents do not ever find out the exact cause. However, it is known that miscarriages often happen because the baby fails to develop properly, usually due to a chromosomal abnormality that was spontaneous, not inherited.

Occasionally, miscarriage is caused by:

• hormonal abnormalities
• immune system and blood clotting problems
• medical conditions such as thyroid problems or diabetes
• severe infections causing high fevers (not common colds)
• physical problems with your womb or cervix

What are the risk factors for miscarriage?

Women are more likely to have miscarriages if they:

• are older
• smoke
• drink alcohol in the first trimester
• drink too much caffeine in coffee, tea or energy drinks
• have had several previous miscarriages

Can you prevent a miscarriage?

Living healthily — no cigarettes, no alcohol and little to no caffeine — can decrease your risk of miscarriage. It’s a good idea to avoid contact with people who have a serious infectious illness when you’re pregnant.

Who can I talk to for advice and support?

Talk to your doctor or midwife for information and advice on what do and how to look after yourself if you experience a miscarriage.

Your hospital should be able to provide details of available support services, such as bereavement support.

Red Nose Grief and Loss provides support for miscarriage, stillbirth and newborn death. Call their support line on 1300 308 307, available 24 hours a day.

The Pink Elephants provide information and peer-support for anyone impacted by early pregnancy loss.

You can also call Pregnancy, Birth and Baby on 1800 882 436, 7am to midnight (AET) to speak to a maternal child health nurse for advice and emotional support.