Miscarriage Guide
First, I am so sorry for this unimaginably difficult experience. I am thinking of you with much love and holding you close to my heart. This guide will not act as a fix, but may provide information that could be helpful.
General Information
About 20 percent of known pregnancies result in miscarriage and occur within the first 12 weeks (early miscarriage). This number is likely higher due to miscarriages before even knowing someone is pregnant. Most miscarriages are due to an unknown factor that is by chance. It’s important to know that stress, exercise, sex, and travel do not increase your risk of a miscarriage. This is a common misconception.
Miscarriage is never your fault.
You didn’t do anything, go anywhere, or eat or drink something that caused this.
Terminology can be a bit confusing since miscarriages and abortions can be treated similarly.
A missed abortion (not the same as elective abortion) is also known as a missed miscarriage, spontaneous abortion, or miscarriage. A missed abortion is a miscarriage where the fetus did not form or is currently developing and the tissues are still in the uterus. There are different symptoms with different types of miscarriage, some experience significant, moderate, minor, or even no symptoms, making it difficult to know that there was a loss.
Many women who experience miscarriages (one or more) do have successful pregnancies after.
With that being said, no matter how you may feel, the truth is this is not your fault and you are not alone.
Types of Miscarriage
Spontaneous miscarriage symptoms can vary, such as experiencing heavy bleeding, significant back pain, or painful contractions like cramping or even more severe. Miscarriage is often a process and not a single event. There are several types of miscarriages that could have different symptoms. The American Pregnancy Association posted this helpful breakdown:
Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping or lower backache. The cervix remains closed. This bleeding is often the result of implantation.
Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is a rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly after the miscarriage is over, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage (D&C) performed.*check out more information below on D&C*
Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the embryo. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
You can talk to your health care provider for more information
Medications and Procedures aiding Miscarriage
Cytotec, DNC, and DNE:
Cytotec is one of the most accessible pills for managing miscarriage. This medication may be recommended by your doctor as an alternative to a procedure (information below).
When you take Cytotec, it softens and dilates the cervix and causes the uterus to contract to release uterine lining. Dosing varies based on the stage of pregnancy. Your doctor will recommend when and how to take the medication. They may advise taking it while at the hospital or doctor’s office, or to be in contact with your doctor while at home.
When taking Cytotec, you could expect it to start working within one to four hours and for symptoms such as cramping to last for three to five hours. Bleeding typically lasts about two weeks.
You’ll want to find a time when you'll be able to rest after taking the tablets. You can take Cytotec either orally or with a vaginal application. Typically, you take Cytotec orally in the first trimester and vaginally in the second trimester.
When taking orally, you may be recommended by your healthcare provider to take 3-4 pills (600-800 micrograms). They usually come in 200 microgram tablets. You’ll insert 1-2 tablets into each cheek pouch, or under your tongue, and hold them there for 30 minutes before washing down what is left with a glass of water.
You could listen to music, journal, or watch a show while waiting. You can also use a
heating pad on your belly to soothe any cramping.
You may see within about 24 hours a blood clot or you might not notice it pass.
With the vaginal application, you insert 2-4 pills, (400-800 mcg) depending on your doctor’s recommendation, as high up in your vagina as you can go and then lay down for 30 minutes to an hour to absorb it fully. You can either insert them while standing or laying down, different people find them both easier.
Since you are in your second trimester you will notice more tissue being released
(about 2-3 inches long).
Either way - you can wear a nighttime pad and have them on hand to switch out.
If you do not experience symptoms like cramping or bleeding after 3 hours, you may be directed by a clinician to take a second dose. Talk to your provider before taking any more.
Taking 600mg of ibuprofen or acetaminophen an hour before taking your prescribed dose of Cytotec may be recommended by your doctor to reduce cramping. You could continue this every 6-8 hours until discomfort begins to go away.
Afterwards, take it easy as much as possible, physically and emotionally. Some people experience symptoms that arise a few days after taking the medication. Then, you would want to have some soothing practices like having something warm on your belly, taking a warm shower, or having your back rubbed.
This is a significant hormonal change; you may feel emotions stronger than usual. You can give yourself time to recover and process however feels best for you.
DNC
Dilation and Curettage is a surgery that dilates or opens the cervix to remove the lining of the uterus and any fetal tissue.
Typically used after early miscarriages when fetal tissue is still in the womb. This more common procedure is also used for pregnancy releases, diagnosing bleeding, removing growths or intrauterine IUDs.
DNE
Dilation and Evacuation - Similar to DNC, as a DNC occurs in the first trimester, DNE is a commonly chosen procedure if experiencing in the second trimester.
It is a similar procedure than a DNC, but since it is later in the pregnancy, different instruments are needed to remove the tissue from the uterus.
After a DNC or DNE it is common to have some discomfort, cramping, and bleeding. It could be helpful to be up and moving around to help prevent blood clots.
Physical healing has a wide range based on your experience. Some things you can expect: your period to return irregularly about four to six weeks after miscarriage. It may take several months to return to how it was before pregnancy. Your doctor may recommend avoiding physical activity and sex until all symptoms of miscarriage are gone.
A good time to call your doctor would be when you have a concern for abnormal bleeding. Some things to look out for: Heavier bleeding than the heaviest day of your period, bleeding longer than two weeks, if your period has not returned 6 weeks after pregnancy loss. You can expect normal bleeding to range from brownish discharge and light spotting to heavy bleeding with bright red blood clots.
Natural Miscarriage Tips
If you live in a state (see chart below) with total and complete bans on abortions including medically necessary ones for miscarriage, these are some ideas for how to encourage your body to miscarry naturally. This is not medical advice and you agree to release the authors of this guide from any liability if you choose to try any of these natural remedies.
Black and Blue Cohosh. Place tinctures or pellets under your tongue every 15 minutes for an hour. Then, every 30 minutes for an hour, then once an hour for up to 8 hours.
Drink the Midwives Brew. 2 tablespoons castor oil, 2 tablespoons of a nut butter like almond butter, 1 cup apricot nectar, 1 cup champagne. Stay hydrated. If you have diarrhea, do not repeat a second dose. If you do not have diarrhea, repeat daily or every other day for up to a week.
Pump 15 minutes on and off for up to 2 hours at a time.
Drink a high concentration of red raspberry leaf tea.
Calendula and papaya seeds can help with expulsion also.
It’s important to visualize the contracting of the uterus and letting go of the pregnancy. Drinking cacao in ceremony and allowing yourself to grieve can help facilitate the journey to begin. Your body is smart, trust its timing.
Some things that may be soothing or helpful:
Heating pad to your belly
Supportive bra without wire
Drinking lots of water
Nourishing with your favorite foods
Sensory items like soft cozy blankets
Ask a Midwife or Herbalist about the following Herbal Tinctures
Blue and Black Cohosh Tincture
Cotton Root Bark Tincture
Teas (can be mixed or separate)
Raspberry Leaf
Nettles
Oat Straw
Tulsi
Dong Quai Red Date Tea
Warm broths
Medications like Tylenol, Ibuprofen, Arnica
Journaling
Sunshine
Walks or moving your body gently
Yoga and/or deep stretches
Low lighting and candles
Belly binding can help to not feel as empty
Therapy sessions
Podcasts
Cry It Out Loud! Miscarriage, Stillbirth and Infant Loss Survivors
Natural MD Radio by Aviva Romm MD:
127 A Complete Guide to Empowered Miscarriage at Home
135- The Birth Circle: Miscarriage as a Portal with Jovan Sage
Books
The Miscarriage Map, by Dr. Sunita Osborn
Our Stories of Miscarriage, by Rachel Faldet
About What Was Lost, by Jessica Berger Gross
Guided Journal
Mourning Retreat: A Journal Through the Sisterhood of Miscarriage Grief
by Katy Huie Harrison, PhD
Experiencing Loss
As you begin to heal and working through your grief, honor your needs and limits:
Ask for understanding and support from those you trust most.
You don't need to go through this alone; finding counseling can be helpful for you and a partner, if you have one.
Give yourself time to grieve and the space to remember.
If you are working, consult with your HR department on your leave benefits for miscarriage. Utilize your benefits like STD and/or FMLA if those are offered.
Healing through grief does not mean forgetting or minimizing, healing is working through life events and caring for your heart. Some families who experience loss find healing in commemoration. This can look many ways, such as with storytelling or ceremony. You can honor in community, with a partner/family, or with yourself.
Ceremony can look like:
Naming your baby
Planting a tree or garden
Having a piece of jewelry with a birthstone or name
Sharing special time with a partner, if you have one, to commemorate, especially on the anniversary
Bringing together friends and family to talk about memories and wishes
Keeping a small group of trusted people together
Writing letters to your baby
Donating to a charity
Closing of the bones ceremony
Volunteering as a mentor to those who experience pregnancy loss or miscarriage
Having people you love and trust shower you in loving acts such as:
Massage, nourishment, foot bath, essential oil shower, being held
Trying to do the things that make you laugh and bring you joy
Celebrating bits of joy and laughter does not minimize the grief, but aids in healing
Sharing your story
Physical soothing such as massage, warm showers, lovingly putting on lotion
Support as your Doula
There are many paths of support you may need, including from a partner (if applicable), friends, and family which can look very different. There may be times you need to process alone and times it is best to process with someone you trust, however that may look.
Having support can appear very different for different people. Some prefer more time on their own or sharing time with others. Sometimes reaching out to friends and family can be extremely difficult during a time of grief.
As your doula, I am a support person you may need. This could look like making meals, sharing meals, sitting together, and processing together. Our processing will be on your terms. We could process verbally, physically, emotionally, creatively, or in ceremony. This relationship may be easier to reach out to for support as it is outside of your friends or family.
I am here for you if and when you want to engage with me.
Support from Friends and Family
It can be very difficult to ask friends and family for the support you need, especially when it is normal to not know exactly what you may need in your healing. Remember that your friends and family know you very well; they may not be able to understand what you are going through, but they may understand that they can be very helpful.
Some of these things could look like:
Being a listening ear
You can set intentions together since they may not know exactly what to say. Loving company and understanding is what is most important.
Driving you or staying with you during an appointment or procedure
Running errands
It may be physically or emotionally difficult to do day to day tasks right away
Providing meals
A change in appetite is completely normal with so much happening
Household tasks/chores
Some friends and family will be more helpful in different ways. Your friends and family are grieving with you and want to be there, but may not know exactly how. You may have people offer to just run errands and someone else who you feel best to sit with and be together. It can be your choice how you'd like someone to show up. And if someone is adding more stress, invite them to return another time or to do something that would be helpful like to talk to a partner, if applicable.
It may be helpful to remind your friends and family that grief is experienced differently for everyone. There is no “right” timeline or way to grieve; it is unique and different for each person. Their role is not to take your pain away, but to take added stress away maybe by doing some reading and showing up with love. Remind them that it’s okay to talk about the baby, to say their name, or just listen to you with kindness in mind. Reassurance in these things can be helpful from a loved one.
Please know, you are loved and there are people who want to help in this difficult time.
Websites that may be helpful with miscarriage and pregnancy loss:
American Pregnancy Association- Physical
American Pregnancy Association- Emotional
One day at a time
Below is information on how abortion laws in each state are affecting miscarriage care. If this is something that would be triggering for you, please feel free to cut this piece out. This information is provided for logistics and preparation for the care and/or barriers you may experience.
Abortion Laws Impacting Miscarriage Care
Changing abortion laws in many states are affecting miscarriage care.
Medically, the same procedures and medications are used when caring for abortion or miscarriage. When laws that restrict abortion or certain medications or procedures, such as Cytotec, DNC, or DNE, are used in abortion, they have the potential to limit miscarriage treatments. There have been many instances where patients were told they could not get care for their miscarriages even when the medications or procedures were legal for miscarriage. These medications or procedures are often used to prevent serious complications and medical emergencies such as hemorrhaging, infections, and sepsis. These decisions to now allow or make it very difficult to receive medical care between the thin line of abortion and miscarriage care is especially prominent in religious hospitals and practices. Numerous states that restricted these medications and procedures had the intention to apply only to abortions, but there are now significant hurdles and extra steps to receiving standard care when treating pregnancy loss.
Abortion Bans as of Feb 2024:
Total Bans: Texas, Missouri, Idaho, Oklahoma, North Dakota, South Dakota, Arkansas, Louisiana, Mississippi, Alabama, Tennessee, Kentucky, Indiana, West Virginia
Severe Restrictions: Nebraska, Arizona, North Carolina, South Carolina, Georgia, Florida
Restrictions: Utah
Some Restrictions: Iowa, Wisconsin, Ohio, Pennsylvania
Mostly Accessible: Kansas, Michigan, Virginia, Massachusetts, New Hampshire
Accessible: Washington, Oregon, California, Nevada, Montana, Wyoming, Colorado, New Mexico, Minnesota, Illinois, New York, Vermont, Maine, Rhode Island, Connecticut, New Jersey, Delaware, Maryland, Washington DC, Alaska, Hawaii
Useful Links
Planned Parenthood State by State Guide
Abortion/Miscarriage/Release Finder State by State Guide
Written by Sarina Abraham, Birth Doula at Sweet Willow Birth, www.sweetwillowbirth.com and
Heidi Snyderburn-Campbell of BirthStory.com and MyDoulaHeidi.com