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Pregnancy

Bleeding and miscarriage

Miscarriage in early pregnancy is a common experience. The Miscarriage Association (2019) say that an estimated one in four pregnancies will end in miscarriage but other estimates vary.  It is difficult to be precise, as miscarriage may occur before a woman has even realised she is pregnant, and she may assume it is a heavy period. Most miscarriages happen in the first 12 weeks of pregnancy (Miscarriage Association 2019) and the risk of miscarriage gets lower with each week of pregnancy (NCT 2019).

For many women, the first worrying symptom was vaginal bleeding, sometimes with abdominal cramps or backache. Women described the terrible sinking feeling that they might be losing their baby, especially if this had happened to them before.

 
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After one miscarriage, she was worried by a heavy bleed in her second pregnancy, but the baby was...

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Age at interview: 24
Sex: Female
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I had an incidence when I went shopping - and I was wearing dark clothes thankfully - and I thought I was, you know when you lose control of your bladder sometimes while you're pregnant later on? So I've had one child and I thought, I thought it was that. But I was only about three months. And I thought, I felt, I felt wetness, and I thought, I tried to, I clenched myself and tried to stop it, making my way to the toilets, and I just kept leaking. I went to the toilet - I thought it was water - I went to the toilet and it was blood. And I was really devastated, so I was on the phone to my husband, went to the hospital and it was a weekend, and they don't actually do scans on a weekend. So a doctor came, did an internal, and what he said was that the womb, the uterus was closed so he couldn't tell whether I'd lost the baby or not, but I had to wait till Monday for a scan, and this was Saturday. So on Monday - and I was convinced that I - I actually saw a lump fall into the loo - and I was convinced that I'd lost the baby, there was no other explanation for losing so much blood. I had lost quite a lot. 

And on Monday morning I went in there and I was absolutely convinced I'd lost the baby, and they said there was a heartbeat there. And it just shows you, you know, if it's going to - you know, there's, there's nothing that can be done - but if it's going to survive it will survive.
 

On this occasion the bleeding settled down and the baby was fine, although she had had a miscarriage before, and another one since. Many women who experience vaginal bleeding go on to have a normal pregnancy, but several described the anxiety of waiting to find out, knowing they could do nothing about it.

 

She had some bleeding at 3 months. She was very anxious waiting for a scan, but the baby was fine.

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Age at interview: 39
Sex: Female
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Tell me about these little episodes of bleeding. What happened?

Well, I actually, the first one, I'd actually just got to three months so, you know, that's quite a milestone really in any pregnancy. You get to three months, you think, 'Oh, the chance of miscarriage now is, you know, sort of almost out the window'. And I was due to have my nuchal scan actually on, on the Tuesday, and on the Monday evening I started bleeding quite heavily. And obviously completely distraught and didn't know what to do. Rang, rang the midwife and she just said, 'Well, you know, there's not really a lot you can do at this early stage. You've just got to sort of see it through and just put your feet up and sit down and try and keep calm sort of thing'. Which is a bit difficult [laugh]. Anyway it, it continued, but it did, during the night it did ease off. But we had to wait the whole of the next day until 4.30 to have our scan. So that day was a very long day, not knowing whether or not I'd lost the baby the night before. So that was quite an emotional, emotional roller coaster that day. It started off very traumatic but, yes, at the end of the day it was all good because it was all good news, the baby was still there and the risk factor for myself was very low. So that was, that was good.

So did it happen more than once, the bleeding?

It did, yes it happened again. Again, I think it was about four weeks, four or five weeks after. But that was very slight, very slight indeed. But I, you know, I still called the midwife, and they referred me to the unit, where they, they did a quick scan just to make sure everything was fine, and it was. And it stopped that evening, so, and since then, touch wood, I, you know, I haven't had any other bleeding at all. And they just said it was, you know, some women do bleed early in pregnancy. So I was obviously just one of those women. So, but it is, it was very frightening.

No particular explanation?

No, they couldn't find anything that was, you know, that was wrong at all. So, you know, despite the scans, every - and everything looked fine. And, as I say, I haven't had any problems since in that department, so [laugh] hopefully I won't now.

Having sought medical advice, one woman (herself a GP) decided to carry on with her camping holiday.

 
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She started bleeding while on holiday and phoned her GP. There was nothing she could do so she...

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Age at interview: 29
Sex: Female
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And then this pregnancy I was bleeding very early in pregnancy from about 5 weeks to 7' weeks or something, and I phoned, after about a few days of bleeding, I phoned up my GP and said, "I'm bleeding." And actually we were camping in the middle of Wales in a field, and I said to this doctor who was just the person who happened to be on the end of the phone, who I in fact know and is lovely, and I said, "I'm planning to do absolutely nothing about it, that's fine isn't it? I'm only 5 weeks or whatever, 5' weeks." So I'd just found out I was pregnant, you know, a week before or something. 

And he said, "Yeah, well, of course," he said, "if in 2 weeks' time you want to have a scan then phone me back", and in fact in 2 weeks time I was still bleeding a bit, so I phoned back. And I was basically just, I suppose the attitude I took at the time was what I try and tell patients, which is very hard to tell anyone, which is, 'Look, if you're going to miscarry you're going to miscarry. There's absolutely nothing you can do about it, so you may as well just not, you know.' And as far as I was concerned, you know, I might as well have a nice time camping in a field in Wales, as best I could anyway, because whatever was going to happen whatever. And my husband was like, "No, we must go home," and I said, "No, it's not going to make any difference if I go to bed. It won't make a blind bit of difference so, you know, let's just stay." And so I had a scan at 7 weeks. And I waited because I knew that there was no point in having a scan younger than they can see a heartbeat, so I waited till I was 7' weeks and then I had one, and of course everything was fine and of course the bleeding stopped 2 days later.
 

(Women who have persistent and severe abdominal pain should see a doctor, as the pregnancy may be ectopic - when the embryo implants and develops in a fallopian tube, rather than the womb. An operation is then needed to remove the embryo as soon as possible. See also 'Symptoms and feelings in the early weeks').

Many hospitals now have an Early Pregnancy Unit which can provide emergency scans and support people who may be having a miscarriage. Several people valued this service and its staff.

 
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When her first pregnancy ended in miscarriage, the staff at the Early Pregnancy Unit were very...

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Age at interview: 24
Sex: Female
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My first pregnancy was actually a miscarriage, I only carried for three months and - I had, I experienced bleeding so I visited the Early Pregnancy Unit, who were, who were absolutely amazing people. All I had to do was just ring them up in the morning before nine o'clock and they'll arrange a scan for me before twelve. So during one of the scans they actually told me that there wasn't actually a heartbeat. It had stopped about a week earlier. I hadn't realised at the time, and so what they did was they took care of everything. They told me that, you know, you can come back tomorrow if you decide to. You know, the, they went through the options of what, what I could do, and I chose to actually have a D&C, an evacuation, so they booked, they booked the next day, they booked me in the next day.
 

Some women thought something was wrong because other signs of pregnancy such as sickness or tender breasts suddenly disappeared. Other people had no sign that anything was wrong, and discovered during a routine antenatal scan that there was no heartbeat and their pregnancy had ended. This is called a missed or delayed miscarriage (or a 'missed abortion') and sometimes an operation is needed to empty the womb. (This is normally an ERPC - evacuation of retained products of conception - although it is often referred to as a D&C or dilatation and curettage). Early miscarriage can also be managed using medicines rather that an operation (see NHS choices).

 

She had one early miscarriage and three missed abortions. Every time she still felt pregnant but...

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Age at interview: 37
Sex: Female
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With my first pregnancy, it was, I basically had a miscarriage at six weeks, and it was a proper miscarriage. I hadn't even been to the doctor, I'd just literally found out myself and told my husband. And then after that we sort of tried again the following year and I became pregnant pretty much straight away. And I ended up having what's known as a missed abortion, whereby the baby died at seven or eight weeks but I retained it until my twelve-week scan and then had, they found out that the baby had died, so I had to have a D & C. And that happened again on two more occasions after that, sort of within a year,  the following year and the following year. 

And both those ones were discovered on the scan?

On the twelve-week scan, yes, so I'd have to go in and have the D & C.

The first time you discovered it on the scan, were you together?

Yes, yeah.

You weren't on your own?

Yeah, but that obviously made the, the scanning of the following pregnancies pretty awful. And the, the most awful thing was that with the three missed abortions, my body was still telling me that I was pregnant, even though the baby had died. I was still getting severe morning sickness, swollen breasts, putting on weight, so my body in effect was still pregnant but - still producing the pregnancy hormones - but the baby wasn't actually viable. So I'd go there every time at that twelve week scan thinking, 'This one's going to be different. It's going to be different.' And then they'd sort of say, 'Sorry' - the words 'We, we can't find a heartbeat.' So it would be pretty awful, but as I say my husband was with me all the time. But we would, we'd go there hoping that everything was going to be OK.

Did they offer you any earlier scans after it had happened once or twice?

With, with the, after the second miscarriage I would, as soon as I found out I was pregnant, I would have sort of a, a funny light bleed at six weeks, then go and have a scan at six weeks, and everything would be fine. And then go back a week later, have another scan and then they'd say, 'Right, that's fine. Come back in five weeks time when you're twelve weeks.' So, in between the sort of, they reckoned that it would happen round about sort of seven to eight weeks. So we always had the hope because we'd have a scan at seven weeks and think, 'Yeah, it's, it's OK." But in between at some stage, just for some unknown reason, the baby would just die, so.

Some people had what is called a 'blighted ovum', an egg that is fertilised but never develops properly. Again, this is often picked up at a scan.

Most women we talked to found miscarriage a shocking and very sad experience, and thought others did not always understand how much grief it could cause.

 

Sometimes people don't realise how devastating it is to have a miscarriage. She wishes she had...

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Age at interview: 35
Sex: Female
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How did you feel when you had the miscarriage?

I was devastated, actually devastated. The thing also with an early miscarriage is that you don't really tell a lot of people at that time, so only my very close family, and like the parents really only knew, and my brothers, and my husband's family. So when we lost the baby a lot of people didn't really know why I was off from work or, you know, why I was not well and things like that. And in a way, at that time we just said, “Oh, she had the flu.” I think it was wrong. I wish I had at the time said, “Well, I just lost my baby.” 

You know, but because it's all taboo and, a lot of people actually just don't know about it so you just - what's the point of telling them now that you've lost your baby? A lot of people actually said, “Oh, it was just a little few cells or, you know, it's nothing.” But it's actually much more dramatic than you actually can understand, unless it has happened to you, because you really sort of, it's like your hopes, you know. 

Well - although the baby was only eight weeks or ten weeks or whatever - you just already had sort of thought about a future for that baby, so it is quite - and you can't, you haven't anything to grieve, you know. You don't hold the baby to say goodbye, you've got nothing, so it's quite difficult and the ERPC [evacuation of retained products of conception, surgical procedure] was quite difficult as well from the sort of physical point of view, I felt really very, in a lot of pain afterwards. You know, I thought probably a normal miscarriage which is sort of, everything sort of goes, is probably easier in a way, but you know, that's something different for me. 

But I think the emotional impact of the miscarriage is probably not recognised, and I think possibly there's nothing wrong to say you've lost a baby, and even if it's an early miscarriage a lot of women have miscarriages and they actually hide it. And it's only when you start telling other people, “When I had a miscarriage” and they say, “Oh, me too, me too.” And everybody else almost has had a miscarriage and they're all keeping it inside. So, but it was you know, difficult. 

When you first found out you were pregnant, did anybody point out to you that miscarriages are quite common?

You read it, but you think it's not going to happen to you. You think, “Oh, these things never happen to me.” And also I had this idea that miscarriages only happen if you'd done something, you know - I don't know, you've overdone or you've carried something heavy or, I don't know, I just felt that it was not something, I was not expecting it to happen to me. I was worried a little bit about the baby and, you know, the whole thing, but I was so excited by it, I didn't think it was going to happen to me, not at all, no. 

A few were upset at the time but got over it quite quickly, especially if they then had a successful pregnancy. A specialist told one woman that 'all the hurt would go away' once she got pregnant again.

Having a miscarriage made people understandably more anxious in later pregnancies in case it happened again. (See also 'Emotions in pregnancy'). Views were mixed about when to tell friends and family about the next pregnancy. Some people wanted to keep it quiet so if they had another miscarriage they did not have to make it public. Other people felt it would be better if people knew so they could offer them support and understanding. This has to be a personal decision. (See also 'Discovering you are pregnant and telling others').

 

Investigations never found a cause for her miscarriages and the uncertainty in each pregnancy was...

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Age at interview: 36
Sex: Female
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Did you talk to any doctors or anyone else about your concerns about having another miscarriage?

I didn't really, because I think the, the immediate problem seemed to be the actual getting pregnant, so whilst initially after my second miscarriage that was my fear - "What if I miscarry again?" - quite quickly the becoming pregnant became the issue. And so miscarriage was something that I really needed to just put to the back of my mind and cross that bridge if and when I came to it. And when I did become pregnant on Clomid, after 4 cycles of Clomid, I really didn't imagine I would have another miscarriage. I really believed that the miscarriage had been bad luck or unexplained reason, just one of the 1 in 4 people that do have miscarriages. I knew that to have 3 miscarriages consecutively was rare. I did read a statistic that only 1% of people, 1% of women have suffered with recurrent miscarriage, which is 3 consecutive miscarriages, so I didn't really expect to form, to form part of that statistic.

So the third miscarriage was when you were on Clomid but not yet IVF?

That's right, that was the third miscarriage and so that was the, that was the trigger to then be investigated for miscarriage as opposed to fertility alone. They can investigate reasons for about 20% of miscarriages, about 20%-25% are chromosomal defect and a blood problem. So I was checked out for both of those and it showed that I didn't have a, there was no chromosomal defect and there wasn't a blood problem either. So that ruled out the reasons. It also meant that there wasn't a quick fix to a mis-, to miscarriage either because it just meant that there was no explained reason and so, obviously, I still don't know why I had 3 miscarriages.

Does it frustrate you that they weren't able to actually tell why this happens?

It did until I had a viable pregnancy. Obviously, it's still there at the back of mind because I would like to become pregnant again, I would like to have a baby again, another baby. But having had one successful pregnancy I no longer have had - my, my personal history is not that every, every pregnancy has ended in miscarriage. So, so it's, it's a frustration, but having actually had a baby puts paid to a lot of that sense of frustration.

How did you feel with the third miscarriage then, when that happened, what was your '?

I almost had a sense of expecting it. On, on one hand I didn't expect it because I thought I couldn't be that unlucky and I realised that three, three recurrent miscarriages would be unlikely, but I think also what happens is your expectations, as you go along this journey your expectations are altered and almost lowered, I suppose. You start out with the expectation that you'll get pregnant relatively easily and the pregnancy will, will be a success and obviously, your expectations alter. So on some level whilst of course it was very, very distressing to have that miscarriage, even though it was at 6 weeks, which is extremely early, but I'd known I was pregnant once I, when I was literally about 4 weeks pregnant. So whilst it was very distressing, there was almost a sense of why should I expect anything else, by then?

That's sounds quite hard, was that?

It, it was difficult because the previous miscarriage I got over relatively quickly, based on the idea that I would be pregnant again within about 6 months and still had a, a lot to look forward to. Whereas by the time I'd had the third pregnancy, which was having taken Clomid, and knowing also that both of my fallopian tubes were damaged, I realised that the

Many women never found a reason why they had a miscarriage and later had normal pregnancies. The cause is rarely investigated unless a woman has repeated miscarriages (three or more), and even then a cause is not always found (see Interview 16 above). Some people took part in research studies about miscarriage and found the research staff very supportive.

It's estimated up to two-thirds of all early miscarriages seem to happen because the baby has a genetic abnormality (NHS Choices 2015). One woman had three miscarriages and initial tests found no cause. Only when a serious chromosomal condition was found in her fourth pregnancy was a connection made with the miscarriages. Like several other people, she was relieved to find a cause and know she could have done nothing differently to prevent the miscarriages.

 

It was in some ways a relief to discover her previous miscarriages were caused by a genetic...

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Age at interview: 37
Sex: Female
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So, we were given all this information. There was no rush, there was no hurry, we were told to go away and think about things and talk to each other and discuss things and for me there was never that much to discuss. It was, in some ways I was relieved to know what the problem had been; that they thought that this was why I had been having miscarriages, that this was why the baby had so many handicaps, that it was nothing that I'd done. There was nothing I could have done any differently so it wasn't my fault, because, prior to that, I think I'd just completely messed myself about thinking, 'Oh, it was that glass of wine, it was eating that cheese', it was something that I'd done that had caused this. And then it turned out to be just me, and the way that my genetic make-up is. And there was nothing I could do about that at all.

One woman whose third miscarriage happened quite late, at 17 weeks, was found to have a blood clotting disorder.

 

After three miscarriages, investigations showed she had a blood clotting disorder. It was a...

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Age at interview: 42
Sex: Female
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The specialist hospital explained that it was quite common to have miscarriages. It wasn't, to have one as late as seventeen weeks wasn't common and what they would look into is a type of blood clotting disorder that women who tend to have recurrent miscarriages they, they seem to have this, this phenomenon really. And so they explained that they would have to do several blood tests and it would take a few, a few months. That if I was found to have this sort of blood clotting disorder then there was a course of aspirin and heparin injections which would thin the blood and hopefully prolong the pregnancy. And so that's what they explained would be the sort of course of treatment once I had, once I had got pregnant.

Did they in the end decide that that is what you had?

Yes. It was.

What's it called?

It's called antiphospholipid syndrome and basically the blood clots in the placenta and therefore oxygen cannot get to the fetus and the fetus is aborted.

So how were you feeling at this point, because you'd been through a bit already?

I felt, I felt a sigh of relief, actually, because, because now I could, now they had pinpointed what, what, you know, what my problem was. And it wasn't anything that I had done or not done. It was just one of those things, but at least there was some sort of treatment that would give us, that would give us a better chance of prolonging the next pregnancy.

And I mean had, the three miscarriages, had that put a strain on between you and your husband? What was, you know, how were you coping as a couple with all of that?

I don't think it, no, it didn't put a strain on me and my husband. I think it really, it actually brought us closer together. I, it's something that we, we both dearly wanted. My husband already had an older son from a previous relationship, older child from a previous relationship, and we desperately wanted, we dearly wanted our own. But no, no, no, it didn't put, it took - it even brought us close, much closer together, and he was very much involved with all the hospital appointments, seeing the specialist, every step of the way.

So once you had a diagnosis were you feeling more optimistic about the future in terms of future pregnancies?

Absolutely. I'm, I, we're very positive people anyway, and we very much, we have a, a very deep rooted faith and we knew that at some point we would have a child. We didn't know how long it would take but we would, we know, we knew that we would have a family. And yes, we're very, very optimistic about the future in terms of the, the treatment that would be available.

In her fourth pregnancy preterm labour started at just under 23 weeks. In her fifth pregnancy, a stitch was put into her cervix, to stop it opening as the uterus became heavier in later pregnancy (cervical incompetence) and causing another miscarriage or preterm delivery. The baby was born healthy at 37 weeks, but she had to spend several weeks being monitored in hospital. (See also 'Looking back - Preterm birth and special care').

 

In her most recent pregnancy she took medication for the blood clotting disorder and also had a...

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Age at interview: 42
Sex: Female
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I didn't [sigh] I just again, it, it does come down to my faith, our faith. I just felt that whatever happened somebody up there has got it in control. So we just needed to take whatever medical advice possible. Go to the specialist hospital, by now they knew us very well, [laugh] they knew us very well. Go to the specialist hospital. Stop working. And this time one of the things that they didn't do the last time was to put a, a stitch in, because they, they were working on the fact that I had the, the blood clotting disorder, and the cervical incompetence wasn't an issue, but to cover all eventualities this time I would be on aspirin, the heparin. I would have a, a stitch put in at twelve, thirteen weeks, which is very early, and be constantly monitored at the specialist hospital.

It is always best to consult a doctor or midwife about bleeding in later pregnancy. It may be caused by harmless changes to the cervix, but it can also be a symptom of something more serious such as placenta praevia (see 'Other conditions in pregnancy').

Amniocentesis and chorionic villus sampling are diagnostic tests to check if the baby has a genetic condition. Both tests carry a small risk of miscarriage. For further information, see the Healthtalk Antenatal screening website.

For links to further information, see our pregnancy resources.

Last reviewed May 2017.
Last updated May 2017.

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