Late miscarriage

A late miscarriage is one that happens after 12 weeks and before 24 weeks of pregnancy.

If you miscarry before 12 weeks, that is called an early miscarriage. If your baby dies after 24 weeks or during birth, that is called stillbirth.

You:

• have sharp, sudden and intense stomach pains
• feel very dizzy or faint
• feel very sick
• look very pale
• have vaginal bleeding or spotting, commonly after the pain has started
• have pain in the tip of your shoulder
• have diarrhoea and are vomiting

You're pregnant and:

• you're bleeding from your vagina
• you've got strong, cramping pain
• your waters break
• you have started to feel your baby move (usually from about 16 to 24 weeks) and the movements have slowed down or stopped

If you're registered, contact your midwife or local maternity unit.

Signs of a late miscarriage can include:

• vaginal bleeding
• strong cramping pain
• a gush or trickle of liquid from your vagina
• your baby's movements changing, like slowing down or stopping

Having these symptoms doesn't mean you are definitely having a late miscarriage. But if you're worried, contact your maternity service. If you're not registered with one yet, contact your doctor.

You may first learn that you've lost your baby at an antenatal appointment. That doesn't mean you missed the signs of a miscarriage. Some people have a later miscarriage without any symptoms at all.

Most of the time, doctors can't find a clear reason why a late miscarriage happens. It's unlikely to be caused by anything you did or did not do.

If you're having a late miscarriage, you may go into very premature labour on your own. If that doesn't happen, your doctor or midwife might recommend inducing labour (this means a midwife or doctor starts it for you).

Sometimes the loss of your baby is found during a scan or another appointment. If so, you may be offered a few options for how to go ahead. You may be able to:

• choose to have an induction (to have labour started) as soon as possible
• choose to delay induction until you've gone home and seen family members
• choose expectant management, where you go home and wait for labour to start naturally

Your doctor or midwife will give you the information you need to choose what's right for you.

If you choose expectant management, they'll make sure you know what to look for and when to come to hospital. They'll also tell you what to do if labour doesn't start, and what your baby may look like when they're born.

Sometimes you won't be able to choose to wait to deliver your baby. This might be the case if:

• you're bleeding heavily and continuously
• you're showing signs of infection
• your waters have broken

If you're having an induction for a late miscarriage, you'll need to go into hospital. The doctor or midwife looking after you will explain what to expect. They can also tell you about pain relief and how long labour might take.

Induction usually happens in 2 stages. First you're given a medicine called mifepristone, which is a tablet you swallow. After that you may be able to go home and come back 36-48 hours later to start labour, because mifepristone takes 36-48 hours to work best.

When you return, you'll be given prostaglandin tablets every few hours until you have regular contractions. Then you go through labour, and your baby is born.

Everyone responds differently to induction. For some women labour and birth happen quickly, and for others it can take several hours.

Think about what emotional support you'll need. A partner, friend or family member can stay with you throughout, and your doctor or midwife will talk this through with you.

After a late miscarriage, there's no right or wrong thing to do about memory making. It depends on how you (and your partner, if you have one) feel. Your doctor or midwife will talk through your options with you and can make suggestions. If you can, take some time to think about it beforehand.

You might be unsure what your baby will look like. The doctor or midwife looking after you can describe your baby. Depending on how far along your pregnancy is, you may be able to see and hold them if you want to. You can also ask the medical staff to take a photo, so you can look at it later in private.

It may not be possible to tell the sex of your baby. You can talk about this with your doctor or midwife. Some people prefer to think of their baby as one sex or the other, and there's no right or wrong way to approach it.

You may also like to invite other family members to spend time with your baby. That is your choice, though. Whatever you decide, the medical professionals caring for you will support it.

There is no formal registration process for babies lost before 24 weeks. You can, however, record your loss in the Memorial Book of Pregnancy and Baby Loss Prior to 24 Weeks.

You may be offered tests for both you and your partner. These will try to find out why you lost your baby. Your doctor or midwife will explain what the test results are, and what they mean for a future pregnancy if you want to get pregnant again.

Your doctor or midwife may also offer to carry out a post-mortem on your baby. This will only be done with your permission.

In many cases, tests and a post-mortem are unlikely to explain why you had a late miscarriage. But they may rule out some possibilities, and they may reassure you if you want to try to get pregnant again in the future.

Most people go on to have a successful pregnancy in the future, particularly if their test results are normal. It's worth remembering that.

After a late miscarriage, your body may go through some physical changes.

Your breasts may produce milk in the first few days after your late miscarriage. They can feel very large, tight, painful and tender.

To help reduce the amount of milk you make, you could try:

• applying ice packs (or a bag of frozen peas) covered in a light cloth to your breasts
• wearing a well-fitting bra
• taking pain relief like ibuprofen or paracetamol
• expressing small amounts by hand (just enough to ease the pain, otherwise you'll encourage your body to make more milk)
• taking a warm shower, which may encourage your milk to leak naturally.

Breast pads can help for the first few days.

There are medicines that can suppress your milk, though they aren't suitable for everyone. If you'd like to know more, speak to the doctor or midwife treating you.

Some people decide to donate their milk to help other babies. Donated breastmilk helps babies whose mothers are unable to give breastmilk, and some people find a little comfort in being able to help others.

After a late miscarriage, it's common to have after-pains. They can feel like labour contractions, cramps or strong period pains. What you're feeling is your womb contracting back to its normal size and its usual place, down inside your pelvis. Painkillers such as paracetamol can help.

After a late miscarriage, you'll bleed from the vagina. This bleeding is called lochia. It's your body's way of clearing out the tissue that formed to help your baby grow. It includes:

• the lining of your womb
• blood from where your placenta was attached

The bleeding is likely to be heavy for around 2 weeks and then lighter for a further 4 to 6 weeks. You may see some small lumps or clots in it. The colour will change from red, to pink, to brown.

The flow can go up and down. Don't worry if you have lighter days followed by heavier days, because this is normal.

During this time, use external period products (like pads) rather than internal ones (like tampons). This can help to avoid infection.

Contact your maternity unit if:

• you're filling a large sanitary pad in 1 to 2 hours
• you're passing blood clots larger than a £2 coin

It's hard to say when your first normal period will come. It's likely to be about 4 to 6 weeks after the miscarriage. Sometimes it's hard to tell lochia from your first period.

Your first period may also be different from your usual ones. This isn't unusual, and there's no need to be concerned.

You may find that your first period reminds you of the miscarriage. Some people find this upsetting, while others take it as a welcome sign that they can try to conceive again.

If you do find it distressing, there's support available to help you.

There's no right or wrong way to feel after a miscarriage. You may feel grief, shock and sadness, and so may your partner (if you have one) and other members of your family. It can help to look for more support from specialist organisations.