What You Need to Know About Miscarriage

The following is an excerpt from 2nd edition of Bumpin: The Modern Guide to Pregnancy (Simon & Schuster, March 2025)

Miscarriage, or a pregnancy loss before twenty weeks, is known by many names: early pregnancy loss, fetal demise, and spontaneous abortion among them. After twenty weeks, it’s called stillbirth. No matter when it happens, miscarriage can be devastating. While it’s hard to remember this if it happens, miscarriage is rarely your fault and is common not only in humans but in other mammal species too.

Many miscarriages happen before a woman knows she’s pregnant, and not all are reported, so it’s nearly impossible right now to quantify what percentage of total pregnancies end in miscarriage. Our best guess is that it happens in 10 to 20 percent, but the miscarriage rate could be as high as one in three. More than a million women report a miscarriage each year, and 80 percent of these happen in the first trimester. The majority are caused by chromosomal abnormalities, as our body’s ability to perform cell division becomes less efficient as we age. This is why the risk of chromosomal issues and miscarriage rises after women hit thirty-five. Men experience fertility decline over forty, too, though chromosomal abnormalities in sperm are a less common cause of miscarriage.

Since it still lives in the shadows, we’ll cover a few of the most common miscarriage myths, followed by the top questions people ask when it happens.

Is miscarriage my fault?

Miscarriages can happen no matter how healthy and diligent you are, and though it’s very hard not to feel this way, miscarriage is rarely “your fault.” The majority are caused by chromosomal ­ abnormalities—not by something you ate or drank, stress, or by working out too hard. 

Outside of chromosomal problems, miscarriages can be related to genetic factors, uncontrolled health conditions like diabetes, hor­monal and thyroid issues, infections, or uterine or cervical abnormalities. The lifestyle-related factors that you can control are being overweight or underweight, smoking, using drugs, and aggressively consuming alcohol. If you’re wondering how to define “aggressive alcohol consumption,” miscarriage risk increases 6 percent for each drink you have over five per week.

Why do chromosomal abnormalities happen?

Errors during meiosis, the process that creates eggs and sperm, are the most common cause. Meiotic errors in eggs are responsible for most chromosomal abnormalities that cause miscarriage, birth defects, genetically abnormal pregnancies, and other issues like implantation failure. An immature egg starts out with two copies of every chromosome and must drop the extras during meiosis before it can be fertilized. 

During that process, the chromosomes can become misarranged, leaving too few or too many chromosomes in the mature egg. One or more extra or missing chromosomes is called aneuploidy. Aneuploidy is random and unpredictable but happens more frequently with advancing age. 

Women in their early thirties have an average of 10–25 percent aneuploid eggs; over forty, that number jumps to 50–80 percent. If I have one miscarriage, will I keep having them? Fewer than 5 percent of women have two consecutive miscarriages, and only 1 percent experience three or more. Recurrent pregnancy loss is poorly understood but, as the stats indicate, is relatively rare.

If you are concerned about recurrence or just want to talk about why your miscarriage might have happened, make an appointment with your ob-gyn or midwife. It’s also a good time to consider making lifestyle adjustments that can improve your overall health. But remember, most miscarriages happen due to chromosomal abnormalities, not something you did wrong, and there was likely nothing you could have done to prevent it.

How can I tell if I’m having a miscarriage?

Spotting and light bleeding around implantation is very common during early pregnancy—one in four women experience it—making it hard to know the difference between that and a miscarriage. If you experience bleeding and any of the below symptoms, it’s time to call your physician:

• Severe abdominal pain
• Cramps
• Progression of vaginal bleeding from light to heavy
• Discharge of tissue with clots
• Fever
• Back pain
• Unexplained weakness

There is also a miscarriage type that passes without symptoms: a missed, or silent, miscarriage. Because pregnancy hormones remain the same and a physical miscarriage often doesn’t happen for days or even weeks after the embryo or fetus has died, the way most people find out is during an ultrasound when a heartbeat cannot be found.

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

Call your provider. They will ask for the start date of your last period to understand how far along you are, symptoms, and any history of fertility issues. Depending on your circumstances, they may suggest waiting to see if it resolves, ask you to come into the office, or direct you to the emergency room to get checked out. If you cannot reach your provider or someone on call after-hours and the bleeding is heavy, head directly to the ER.

If you do go in, a doctor or nurse will perform an ultrasound to check for an embryo and fetal heartbeat. How does a miscarriage resolve? There are several ways. The first is known as expectant management, which means letting a miscarriage take a natural course. When a miscarriage happens before nine weeks, most providers take this wait-and-see approach. A first-trimester miscarriage usually feels and looks like a heavy period. Bleeding or passage of tissue should stop in a few hours, and light bleeding typically concludes after several days.

If the miscarriage doesn’t or can’t clear on its own and it occurs before nine weeks, your doctor will typically prescribe a combination of two medications, mifepristone and misoprostol. They work over a twenty-four-hour period and cause bleeding and intense cramping, and in some cases nausea, vomiting, fever, chills, diarrhea, and headaches.

You may not need bed rest but be prepared to take it easy for a few days, and have high-absorbency pads on hand, especially overnight. If you are nine weeks or more into your pregnancy, a dilation and curettage (D&C) may be performed to remove any remaining tissue. It can be done in an office, in an emergency room, or as a minor outpatient procedure. A D&C takes under thirty minutes and does not require a long recovery period. Your doctor may start the process of dilating your cervix a few hours or the day before the procedure with medication. 

After it’s dilated, the remaining tissue will be removed from your uterus with a long instrument called a curette. You’ll spend an hour or two in recovery, so the effects of anesthesia wear off before you leave, and to ensure there is no bleeding. If your blood type is Rh-negative, a shot of RhoGAM will be given, too. Complications from a D&C are rare, but expect to feel drowsy and have mild cramping and light bleeding afterward. 

Sex is off-limits for one to two weeks to reduce your infection odds. Your uterus must build a brand-new lining after a D&C, so your period can take longer than one cycle to come back.

When can I try to get pregnant again after a miscarriage?

If the miscarriage happened early and did not require medical intervention to resolve, there is no evidence that shows that waiting even one cycle contributes to the health of future pregnancies. Ovulation can happen as soon as two weeks after a miscarriage, which means you can get pregnant before your period arrives. Most health professionals will tell you that letting yourself heal physically is only half the process, and you should not feel pressured to get pregnant again until you feel ready.

Exactly how many cycles you should wait is best determined by talking to your provider, as it depends on how far along you were when the miscarriage happened, how it resolved, and your overall health. Opinions range from as soon as you are medically cleared to have sex again to six months, and depend on whether you had a procedure like a D&C and how you recovered. 

Everyone’s reaction to miscarriage is different. Some women are raring to go immediately, and others need time to deal with what happened. Because it wasn’t as physically real to them, your partner might process it very differently. Try not to judge if they don’t seem to feel it as intensely. 

Friends and family may not always know what to say or do, so tell them what you need. Same goes for your partner. The answer can be funny cat videos, a night of distraction, or absolutely nothing but the physical presence of another human being. You may be surprised at how many people in your life have had a miscarriage, and that they will mourn the loss with you.

Seeing a therapist or counselor who specializes in processing grief or trauma can also be helpful. If you have pelvic pain or pain with sex, following a miscarriage, a pelvic floor physical therapist can help. Joining a support group allows you to connect with others who have gone through the same loss. Whether you do it in person or online, hearing and reading other people’s experiences can be healing, but it can also be triggering, so manage your consumption if it’s causing more heartache than help.