What Happens After A Miscarriage And How To Cope - What To Expect

If you were rejoicing over a positive pregnancy test just weeks ago, coping with a sudden and unexpected miscarriage can be difficult. You may feel a range of emotions — sad and disheartened over the loss, angry and resentful it happened to you, and possibly withdrawn from friends and family.

You may have trouble eating or sleeping. You may cry a lot, or you may not cry at all. All of these reactions are natural and healthy responses to pregnancy loss. Remember: What's normal is whatever you're feeling.

Feeling unsure about what's happening with your body and what comes next can make an already painful situation even harder. Here's what to expect both physically and emotionally during this time, and how to take care of yourself as you heal.

Key Takeaways

• Miscarriage is both a physical and emotional process, and every reaction is normal. Symptoms can include bleeding and cramping that may last days or weeks. Emotionally, many people move through stages of grief such as shock, anger, sadness, and eventual acceptance.
• There are several safe options for completing a miscarriage, depending on your situation. These include expectant management (letting your body pass the tissue naturally), medication (such as misoprostol), or a D&C. Your provider will help you decide the best approach based on how far along you are, potential risks, and your physical and emotional needs.
• Follow-up care and emotional support are essential for healing. Watch for signs of complications like prolonged bleeding, fever, or infection, and attend your follow-up appointment. Seek support in whatever ways feel right for you — from partners, friends, spiritual leaders, or support groups. Most people are able to conceive again successfully after a miscarriage.

What is a miscarriage?

A miscarriage is the loss of a pregnancy before 20 weeks. Often, the first sign is bleeding that may be heavy, along with abdominal or back pain and cramping.

Depending on how far along your pregnancy was, symptoms can last for just a few days — like a heavy period — or they may continue for three or four weeks. If you experience any of these symptoms, call your doctor right away.

What happens after a miscarriage

Your practitioner will confirm the miscarriage using an ultrasound and possibly perform a pelvic exam to check your cervix. You may also have blood tests to measure your hCG levels, check for blood loss, and determine your Rh factor. If you're Rh-negative, you may also receive a shot of Rh immunoglobulin to prevent complications in future pregnancies.

Emptying the uterus

Once the miscarriage is confirmed, your uterus needs to be cleared so your menstrual cycle can return to normal — and you can try to get pregnant again, if you choose to. Keep track of your medications with the My Journal tool in our free app

If your first sign of a miscarriage was heavy bleeding — especially if it was just a few weeks into pregnancy — then it's possible that the miscarriage was "complete," meaning all the fetal tissue has already been cleared out of your uterus.

But sometimes, especially later in the first trimester, a miscarriage is incomplete, and some tissue remains in the uterus. In that case, your provider may recommend one of the following:

• Expectant management. You can choose to let your body pass the tissue naturally. This process may take a few days to several weeks, depending on your body and how far along you were.
• Medication. If your body hasn't begun expelling the tissue on its own, your provider may recommend medication — often misoprostol, alone or with mifepristone — to help the uterus empty. Within a few hours of taking a pill or using a vaginal suppository, you'll start to bleed and expel fetal and placental tissue. Most women will pass the tissue within 24 to 48 hours. These medications cause some of the same side effects that you might experience if you just letting nature take its course — cramping, bleeding, nausea, and diarrhea.
• Surgery. Another option is to undergo a procedure called dilation and curettage (D&C)., during which a doctor gently removes the pregnancy tissue. Bleeding following the procedure is usually light and lasts less than a week. Complications are rare, though there is a small risk of infection.

How to choose the right approach

You and your provider will consider several factors, including:

• How far along you were. If bleeding and cramping are already heavy, the miscarriage is probably already well under way. In that case, allowing it to progress naturally may be preferable. For a missed miscarriage with no bleeding, medication or a D&C may be best.
• Your emotional and physical well-being. Waiting for a natural miscarriage can be emotionally difficult for some women. Completing the process sooner may help you begin to heal and allow your cycle to return to normal more quickly. "I think the waiting is just the worst part, but I would prefer to do it naturally," says What to Expect Community member scopeland9.
• Risks and benefits. Because a D&C is invasive, it carries a slightly higher (though still very low) risk of infection. The benefit of having a miscarriage complete sooner, however, may greatly outweigh that small risk for most women. Natural management comes with a small chance that tissue may remain, requiring a D&C later.
• Ability to evaluate the miscarriage. If determining the cause is important, a D&C may make it easier to examine the pregnancy tissue.

What not to do after miscarriage

Your doctor will let you know when it's safe to return to your usual activities. In general, you'll be advised not to insert anything into your vagina — including tampons or engaging in vaginal sex — for about two weeks to help prevent infection.

Be sure to attend your follow-up appointment so your provider can make sure you're healing well.

What to watch for after miscarriage

Even if your miscarriage progresses naturally and is relatively pain-free, your practitioner will likely want to keep an eye on your recovery for a few weeks. Complications are uncommon, but contact your doctor if you experience:

• Bleeding that continues for more than seven days
• Fever or chills
• Foul-smelling vaginal discharge
• Worsening abdominal or pelvic pain

These symptoms can signal an infection or that tissue remains in the uterus. In rare cases, retained tissue can grow abnormally and lead to a type of tumor called a choriocarcinoma, which requires treatment.

After a D&C, there's also a small chance of scarring inside the uterus (Asherman syndrome). This can usually be treated successfully with another minor procedure, and most women go on to have healthy pregnancies.

Your emotions after miscarriage: The stages of grief

A pregnancy loss often brings a mix of emotions, and there's no right or wrong way to feel.

"It's exhaustive and devastating," says What to Expect Community member anamb2. "Be kind to yourself and let yourself grieve."

Understanding common stages of grief may help you make sense of your reactions:

• Shock and denial. There may be numbness and disbelief, the feeling that "this couldn't have happened to me." This is a protective response in the face of trauma.
• Anger and guilt. Desperate to pin the blame for such a senseless tragedy on something, you may blame it on yourself ("I must have done something wrong to cause the miscarriage" or "If I'd been happier about the pregnancy, the baby would still be alive."). Or you may blame others — God, for letting this happen, or your practitioner, even if there is no reason to. You may feel resentment toward people who are pregnant or have children.
• Depression and despair. You may feel overwhelmingly sad and cry often, lose interest in activities you usually enjoy, or struggle to eat or sleep. You may wonder if you'll ever be able to have a healthy baby.
• Acceptance. Over time, you'll come to terms with the loss. Keep in mind that this doesn't mean forgetting — just that you'll be able to move forward while still honoring your loss. Everyone moves through these feelings differently, and there's no right timeline.

Miscarriage support

The grief you're feeling is real and valid, no matter how early in pregnancy your loss occurred. Some well-intentioned friends and family may try to minimize the significance with a "Don't worry, you can try again," not realizing that the loss of a baby, at any point in pregnancy, can be devastating.

If you've suffered a miscarriage or an ectopic or molar pregnancy, remember that you have the right to grieve in whatever way feels right to you. There's no "correct" amount of sadness to feel and no timeline you need to follow. Give yourself permission to mourn as much — or as little — as you need.

Lean your partner, if you have one. They're likely grieving too, even if they express it differently. Being open about your feelings, rather than trying to protect each other from them, can help you both heal.

If you're religious, ask your pastor, priest, rabbi, or spiritual leader for guidance. Perhaps you'll find closure in a private ceremony with close family members or just you and your partner.

Sharing your feelings — through a support group, with a friend, or online — with others who experienced a miscarriage can also be a comfort. Ask your practitioner to recommend a therapist or bereavement group to help you through this difficult period.

"I cannot recommend therapy enough," says What to Expect Community member WiatingForLABebe about coping with her miscarriage. "I think I just needed an impartial person to validate all of my feelings."

You may be surprised by how many people around you have quietly experienced a miscarriage — about 10 to 20% of confirmed pregnancies end in miscarriage. You're far from alone.

"Something that really helped me was opening up about it," says What to Expect Community member BabuyP3520. "You'd be amazed how many women around you have been where you are, and they are more than willing to help you."

And if you don't feel ready to talk about your loss, that's okay too. Honor what feels right for your healing, one step at a time.

When will you feel normal again?

No matter what you're feeling — and given your situation, your feelings may be all over the emotional map — give yourself time. Accept that you may always have a place in your heart for the pregnancy you lost, and you may feel sad or down on the anniversary of the due date of your lost baby or on the anniversary of the miscarriage, even years later.

If you find it helps, plan on doing something special at that time — at least for the first year or so — that will be cheering yet allow you to remember: planting some new flowers or a tree, having a quiet picnic in the park, or sharing a commemorative dinner with your partner.

While it's normal to mourn your loss — and important to come to terms with it your way — you should also start to feel gradually better as time passes.

If you don't, or if you have continued trouble coping with everyday life (you're not eating or sleeping, you're not able to focus at work, you're becoming isolated from family and friends) or if you continue to feel very anxious (anxiety following miscarriage has been shown in studies to be even more common than depression is), reach out to your provider or a mental health professional. Support can help you recover.

Getting pregnant again after a miscarriage

Health care providers used to recommend waiting a number of months before trying to get pregnant again after a miscarriage. They've learned, though, that the uterus is remarkably good at recovering from a miscarriage. Most doctors now say it's okay to try again as soon as you've had one normal menstrual cycle.

But check with your practitioner about your specific situation. If there's scarring in your uterus or pieces of placenta left behind, they might recommend a longer wait. Even among women who have had two or three consecutive unexplained pregnancy losses, about 65 to 75% have a successful next pregnancy that ends in a live birth.

Once you're ready to try again, use our ovulation calculator & calendar to help you discover which days you're most fertile. The What to Expect app has a pregnancy loss mode that can help you through the recovery stages if you choose to try it.

Try to remind yourself that you can — and most likely will — become pregnant again and give birth to a healthy baby. For the vast majority of women, a miscarriage is a one-time event — and actually, an indication of future fertility.