Having had five miscarriages, I’ve become somewhat of an unfortunate expert. I’ve had a range of experiences from mysterious to practical, from labour & birth to hemorrhage, from grief and pain to relief. When I first started researching miscarriage before I started having my own, my most powerful learning came from storytelling. I hope now to add to that narrative and bring some wisdom from my losses.
Physical
The thing to know about miscarriages is that they are at once all alike and all unique. In a very generalized sense, all my miscarriages, and all the ones I’ve attended, have followed a somewhat familiar pattern:
We start with a knowing: maybe this is by ultrasound, maybe intuition, maybe by feeling the symptoms, but at some point we realize: I’m losing this baby.
Sometimes there’s a waiting: when it’s known ahead of symptoms presenting, there will be time to think and mull and wait and feel every tiny twinge in the uterus and think: Is this it? Is it now?
Then there’s the start of the release: usually cramping, sometimes big, sometimes small, and always some bleeding but sometimes big, and sometimes small.
Then there’s the peak of expulsion, which is also the peak of pain for most people. This is the peak of dilation for the cervix, and this passing through and over the threshold is often intense.
Then there’s the resolution: once the peak has been crested, the symptoms usually resolve quite quickly. Bleeding tapers off, the pain subsides and there are tiredness and relief that washes over.
Then there’s the long integration: usually light bleeding and some after-pains for a few days or a few weeks, and the body slowly returning to “normal."
I like this diagram and often share it with clients, as it shows the symptoms you may experience all leading up to peak expulsion and then tapering off quickly. It also shows what’s going on inside the uterus as each of these stages happen. This diagram helped me learn about miscarriage and categorize what I was feeling.
There are different types of miscarriage, and I’ve had a few. I’ve had:
chemical pregnancies
missed abortions and
straight-up miscarriages.
A chemical pregnancy is when an egg is fertilized, and even implants in the body (which will trigger the start of manufacturing pregnancy hormones like hCG), but there’s a malfunction in cell division. The cells divide and make a sac, fill it with a small amount of amniotic fluid, and make the beginnings of a placenta, but they never actually make a baby. So, chemically, the body is pregnant (in that the building blocks are there, so pregnancy hormones start manufacturing), but there’s no baby to grow. This usually means the levels of pregnancy hormones are low, so home pregnancy tests come back faint or sometimes negative, but pregnancy symptoms may persist (since it’s the hormones that make symptoms in the first place, not the baby) and a full-on miscarriage can still occur since the loss is still physiologically and chemically the same regardless of if there’s a baby there or not.
I’ve had two chemical pregnancies. The first one was a bit mysterious, which I’ve always referred to as my ghost baby. At this particular time, my period was three weeks late. I never took a pregnancy test but my intuition was keenly piqued and I felt at least possibly pregnant. Prior to this occurrence, my period had never been more than 2 days late for ten years. When it finally came, I was doubled over in rhythmic pains, with heavier bleeding and clotting than normal for a few days, followed by a quick subsiding. It was my first miscarriage, and I refused to call it such for years, as those words did not enter my mind until after I’d had a few more miscarriages and reflected back on this mysterious experience as oh, huh, I guess that was probably an early pregnancy ending. A few years later I had another chemical pregnancy. This time my period was two weeks late, and I was experiencing nausea and breast tenderness. I had been trying hard to conceive and was cautiously thrilled. After the two weeks and symptoms I broke down and took a pregnancy test which was… confusingly… negative. A few days later I had a very heavy period with lots of clots. Immediately after passing a bigger clot my nausea lifted. I’d always reflected on this as pregnancy, but with the confusing caveat of a negative pregnancy test, I tell myself this was either a chemical pregnancy or an early loss where hCG had already dropped enough to not be detectable on a home test.
In my experience, the chemical pregnancies were lighter, physically. The bleeding was heavier than a period but lighter than my later miscarriages. The hormonal/emotional response felt uncontrollable and heavy for a little while, but it was manageable. The pain was hard for a few days but subsided.
I’ve also had two missed abortions (as they’re called in the medical world), or missed miscarriages (as they’re called colloquially to distance them from the word abortion), which have been, in many ways, the hardest physically, but the most predictable. In both cases, it was a wanted and planned and loved pregnancy. In both cases, I had a strong moment of knowing which I only pieced together in retrospect, of irrational (hormonal) rage and fear and deep grief usually manifested as arguments with my partner. In my first missed abortion I contracted a terrible cold which knocked me out for a few weeks, including a few days of fever. When the cold finally subsided, so did all my pregnancy symptoms. When the spotting started, I scrambled to get an ultrasound to confirm what I was already pretty sure I knew. In my second missed miscarriage I felt uneasy and after a few weeks of the faintest spotting, I finally sought an ultrasound. I’d already had an ultrasound at 6 weeks in this pregnancy as my uneasiness got the better of me, which had shown a healthy heartbeat. This time the ultrasound after the spotting was different.
Both times the ultrasound techs took their time to tell me, wanting to be really really sure. They’re not supposed to say anything (they leave that to radiologist/your doctor), but because they knew I was a midwife and knew I could interpret things myself, they showed me the screen and showed me the lack of heartbeat, the pooling blood, the baby embryo that was two weeks too small. In both cases, the prodromal early labour started within a few days. The first one developed quickly into full-blown labour and birth. Rhythmic contractions set in. After building in intensity and pain for about an hour I had an overwhelming urge to vomit (transition), my waters released, and with salty amniotic fluid running down my legs I caught a teeny embryo the size of my thumb in a little bowl. After a brief lull, contractions picked up and out following a smooth placenta the size of a quarter with a sweet little egg sac still impressed upon the outside of the membranes, and a trailing little cord (which had been detached from baby). A few more gushes of blood and it was over.
The second one was longer, more drawn out. In part, I believe because my paranoia about losing the pregnancy had prompted me to take a bunch of miscarriage-prevention herbs daily for about three weeks prior to the miscarriage. Once I had the unfortunate ultrasound, I stopped all the herbs and let grief take over. After start-and-stop labour it started in earnest one evening. The rhythmic pains were intense and required help to cope. My waters eventually released over the toilet and after labouring and passing a few small clots I passed two large ones and felt an uncontrollable sigh in my body of release and relief followed by profound exhaustion. I climbed into bed with a hot water bottle and fell asleep.
It still astounds me how much these experienced mirrored labour and birth in miniature: a build-up of contractions, a release of waters, a passing followed by relief, and a slow and steady bleed after that resolved on its own.
I’ve also had what I refer to as a straight-up miscarriage as opposed to a missed abortion, simply because I didn’t know it was coming and it surprised me with no lead up of symptoms or unfortunate ultrasound to predict its coming. My general theory is that (almost) all miscarriages are missed abortions, just some we actually know about ahead of time and some we don’t. It just physiologically makes sense to me that the pregnancy would (most of the time) have to slowly end, and hormones change enough to release: and this takes time.
The straight-up miscarriage was bloody. The day before it happened I’d had a 6-hour car ride over bumpy uneven ground. As I got to my destination I felt cramping and twinges in my uterus, just for a few minutes. I put my hands on my belly and asked my little one to calm down, all was okay. The next day with no spotting, no warning, I started gushing clots and blood. For the next few days I lost more blood than I was objectively comfortable with but stubbornly decided I could nurse myself back to health. I don’t remember any real amount of cramping or pain, just lots of blood. This stopped as abruptly as it started, but I knew there’s no way the baby survived.
Emotional
Just as the physical symptoms follow a somewhat familiar pattern as my body loses babies, my emotions do, too.
First comes panic and protest. Sometimes this lasts just in the moment of seeing the blood, because this is all the time I have to process what’s happening, and other times, like with the missed abortions, when I start to see symptoms I panic and do everything in my power to hold on. This, of course, doesn’t work and I still eventually lose them.
Sometimes, there’s bargaining. Reasoning with the baby, with powers that be: if I give up this, can I keep the baby? If I change this, will you stay?
Then comes helplessness, or my woe-is-me phase, or maybe I should call it desperation. I accept it’s happening, but I’m just so damn devastated. Usually, this is when the physical symptoms are really setting in, the pain feels unbearable and it just feels so unfair to have to suffer physically while also not getting to keep the baby. If I don’t get to keep the baby, could I not also have to bleed and writhe and squirm in pain, please?
Then comes getting practical. This is usually partway through the release when an emotional switch is flipped in my body and I know what I need to do. For me, it always involves getting upright and working to get my cervix to release. I see the path ahead of me, I focus on it, and I leave my emotional grief aside.
Then comes relief, after the passing of the largest clots and my knowledge that the release is over, I am just so glad to be done. I’ll never be glad to lose the babies, but there’s a part of me that is proud of myself and my body when we see ourselves through, and all tuckered out emotionally and physically, I tuck into rest.
Then comes a long, dull mourning. I wear black for a few days, I keep quiet and subdued and try to minimize my interaction with the world outside my own self. I slowly unravel the bonding and plans and hopes and dreams I’d had for myself and the baby and our lives together, I un-know my due date and my milestone dates I’d already filed away in my heart, and I make my peace with a deeper knowing of loss, and an acceptance that this one will never be.
The emotional journey through my miscarriages has been harder than the physical journeys. I’m blessed with a body that (mostly) does its physical job in miscarriage efficiently and predictably. Emotionally my responses have been varied. In some ways I have to say it gets easier the more I have: a peace settles in around it all much quicker, I know what to expect with my emotional wellbeing. After my third miscarriage, I grieved hard for about 7 months and finally sought guidance from a friend on re-connecting with spirit in order to attempt to engage and let go. After a meaningful set of visions, it finally subsided. The most recent miscarriage took about two months to feel emotionally well again. In the meantime, I was able to lead an outwardly stable life, with an undertone of grief I was able to recognize and deal with as it came.
Still, there is nothing easy about these losses. Even with the wisdom of other losses behind me and an efficient body, I’d prefer to never have another. They challenge me, overwhelm me, and hollow me out each time. They also bring me gifts, and moments of wisdom when I need it desperately: one miscarriage brought the value of the relationship between me and my now-husband into focus enough for me to uproot my life and decide to be with him. Our most recent miscarriage answered for us a tough question we’d been asking ourselves throughout the early pregnancy: who I was going to have as a birth attendant (answer: simply me and my husband, we totally rocked it). I can easily attest that my miscarriage experiences have been the lowest lows in my life. They have also brought powerful insights and clarity that I’m not sure I’d have considered so profoundly without them being attached to such pivotal experiences. Nothing draws life choices into focus quite like a pregnancy, and nothing solidifies values and lessons quite like a loss.
For all those out there reading this before, during, and after their own losses, I wish you a smooth physical process, and the peace you deserve when it’s right for it to come.