Miscarriage: Every question you have, answered by the experts

On Wednesday morning, news broke that Meghan Markle, Duchess of Sussex, had suffered the devastating experience of a miscarriage in July 2020. In October, Chrissy Teigen shared photographs of her and her family suffering a similar loss, that of her stillborn baby Jack. Zara Tindall, Beyoncé, Lily Allen and Emma Thompson have all spoken out about pregnancy loss, but despite these public figures vocalising such deeply personal experiences, still women – pregnant or not – find the topic shrouded in mystery and intimation.

For both women and men, it can be an incredibly sensitive topic and one that’s not easy to discuss, but that doesn’t mean it isn’t deserving of a conversation. Women that choose to share their stories of pain and grief (however publicly) must not be shamed for doing so. Silencing women’s stories of miscarriage won’t make it go away – but amplifying them can help alleviate feelings of guilt, sadness, confusion and distress that losing a child can provoke.

And it can be confusing. The language used to address miscarriage and an archaic sense of shame around anything to do with womens’ bodies can suggest we still live in Victorian Britain, but with more than one in five women experience a miscarriage in the UK every year, that’s not something we can afford to leave unchanged. “The number one misconception about miscarriage is how common it is,” says Ruth Bender Atik, national director of the Miscarriage Association. “Anyone who can conceive can also miscarry.” The Miscarriage Association defines miscarriage as when the fetus or embryo dies in the uterus during pregnancy before it is 24 weeks old. After 24 weeks, pregnancy loss is called a stillbirth, and if the baby is born alive but does not survive, it is called a live birth and a neonatal death. We asked Ruth to break down some of the most commonly asked questions around miscarriage.

Why does miscarriage happen?

“Usually, it’s impossible to identify the cause of a miscarriage,” says Ruth. “Most miscarriages are caused by abnormal chromosomes in the embryo, and have nothing to do with the mothers’ health or actions before or during pregnancy. “More than half of miscarriages are random, one-off chromosome abnormalities,” says Ruth. “The most significant factor is age. Women are born with all their egg cells, and as we get older the eggs become more susceptible to miscarriage.”

What is a missed miscarriage?

A missed miscarriage is when a woman miscarries but does not present any symptoms, such as bleeding or pain. It is rare, and can come as a shock for those expecting. “ If a woman is carrying a baby and doesn’t realise it has died, she may get signs of infection – flu-like symptoms, a temperature, aches and pains – which can be aided with antibiotics or a procedure, but it’s unusual to have no symptoms whatsoever,” Ruth adds.

What are my options if I miscarry?

Miscarriages happen naturally over time, and ‘expectant management’ is when you choose to wait between 7-14 days for the tissue to pass out naturally. You will also be offered medical management (medicine) or a surgical procedure. “It absolutely must be a choice,” says Ruth. “There’s no ‘better’ option, apart from it not happening at all, but it’s what the woman feels she can cope with best. Unless there is a risk to her life, it is up to her to choose.”

What happens during a miscarriage?

“It varies hugely. Women can experience acute, sudden pain and heavy bleeding, or they can have no symptoms bar a bit of spotting. It can take hours, and it can take days. The bleeding can come and go. You still go through a kind of birthing process, and depending on how far along you are, it can be terribly difficult to see the fetus, embryo or baby,” Ruth explains. She is also emphatic that in the UK, our perception of miscarriage has been skewed by soap operas and mainstream media. Many women will only ever have witnessed a miscarriage through the lens of a family-friendly TV show, but it’s crucial that women understand every experience is unique.

Do I get a check up scan after a miscarriage?

You may be offered an ultrasound scan following a miscarriage. If you have had recurrent (three or more) miscarriages, you may be offered tests to find out why – but it is important to remember that these are not always conclusive.

Did I cause my miscarriage?

“More often than not, it’s impossible to identify the cause of a miscarriage, and they cannot always be prevented,” Ruth emphasises. “It’s so important that women know this, because as human beings we don’t like it when there’s no explanation for something – so women blame themselves and ask ‘should I have eaten that curry? Do I live too close to that phone mast?’ because that provides a reason, and a reason means we have the power to stop it from happening again.” Blame can be a knee-jerk reaction to a tragedy, one that takes 2+2 and equals six times the pain. “It’s bad enough going through a loss like that, without laying on this blame as well,” says Ruth.

What do I do if I miscarry abroad?

Do not hesitate to call your antenatal healthcare provider for advice; seek medical attention, ask for a midwife or gynaecologist (OB-GYN), and ask for a translator if you don’t feel you can communicate your needs and concerns or understand the recommended treatment.

Does miscarriage run in the family?

There are no conclusive studies to confirm that miscarriage is genetic – the majority are caused by a chromosomal abnormality which any woman can experience. There are few factors that parents can control: a mother’s general health, alcohol and caffeine intake, drug use and obesity can all contribute, but few other biological, behavioral or socioeconomic factors have been definitively linked to risk of miscarriage. “We know that there is a higher risk of having a stillbirth if you are Black, Asian or of an ethnic minority,” says Ruth, but she – like many others – is audibly frustrated at the negligent research into factors such as race and ethnicity when it comes to miscarriage specifically.

How can I support someone going through miscarriage?

“If you know of somebody who has had a miscarriage, try not to avoid them – message them, speak to them, tell them you’re sorry to hear their news and that you’re there for them. Really listen to what they say. And whatever you do, don’t tell them you know someone who had six miscarriages and then gave birth to a healthy baby – it’s not comforting, it just means that they have five more to go. Anything that starts with the words ‘At least’ (it was early/you are young/you can have another one) is also unacceptable.” Just be there for them, ask them what they need, and listen when they tell you.

“Miscarriage is rarely painless,” Ruth adds, and the phrase could apply to both the physical and emotional suffering women endure as a result of a miscarriage. In her op-ed for the New York Times, Meghan Markle described heartbreak and “unbearable grief”; Chrissy Teigen wrote of “utter and complete sadness” and “the kind of pain we’ve never felt before”. As well as looking after your physical health in the aftermath of a miscarriage, it’s imperative you receive emotional support too – it can be comforting to share your experience with mothers who have been through something similar, or simply talk to a loved one about how you are feeling. There is no right or wrong way to react, and The Miscarriage Association provides a nonjudgemental, confidential helpline which can help connect you with a support group or simply listen to your concerns, plus they offer email support and information on counselling.