For many, a positive pregnancy test and the resulting early sings of pregnancy are cause for celebration, but for those who have experienced signs of miscarriage, it can also be a time of worry and concern. One out of every four to five pregnancies results in miscarriage or loss, according to Cynthia Mason, a Certified Nurse Midwife and Advanced Practice Registered Nurse practicing in Ohio.

And while it’s important to care for your body and your mind once you find out you are pregnant, it’s also important to understand the causes and signs of miscarriage. In the vast majority of cases, a miscarriage is not a result of anything a pregnant mother has or has not done—it’s simply a matter of nature doing its part to make sure you have a healthy pregnancy and baby.

That said, pregnancy loss is never easy. But getting the facts straight and knowing the signs of miscarriage can help calm your nerves about trying again. Here, everything you need to know about miscarriage.

Early Miscarriage

An early miscarriage is when a pregnancy spontaneously ends during the first trimester, or the first 12 weeks, of pregnancy. Approximately 10 to 15 percent of known pregnancies end in miscarriage during this time period.

The majority of miscarriages happen in this time, says Mason

Many miscarriages happen without a woman even knowing, often in the first few weeks after conception when cells are dividing and growing rapidly, since this is when chromosomal abnormalities occur.

Early Miscarriage Causes

Almost all early miscarriages that occur during this time period are due to circumstances beyond anyone’s control. In fact, chromosomal abnormalities account for up to 66 percent of early miscarriages. Other reasons include:

  • Improper implantation of the embryo into the uterine lining
  • Maternal health issues, like obesity, diabetes, and thyroid and hormonal imbalances
  • Poor lifestyle choices, like smoking, excessive drinking, or drug use
  • Maternal age (women ages 35-45 have a 20-35% chance of miscarriage and women over 45 have a 50% chance of miscarriage, according to the American Pregnancy Association)
  • History of miscarriage (women who have had a previous miscarriage have a 25% chance of having another one)

Early miscarriages are incredibly common, but experiencing one can feel isolating for a variety of reasons:

  1. Many women conceive, but lose the pregnancy before they have a missed period and, therefore, don’t know they’ve experienced a miscarriage.
  2. Many women don’t announce a pregnancy until the risk of miscarriage is lower, so we don’t even know about the pregnancy (or loss).
  3. Many women don’t talk about their losses with anyone, including close family.

And because there are so many different types of miscarriages and signs of miscarriage, the topic can be confusing. Here, we explain the various miscarriage causes:

Types of early miscarriage

Blighted ovum

You might ask: “Can I have a miscarriage and not know it?” The simple answer is yes. A blighted ovum, also called an anembryonic pregnancy or anembryonic gestation, occurs when a fertilized egg stops developing during early pregnancy. This often happens between weeks 8 and 13, but can happen before a woman experiences a missed period. Some women will notice signs of pregnancy, because the early embryo produces human chorionic gonadotropin (HCG). An ultrasound, however,  will show an empty gestational sac or a lack of heartbeat. Most women will miscarry on their own.

Missed miscarriage

A missed miscarriage is when an embryo dies early in the pregnancy, but the body doesn’t pass the tissue. Many women will continue to feel pregnant when this occurs. Because of this, missed miscarriages are often discovered at a checkup of the fetus via ultrasound if the baby’s size is not measuring correctly or a heartbeat cannot be detected.

With a missed miscarriage, a woman may choose to wait a few days to see if the tissue naturally passes on its own. An alternative option, in very early pregnancies, is a medication called misoprostol that helps the uterus contract and expel the tissue.

Another option is what’s known as a D&C, or dilation and curettage. This is a procedure that is usually done in a hospital, under sedation, where the cervix is dilated and a medical professional uses suction or scraping and scooping to remove all the tissue from the uterus.

Recurrent pregnancy loss

A woman is said to have recurrent pregnancy loss if she has two or more miscarriages. Only a small percentage of women (about 1%) experience this, and should visit their healthcare provider to identify any possible underlying health issues, such as diabetes or thyroid disease.

Chemical pregnancy

A chemical pregnancy is when an egg gets fertilized and implants, but dies soon after. Typically this happens before a missed period—many women may never even know they were pregnant and won’t have any signs of miscarriage. However, with higher-sensitivity pregnancy tests, it’s possible to get a positive test even before a missed period and then lose the pregnancy only a day or two later.

Threatened miscarriage

When a woman has signs of miscarriage, like excessive bleeding, but the cervix is still closed, it’s called a threatened miscarriage. This doesn’t always lead to an actual miscarriage—women who experience certain miscarriage symptoms can go on to have a healthy pregnancy. If a threatened miscarriage occurs and the cervix begins to dilate, it’s called an inevitable miscarriage because an actual miscarriage is likely to occur.

Incomplete miscarriage

An incomplete miscarriage is when the miscarriage begins but not all of the tissue is passed. A woman who experiences this should consult her healthcare provider—a D&C may be recommended.

Complete miscarriage

A complete miscarriage is common when a woman experiences pregnancy loss during the first 12 weeks. This occurs when all of the tissue is passed naturally and without assistance.

Signs of Miscarriage in Early Pregnancy

Many women experience spotting in their first trimester, which usually isn’t cause for much concern, Mason explains.

What are the signs of miscarriage in early pregnancy?

Here, signs of miscarriage that may be cause for concern:

  • Bleeding that doesn’t stop or gets heavier (some bleeding during pregnancy, however, is very common and does not mean you will have a miscarriage)
  • Unusual discharge that is brown or pink-tinged
  • Abdominal cramping or lower back pain
  • Passing tissue and clots
  • Dizziness or feeling faint
  • Reduction in pregnancy symptoms, like sore breasts or fatigue

If you experience any of these possible miscarriage signs in your first trimester of pregnancy, you should be evaluated by your health professional immediately. While it may not be a miscarriage, it is important to have your midwife or doctor check to make sure you and your fetus are healthy.

Signs of miscarriage at two weeks

At two weeks pregnant, you’re technically not pregnant yet. (Learn more about how pregnancy is dated here.) If you experience signs of miscarriage, like spotting, at this point, it may signal the onset of your period.

Signs of miscarriage at four weeks

At four weeks pregnant, the embryo has likely implanted in your uterus, but your body might not be producing enough hCG to get a positive pregnancy test yet. This is also about the time you might expect your period to arrive if you’re not pregnant. Because of this, many women who experience a miscarriage at this point don’t even know it. This type of miscarriage is most often referred to as a chemical pregnancy.

Signs of miscarriage at six weeks

Once you’ve reached six weeks pregnant, you’ve likely had a positive pregnancy test. You may not be experiencing many signs of pregnancy (morning sickness, sore breasts, etc.) yet, but most women are hyperaware of how their bodies are changing at this point. Although some women do not experience any signs of miscarriage at six weeks (often referred to as a missed miscarriage), between six and 12 weeks, excessive bleeding, cramping, dizziness, or reduction in pregnancy symptoms could signal pregnancy loss.

What to do if you think you’re having a miscarriage

If you think you might be experiencing signs of miscarriage, the most important thing to do is stay calm and call your healthcare provider immediately. There is a chance of a threatened miscarriage, where the pregnancy will continue and the baby will be fine, but the right precautions need to be made. Some other things to do while waiting to be evaluated by your provider are:

  • Lie down and rest
  • Avoid strenuous activity
  • Hydrate
  • Avoid pelvic activity, such as sexual intercourse

Late Miscarriage

While all miscarriages are difficult to process, late miscarriages, or those that happen after between 13 and 20 weeks, can be especially hard. This is because late miscarriages often occur after the “waiting period” of the first trimester, when most miscarriages usually occur. This is also because the rate of miscarriage drops significantly as the pregnancy progresses. According to research by American Family Physician, only 1 to 5 percent of miscarriages happen between weeks 13 and 20 of pregnancy (losing a fetus at 20 weeks of pregnancy is considered a stillbirth). By this point, many women have started sharing their good news with others, which can make losing the fetus especially painful.

Causes of late miscarriage

Like early miscarriages, most late miscarriages are caused by genetic or chromosomal abnormalities. Unexpected trauma, like a car accident or an especially large fall, can also be to blame. Other possible reasons for late miscarriage causes include:

  • Infection
  • Immune disease
  • Preeclampsia
  • Diabetes
  • Hypertension
  • Thyroid conditions

Signs of Miscarriage in Late Pregnancy

The late signs of miscarriage (after 12 weeks pregnant) are largely the same as with early miscarriage:

  • Bleeding that doesn’t stop or gets heavier
  • Unusual discharge that is pink-tinged
  • Cramping or lower back pain
  • Passing tissue and clots
  • Reduction in pregnancy symptoms

Women who have a late miscarriage may also experience:

  • water breaking
  • a sudden decrease or lack of movement

If you experience any of these miscarriage symptoms in your second trimester, or in any trimester of your pregnancy, it is important to call your healthcare provider right away.

On rare occasions, a pregnant woman won’t experience any signs of miscarriage, but an ultrasound will fail to show a heartbeat.

What to do if you have a late miscarriage?

There are a few options if you are experiencing a late miscarriage. If you’ve found out that your baby no longer has a heartbeat but have not begun to miscarry yet, you have the option of waiting to miscarry naturally, which may take a few weeks.

Other options include proceeding with a D&C or being induced. If medical intervention is necessary, some women prefer to be induced because it gives them closure and provides a more natural end to the pregnancy. Hospital staff may ask you if you would like to see, touch, or hold the baby’s body. This can be a particularly emotional time, and it’s okay to do whatever you feel is right for you. Some families choose to take pictures and decide later if they want to look.

When Is a D&C Necessary?

Dilation and curettage (D&C) is a surgical procedure to remove conception tissue after a pregnancy loss. Some natural mamas are concerned that D&C is not the right choice for them. Luckily, if you are hoping to have a natural miscarriage instead, you often can.

If a miscarriage occurs in the first 10 weeks of pregnancy, you can often wait and allow your body to pass the conception tissue on its own. After 10 weeks, the chance of incomplete miscarriage goes up, but you may still be able to pass the tissue on your own. If the bleeding and cramping last for longer than 2 weeks, you may need to consider medical help, like prescription misoprostol (similar to what they use for induction) or D&C, to avoid infection or hemorrhage. Always consult with your healthcare provider about what’s right for you.

Pregnancy After Miscarriage

While doctors used to recommend waiting three menstrual cycles after a miscarriage before trying to get pregnant again, many now feel that once you’ve had a regular period and are feeling up for it, you may try again. Mason says:

Recovery time is usually minimal and women can start trying again to conceive as soon as they are comfortable, at least after an early miscarriage

It’s important to remember that most women do not experience multiple miscarriages—only about 1 percent of women will experience pregnancy loss two or more times. Most women who have had a miscarriage will go on to have a healthy, full-term pregnancy. It’s also important to understand that miscarriages are rarely the fault of the mother and that they are nature’s way of protecting the health of mother and baby.

Have you had a miscarriage? You’re not alone—I had three miscarriages before conceiving my third child. → Read my miscarriage story here

How About You?

If you’d like to, feel free to offer other mamas support by sharing your own story and what signs of miscarriage you experienced.