Signs of miscarriage: Here's what to look for

When I was six weeks pregnant with my first baby, I went horseback riding. My little palomino mare was normally pretty calm, but on this day we were stalked by an annoying horsefly, and in her attempts to get rid of it she managed to buck me off. I wasn’t hurt, just bruised, and I trudged through the woods until I caught her. The next morning, still sore from the fall, I noticed spots of blood in my underwear. My heart sank as I wondered if this was one of the signs of miscarriage.

Miscarriage symptoms can vary, but the most common signs are spotting or bleeding, pain or cramping and unexpected vaginal fluid or tissue.

What is a miscarriage?

Miscarriage, also called "spontaneous abortion", is the loss of a pregnancy before 20 weeks. Up to one in four of all pregnancies end in a miscarriage; however, in many cases the woman may not have even known she was pregnant.

The rate of miscarriage in known pregnancies is lower, about 10 percent. Most miscarriages—80 percent—happen in the first trimester, or before 13 weeks. This is called an "early miscarriage." The loss of a baby after 20 weeks is called a stillbirth.

If you're wondering if miscarriages are more common now than a few decades ago, OB-GYN Haim Abenhaim of McGill University explains that pregnancy tests now let people know they are expecting very early in the pregnancy. Before tests were this sensitive, a woman who had an early miscarriage might not have known she was pregnant and simply assumed her period was late when she started bleeding, he explains.

So how do you know if you're having a miscarriage?

Signs and symptoms of miscarriage

What does a miscarriage look like?

Vaginal bleeding

“The first warning sign of a miscarriage is usually bleeding,” says Abenhaim. That doesn't mean if you notice some spotting, you're necessarily having a miscarriage though. A few spots of blood on your underwear in the first trimester is common, he explains. Miscarriage is more likely if the bleeding progresses from light spotting to something more like a normal period; if the colour is bright red rather than brownish, or if you are also feeling cramping.

What does a miscarriage feel like?

Uterine Cramping

Cramping during pregnancy can be normal and is not necessarily a sign of miscarriage. “That crampy feeling may just be the uterus expanding,” explains OB/GYN Alison Barrett. They may also be what are called Braxton-Hicks contractions, which tend to start earlier with each pregnancy.

However, cramps or contractions that become progressively stronger may indeed be a sign of miscarriage.

Sharp or persistent pains

There’s a lot going on inside your body during pregnancy, so it’s probably not surprising that you’ll experience occasional aches and pains, which might feel sharp and stabbing, or like a dull ache. Your growing uterus is pushing other organs out of the way and stretching the tendons that hold it in place, and that can be quite uncomfortable at times.

Another possible cause of persistent or intermittent pain is a bladder infection—something women are more prone to during pregnancy and which should be treated. “On the other hand, pain in the abdomen can also be a sign of a tubal pregnancy,” says Barrett. “So if you are experiencing persistent pain, you should see your doctor or midwife to rule out any problems.”

No more nausea

Sarah Johns had a healthy first pregnancy, but she was nauseous from beginning to end. When she conceived again, the nausea hit at around five weeks. “I was incredibly sick, and my doctor prescribed medication so that I could cope,” she says. She braced herself for eight more months of barfiness.

But at around 11 weeks, Johns started to feel less sick. She wasn't relieved though—the dramatic decrease in nausea worried her. Johns got an ultrasound that confirmed the baby had died.

Abenhaim stresses, though, that in most cases it’s quite normal for “morning sickness” to end at around twelve weeks and it doesn’t necessarily indicate a sign of miscarriage.

Not feeling pregnant

What about the other typical symptoms of pregnancy, like tender breasts, tiredness and frequent urination? Is it a bad sign if these symptoms disappear?

Not necessarily, says Barrett. Every pregnancy is different. For example, your breasts will be most uncomfortable during your first pregnancy because they are growing and developing the duct system that will produce milk for your baby. During a second or third pregnancy, especially if it’s soon after the first, there will be less growth and development—so less tenderness.

Some of the improvement can simply be the natural progression of the pregnancy. During the first trimester, the growing uterus puts a lot of pressure on your bladder, so you need to pee frequently. Once the uterus has grown a bit bigger, it comes out of your pelvis and the pressure on your bladder eases up. Similarly, many women feel much more energetic as they enter the second trimester.

However, Barrett adds, when a miscarriage is inevitable, women may notice an overall difference in how they feel. When the baby dies, the placenta stops producing the hormones that cause the familiar symptoms. Many women describe suddenly or gradually feeling their bodies change, and knowing that the pregnancy has ended.

Can miscarriages be prevented?

Most miscarriages are caused by genetic abnormalities and can't be prevented.

However, a healthy lifestyle can help. A Danish study published in 2011 followed over 100,000 women from the beginning of their pregnancies. The study identified a number of risk factors that may increase the risk of miscarrying, including binge drinking, drinking large amounts of coffee, smoking (but not nicotine replacement treatments—good news for those trying to quit!), being overweight or underweight before conception, and lower education. Some of the results were a bit surprising: Working night shifts was also a risk factors, and so was the age of the baby’s father if he was 45 or older.

If you think you're having a miscarriage

“I tell mothers, ‘It isn’t over until it’s over,’” Barrett says. “Sometimes you have symptoms that seem pretty scary, and yet the pregnancy continues.”

Abenhaim says that an ultrasound provides the best confirmation of whether a miscarriage is inevitable or not. He encourages women to see their doctor if they are concerned, because in certain situations, prompt care may prevent a miscarriage. If you have had three or more miscarriages, or miscarry after 12 weeks, he recommends seeing a specialist who may be able to determine underlying causes and help reduce the risk with your next pregnancy.

He also stresses the need for emotional support. “A miscarriage is very difficult for most women,” he says. “Even though they are common, and even though they are usually not caused by anything the mother has done, a miscarriage can be devastating.”

Even though miscarriages are fairly common, the majority of pregnancies continue just fine despite worrying symptoms. When the baby and pregnancy are healthy, even a fall from a horse isn’t likely to cause a problem. Although I was pretty nervous when the spotting that I had after getting bucked off lasted for two or three days, a visit to the doctor confirmed everything was fine, and my nine-pound baby boy arrived safe and sound, two weeks after his due date.