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. This was one of the miscarriage signs, right?
Worrying about a miscarriage is very common. In fact, about one in four pregnancies does end in miscarriage (sometimes called a “spontaneous abortion”). Obstetrician-Gynecologist Dr. Haim Abenhaim of McGill University explains that miscarriages seem even more common these days because new pregnancy tests now let us know we’re expecting very early on. In the past, he explains, a woman who had an early miscarriage might not have known she was pregnant but simply assumed her period was late when she started bleeding.
What are the most common miscarriage signs?
“The first warning sign is usually bleeding,” adds Abenhaim. “But not all bleeding means that you are going to miscarry, because it’s very common in the first trimester.” In most cases, it’s simply a few spots of blood on your underwear. 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.
That’s what happened to Jen Kowal. Her first pregnancy seemed to be going OK. “I had the normal pregnancy symptoms—nausea, sore boobs—but they were mild. I had the pregnancy confirmed by a blood test, and my doctor said I was pregnant, but barely.” Kowal thought perhaps she was just not as far along in the pregnancy as she’d thought. A few days later, though, she began bleeding.
“It was bright red, and it was a lot,” says Kowal. “I went to the doctor for confirmation, and there was no real question. It was over.”
What does a miscarriage feel like?
What about cramps without bleeding—could that be one of the miscarriage signs as well? Sarah Dufton was pregnant for the fourth time. By five months, she was having “big contractions. I had to actually stop until they were gone, they were that strong.” But the contractions would peter out after a short time, only to start again another day. No miscarriage. Her son, Micah, was finally born 12 days after his due date. “With all those contractions, I really thought he might come earlier, but he didn’t,” Dufton says.
“That crampy feeling may just be the uterus expanding,” explains obstetrician Dr. Alison Barrett. As Dufton found, 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 miscarriage sign. Kate Vanderwielen was about six weeks pregnant when she began having severe back pain. “I thought it was the chair I was sitting in that day,” she says. But as the back pain progressed to cramps, she decided to call her midwife. “I knew something was wrong. My midwife sent me for an ultrasound.”
Vanderwielen was told that the baby didn’t have a heartbeat, and she opted to take medication to end the pregnancy. “It was a relief, really,” she says. “I think I knew something was wrong from the start of the pregnancy. It just didn’t feel right.”
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 even cut back on her medication and still felt pretty good. “At first I said to my husband that maybe I was going to be like a normal person and feel better after the first three months,” she recalls. But somehow that dramatic decrease in nausea worried her.
Johns had earlier purchased a hand-held Doppler machine to hear the baby’s heartbeat, and had first listened to it when she was about nine weeks along. “I decided to try, thinking that if I could hear the heartbeat, it would reassure me,” she says. But this time she couldn’t find the heartbeat at all. “I tried for an hour, and then again the next morning, and there was nothing,” she says. An ultrasound confirmed that the baby had died.
Dr. 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 (tender breasts, tiredness, frequent urination, morning sickness)? 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?
In some cases, perhaps. A new 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 and intense exercise were also risk factors, and so was the age of the baby’s father if he was 45 or older.
So am I going to miscarry?
“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 doctors if they are concerned, as in certain situations prompt care may prevent a miscarriage. If you have had three or more miscarriages, or miscarry after the first 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.”
Kowal understands that emotional challenge. She conceived again three years after her miscarriage, and says: “It was torture. I pored over every symptom. I felt terror whenever I felt better! I wanted to have morning sickness, like it would guarantee I was still pregnant.” This time, though, all went well and her daughter Lily was born—a little early, but healthy and strong.
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.