What to Expect During and After a Miscarriage / Abortion

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Miscarriages and Abortions are extremely common reproductive experiences. About 1 in 4 pregnancies ends in miscarriage, and about 1 in 3 people will have an abortion at some point in their reproductive lifetime. While these experiences may have very different social and emotional contexts, physiologically, the body experiences them similarly.


Lots of people approach me during and after an abortion or a miscarriage describing very normal, expected symptoms and worrying that something is wrong with them. They often feel inadequately prepared by their healthcare providers, or have been helping themselves at home without outside guidance, and are now concerned about their well-being and their bodies. So, here’s what to expect during and after a miscarriage / abortion, what’s normal, what’s not normal, and when to seek more help...


Bleeding / Discharge


Everyone experiencing a miscarriage or an abortion will experience some extent of bleeding. The volume of bleeding will depend on how far along the pregnancy was, what management methods, if any, were used for the miscarriage / abortion, the individual tendency toward uterine bleeding, and many other factors.


Typically if the miscarriage / abortion was spontaneous, or managed by herbs or medications, the bleeding throughout is likely to be heavy. At the onset of the miscarriage / abortion the bleeding is likely to be slow and steady, pick up quickly / heavily, reach a peak at expulsion of the embryo / fetus / large blood clot, and slowly diminish. After the peak experience, the bleeding will taper off to about a medium-to-light menstruation that is normal for the person experiencing the miscarriage / abortion. This bleeding is likely to persist, and eventually taper off entirely for 2-6 weeks. This is an average experience, but there are significant individual variations. Some people bleed a lot less overall, or a lot more overall, and still are within normal limits. As a general measurement, people tend to follow their normal pattern of uterine bleeding (heavy menstrual bleeders tend to bleed heavier during abortions / miscarriages, and lighter menstrual bleeders tend to be lighter bleeders during abortions / miscarriages), though I have seen exceptions to this. Bleeding and pain (see below) are often correlated, as well (more pain = more bleeding as the uterine contractions try hard to expel the contents of the uterus).


Bleeding should not be soaking a maxi pad in 30 min or less, and blood clots expelled should generally be less than the size of the palm of your hand. Heavier bleeding and bigger blood clots may be normal at the very peak of expulsion during the miscarriage / abortion, but should not persist after expulsion.



If an abortion / miscarriage was managed by a D&C, vacuum aspiration, or other instrumental option, there is likely to be much less immediate bleeding following the experience, rather skipping ahead to the spotting / discharge phase.


As bleeding tapers off, spotting may persist for a few days to a few weeks. This spotting is usually pinkish or brownish, as the uterus expels all the last bits of tissue and lining and hormones re-regulate in the body. There is sometimes milky, sticky, slippery, or slightly bloody discharge associated with this phase as well. This discharge should smell like blood, or like your bodily fluids normally do. It should not be rank or foul smelling, and should not be overwhelmingly itchy or irritated.  


If bleeding, spotting, or discharge different from your pre-pregnancy discharge persists for 6+ weeks, there may be small bits of retained tissue left behind in the body. Your body may or may not be able to menstruate while trying to work this out. You may be able to encourage these last bit of tissue to leave at home, at home with help, or in a doctor’s office, with all the same options available to you for instigating the abortion / miscarriage. If your menstruation is able to return, these remnants may expel with the next menstruation.


Next Menstruation


The next menstruation following a miscarriage / abortion is often heavier than pre-pregnancy menstruations. I generally think the next menstruation is a full flush of uterine contents, including any straggling bits left behind after the miscarriage / abortion. The menses is often more painful than expected, with stronger-than-usual contractions and associated heavier bleeding. This can be very normal, within reason. The same precautions around bleeding apply at the next menstruation as did during the miscarriage / abortion and immediate recovery.


This experience (heavier bleeding, more pain) can be emotionally triggering, bringing the person back into the headspace of the miscarriage / abortion that happened weeks or months ago. Be gentle, emotionally, during this time as it passes. This experience (heavier bleeding, more pain) does not usually repeat at future menstruations beyond the one that first follows an abortion / miscarriage.


Pain


As the uterus contracts to expel the contents of the uterus and promote bleeding, and as the cervix dilates to allow passage from within the uterus, people often experience varying levels of pain. I’ve seen pain on a spectrum of slight discomfort to excruciating pain landing someone in the ER. Mirroring typical bleeding patterns with spontaneous, medication, or herbally induced miscarriages / abortion, pain often starts low and slow at the onset of the the miscarriage / abortion and builds to a peak at expulsion of the embryo / fetus / uterine contents, which will taper off and come and go with greater ease over the coming weeks until bleeding stops altogether.

Sometimes, excessive pain comes from the body attempting to expel the embryo/ fetus / tissue, which is stuck behind the cervix and cannot make its way out. The body increases contraction strength to try to manage expulsion, but is unable to. Typically staying active, squatting, trying different positions and hip movements, may help dislodge and expel. In some circumstances, you may need help to expel the tissue.


Again, as a general rule, I find the pain experienced typically mimics typical experiences of uterine pain in that individual person (people with exceptionally painful periods and painful labours/births are likely to have very painful miscarriages / abortions, and people who have more ease around menstruations and other uterine experiences are likely to have less painful abortions / miscarriages), though I have seen exceptions to this.


If an abortion / miscarriage was managed by a D&C, vacuum aspiration, or other instrumental option, sedation or some sort of pain management was likely offered during the procedure. Painful cramps will likely persists for days or weeks following the procedure until bleeding stops altogether.


Fever


If the drug misoprostol (“Cytotec” in North America, may have other trade names in other countries) was used to manage the miscarriage / abortion a temporary, immediate spike in temperature is common, and an expected side effect. This temporary temperature spike is often accompanied by shaking and chills. If this temperature spike persists beyond 24 hours and/or beyond the expulsion of uterine contents, it is now a fever, and may need medical attention (see below). Taking antipyretic medications (Tylenol, etc.) will mask the fever, but not treat the underlying reason for it.


Tenderness


Uterine tenderness is common and expected following an abortion / miscarriage. Many people describe that they can “feel” the organ in their body in a way they normally can’t, like a bruise, a dull ache, or like being punched in the gut. This dull ache, and general tenderness may persist for a few weeks, accompanied by occasional pain / contractions. Sharp, shooting pains, especially when touching the uterus (just over / behind the pubic bone), especially if accompanied by a fever or foul smelling discharge, are not normal.


Emotional Distress


Beyond feeling tender physically, people often feel tender emotionally. Even when the abortion / miscarriage was wanted, necessary, and/or a relief, and especially when it wasn’t, there is an unavoidable major shift in hormonal makeup in the body following the end of a pregnancy. Feeling especially tender or distressed emotionally is common and normal. Feeling relieved and happy is also common and normal. Taking extra care and gentleness during this time is important.


Perinatal mood disorders (postpartum depression, anxiety, OCD, rage, etc.) are not at all common following an abortion / miscarriage, but are within the realm of possibility. If dark thoughts plague the mind, and sadness is the overwhelming feeling for 2+ weeks, seek professional help for caring for the mind and heart.


Future Fertility


Fertility returns at different rates in individual bodies following an abortion / miscarriage. Ovulation may occur irregularly, including earlier or later than expected, and with or without the typical other fertility symptoms in the body (cervical fluid, temperature increase, cervical position, etc.) If a person was previously relying on a method of birth control, and they do not wish to conceive again right away, they might consider resuming their previous, or starting a new form of birth control. If a person was previously relying on fertility awareness based methods of fertility management, I recommend back-up methods of birth control for any potentially fertilizing sex for 2-3 months or until the body is cycling normally again.


Good evidence over the years has shown abortions, even multiple abortions do not / should not affect future fertility. People who have had abortions should be able to conceive spontaneously in the future without increased difficulty.


After a person experiences one miscarriage, their chance of experiencing another remains the same in future pregnancies (about 20-25%). After two miscarriages, their chance of miscarrying in future pregnancies increases by about 5% (to 25-30%). After three+ miscarriages, their chance of miscarrying in future pregnancies increases by about 10% (to 30-40%).



Common Precautions to Prevent Complications


In order to support the body during and after abortion / miscarriage, there are a few general principles in caring for the body, as well as specific pieces of advice, to promote health and well-being and prevent complications:

  • Try to keep things out of the vagina in order to prevent infection for about two weeks or until bleeding has stopped. This includes any sexual acts that involve penetration, tampons, menstrual cups, and fingers. If you cannot or will not follow this advice, consider extra immune system support and be vigilant for signs of infection in the body. Read more here about my experience with sex after my second miscarriage, and why I’m glad I didn’t wait the two weeks!

  • Monitor the body for symptoms of infection (see below) by observing discharge from the vagina as well as taking your temperature daily until bleeding has stopped.

  • Monitor your bleeding. Keep an eye out to make sure you’re not experiencing excessive blood loss (see below).

  • Keep an eye on your pain control. If you are suffering, consider taking extra-strength ibuprofen (trade name Advil in North America)

  • Surround yourself with loving support that tends to your heart and soul. If you are unable to get compassionate care from those that surround you, consider reaching out to your local full spectrum doulas, or seek full spectrum doula care long-distance.



What’s NOT Normal (and when to seek help)

  • A uterine infection is no joke. Apart from being extremely painful, unchecked it could lead to lasting complications in the uterus, including the need for more instrumentation, antibiotics, and a potential impact on future fertility. Symptoms of uterine infection include: sharp, shooting pains in the uterus, especially on touch, foul or rank smelling discharge or blood, fever over 101 degrees F or 38.5 degrees C lasting more than 24 hours, and generally feeling as if you have the flu. Seek medical attention.

  • While individual bodies can tolerate different amounts of blood loss, excessive bleeding in general, otherwise known as hemorrhage, can be life-threatening. Soaking a maxi pad front-to-back, side-to-side so there’s no white spots left on it in 30 min or less is too much bleeding. If this happens for one or two 30 min spans at the peak of expulsion during the miscarriage / abortion, and you feel physically okay, this may be acceptable, but over an hour of this pattern and you should seek medical attention. At any point if bleeding is present and you feel like fainting, or like skin is cold, clammy, and/or pale, your body is not coping well with your blood loss (no matter how big/small it seems), and you should seek medical attention.

  • If the pain is excruciating and unbearable even after Ibuprofen, increasing activity and changing positions, and having loving support present with you, seek medical attention.

  • If you are experiencing unmanageable depression, anxiety, OCD, rage, or other perinatal mood disorders, seek the help of a skills mental health professional or clinic, especially that have specific experience with perinatal mood disorders.