5 Misconceptions about miscarriage

Below are real accounts of pregnancy loss and details some readers may find upsetting.

As a medical anthropologist with more than a decade’s experience researching miscarriage, I have been struck by the number of misconceptions and general lack of knowledge on the subject. This lack of understanding about miscarriage, how it is managed in our healthcare systems, and what to expect in terms of the physical process often leads to shock and feelings of lack of preparation for those experiencing it. In this article, I outline five misconceptions about miscarriage and provide information for those interested in understanding the complexity of miscarriages and how they are experienced.

1. Miscarriage is rare or unusual

Miscarriage is a common women’s health experience for individuals worldwide. 20% of pregnancies end in miscarriage, and 1 in 4 women will experience a miscarriage in their lifetime [1]. Many miscarriages are unreported, and some will go unnoticed as a miscarriage may happen very early before a pregnancy is detected. 

250,000 miscarriages are diagnosed annually in the UK, with most (85%) happening in the first trimester. Approximately 50,000 require hospital admission [2].

One of the reasons miscarriage may be perceived as rare or unusual, despite these high numbers, is because it’s not often talked about. Since most miscarriages happen early in pregnancy, they often occur before individuals may have told their friends or family, as many women will wait until after their 12-week scan to do this. 

Talking about miscarriage is an individual preference, but some may find it helpful — and this added barrier of not announcing pregnancy until after a healthy scan is confirmed can make it harder to do this in the event that a miscarriage is diagnosed.

2. Miscarriage is always treated by surgery

Historically, women with miscarriages in much of Euro-America were treated by surgical intervention to remove the pregnancy tissue. However, depending on the clinical circumstances, women may now choose from several different treatment options. 

In the UK, NHS providers offer a choice of three options: 

• Expectant management: This involves waiting and letting the miscarriage progress on its own. This occurs in around 60% of cases.
• Medical management: Prescribed medication is taken that dilates the cervix and causes the uterus to expel pregnancy tissue, this has a success rate of around 80%
• Surgical Management: The tissue is removed under general anesthetic during a minor operation involving inserting a small suction tube into the womb to gently remove any tissue inside (surgical management of miscarriage or SMM) or using a similar procedure under local anesthetic (manual vacuum aspiration or MVA).

In my research into early miscarriage in England, women were offered a choice of the three management options and were guided by their preference or situation, although during COVID restrictions, surgical options were limited. A recent review demonstrated that there is no strong argument for any one of the three options over another and that the main deciding factor should be the individual’s preference [3]. 

Those who experience second-trimester pregnancy loss have more restricted choices, as highlighted by sociologist Dr. Aimee Middlemiss. During her research into later pregnancy loss, the women that Middlemiss met and interviewed had not anticipated that they would have to labor and deliver their babies vaginally [4, 5]. In later second-trimester miscarriage, the lack of availability of surgical resolution is broadly unknown. 

3. Miscarriage happens quickly

While some women experience pain, bleeding, and the spontaneous expulsion of the pregnancy as a relatively quick event, it is far more common for a miscarriage to unfold over days, weeks, or even months. There are several factors that may impact the duration of a miscarriage experience, including:

• An unclear diagnosis of miscarriage: This can happen if an early scan is inconclusive. It could be that the pregnancy is just very early before it's identifiable, or a heartbeat can be detected. Or it may be that the pregnancy stopped developing. A second scan in a week’s time will be suggested to identify if the pregnancy has developed or not. If the pregnancy has not developed, then miscarriage may be diagnosed at the second scan.

• How the miscarriage is managed: As covered above, there are several ways a miscarriage can be managed. If an individual elects for an expectant miscarriage, it can take several days or even weeks before the miscarriage occurs. When it does happen, periods of pain or bleeding can be sporadic and happen over several days. 

• Further treatment is needed: For 20% of those who opt for medical management, the treatment is not successful, leading women to either opt for an additional round of medication or progress to surgery. In my research, I found that most women who had surgical management of their miscarriage had opted for other management options first (i.e. expectant miscarriage or medical miscarriage). This meant that often several weeks had elapsed between diagnosis and the completion of the miscarriage. Regardless of the chosen management option, it’s always possible that some tissue will remain, and further treatment may be needed. 

Any of the above factors can impact how long a miscarriage takes to progress. Periods of waiting due to delays in diagnosis or treatment can be difficult. Still, they can also lead to the emotional processing of miscarriage differing from the physical timeline of events. During my research, I spoke to Nell, aged 30, about her experience with her 12-week pregnancy:

“I think it might have been five weeks from the point where I had a scan to when I had the surgery. So, by the time I had the surgery, I already felt like I had processed it. I think I just felt like I was over it. Just wanted to move on and wanted it to be done with.” 

This response reflects the fact that every experience of miscarriage is different but for many women, it is more of a process with no clear start or end point than one single event. For many, the return of their period (usually four to six weeks after miscarriage) is seen as the culmination of the physical experience of miscarriage. However, for some individuals, the emotional impact remains for longer.

4. A miscarriage feels like a heavy period

As touched on above, there is a great deal of variation in the physical experience of miscarriage. While some may experience minimal pain and might describe it as similar to a heavy period, most of the women I have interviewed describe something rather different. 

Just before her 12-week scan, Maisie noticed some brown spotting but was reassured that this was not uncommon in early pregnancy. She was not particularly worried, as there was no pain or discomfort accompanying the light bleeding. However, a scan revealed her pregnancy had not developed past five weeks, and a miscarriage was diagnosed. As she was already bleeding, Maisie elected to return home to undergo expectant management and was told: “It would be like a heavy period.” Maisie describes being wholly unprepared for the amount of blood and pain she experienced. Similarly, Grace, a doctor, found the description of miscarriage as being like a heavy period misleading:

“I don’t know whether it’s to do with having had children, but for me, it felt like contractions, it felt coordinated- it was a very visceral memory. This is not period pain… this whole idea of a heavy period was not my experience. I was having contractions, passing a lot of blood, and then nothing for a few hours, and then it would happen again. And that felt so much like having a baby. And I feel ridiculous for saying that I haven’t read anyone else that has talked about that.”

While Grace describes not hearing about similar accounts from others, I assured her that others I interviewed recounted something comparable while highlighting the variation in women’s experience of miscarriage. Whereas some women’s menstrual period involves minor discomfort and light bleeding, others may experience extreme pain and heavy bleeding. As periods are experienced very differently and are highly subjective, describing miscarriage as similar to a heavy period is meaningless. 

For this reason, I always implore medical students I teach not to describe miscarriage as “like a heavy period” and instead suggest they describe the range of possible experiences to prepare women for what they will encounter.

5. Everyone feels grief after a miscarriage 

Just as there is variation in the physical experience, there is also a difference in how women respond to miscarriage. The way miscarriage is framed, approached, and responded to depends on its historical, cultural, and individual context. 

My research in Qatar revealed that Qatari women were relatively pragmatic in the face of pregnancy loss, which is likely linked to the perception of miscarriage in Qatari culture [5]. This is often perceived as God’s will, which can minimize feelings of self-blame and lead to acceptance. With higher fertility rates and expectations for large families, Qatari women expect to experience multiple pregnancies and have an awareness that some will not end in a successful birth. 

In this culture, where infertility is highly stigmatized, miscarriage is seen as a sign of fertility. This attitude to miscarriage is not unique to Qatar or the Middle East. Anthropologist Emma Varley describes miscarriage in Gilgit, Northern Pakistan, in similar terms, describing it as ‘half the battle won.'[6] In other words, pregnancy is possible, it just didn’t work out this time.

While culture impacts how we understand and experience miscarriage, individual understandings and circumstances inform this too. The same woman may respond to how her pregnancy ends differently depending on her particular situation at the time. The women I’ve interviewed in England offer a range of responses to miscarriage that embody everything from relief to grief. 

Miscarriage is a complex experience that may elicit a range of emotional responses. This is informed by historical, cultural, and individual context. The important thing to remember is that everyone’s experience is different, and there is no right or wrong way to react. 

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Huge thanks to Dr. Susie Kilshaw for sharing her knowledge on this sometimes tough-to-tackle topic. If you’d like to read more about Susie’s research, you can access her full list of publications here. 

At Natural Cycles, our mission is to empower every woman with the knowledge she needs to take charge of her health. Sometimes, this means addressing the difficult subjects, too, as stigma acts as a barrier to knowledge and can perpetuate a lack of understanding when it comes to certain topics.

We also recognize that the fertility journey is different for everyone, and there is no right or wrong way to feel when a pregnancy ends. As well as supporting your fertility journey in planning or preventing pregnancy, we also support users after miscarriage with our Recovery Mode. This is a space designed to support you as you experience the physical and emotional changes that can happen post-pregnancy loss. 

References

1. Melo, P. and I. Granne 2020. Chapter one: Does Twenty-First Century technology change the experience of early pregnancy and miscarriage? Navigating miscarriage: Social, Medical and Cultural Perspectives. Edited by S. Kilshaw and K. Borg. (Oxford: Berghahn 2020). Pp33-58.

2. National Institute for Health and Care Excellence. 2012a. ‘Ectopic Pregnancy and Miscarriage: Diagnosis and Initial Management: Clinical Guideline’. NICE

3. Kim, C., S. Barnard, J.P. Neilson, M. Hickey, J.C. Vazquez and L. Dou. 2017. ‘Medical Treatments for Incomplete Miscarriage’, Cochrane Database of Systematic Reviews 1.

4. Middlemiss, A. 2024. Invisible labours: The reproductive politics of second trimester pregnancy loss in England. Oxford and New York: Berghahn.

5 Middlemiss, A. and S. Kilshaw, 2022) Sharing the burden of miscarriage knowledge. https://heathertrickeyprize.org/2022/01/30/sharing-the-burden-of-miscarriage-knowledge/

6. Varley, E. 2008. ‘Belaboured lives: An ethnography of Muslim women’s pregnancy and childbirth practices in Pakistan’s embattled, multi-sectarian northern areas’,

Dr. Susie Kilshaw's research is funded by the Wellcome Trust as part of a University Award in the Social and Historical Science (Award No.: 212731/Z/18/Z); further support from the Engineering and Physical Sciences Research Council (EPSRC) Impact Acceleration Account (IAA) (Grant Reference EP/X525649/1) made this collaboration with Natural Cycles possible.