Miscarriage

In Aotearoa New Zealand, pregnancy loss is generally referred to as a miscarriage when it occurs before 20 weeks of pregnancy, or when a baby weighs less than 400 grams at birth. Loss after this time or above this weight is legally defined as a stillbirth.

Regardless of your gestation, the loss of a baby is very distressing. Miscarriage affects around one in four pregnancies, with most occurring before 12 weeks gestation. If it happens to you, please know it is unlikely that there was anything you did, or didn’t do, that caused this.

Grief can be complex and personal. Some people find comfort in talking, while others prefer time and space. Support from family, friends, or a professional can be helpful, whether immediately or later on.

What symptoms may look like

The majority of miscarriages begin with bleeding, and you may feel cramps similar to period pain. You may pass clots or pregnancy tissue, which can be physically and emotionally difficult. The further along the pregnancy, the more intense symptoms may be.

If a miscarriage occurs early, you may be able to remain at home with guidance from your care provider. Later miscarriages may require additional support, monitoring, and pain relief.

It’s important to monitor how much bleeding you are experiencing. Seek medical advice from your LMC, GP, or hospital if you:

  • Soak a pad in less than an hour or more than one pad per hour
  • Have severe or worsening pain
  • Pass large clots
  • Feel dizzy or faint

If you develop fever, chills, body aches, smelly discharge, or feel generally unwell, contact your care provider urgently as this may indicate infection.

Types of miscarriage

  • Very early miscarriage (chemical pregnancy) happens shortly after implantation, often before you realise you are pregnant. A faint positive test confirms conception occurred even if the pregnancy ends very early.
  • Clinical pregnancy loss occurs around 5–6 weeks, usually just after a missed period. Bleeding may be heavier than a normal period, and emotional impact can still be significant.
  • Missed miscarriage is when the pregnancy stops developing before 20 weeks but there may be no physical signs. It is often discovered during a scan when no heartbeat is detected, or when a fertilised egg implants but no embryo develops (blighted ovum).

Management of miscarriage

Management depends on how far along the pregnancy is, your symptoms, and your preferences. Your care team will discuss options with you so you can make an informed decision.

  • Expectant management (waiting for miscarriage to happen naturally) This involves allowing your body to pass the pregnancy tissue without medical treatment. It may take several days to a few weeks. You will be given guidance on what to expect, how to manage pain, and when to seek help. Some people prefer this option as it avoids medical procedures, though bleeding and cramping can be unpredictable and emotionally difficult.
  • Medical management Medication may be offered to help your uterus empty more quickly. This is usually given as tablets taken by mouth or inserted vaginally. Cramping and bleeding typically begin within hours to a couple of days. You may be given pain relief and instructions on what to expect at home, including how much bleeding is normal and when to seek help. A follow-up appointment or scan is usually arranged to confirm the miscarriage is complete.
  • MVA or MVAC (Manual Vacuum Aspiration) Manual vacuum aspiration is a minor procedure used to gently remove pregnancy tissue from the uterus using a small handheld suction device. It is usually performed in a clinic or hospital setting under local anaesthetic, sometimes with sedation. The procedure typically takes around 10–15 minutes. You may experience cramping during or after the procedure, and light bleeding for several days. Recovery is usually quick, and many people prefer this option because it provides a faster resolution without a general anaesthetic.
  • Surgical management (Dilation and Curettage – D&C) A D&C is a surgical procedure performed in hospital, usually under general anaesthetic or sedation. The cervix is gently opened (dilated), and pregnancy tissue is removed using suction and/or a small surgical instrument. The procedure is typically short, and you can usually go home the same day. Mild cramping and light bleeding may continue for several days to a couple of weeks. A D&C may be recommended if:
    • There is heavy or ongoing bleeding
    • There are signs of infection
    • Tissue remains in the uterus
    • You prefer a quicker, planned procedure

Aftercare and recovery

After a miscarriage, follow-up may include a check-up, blood tests, or a scan to ensure the uterus is empty and your recovery is progressing well.

Your period will usually return within 4–6 weeks. Ovulation can happen before this, so contraception may be discussed if needed.

It is also normal to experience emotional ups and downs. Hormonal changes, physical recovery, and grief can all affect how you feel.

Emotional support

Grief after miscarriage can be profound, regardless of how early the loss occurred. Some people feel sadness, guilt, anger, relief, or numbness. All feelings are valid.

Support is available through your healthcare provider, counsellors, and support organisations. Reaching out when you feel ready can help you feel less alone.