After week twelve, a miscarriage is counted as a late miscarriage. This is a great strain on you both physically and emotionally. A lot of thoughts and concerns tend to arise when this happens. In this article, our midwife Maria has summarised the basic information about a late miscarriage.

After twelve weeks of pregnancy, a miscarriage is called a late miscarriage. If there is heavy bleeding without or in combination with pain in the abdomen, you may be having a miscarriage, even though you have got this far in your pregnancy. Miscarriages after week twelve are considerably rarer, but they do occur and involve great physical and mental stress for the person experiencing the miscarriage.

This is how a late miscarriage happens
Since the pregnancy has been going on for many weeks, the foetus has had time to grow. In this case, the miscarriage is usually a bleed that is heavier than your period and often contains fresh blood mixed with clots. It may be that you see remnants of the placenta and that the foetus comes out during the bleeding.

The pain is similar to that of severe period pain or worse and is often felt mostly in the lower abdomen or lower back. It can also radiate down into the groin and thighs. As the uterus contracts (and it is a strong muscle that has had time to grow significantly larger), the pain is usually severe.

Make sure you are not alone if you suspect that you are having a miscarriage, but be with someone you feel safe with.

The further along in the pregnancy you are, the more like a small birth the miscarriage can feel like. The pain can be persistent but also come in intervals like contractions and breaks. You can relieve the pain on your own by showering, using a heating pad and taking paracetamol.

When and where should I seek care?
If you have met your midwife at the midwifery clinic, we recommend that you contact her for advice, guidance on where to go for physical care, as well as where to go for an examination and emotional support. You can also contact the health care services for advice and further guidance if you need physical care.

If the bleeding is so profuse that it worries you or if you bleed through a thicker pad in the space of an hour, you should be examined by a doctor/gynaecologist, and you should contact a gynaecological emergency or abortion clinic. This also applies if you have pain that you cannot handle or that is not relieved by the self-care advice you have been given. The bleeding lasts for several days and commonly lasts for one to two weeks, tapering off over time and eventually stopping.

If the bleeding has lasted more than four weeks, it is recommended that you contact a gynaecologist or an abortion clinic to ensure that nothing is left in the uterus. In some cases, additional treatment is needed to complete the miscarriage, such as tablets or a scraping of the uterus. If you also get a fever above 38 degrees (which is not related to, for example, a cold), it is recommended that you contact your healthcare provider. Few people get an infection thanks to a miscarriage, but it can happen. If you get an infection in your uterus, in addition to a fever, you may get another type of pain in your lower abdomen and you may feel sick. Such infections are treated with antibiotics and if you are on a course of tablets, you can stay at home during the treatment.

Common feelings associated with a late miscarriage
Miscarriages evoke different emotions and it is common to feel sad, depressed and anxious. The worry can be about what is happening right now, whether you will be able to become a parent in the future or what others will think and say. Unfortunately, the pregnant person can be quick to blame themselves, thinking that they did something wrong and that caused the miscarriage, or that they are not worthy of having a child. Their partner may feel guilty about the miscarriage because they did not do everything they could to take care of their pregnant partner or blame themselves for having sperm that were not good enough.

In a same-sex female relationship, a feeling of helplessness can arise. Partners can also feel that they barely had time to settle into the joy of the pregnancy and as such feel that they were not sufficiently involved. People are individuals, and we have different ways of reasoning and experiencing things, so as a couple you may be in different places emotionally. Talk to each other to try to understand your own and your partner’s reactions and needs.

Jealousy of friends or acquaintances who are pregnant or have children is a very common feeling, as is the feeling of shame because you suffered a miscarriage. All these feelings are both common and reasonable as it is a very tough experience.

That said, the thoughts and feelings are tough to bear, and you or your partner did nothing to cause the miscarriage to happen. Remind yourself and each other that carrying guilt and shame does not move you forward, and that it is natural to feel sad and to grieve. Regardless of whether your emotional response comes quickly or later on, it’s important to get support and help to process the experience. Who you talk to or how you approach it is up to you, but make sure you take care of your thoughts and feelings so you can get a chance to feel good again.

Virtually all miscarriages occur because the foetus had some sort of abnormality or because the development of the foetus or the pregnancy could not continue. There are many systems in the pregnant person’s body and uterus that need to function properly during pregnancy, and in your particular case, something may have happened that prevented the system from being healthy and well-functioning, or that the foetus could not continue to develop due to the abnormality. Healthcare professionals, such as doctors, nurses, assistant nurses and midwives are used to dealing with crisis responses and physically urgent situations, so tell the person you meet during a check-up how you are feeling and experiencing your situation so that you can receive the best care possible.

For those of you who have had a late miscarriage, it can be comforting or encouraging to know that this **doesn’t** mean that you are more likely to suffer one again, or that it is difficult to get pregnant after this. You can get pregnant, your mind and body can handle it. Let tour body and mind grieve, and if you want to get pregnant again, you will be able to try as soon as both your body and mind are ready for it.