Written by: Molly
Miscarriages and abortions are extremely common reproductive experiences. About 1 in 4 pregnancies ends in miscarriage, and about 1 in 3 people will have at least one 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.
Too often people feel inadequately prepared by their community or healthcare providers for what to expect during and after the experience, or are having the experience alone and don’t know what it’ll be like. 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
What’s Normal
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. 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. At the onset of the miscarriage/abortion the bleeding is likely to be slow and steady, pick up quickly and heavily, reach a peak at expulsion of the embryo/fetus/large blood clot, and then 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 there are exceptions to this. Bleeding and pain are often correlated with bleeding (more pain = more bleeding as the uterine contractions try hard to expel the contents of the uterus).
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.
What’s Not Normal: Seek Help!
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.
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. 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.
Bleeding and discharge 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. The body may or may not be able to menstruate while trying to work this out. These last remnants may be managed with abortion methods as appropriate. If 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. The next menstruation is often 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
What’s Normal
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. We’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.
As a general rule, the pain experienced 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 there are exceptions.
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 persist for days or weeks following the procedure until bleeding stops altogether.
What’s Not Normal: Seek Help!
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.
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.
Fever
What’s Normal
If the medication misoprostol 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.
What’s Not Normal: Seek Help!
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.
Uterine Tenderness
What’s Normal
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, or a dull ache. This tenderness may persist for a few weeks, accompanied by occasional pain/contractions.
What’s Not Normal: Seek Help!
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.
Symptoms of uterine infection include: sharp, shooting pains in the uterus, especially on touch, foul or rank smelling discharge or blood, fever over 101℉ or 38.5℃ lasting more than 24 hours, and generally feeling as if you have the flu. Seek medical attention
Emotional Distress
What’s Normal
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 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.
What’s Not Normal: Seek Help!
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.
If you are experiencing unmanageable depression, anxiety, OCD, rage, or other perinatal mood disorders, seek the help of a skilled mental health professional or clinic, especially those that have specific experience with perinatal mood disorders.
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, 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 activity that involves penetration, tampons, menstrual cups, and fingers. If you cannot follow this advice, consider extra immune system support and be vigilant for signs of infection in the body.
Monitor the body for symptoms of infection by observing discharge from the vagina as well as taking temperature daily until bleeding has stopped.
Monitor bleeding. Keep an eye out to make sure the body is not experiencing excessive blood loss.
Keep an eye on pain control. If the person is 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 Holistic Repro Project’s Doula Program.
Holistic Repro Project’s No-Cost Abortion Doula Program
Our dedicated and experienced doulas are here to provide compassionate, quality virtual care to those seeking emotional, logistical, and spiritual support before, during, and after their abortion. These services are provided at no-cost thanks to funding from grants and donations.
Our doulas offer:
Resource Connection: Our doulas will connect you with the resources you need to access safe and effective abortion care.
Guidance on Abortion Methods: We’ll help you understand the different abortion methods available, empowering you to make informed decisions.
Education and Information: We provide clear and comprehensive information about what to expect throughout the process.
Nonjudgmental Listening: We offer a safe, nonjudgmental space where you can share your thoughts and feelings openly.
Pain Management Support: Our doulas can assist you in connecting with various modalities to manage pain and discomfort effectively.
Postpartum Care: We stay with you postpartum and support with nutrition and herbs for healing. We can also help in integrating the experience into your life, offering guidance and care as you navigate your journey.
How We Support You: Our support is flexible and accessible, offered through phone calls or text support, ensuring you receive the care you need in the way that suits you best.
View details about our doula program and submit a request form here:
About the Author: Molly is a midwife experienced and skilled in supporting a full spectrum of reproductive health. Molly has focused her work on pregnancy loss and abortion, and advocates for home-based midwifery models of care for all reproductive experiences. She lives in Toronto, Ontario on the traditional and contemporary lands of the Anishnaabe and the Mississaugas of the Credit.