After week twelve, a miscarriage is considered a so-called late miscarriage. It is a great strain for both your body and you emotionally to go through. Many thoughts and concerns usually arise when this happens. In this article, our midwife Maria has summarized the basic information about a late miscarriage. 

After twelve weeks of pregnancy, a miscarriage is referred to as a late miscarriage. If there is heavy bleeding without or in combination with abdominal pain, it may be a miscarriage, even though you are this far along in the pregnancy. Miscarriages after week 12 are much rarer, but they do happen and can be very physically and emotionally stressful for the person experiencing the miscarriage. 

How a late miscarriage happens

As the pregnancy has been going on for many weeks, the fetus has had time to grow. The miscarriage will usually be a bleed that is heavier than your period usually is and often contains fresh blood mixed with clots. You may see remnants of the placenta and also the fetus coming out in combination with bleeding. 

The pain is experienced as a severe menstrual pain or worse and is often felt mostly in the lower abdomen or lower back. It can also radiate into the groin and thighs. As the uterus contracts (and it is a strong muscle that has grown much larger), the pain is usually severe. 

If you suspect you are having a miscarriage, make sure you are not alone, but with someone you feel safe with. 

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

When and where should I seek care?

If you have met your midwife at the midwifery clinic, we recommend that you contact them for advice, guidance on where to go for physical care as well as for examination and emotional support. You can also contact 1177 for advice and to be guided further if you need physical care. 

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

If the bleeding has lasted for more than four weeks, you are advised to contact a gynecologist's office or an abortion clinic to make sure that there are no residues left in the uterus. Sometimes additional treatment is needed to complete the miscarriage, which may involve taking tablets or scraping the uterus. If you also develop a fever above 38 degrees (which is not associated with a cold, for example), you should contact your healthcare provider. Few people get an infection during a miscarriage, but it can happen. If you get an infection in the womb, in addition to a fever, you may have another type of pain in the lower abdomen and you may feel sick. Such infections are treated with antibiotics and, if you are taking tablets, you can stay at home during treatment. 

Common emotions associated with a late miscarriage

Miscarriage evokes different emotions and it is common to feel sad, depressed and worried. These worries can be about what is happening now, whether you will be able to become a parent in the future or what others will think and say. Unfortunately, pregnant women tend to blame themselves, thinking that they have done something wrong and therefore had a miscarriage, or that they are not worth having children. The male partner may feel guilty about the miscarriage because he did not do everything he could to take care of his pregnant partner or blame himself for having sperm that were not good enough. 

In a same-sex female relationship, feelings of helplessness may arise. Partners may also feel that they have barely had time to come to terms with the happiness of the pregnancy and thus feel that they have not committed enough. 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 the other's reactions and needs. 

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

But the thoughts and feelings is tough to bear, and you or your partner have done nothing to make the miscarriage happen. Remind yourself and each other that carrying guilt and shame does not lead to progress, but that it is natural to feel sad and grieve. Whether the emotional reaction comes quickly or later, it is important to take support and help to process the experience. Who you talk to or how you do it is up to you, but make sure you take care of the feelings and thoughts so you can have a chance to feel good again. 

Almost all miscarriages occur because the fetus had some kind of abnormality or because the development of the fetus or the pregnancy could not continue. There are many systems in the pregnant woman's body and womb that are supposed to function during pregnancy and in your particular case, something may have happened that prevented the system from being healthy and functioning properly, or the fetus from continuing to develop because of the abnormality. Healthcare professionals, such as doctors, nurses, assistant nurses and midwives, are used to dealing with crisis reactions and physical emergencies, so tell whoever you meet during a healthcare visit how you feel and how you experience your situation so that you can receive the best possible care. 

For those who are having or have had a late miscarriage, it may be comforting or encouraging to know that this not means that you are more likely to be affected again, or that it is difficult to get pregnant after this. You can get pregnant, your mind and body can. Let your 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.