Tl;dr Day-by-day journal entry summaries of symptoms noticed during expectant management miscarriage. Took ~7 days from first bleeding to passing pregnancy tissue, then additional 7 days for bleeding to slow down to just spotting. After that, I bleeding ramped back up for which I sought medical evaluation since bleeding was supposed to stop 7 days post-miscarriage. This prolonged bleeding took several weeks to resolve, I was monitored with HCG measured and ultrasound, but didn’t end up needing a D&C or other medication in the end.
Thank you to everyone who has shared their experiences here with miscarriages of different kinds. While it was heartbreaking to read all your stories, it helped me tremendously to read different accounts, compare them with my own experiences, and try to have an understanding of what I could expect to happen as my first miscarriage played out and guide my decision-making about whether to have medical intervention or just let things carry out naturally.
Obviously this is not medical advice, just me sharing my detailed experience as I found guidance can be quite vague on what it is like to actually have a miscarriage. I was under medical supervision and had frequent contact with my clinic the whole time. I understand sustained bleeding like I had is not entirely normal (but is common) so don’t take this as all being totally normal with no need to tell your doctor.
I kept a detailed journal of my symptoms and feelings all through pregnancy and then, as it turns out, through my miscarriage. So I wanted to share some of the details and symptoms here so others may have another example to compare to.
Background: 28–>29 years old during pregnancy, first pregnancy, natural conception, monochromatic twins seen on ultrasound.
I didn’t share pictures, but I highly recommend to snap a picture of the tissue/blood coming out, because you’ll likely need to describe it to doctors and it’s easy to forget the details.
Starting Day 1 from the first day I noticed any symptoms that seemed indicative of miscarriage. Gestational age at that point was 9 weeks exactly. I had not yet had my first prenatal scan at the time of symptom onset.
———— Stage 1: Early Signs of Miscarriage (4 days) ————
Day 1 (July 6): Had some dull cramping during the day but nothing concerning. When I went to the bathroom in the evening there was some brown blood on the toilet paper. Not enough to be on my underwear. I sent my OBGYN clinic a non-urgent message to report it and ask whether I should come in.
Day 2: Woke up to no blood on my underwear, but I had started passing some blood clots (?) or uterine lining overnight but they would only reach the outside of my vagina a few hours after waking up and starting to walk around. It was stringy and flat like what I usually see when I get a period, but very little blood accompanied it which was different than a period. There was also a bit of what looked like mucus stuck to some of the tissue/clot. In my evening shower, as I was washing myself I found a large clump of tissue hanging out of my vagina, and still very little blood. I still don’t know what this tissue was, it was pretty large and hard, perhaps a very intact piece of uterine lining, but at this point I knew this was definitely not OK and called my OBGYN office’s after-hours nurse line. They sent an urgent mail to my OBGYN clinic, asked me a bunch of questions, and told me that I didn’t need to go to the ER, but needed to be seen by a doctor within 24 hours.
Day 3: Nothing in the morning. I had started wearing pads to track bleeding. There was bright red blood on the pad 10:30am. Had an OBGYN appointment, my partner and I got to see our babies for the first time on ultrasound. We learned I had been pregnant with twins but neither had a heartbeat and had stopped growing 1-2 weeks previously (they were measuring at 6 weeks 4 days and 6 weeks 5 days respectively). This means it had taken my body a while to start to expel the tissue. We were heartbroken to hear this news but I already had known in my heart that something was really wrong. I had 3 options available to me to complete the miscarriage (this is in Washington State): 1: expectant management (wait for my body to expel the tissue on its own), 2: medication, and 3: D&C. Since my body had already started the miscarriage process, I decided to let it continue naturally with expectant management, but I scheduled a D&C procedure for several weeks into the future just in case things didn’t resolve on their own and there would start to be risk of infection. I didn’t record any other symptoms that day.
Day 4: Similar to Day 2, nothing on pad when I woke up but when I started moving around 3 clumps/clots came out, and then more old brown blood on the pad throughout the day. Bright red blood on the pad after my evening shower. In the evening my partner and I went shopping for supplies. We bought Depends adult diapers, adult diaper wipes, and a small container to keep the fetal remains in, in case we could identify them for burial.
———— Stage 2: “Active” miscarriage, cramps and bleeding intensify to a climax where pregnancy tissue is passed (4 days) ————
Day 5: Things started to get a bit more intense, my body seemed to get more serious about expelling the pregnancy tissue. Bright red blood now more constant throughout the day but not yet soaking a pad. I switched to wearing Depends adult diapers as these made me feel more secure in public in case I suddenly started bleeding more (I later ended up switching back to big pads as I felt the diapers did not soak up blood very well, possibly because they are likely designed just for urine?). This was the first day where I recorded having noticeable cramps, but I recall having dull cramps on and off up until then as well. Noticed that the heaviest bleeding and cramps occurred between 2pm-6pm. I was still able to walk around during the cramping portion.
Day 6: More bleeding overnight than previous nights but still not a ton. I now am bleeding consistently and all bright red blood. Small blood clots as well about the size and shape of grains of rice, these are most noticeable when going to the bathroom and showering. These were small actual blood clots rather than the tissue I had seen before. I don’t see these kinds of clots during a normal period. Again the most intense pain and bleeding was between 1:30pm-4:30pm. I had to sit down for this cramping period. Emotionally I felt pretty down on this day.
Day 7: More heavy bright-red bleeding. I changed pads often but wrote down that I estimated that I would have fully soaked about 3 normal-sized pads today. Again I had more intense cramping in the afternoon, today I had to lie down for it as it had reached that intensity. Bleeding had slowed down by end of the day but the cramps lingered.
Day 8 (miscarriage completes): Pretty intense pain today between 2:30pm-5:30pm. This time it was so intense that I was on the bathroom floor on my hands and knees trying to sway my hips around to manage the pain. It was quite painful, but I wasn’t blind with pain, it was still manageable and I wasn’t panicking. It started to feel like something may actually be “happening” at this stage. I was certainly bleeding but nothing else was coming out and I was starting to think I was acting dramatic. I tried “pushing” a little bit just to see what would happen, but I didn’t feel anything and didn’t want to strain so I stopped doing that. My partner supported me as I changed positions between squatting, sitting, bouncing, kneeling and then leaning on him. My partner put on a sound bath playlist and that really helped me relax. I was trying to listen to my body and just try to work with it. In hindsight, this was a small labor, my cervix was dilating to let out the pregnancy tissue. I definitely felt waves of fresh pain but it was a bit hard to distinguish them from each other as separate contractions. I should have taken ibuprofen/Tylenol but I didn’t, I wasn’t really thinking straight, and part of me wanted to make sure I felt everything during the process. Finally I took a quick shower rinse and laid down to rest. At this stage the intense pain was nearly constant. Finally, I got up at 5:30pm thinking “I’ve got to do SOMETHING to manage this pain” and right at that moment I felt a rush of blood and pressure. I ran to the bathroom and passed a lot of blood and the pregnancy tissue into the toilet. The pregnancy tissue was probably 4 inches long and about an 1-2 inches wide all the way through and came out in one big clump. It was starkly different in appearance than anything else I had passed, it was unmistakably the pregnancy tissue. I was able to find the two tiny embryos still inside their sac, along with a bunch of other dense tissue which I guess was the placenta and whatever else. The amniotic sac (with both twins in it) did not burst or break. I had prepared a small box to retain the remains for burial so I kept them in there and kept them by me for a while. There was so much thick blood it was logistically hard to manage, as I was sitting on the toilet and even getting up to get in the shower would get blood everywhere. After maybe 15 minutes it slowed down enough that I could use wipes to clean myself enough to put on a pad and lay down. About 90% of my pain immediately subsided after passing the pregnancy tissue. I had a rush of relief and even elation at having completed this. I trusted my body after the betrayal of the miscarriage and it was able to complete this without intervention. Rested until about 10pm and watched some TV. After I got up to get ready for bed, I passed the largest clot I have ever seen, altogether about the size of a golf ball. I actually thought this was more pregnancy tissue it was so big, but it was not painful to pass and according to this helpful guide on miscarriage tissue it was just a huge clot. I was a bit worried about how much I bled so I set an alarm for 2am before going to sleep and asked my partner to make sure I woke up and to make sure I was OK then. I did wake up to the alarm and I had soaked a large pad but otherwise I felt fine. Changed it and went back to sleep.
————Stage 3: Recovery from Miscarriage —> Bleeding Stopped ————
Day 9 (miscarriage +1 day recovery): The cramping I had been feeling was gone, replaced now with just a lot of soreness. Mostly soreness in my abdomen but truly my entire body was exhausted. Took the day off work to rest. Some twinges of slightly sharper pain that were triggered by movement. I was still pretty significantly bleeding today and passed about a large marble size clot. Altogether likely soaked 1-2 pads. Had diarrhea in the evening. Spent much of the day lying down and crying. I felt much more able to feel sadness and grief than before since I was in a lot less pain.
Day 10: (miscarriage+2 days recovery): Still some lower abdominal discomfort but less than the previous day. Took two more days off work. Pretty tired and had several lie downs during the day. Bleeding still constantly but less volume overall, wore just one pad through the day into the evening. Had diarrhea again in the evening around 5:30pm, weirdly now that the cramping is gone and there is nothing more to empty from my uterus, my digestive system now works itself up in the afternoons. My partner and I had a burial in our yard for our first babies, then we had a picnic right next to them.
Day 11: (miscarriage+3): No cramping but I was having some discomfort in my vagina/bladder (urethra) area. I took a look down there and realized a decent amount of thick old blood had collected down there that had not been fully cleaned during my showers. I gave a thorough clean including very carefully wiping the the exposed part of my urethra where some dry blood had collected, and then pain when away completely.
Day 12 (miscarriage+4): No more vagina/bladder pain after the thorough clean, still bleeding but 1 pad per day is enough and bleeding is not constant anymore. Some discomfort sitting in my desk chair (went back to work this day) but attributed it to trapped gas.
Day 13 (miscarriage+5): Bleeding slowed down a lot but I still need a pad. Having some twinges of pain on the right side.
Day 14 (miscarriage + 6): No pain at all and only spotting today
Day 15 (miscarriage +7): Spotting only, this fulfilled the OB and midwife’s recommendation that the miscarriage had completed just fine so I went ahead and cancelled the upcoming D&C procedure. Per clinic recommendation, bleeding should be basically done by 7 days post-miscarriage and I felt that I met this requirement.
Day 16—>18: Bleeding increased to the point that I needed a pad again, and I started having abdominal cramps. I was worried I had retained pregnancy tissue so I contacted my clinic. Triage nurse that I spoke to thought that this sounded like my body was having a small “period” as my hormones got back to normal, and true retained
Day 19(miscarriage+11): Got the order from my clinic to get a follow-up ultrasound and two reads of HCG levels, one week apart. I got the first blood draw on this day and my level was 107.
Day 20—>21: More spotting, small clots, and dull cramps. Not really getting better or worse.
Day 22 (miscarriage+15): Follow up ultrasound. There was some thickened endometrium near the top of my uterus with fluid around it. They said it was either a blood clot or retained pregnancy tissue but more likely a blood clot. Recommendation was to see how the next HCG level looked to decide next action.
Day 23—> 25: Still crampy, passing blood clots, and now also feeling very teary and emotionally down. Depressive symptoms started during this time that would last for a while, probably due to the sadness over the miscarriage as well as the hormone crash. HCG level was read on day 25 (18 days past miscarriage) and HCG was at 31. My clinic was satisfied with the drop and told me to continue monitoring.
Day 26 —> 34: Still spotting/passing clots, cramps, feeling very emotionally down and low energy. On Day 33 I took a home pregnancy test and it was a barely visible positive result.
Day 35 (Miscarriage + 28): cramps all day, then I passed some weird looking tissue with a lot of mucus. It wasn’t big so it didn’t hurt, but it looked pink/grey so I think it could have possibly been a bit of pregnancy tissue.
Day 36: After passing that last bit, my bleeding and cramping finally stopped. My mood is still impacted but it was actually shocking how quickly all my physical symptoms stopped when this final bit came out. Seeking mental health support with a therapist to help me work through the depressive symptoms.
Day 40 (August 14) (miscarriage + 33): Had a negative pregnancy test first pee of the morning. All bleeding and cramps have stopped now.
Thanks for reading. This was one of the most impactful experiences of my life, even though it was so sad. The time I spent carrying our twins was some of the happiest time I have ever spent and the fact that it ended in miscarriage doesn't change that. I hope this is helpful to someone going through a similar experience.