Early Pregnancy Loss (Miscarriage): Information, Support and Guidance from a Midwife.
Discovering you are pregnant is often filled with excitement, hope, and dreams for the future. When a pregnancy ends unexpectedly, it can be devastating. Early pregnancy loss, commonly called miscarriage, is unfortunately a common experience, yet many women and families feel isolated and unprepared when it occurs.
As a midwife, I want you to know that you are not alone, and support is available. Understanding what miscarriage is, recognising the signs, and knowing when to seek help can help you navigate this difficult time.
What Is Early Pregnancy Loss?
Early pregnancy loss, or miscarriage, refers to the spontaneous loss of a pregnancy before 20 weeks gestation. Most miscarriages occur during the first trimester (before 12 weeks).
Pregnancy loss can occur for many different reasons, and in most cases it is completely beyond anyone's control.
Types of early pregnancy loss include:
Threatened miscarriage
Missed miscarriage
Incomplete miscarriage
Complete miscarriage
Blighted ovum (anembryonic pregnancy)
Recurrent miscarriage (multiple losses)
Many women experience a miscarriage before they have even had their first pregnancy appointment.
How Common Is Miscarriage?
Miscarriage is much more common than many people realise.
Research suggests:
Around 1 in 4 pregnancies end in miscarriage.
Approximately 10-20% of known pregnancies result in miscarriage.
Most miscarriages occur before 12 weeks gestation.
Many very early losses happen before a woman even realises she is pregnant.
Despite these statistics, miscarriage is often not openly discussed, which can leave families feeling isolated and unsupported.
What Causes Miscarriage?
In most cases, miscarriage occurs because the pregnancy was not developing normally.
Common causes include:
Chromosomal Abnormalities
The most common cause of first-trimester miscarriage is a chromosomal abnormality that prevents normal development of the embryo.
Hormonal Factors
Certain hormonal conditions may contribute to pregnancy loss, including:
Thyroid disorders
Uncontrolled diabetes
Progesterone deficiencies
Structural Factors
Sometimes abnormalities of the uterus or cervix may increase miscarriage risk.
Other Factors
Certain infections
Autoimmune conditions
Severe maternal illness
Advanced maternal age
Importantly, everyday activities such as exercise, working, sexual intercourse, lifting normal household items, or experiencing stress do not generally cause miscarriage.
Signs and Symptoms of Miscarriage
Not all bleeding in pregnancy means miscarriage, but it should always be assessed by a healthcare professional.
Common symptoms may include:
Vaginal Bleeding
Bleeding may range from:
Light spotting
Brown discharge
Bright red bleeding
Heavy bleeding with clots
Abdominal Cramping
Women may experience:
Period-like cramps
Lower abdominal pain
Lower back pain
Strong contractions
Passing Tissue
Some women may pass:
Blood clots
Pregnancy tissue
Grey or white tissue
Loss of Pregnancy Symptoms
Some women notice:
Reduced breast tenderness
Nausea disappearing suddenly
A general feeling that pregnancy symptoms have changed
However, symptoms can naturally fluctuate during pregnancy, so this alone does not mean miscarriage has occurred.
When Should I Seek Medical Help?
You should seek medical assessment if you experience:
Any vaginal bleeding during pregnancy
Moderate to severe abdominal pain
Passing clots or tissue
Dizziness or fainting
Shoulder tip pain
Severe one-sided pelvic pain
Fever or signs of infection
These symptoms require prompt assessment to exclude miscarriage, infection, or an ectopic pregnancy.
Where Can I Seek Help in Perth?
Depending on your symptoms and circumstances, support may be available through several healthcare providers and services throughout Perth.
Private Endorsed Midwife or GP
Both a Private Endorsed Midwife and GP can provide comprehensive assessment and support for early pregnancy concerns.
They can:
Arrange blood tests, including pregnancy hormone (hCG) monitoring
Request ultrasound examinations
Assess symptoms and discuss likely causes
Discuss miscarriage management options
Provide referrals to specialist services when required
Explain test results and treatment options
Provide emotional support and ongoing follow-up care
Coordinate care during future pregnancies following pregnancy loss
Seeking early assessment can help provide clarity, reassurance, and timely access to appropriate care.
Emergency Department
Attend your nearest Emergency Department immediately if you experience:
Heavy vaginal bleeding
Severe abdominal or pelvic pain
Dizziness, fainting, or collapse
Shoulder tip pain
Signs of infection such as fever or feeling unwell
Suspected ectopic pregnancy
These symptoms require urgent medical assessment.
Early Pregnancy Assessment Services (EPAS) in Perth
Several Perth maternity hospitals provide specialised Early Pregnancy Assessment Services (EPAS) for women experiencing complications during the first trimester of pregnancy.
EPAS clinics are available at:
King Edward Memorial Hospital (KEMH)
Joondalup Health Campus
Fiona Stanley Hospital
Rockingham General Hospital
Armadale Health Service
St John of God Midland Public Hospital
These clinics provide specialist assessment for women experiencing concerns in early pregnancy, including pain and bleeding that may indicate miscarriage or ectopic pregnancy.
The dedicated EPAS at King Edward Memorial Hospital provides a senior clinician-led service with ultrasound support for women within the KEMH catchment area and those requiring tertiary-level maternity care.
Who May Be Eligible for Referral?
EPAS services generally review women up to 13 weeks and 6 days gestation who have a positive pregnancy test and one or more of the following:
Vaginal bleeding
Abdominal or pelvic pain
Previous ectopic pregnancy
Previous tubal surgery
Intrauterine contraceptive device (IUCD) in place with an unsited pregnancy
Suspected or confirmed miscarriage requiring management advice
Retained products of conception following pregnancy loss before 20 weeks gestation
Monitoring of pregnancies of unknown location
If an EPAS clinic is available at your local maternity hospital, referral there is usually recommended in the first instance.
Your GP or Endorsed Midwife can advise whether an EPAS referral is appropriate and assist with arranging access to these services.
How Is Miscarriage Diagnosed?
Diagnosis may involve:
Ultrasound
An ultrasound helps assess:
Pregnancy location
Foetal development
Presence of heartbeat
Signs of miscarriage
Blood Tests
Blood tests may measure:
Pregnancy hormone levels (hCG)
Blood group
Iron levels if bleeding is significant
Sometimes repeat testing is required over several days to clarify what is happening.
Management Options Following Miscarriage
Management depends on the type of miscarriage and individual circumstances.
Options may include:
Expectant Management
Allowing the body to complete the miscarriage naturally.
Medical Management
Medication may be prescribed to help the uterus expel pregnancy tissue.
Surgical Management
A procedure may be recommended if:
Heavy bleeding occurs
Tissue remains in the uterus
Infection develops
Your healthcare provider will discuss the benefits and risks of each option.
The Emotional Impact of Pregnancy Loss
Pregnancy loss affects every person differently.
You may experience:
Shock
Sadness
Anger
Guilt
Anxiety
Relief
Numbness
All emotional responses are valid.
Some parents feel grief immediately. Others may not fully process their loss until weeks or months later.
Partners may also grieve deeply, often while trying to support the woman experiencing the physical loss.
Remember: It Was Not Your Fault
One of the most common questions women ask is:
"Did I do something wrong?"
In the overwhelming majority of cases, the answer is no.
Miscarriages are rarely caused by something a woman did or did not do.
You did not cause your miscarriage by:
Exercising
Working
Having sex
Lifting groceries
Feeling stressed
Travelling
Self-blame is common but usually misplaced.
Supporting Yourself After Pregnancy Loss
There is no right way to grieve.
Some families find comfort in:
Talking openly about their baby
Creating a memory box
Naming their baby
Planting a tree or flowers
Writing letters
Joining support groups
Seeking professional counselling
Allow yourself time and space to process your experience.
Healing is not linear.
Future Pregnancies After Miscarriage
Many women worry they will never have a successful pregnancy after miscarriage.
The good news is that most women who experience a miscarriage go on to have healthy pregnancies and babies.
After a loss, it is normal to feel:
Increased anxiety
Fear of another loss
Difficulty feeling excited
Hypervigilance regarding symptoms
Having a supportive healthcare provider can make a significant difference during future pregnancies.
How Midwifery Support Can Help
Experiencing pregnancy loss can feel overwhelming, especially when navigating appointments, test results, and difficult decisions.
As an endorsed midwife, I provide compassionate support for women and families experiencing:
Positive pregnancy tests
Early pregnancy concerns
Bleeding in pregnancy
Suspected miscarriage
Confirmed pregnancy loss
Pregnancy after miscarriage
Emotional support and counselling referrals
You do not need to navigate this journey alone.
Need Support Following a Miscarriage or Early Pregnancy Concerns?
If you are experiencing bleeding, pain, have received a positive pregnancy test, or simply need someone to talk through your options with, I offer personalised early pregnancy support and care for women throughout Perth and the Perth Hills.
Before and After Baby provides compassionate, evidence-based midwifery care to support you through every stage of your pregnancy journey — including the difficult moments.
Contact Jess Boland, Private Endorsed Midwife, to discuss your concerns and access the support you deserve.
