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The two key signs of a possible miscarriage which are likely to get you searching the internet for information and positive encouragement are bleeding and cramping. Other more subtle signs that you're losing your pregnancy such as loss of breast tenderness and nausea can be easily ignored when you're already planning baby names but after miscarriage you will realise they were there.

My own personal experience of miscarriage is that each one is different. Some start with cramping and some start with some spotting and then bleeding. Eventually it will involve both. But how do you tell if you really are about to miscarry?

1) Cramping - this can be confusing because in early pregnancy there's a lot of stretching going on so it's difficult to tell what's stretching and what's cramping. The difference is in the intensity. Ligament stretching is uncomfortable but not necessarily painful. If you are miscarrying the pain is much greater, like bad period pain, and it pulls in your belly and probably in your lower back too. If you are biting your lip with the pain or finding it difficult to move around then it's cramping rather than stretching.

2) Bleeding - also confusing because a lot of women bleed during pregnancy. In the early stages many women get spotting as a result of implantation bleeding or around the time when their period may have been due. This is usually fairly light bleeding and nothing to worry about. However, another cause of more significant bleeding which is less known about is a 'subchorionic hematoma'. This is where the placenta is not quite attached to the womb lining and it causes bleeding which often pools. During my last (and successful) pregnancy I experienced significant blood loss at about week 14 which I assumed meant an impending miscarriage. I had a sleepless night waiting for the cramps to start but by 9am the next day when I was due for an ultrasound there was still no pain. As the radiologist scanned my belly I covered my eyes and prepared to hear the worst but was greeted by laughter - the baby was still in there and was waving at her! I couldn't believe it. So, bleeding (bright red) without cramps is not necessarily a problem and in fact, subchorionic hematomas are fairly common and don't necessarily threaten the pregnancy unless they are exceptionally large (once the baby is bigger than the hematoma you're pretty safe). With my pregnancy I continued to bleed for about another 4-5 weeks during which time I was warned to be careful and not to have sex. The difference with a miscarriage is that the bleeding might start brownish, become redder and heavier and eventually include clots. Also, with a subchorioic hematoma there is no cramping so if you're experiencing pain too then it's likely to be bad news.

3) Bleeding and Cramping - in my experience if you have both of these then you are most likely to be miscarrying.

What to do about it?

If you have any of these signs then you need to see your doctor. Even if you think you've miscarried and it's all over you still need to have an ultrasound afterwards to check that everything's been expelled (bits left in there can cause infection). There's no doubt that it's a very worrying and stressful time when you start to experience these symptoms and ultimately the only way to know for sure is to see your doctor and get an ultrasound.

Learn more about this author, Elaine Seager.
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