Understanding early miscarriage
Most often chromosomal, not something you did.

When to call, when to go

For everything else, call your doctor any time you are unsure. One extra call is better than one call too late, and OBs expect these calls: you won't be bothering anyone.

What happens next

1. Contact your doctor
2. Get an ultrasound to confirm the status of the pregnancy
3. Serial beta-hCG, if needed
4. Follow medical guidance: expectant, medical or surgical management

Serial beta-hCG means two blood tests 48 hours apart. In the book's reading, an increase of less than 35% is a warning that can indicate a non-viable pregnancy, and a drop indicates a pregnancy that won't progress. Your doctor reads these results together with the ultrasound.

The risk falls with time, and you don't have to carry it alone

The risk of miscarriage drops significantly from week 8, and after 12 weeks it falls to less than 2% in the second trimester.

• Two or more previous miscarriages: book your first OB appointment earlier, by 6 weeks. Your doctor may order serial beta-hCG.
• Telling people: with previous losses, consider telling your close network early, so that if another loss happens you have support without explaining from scratch. It is your choice.
• Therapy: consider it, especially with a history of previous losses. A therapist who specializes in reproductive health and pregnancy makes a real difference.

This is one chapter. The map has 42.

Miscarriage is covered in Chapter 40 of Map to the Positive, in Station V (Positive), with the other first-trimester warning signs; the chapters that follow cover when to tell people and the anxiety of the beginning. The book is the complete map from preparing to conceive through the first 30 days after a positive, and its earlier stations, from preconception tests to knowing when to see a specialist, stay useful for anyone who is trying.