After a woman miscarries, it can take many days, or even many weeks, for her to physically heal and recover. Exactly how long this will be is very individual for each woman.
It will often depend on:
How advanced the pregnancy was.
How heavy the bleeding was.
How the miscarriage unfolded and if there were any complications.
If the miscarriage has left you feeling physically unwell, possibly because you lost a lot of blood or required an operation (particularly for ectopic pregnancies) then it may take you a while to feel strong and back to full health. Try to rest as much as possible, take time off work or study if you can, have someone help with other children if you have them and eat regular, nourishing meals. Your doctor may ask you to have a medical check up about 3 to 6 weeks after the miscarriage to make sure you have recovered.
Some women will be anaemic after their miscarriage. Anaemia is a low haemoglobin (or low red blood cell count) that can cause feelings of excessive tiredness, lethargy, irritability and physical weakness. Your caregiver may recommend an iron supplement and possibly some dietary changes to help with this.
You may wish to consult with your natural health practitioner about some supporting remedies. Homoeopaths may suggest Arnica, Ferrum metallicum or Calcarea phosphoricum. Herbalists may recommend nettle, as well as things like vitamin C, Echinacea and garlic to boost your immune system. You may find acupuncture helps in balancing your hormones and general health.
Most women have questions about their physical health, and what to expect during the time following their miscarriage. The most common issues that come up include:
Bleeding and infections
Once the miscarriage has completed (or after the operation has been performed) the heaviness of the bleeding should be similar to that of a normal period. In many cases the bleeding will be relatively lighter. How long your bleeding lasts for will be very individual to you. It may continue for up to 1 week, or as long as 3 weeks, gradually easing (usually on and off) before stopping completely. Most caregivers recommend you use sanitary pads during this time. Tampons can be used again when your first period starts (generally 4 to 8 weeks after the miscarriage).
If your bleeding becomes heavy again (soaking pads every ½ an hour to an hour) and/or you are passing large blood clots (more than 3 cms in width), the miscarriage may be 'incomplete' and you will need to seek medical attention as soon as possible. You should also seek help immediately if your bleeding is accompanied by feeling light-headed, faint, nauseated and/or dizzy.
Occasionally a woman will develop an infection of the uterus within days (or a few of weeks) after the miscarriage. The physical signs of an infection can include lower abdominal pain or tenderness when touching the lower belly, a fever and/or an offensive smelling vaginal discharge. Often the infection will also trigger heavier bleeding again. Your caregiver may order an ultrasound to try and detect if any of the pregnancy still remains inside the uterus. They will also usually prescribe antibiotics. Sometimes an operation is required to remove the rest of the pregnancy (if it is evident some still remains), or the caregiver may take a 'wait and see' approach, in the hope that your body will pass it eventually, just advising you take antibiotics.
Many women and their partners are unsure about when they can resume sexual intercourse after a miscarriage. From a physical perspective, it is usually recommended that you wait until after the bleeding from the miscarriage has stopped (often taking from 1 to 3 weeks). If the woman is unwell because she has experienced heavy bleeding or there were complications, her physical recovery may take a while. Meaning her interest in sex may be delayed until she feels well again. It is important to rest and give your body the time it needs to heal.
From an emotional perspective, your desire to have sex again will individually vary. Resuming your sexual relationship with your partner will very much depend on how you are both feeling. When grieving over the loss of a baby, sex may be the last thing on your mind, or it could be something you engage in as part of your healing with your partner, or as an emotional release. Share your thoughts and feelings, so that the timing feels right for both of you. It may be that you engage in touching, cuddling and kissing to help you fell loved and connected, without involving actual intercourse.
Be aware that it is possible for you to release an egg (or ovulate) and be fertile within 1 to 4 weeks from the miscarriage. If you do not wish to conceive again quickly, you may want to speak with your caregiver about appropriate contraception.
The decision to conceive again is something most women and their partners contemplate after losing a baby through miscarriage. From a physical perspective, there are no clear guidelines as to whether there is any advantage for the woman to wait a period of time before she conceives again. Essentially if you are well, it really comes down to what you would like to do.
Some caregivers will recommend delaying attempts to conceive again (for one or even several months), particularly if you are unwell or lost a lot of blood and are anaemic. If this is the case, it may be better to wait until you have fully recovered physically before dealing with being pregnant again. If you have a specific health condition (such as diabetes or high blood pressure you may need to stabilise your health condition first, or have further investigations if you are experiencing recurrent miscarriages, before trying to conceive. Be guided by your caregiver.
If you are keen to have another baby soon, then in most cases this is acceptable, being mainly based on the woman's overall health and your emotional readiness to embark on another pregnancy. It is a normal grief reaction to want to 'immediately put things back the way they were' in a sense. It is for this reason that many women have an initial reaction to want a pregnancy after miscarriage as soon as possible. This is OK and you may find that this is exactly what happens. Just try to be aware that you may need to work through your grief of losing this baby, before moving on to have another one. A subsequent pregnancy is not a replacement, but a new pregnancy with a new baby, often accompanied with much fear and anxiety that another miscarriage may occur.
A woman's fertility can return within 1 to 6 weeks after a miscarriage. Be aware that you will release an egg (or ovulate) about 2 weeks before your next period arrives, therefore it is possible to conceive straight after a miscarriage, but before the next period even happens. If you do not wish to conceive again quickly, you may want to speak with your caregiver about appropriate contraception.
Milk coming in
If the miscarriage happens after 14 weeks of the pregnancy, it is possible to start producing breast milk (although it is also very normal for breast milk production to be delayed until later in the pregnancy for some women). If your milk does come in, your breasts will start filling anytime from 2 to 5 days after the miscarriage. The breasts can feel swollen, very hot and painful to touch. This is called 'engorgement', with the discomfort lasting up to 3 to 10 days.
Wearing a well-fitting bra day and night can help. This firmly holds the breasts in place and reduces any stimulation of the nipples (which can increase milk production). Some women prefer to wear no bra at all, just a loose T-shirt, allowing the milk to slowly drip (although not every woman will actually 'leak' milk). This can sometimes feel more comfortable, while reducing the 'engorged', painful feelings. Lying on a towel at night will soak up any milk that may leak.
Try to avoid running hot water directly over your breasts while showering. This can bring more blood supply to the breasts, increasing the swelling and stimulation to the nipples. Also try not to express the milk, as this can stimulate you to make more milk. If you really need to, you can occasionally squeeze a few millilitres off for comfort to ease the pressure, but do this as little as possible.
It used to be recommended to use cabbage leaves or cool compresses to reduce engorgement. However, the research has not been able to show any effectiveness of these methods. Even so, some women find cold compresses soothing and pain relieving for hot, sore breasts. If you do use them, place the cool compresses on your breasts for about 10 minutes every half an hour or so (when you are awake). Avoid leaving them on for longer periods, as this may cause damage to the blood circulation in your breasts. You may wish to take some mild pain killers to help with the discomfort during this time (such a paracetamol). Some caregivers may suggest prescribing medications to suppress the milk.
A few women like to use homoeopathic remedies prescribed by their practitioner for engorgement (such as Belladonna or Bryonia). Herbalists may prescribe remedies containing parsley, sage or phytolacca. Aromatherapists may suggest a few drops of Clary sage oil, mixed with a carrier oil (such as almond) to gently rub into the breasts (or burning the oil). It is important not to stimulate the breasts too much, but to simply apply the oil with some very light stroking. Do a small skin test first and wait for a few hours, to make sure you are not allergic to it.
If your breasts develop painful, reddened areas on the skin and you have a fever and feel unwell, you may be developing mastitis (an infection of the breast tissue). This may need to be treated with antibiotics. You will need to seek the advice of your local doctor or caregiver.
Read more about miscarriage here