Silent Miscarriage: What Every Pregnant Woman Needs to Know

This morning I spoke on This Morning about something that comes up in clinic more than most people might expect, and that still, despite how common it is, catches women completely off guard: silent miscarriage.

I wanted to write this up properly, because a conversation on television is never quite long enough. If you have been through a silent miscarriage, if you are in the middle of one right now, or if you simply want to understand what it is, this is for you.

First, the numbers

Miscarriage is far more common than most of us are raised to understand. It is estimated that around one in four pregnancies in the UK ends in miscarriage, the majority of those in the first 12 weeks. Half of all adults in this country say that either they or someone they know has experienced pregnancy loss.

And yet it remains one of the most under-discussed experiences in women's health. People carry it quietly, often alone, sometimes not even telling close friends or family because of the widely held convention of waiting until 12 weeks to share news of a pregnancy.

That silence around miscarriage is something I feel strongly about changing. And silent miscarriage, specifically, is a type of loss that deserves far more open conversation.

What is a silent miscarriage?

A silent miscarriage, known medically as a missed or delayed miscarriage, happens when a pregnancy stops developing but your body does not physically miscarry. There is no bleeding. No cramping. No obvious sign that anything has changed.

Your pregnancy hormones may continue to be elevated for some time, which means you may still feel pregnant. You might still be experiencing nausea, breast tenderness, fatigue, all the things you associate with early pregnancy. A home test may still come back positive. From the outside, and from the inside, everything can appear completely normal.

That is precisely what makes it such a shock. Because in most cases, a silent miscarriage is discovered at a routine ultrasound scan, often the 12-week booking scan, or sometimes an early private scan. The sonographer turns quiet. The screen is not turned towards you. And then comes a sentence that nobody is ever truly prepared to hear.

The scan may show that the baby has no heartbeat, or that the baby is measuring smaller than expected for the dates given. In some cases, the scan shows an empty sac, which means the embryo stopped developing very early on and has been reabsorbed by the body. This is sometimes called early embryonic demise or, in older terminology, a blighted ovum.

It is not clear why some miscarriages happen within days of a baby dying while others take much longer for the pregnancy hormones to drop and the physical process to begin. That delay can be a matter of days, or it can extend to several weeks. The body, for reasons we do not fully understand, simply has not yet registered what has happened.

Why does silent miscarriage happen?

This is almost always the first question women ask, and it is completely understandable. When something this unexpected happens, we want a reason.

The most important thing I want to say here is this: in the vast majority of cases, a silent miscarriage is not caused by anything you did or did not do. Miscarriage is not caused by stress, by exercise, by a fall, by eating the wrong thing, by working too hard, or by any of the other things women tend to blame themselves for.

In most early miscarriages, the cause is a chromosomal abnormality. The NHS explains it clearly: during conception, something can go wrong and the embryo receives too many or too few chromosomes. This means the pregnancy simply cannot develop as it should. It is a random event, not an inherited flaw, not a reflection of your body's ability to sustain a pregnancy, and not something that can be predicted or prevented.

The likelihood of chromosomal abnormalities does increase with age, which is why the risk of miscarriage rises as women get older. But it can happen at any age, and it happens by chance.

Other possible causes of miscarriage include problems with the placenta, certain blood clotting conditions such as antiphospholipid syndrome, and some structural differences in the uterus. But these tend to be associated more with recurrent pregnancy loss than with a single isolated miscarriage.

The waiting: what happens after diagnosis

One of the hardest parts of a silent miscarriage, and something I hear from patients time and again, is the period between diagnosis and the physical process ending.

Because your body has not yet responded to the loss, you may be asked to wait. In some cases, a repeat scan is scheduled after a week or two, to confirm the findings and give the pregnancy every chance before a diagnosis is confirmed. That waiting period, not knowing, hoping, and dreading at the same time, can feel unbearable.

Once a missed miscarriage is confirmed, you will be offered a choice about how to manage it. The NHS currently offers three main options:

Expectant management means waiting for the miscarriage to happen naturally. This can take anywhere from a couple of weeks to longer. It allows the process to happen in your own home and in your own time, but it can feel like an extended period of limbo, and there is some uncertainty around when it will happen and how it will feel.

Medical management involves medication, usually tablets or pessaries, to help the body begin the miscarriage process. This gives you more control over the timing and can be done at home in many cases, though you may be asked to stay in hospital for monitoring initially.

Surgical management, sometimes called a surgical evacuation of retained products of conception or ERPC, is a procedure where the pregnancy is removed under anaesthetic. It is typically completed as a day case. For women who cannot face the uncertainty of waiting, or for whom medical management is not suitable, this can feel like the right choice.

There is no single right answer. Your care team should give you the time and information you need to make the decision that is right for you. If you feel rushed, you are entitled to ask for more time.

The emotional reality

The clinical facts of a silent miscarriage are one thing. The emotional reality is quite another.

The shock of discovering a loss when nothing felt wrong is a particular kind of grief. There is often a sense of disorientation, of having been pregnant one moment and not the next, without your body ever signalling the shift. That can make it harder to process.

Many women experience guilt, even when they know intellectually that nothing they did caused this. They feel it anyway. That guilt is real, and it deserves to be acknowledged rather than dismissed with reassurance.

Partners can struggle enormously too. They have experienced the same loss, often from a position of helplessness, watching someone they love go through something painful and being unable to fix it. Support for partners is something the medical community is still not doing well enough, and it matters.

Feelings of anxiety, grief, sadness and isolation following pregnancy loss are entirely normal. So are feelings of numbness, or of being fine one minute and devastated the next. There is no correct way to grieve this. Whatever you are feeling is valid.

If those feelings persist, if you are finding it difficult to function day to day, or if you are experiencing symptoms of depression or anxiety weeks after your loss, please do reach out to your GP. Counselling and support are available, and asking for help is not weakness.

What about future pregnancies?

This is the question that sits underneath almost every conversation about miscarriage. And I want to be as clear and as honest as I can here.

For most women, having a miscarriage, including a silent miscarriage, does not reduce your chances of going on to have a healthy pregnancy. The Miscarriage Association and Tommy's both emphasise this: the majority of women who experience a miscarriage do go on to conceive again and carry to term.

Recurrent miscarriage, defined as three or more consecutive losses, affects around one in 100 couples and warrants further investigation. But a single miscarriage, however devastating, is not a predictor of future losses.

Once the miscarriage process is complete and any bleeding has stopped, your body will begin to recover. Most women find that their first period returns within four to six weeks. There is no medical reason to wait a set number of cycles before trying again, though some couples find it helpful to wait until after their first period to make dating a subsequent pregnancy easier. What matters most is how you feel physically and emotionally. There is no rush, and there is no wrong answer.

Please do not carry this alone

There is still a culture of silence around pregnancy loss that I find genuinely troubling. Women suffer quietly because they did not tell anyone they were pregnant, or because they feel they should be coping better, or because they worry that others will not understand the depth of the loss.

A miscarriage, whether it happens at six weeks or twenty, whether it comes with warning signs or none at all, is a real loss. You are allowed to grieve it. You are allowed to talk about it. And there is real support available when you need it.

If you have been affected by anything in this article, the Miscarriage Association runs a helpline, a live chat service, and a wide library of personal stories and information. Tommy's also offers a wealth of evidence-based support. Your GP and your early pregnancy unit are there for you too.

You do not have to go through this alone.

Sources and further support

NHS Miscarriage information:www.nhs.uk/conditions/miscarriage

The Miscarriage Association — helpline, live chat, and information on missed miscarriage: www.miscarriageassociation.org.uk Helpline: 01924 200 799

Tommy's — miscarriage statistics, support tool, and information on types of miscarriage: www.tommys.org/baby-loss-support/miscarriage-information-and-support

NICE guidance on ectopic pregnancy and miscarriage:www.nice.org.uk/guidance/ng126

NHS 111 — if you are experiencing symptoms or are worried, call 111 at any time.