Miscarriage and stillbirth: understanding and getting support

What are the different types of pregnancy loss?

Losing a pregnancy is a painful ordeal, whatever the stage. Information on pregnancy care and birth can be found on the Giving birth in Paris page.

These limits can vary slightly between professional societies and countries. The threshold of 22 weeks, or a weight of 500 grams, is the World Health Organization viability criterion. In France it no longer determines registration of a stillborn child (acte d'enfant sans vie), which since 2008 has been based on a medical certificate of delivery.

Why does miscarriage or stillbirth happen?

Early miscarriage

It affects about 15% of recognised pregnancies. In most cases, it is caused by a chromosomal abnormality in the embryo that occurred by chance at conception. The risk rises with the mother's age. Stress, work, moderate exercise or sex do not cause it. The first signs and what to do are covered in the article on bleeding in the first trimester.

Late miscarriage

The most common causes are an infection (which can travel up from the vagina to the uterus or come from the bloodstream, such as listeriosis), a weak cervix (cervical insufficiency) that opens without contractions, a uterine malformation, or more rarely an abnormality in the foetus.

Stillbirth

The main causes found are placental problems (placental insufficiency, placental abruption), maternal complications (pre-eclampsia, diabetes, autoimmune diseases, severe obstetric cholestasis), infections, cord problems and foetal abnormalities. Smoking, obesity and older maternal age increase the risk. Despite full investigations, some deaths remain unexplained.

What happens medically after a miscarriage or stillbirth?

After an early miscarriage

Depending on the situation and your choice: waiting for natural expulsion, medication, or vacuum aspiration. Before 12 weeks, the French College of Obstetricians and Gynaecologists (CNGOF) has recommended since 2024 that anti-D immunoglobulin should not be given, even if you are rhesus negative. Follow-up is described in the article on follow-up after a miscarriage.

After a late miscarriage or a stillbirth

The diagnosis is confirmed by ultrasound. The team gives you the time you need, unless there is a medical emergency (infection, haemorrhage, severe pre-eclampsia). Most often, the birth takes place vaginally, after induction with medication, with pain relief, often an epidural. A caesarean is offered only in specific situations, because it does not make the experience easier and carries risks for future pregnancies.

If you are rhesus negative, an anti-D immunoglobulin injection is given within 72 hours. Treatment to limit milk production is also available if you wish.

What tests are done to find the cause of a pregnancy loss?

After recurrent early miscarriages

After a single miscarriage, no tests are needed. In France, tests are traditionally offered after three consecutive early miscarriages; the 2022 European guidelines of the European Society of Human Reproduction and Embryology (ESHRE) suggest considering them after two pregnancy losses. They include:

• screening for antiphospholipid syndrome (antibodies in the blood);
• thyroid tests;
• an assessment of the uterine cavity, preferably by 3D ultrasound, or by saline infusion sonography or hysteroscopy;
• chromosome analysis of the pregnancy tissue when possible; a karyotype of both parents is offered only in certain situations.

Routine testing for inherited thrombophilia is no longer recommended. In about half of cases, no cause is found, and the chances of a live birth in a future pregnancy remain good.

After a late miscarriage or a stillbirth

Tests are guided by the circumstances: swabs to look for infection, blood tests (pre-eclampsia, diabetes, clotting, antibodies, passage of foetal blood into the mother's circulation using the Kleihauer test), targeted serology (parvovirus B19, CMV, toxoplasmosis).

The two most informative tests are examination of the placenta and foetal post-mortem examination (autopsy). A post-mortem is carried out only with the parents' written consent. It is done respectfully, and the baby's body can then be seen and cared for. Genetic testing may also be offered.

How can I cope with grief after a pregnancy loss?

Losing a pregnancy is often experienced as losing a child, even very early on. Shock, sadness, anger, guilt or a sense of injustice are common reactions. After a miscarriage, post-traumatic stress, anxiety or depression affect a significant proportion of women and sometimes persist beyond nine months.

• Support from a midwife, psychologist or psychiatrist can be offered to you and your partner, during your hospital stay and afterwards.
• After a late loss, some parents wish to see their baby, hold them, give them a name, keep a photo or a footprint. Nothing is compulsory: your choices will be respected, and you can take time to think about them.
• Brothers and sisters may be very upset; simple words suited to their age help them. The team can advise you.
• Associations of bereaved parents offer listening and support groups; the team can direct you to a suitable association.

If you are in severe distress or having dark or suicidal thoughts, in France you can call 3114, the national suicide prevention line, free and available 24/7.

What are the practical steps after a pregnancy loss in France?

• Registration of a stillborn child (acte d'enfant sans vie): in France, when a birth has taken place, the maternity unit can issue a certificate allowing you, if you wish, to register the child with the civil registry. Since 2021, a first name and a family name can be included. The child can also be entered in the family record book (livret de famille).
• Funeral: you can arrange a funeral (burial or cremation) or entrust the body to the hospital, which takes care of it. The maternity team will explain how long you have to decide and the practical arrangements.
• Leave: in France, after a stillbirth from 22 weeks or with a baby weighing at least 500 g, maternity leave still applies. The second parent is entitled to paternity and childcare leave (25 days, 4 of them compulsory after the 3-day birth leave; 32 days for multiple births), provided a stillbirth certificate (acte d'enfant sans vie) has been issued. Below this threshold, or without a certificate, there is no paternity leave; sick leave may be prescribed (service-public.gouv.fr). Since 1 January 2024, sick leave prescribed after a miscarriage before 22 weeks is paid from the first day, with no waiting period.

Do not hesitate to ask the maternity unit's social worker for help.

What about the next pregnancy, and when should I seek urgent care?

A follow-up appointment, often a few weeks after the loss, is a chance to review test results, answer your questions and prepare for a possible new pregnancy. French guidelines do not advise delaying a new pregnancy after an early miscarriage; after a late loss, the timing is decided with you, according to your physical and emotional recovery. Depending on the cause found, closer monitoring, treatment (aspirin, heparin, cervical stitch) or more frequent ultrasounds may be offered.

After the loss, seek urgent care if:

• you have a temperature of 38 °C or more, chills, or foul-smelling discharge;
• you are bleeding heavily or feeling faint;
• your pain is getting worse.

In a future pregnancy, go to the maternity emergency department if:

• you notice fewer or different movements from your baby;
• you have bleeding, leaking fluid or contractions;
• you have severe headaches, vision problems or intense itching of the hands and feet.

If you feel faint, are haemorrhaging or are in distress, in France call 15 or 112 (or your local emergency number). You can also go to the emergency department of the maternity unit where you are followed (Maternité Sainte-Félicité or Clinique Sainte-Thérèse).

Frequently asked questions

General information article: it does not replace a medical consultation. In an emergency, call 15 or 112 in France, or your local emergency number.