Physical recovery after pregnancy loss: what to expect and how to heal

Pregnancy loss is a deeply challenging experience, no matter when it occurs. Whether you have experienced a miscarriage, ectopic pregnancy, stillbirth, or infant loss, you are not alone. Many people have walked this difficult path and understand the pain and emotions you may be feeling. We extend our deepest sympathies and offer guidance to support your physical recovery.

Understanding your recovery after pregnancy loss

Everyone's experience is unique, and your recovery will depend on the stage of pregnancy when your loss occurred and the type of procedure (if any) you underwent.

Miscarriage

A miscarriage is the loss of a pregnancy before 20 weeks. It’s a common occurrence, with around a quarter of all pregnancies ending in miscarriage, and 80% of these happening in the first trimester. In a miscarriage, your uterus contracts to pass embryonic or fetal tissue and other products of pregnancy. This can happen naturally (spontaneous miscarriage) or with the aid of medication or a surgical procedure like a D&C (dilation and curettage). You might expect:

• Cramping and bleeding that is heavier than a normal period. You might pass blood clots and tissue for a few hours, followed by bleeding that tapers off to spotting over several weeks. Use pads for the first two weeks to reduce the risk of infection.

• Medications. Your provider may prescribe pain medication or suggest over-the-counter options. They may also prescribe an antibiotic to prevent infection.

• Physical recovery. You may be able to resume normal activities a day or two after an early miscarriage. Recovery after later miscarriages may take longer. If you had pregnancy symptoms like nausea, they usually go away a few days after the miscarriage is complete. Ask your provider when it’s safe to resume sexual activity.

• Return of your period. Your period may return a few weeks after the bleeding stops.

• Follow-up. Some providers may want to do an ultrasound or a pregnancy test a few weeks after your miscarriage to ensure all pregnancy tissue has passed. They may also suggest a follow-up visit two to six weeks after the miscarriage.

Ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. This can lead to life-threatening bleeding if the tube bursts. Most ectopic pregnancies become symptomatic around six to eight weeks, with symptoms like abdominal and referred shoulder pain, bleeding, and discomfort during bowel movements. Before the tube bursts, you may be treated with medication to stop the pregnancy. If the tube bursts, immediate surgery is required. You might expect:

• Pain and tenderness in your abdominal area from surgical incisions or your body’s response to medication.

• Medications. Your provider may prescribe pain medication or suggest over-the-counter options. They may also prescribe an antibiotic to prevent infection.

• Fatigue. Surgical recovery or the effects of medication can cause fatigue.

• Vaginal bleeding for a few weeks as your body sheds the thickened uterine lining. Some people treated with medication may not experience bleeding.

• Return of your period. Your period may return a few weeks after your treatment.

• Return to normal activities. Recovery time depends on the type of treatment. You may be able to resume normal activities a few weeks after treatment, but some people find it takes six weeks or more. If you had pregnancy symptoms, they usually go away a few days after treatment. Ask your provider when it’s safe to resume sexual activity.

• Follow-up. Your provider may monitor your hormone levels (hCG) to ensure the ectopic pregnancy is resolved. They may also suggest a follow-up visit around six weeks.

Stillbirth

Stillbirth is the loss of a pregnancy after 20 weeks or during delivery. Some stillbirths require immediate delivery, either by labor induction or with surgical procedures like a D&E (dilation and evacuation) or a cesarean section. However, it’s often safe to wait for your body to go into labor naturally. You might expect:

• Afterpains as your uterus continues to contract after delivery to expel the placenta. Mild contractions, or afterpains, continue for a few days as your uterus shrinks.

• Soreness and pain. For a vaginal delivery, your vaginal and perineal tissues may be sore and stretched from pushing or an episiotomy. Follow your provider’s aftercare instructions. For a C-section, follow your provider’s care recommendations for bandaging and cleaning your abdominal incision, and use ice packs and medications to relieve pain.

• Vaginal bleeding. Expect heavy bleeding, or lochia, in the first days to weeks after delivery, similar to a very heavy period. Bleeding will gradually taper and change color from bright red to darker brown. By six to eight weeks, bleeding may slow to spotting. Use pads for the first two weeks to reduce the risk of infection.

• Medications. Your provider may prescribe pain medication or suggest over-the-counter options. 

• Tender nipples and breasts. Your breasts may feel enlarged, swollen, and tender a few days after delivery when they start making milk. Manually expressing some milk while taking a warm shower can help relieve discomfort.

• Hemorrhoids and constipation. Pushing during vaginal delivery can cause hemorrhoids. Anesthesia and pain medications can make your bowels sluggish, which can cause constipation and difficult bowel movements..

• Return of your period. Your menstrual cycle may resume a few weeks after your bleeding stops.

• Follow-up. Your provider will suggest a follow-up visit around six weeks.

When to see your provider

Most pregnancy losses are uncomplicated, but you should see a provider right away if you:

• Soak more than two pads in an hour

• Have chills, severe pain, or swelling in your hands, face, or legs

• Experience sudden weight gain, headache, vision changes, or a temperature higher than 100°F

• Have thoughts of harm or are unable to care for yourself or other children (Call or text the 988 Lifeline and find more resources for emotional support here.)

Fertility after pregnancy loss

Most people can have a healthy pregnancy after a miscarriage, ectopic pregnancy, or stillbirth. There’s no evidence that delaying conception after a pregnancy loss offers benefits. Ask your provider when to resume sexual activity. Waiting at least two weeks is recommended, but you may want to wait longer for your comfort. Contraception is also safe to use right after an early pregnancy loss. Talk to your provider if you are planning to become pregnant again.

Physical therapy and exercise for pregnancy loss recovery

Focusing on your health and self-care after a pregnancy loss can help you heal and recover. With an early pregnancy loss, you may not experience significant physical aftereffects. However, pelvic issues can still occur. Late-pregnancy losses and stillbirths can lead to more noticeable symptoms such as pelvic floor and abdominal muscle weakness, and urinary incontinence.

Physical therapy and exercise can improve muscle coordination, strength, and flexibility, and help address pregnancy- or postpartum-related symptoms. While your provider typically recommends waiting six weeks to resume activities like sex and vigorous exercise, there are steps you can take during this period to help with your recovery.

A pelvic floor physical therapist can help you:

• Improve the strength and mobility of your pelvic floor

• Develop a personalized exercise program to progress safely

• Learn healthy ways to move your body during daily activities

• Find positions that decrease strain on your back and neck

• Adopt good toileting habits to manage leakage and pelvic pain

• Understand recovery expectations after pregnancy loss, including vaginal or C-section delivery

• Manage pressure on your abdomen during daily activities to reduce strain on your pelvic floor and re-engage your abdominal muscles

• Identify mood issues and when to seek additional help for depression and/or anxiety

When to see a pelvic floor physical therapist 

Many common conditions can occur after pregnancy loss. Consider pelvic floor physical therapy if you have any of these treatable symptoms: 

• Back, hip, or pelvic pain  

• Pain in the front of your pelvis (over your pubic bone), such as when standing on one leg, putting on or taking off your pants, or getting in or out of bed 

• Leaking urine or bladder incontinence 

• Leaking feces or bowel incontinence (even staining your underwear) 

• Constipation or pain with voiding or bowel movements

• Pain during or after sexual activity

• Pelvic pressure or a feeling of bulging or heaviness in your vagina

• Diastasis recti (stretching of the abdominal muscles during pregnancy)

Getting back to exercise

In addition to doing exercises that target pelvic floor muscles, you may want to get back to activities like running, gym workouts, and sports. But you may find exercise challenging due to low energy or uncertainty about where to start. A pelvic floor physical therapist can help you develop a personalized exercise program to meet you where you are and teach you how to progress safely.

You can see a physical therapist in person or use a program like Hinge Health, where you may access a PT via telehealth/video visit. 

How Hinge Health can help you

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

1. Dugas, C., & Slane, V. H. (2019, May 11). Miscarriage. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532992/ 

2. Early Pregnancy Loss. (2018). Acog.org. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/11/early-pregnancy-loss 

3. Cohen, R. (2022, June). What Happens After a Miscarriage? An Ob-Gyn Discusses the Options. Www.acog.org. https://www.acog.org/womens-health/experts-and-stories/the-latest/what-happens-after-a-miscarriage-an-ob-gyn-discusses-the-options#:~:text=Physical%20recovery%20is%20usually%20quick :

4. Miscarriage - What happens. (2017, October 23). Nhs.uk. https://www.nhs.uk/conditions/miscarriage/what-happens/#:~:text=You%27ll%20experience%20symptoms%20similar 

5. Ectopic Pregnancy. (2022, July). Www.acog.org. https://www.acog.org/womens-health/faqs/ectopic-pregnancy#:~:text=The%20most%20common%20drug%20used 

6. The Ectopic Pregnancy Trust. (n.d.). The Ectopic Pregnancy Trust. Retrieved July 19, 2023, from https://ectopic.org.uk/ 

7. CDC. (2020a, June 15). What is Stillbirth? | CDC. Centers for Disease Control and Prevention. https://www.cdc.gov/ncbddd/stillbirth/facts.html#:~:text=A%20stillbirth%20is%20the%20death

8. Stillbirth. (2020, October). Www.marchofdimes.org. https://www.marchofdimes.org/find-support/topics/miscarriage-loss-grief/stillbirth 

9. Your body after stillbirth or neonatal death. (2021, May 31). Www.pregnancybirthbaby.org.au. https://www.pregnancybirthbaby.org.au/your-body-after-stillbirth-or-neonatal-death