After a second trimester loss (late miscarriage)

A second trimester loss (also called a late miscarriage) is one that happens after 13 weeks and before 24 weeks of pregnancy.

This can be confusing as the second trimester actually ends at 28 weeks. But if your baby dies during pregnancy or birth after 24 weeks of pregnancy, it is called a stillbirth. If your baby is born alive at any time, and then dies, this is called a neonatal death.

If you have had a second trimester loss (also called a late miscarriage), doctors may need to help you to give birth to your baby and the placenta (sometimes called managing your loss). The way they help you do this is often different to how earlier losses are managed. 

This page explains more about what might happen during and after this time. If you delivered your baby unexpectedly, for example at home, you may want to skip the section on delivering your baby.

You may feel the word ‘miscarriage’ doesn't properly describe your loss. You may find some of our information on stillbirth feels more appropriate.

We know that many people search for ‘late miscarriage’ to find out more information about what is happening to them. We also know many other people find this description upsetting and prefer to use 'second-trimester loss or mid-trimester loss'. 

We have used the phrase ‘second trimester loss’ as well as ‘late miscarriage’ in this information. If neither of these phrases feel right to you, we are very sorry. We hope you still find the information helpful.

On this page

Delivering your baby

Seeing and holding your baby after a second trimester loss 

What happens to my baby after a second trimester loss?

Changes to your body after a second trimester loss

Support for you

 

Delivering your baby

If your baby has died but you have not given birth, you may be able to wait until you go into labour naturally (at which point you should return to hospital) or doctors may need to help you.

Having to go into labour and give birth after your baby has died can come as a real shock. A lot of women and birthing people assume that they will be given a caesarean. You may be worried about how you will cope emotionally as well as physically. There will be a nurse or midwife with you, who can support you and answer any questions. A partner, friend or family member can stay with you throughout.

In most cases, doctors will advise that your labour is induced (bought on by medication). You will have to go into hospital to have an induction, where you should be given your own room.  

Induction is usually a 2-stage process. First you will be a given a medicine called mifepristone. This is a tablet that you swallow. This medicine might be given as an oral tablet or a vaginal pessary. After taking this, you may be able to go home and return 36-48 hours later to start the labour. 

When you return, you will be given prostaglandin tablets every few hours until you have regular contractions, and your baby is born.  

It may take several hours for the medicine to work, and the labour is likely to be painful. You will experience contractions, which often feel like strong cramping pain. You will be offered pain relief to help with this.  

Everyone responds differently to induction. For some the labour and birth happens quickly, for others it can take several more hours.  

If your waters have broken and the team caring for you need to encourage contractions, you may be given a drug called oxytocin. Oxytocin can also be used to make contractions regular and stronger.

 

 

Seeing and holding your baby after a second trimester loss

 

There is no right or wrong thing to do once your baby is born. It depends on how you and your partner (if you have one) feel. Take some time to think about it beforehand if you can.

If you know in advance, let hospital staff know if you want to see your baby and hold them after they are born. Depending on how far along in your pregnancy were and how delicate your baby's body is, you may be able to cuddle and dress them too.

You might be unsure about what your baby will look like. You could ask the midwife or doctor to describe your baby to you. This could help you decide whether you want to see and hold them. You could ask hospital staff to take a photo of your baby for you to look at later in privacy. 3

If you prefer not to see the baby at all after the birth, staff at the hospital may be able to take photos for you and keep them for you for later in case you change your mind.

It may not be possible to tell the sex of your baby. This is something you can talk about with the team caring for you. Some people prefer to think of their baby as one sex or the other anyway. There’s no right or wrong way to approach this.

It’s worth thinking about the future as well as right now. Parents have said that even though they were reluctant at first, they valued time spent with their baby to build memories and feel that their baby had a presence in the world.  

Do what feels right for you and spend time with your baby if you want to - hospital staff will support your choices.  You may also like to invite other family members to spend time with your baby.

Hospital staff may also be able to do things like:

• help you create hand and footprints if this is possible
• dress your baby in clothes you have chosen or help you to dress them  
• take photographs of you as a family
• give you copy of a scan image if you don’t already have it
• give you a cord clamp or hospital identity band
• save a lock of hair if the baby has hair
• record the birth in a hospital remembrance book if there is one available.

 

“When we were asked if I wanted to see our baby, Arthur, our feelings were all over the place. Did we want to see him? Would he look ok? We decided to see him and he was bought to us on the ward. The hospital took pictures of him, which are good, but I do wish I had taken my own. I think I felt a bit self-conscious about it. Was this a normal thing to do? Looking back, there is nothing more normal than taking a picture of your own child.  

We made the decision to make our own funeral arrangements as I wanted to keep Arthur’s ashes. We did have a little funeral for him. This was very small and private between me and my husband.  

My advice, and one is wished I had done, is even if you think you are handling everything ok, go find a group or someone to talk through. As looking back I really could have done with the additional support to help process my feelings. As even though I thought I was fine, I was actually in a pretty bad place.”

Jennifer

 

What happens to my baby after a second trimester loss?

If your baby dies during pregnancy before 24 weeks, the decision about what happens is a very personal one. There is no legal requirement to have a burial or cremation.  If your baby was born before 24 weeks but died after birth this is called a neonatal death.  We have more support and information about neonatal death here.

 

Burials, cremations or funerals

Some hospitals offer burials or cremations for babies who die after 12 weeks. Sometimes a number of babies are buried or cremated together. You may have to sign a paper to authorise this.

Your nurse, midwife or hospital chaplain can tell you about the arrangements at your hospital. If you opt for hospital cremation the hospital should provide you with written information about the options, including information about the recovery of ashes. You should also be offered contact with the spiritual care/chaplaincy team if this would be of comfort to you.

You may want to make your own arrangements. Some people choose to use a funeral director or specialist cremation service. Others or choose to bury the remains or scatter the ashes somewhere meaningful.

You might not be ready to decide right now. There’s no rush and those caring for you with gently help you make decisions at a pace that feels right for you. They should also give you a person to contact in case you change your mind and let you know how long you have to make any changes.

A certificate for your baby

There are no legally required birth or death certificates for babies born before 24 weeks of pregnancy who do not have any sign of life at birth. This can be really upsetting, as it may feel as if your baby's short life has not been recognised. You do have some other options for recognition and remembrance. 

In Scotland you can apply to record your loss in a Memorial Book and receive a certificate of loss.

In England you can apply for a baby loss certificate.

Some hospitals in England, Wales and Northern Ireland also offer a memorial book. 

Read more about remembering your baby here.

Tests after a second trimester loss 

After a second trimester loss, most hospitals will offer to carry out some tests to try and find a reason for your loss. You may also be offered a post-mortem. Tests, investigations and post-mortems are only done if you give your consent (if you say it is ok for them to do it).

You may have lots of questions about how and where the post-mortem is performed, and what the results might tell you. Talk to the midwife and doctor caring for you about your concerns and questions. You will have care from a clinician who will talk you gently through all the sensitive details. Your baby will be treated with respect and dignity at all times.

It may be several weeks or months before the results of your baby’s post-mortem are ready.  You will be invited to a follow-up appointment to talk about the results.  A post-mortem often does not give a reason for a miscarriage, so you may not find out why your baby died. But it may help rule out some possibilities and perhaps reassure you if you want to try to get pregnant again in the future.

 

Changes to your body after a second trimester loss

Your body will need to recover after the birth. This can be very difficult to deal with. It may feel very unfair to have to go through this on top of your feelings of grief and loss. It’s important to take things gently and ask for support to get you through.

Your experience will depend on how far along your pregnancy was.  

You may find it helpful to have a look at our information on changes to your body after a stillbirth. You may experience similar things.

Your breasts and breastmilk

Your breasts may produce milk and this can feel like a distressing reminder of what could have been. Breast engorgement, sometimes referred to as milk ‘coming in’, happens when your breasts fill with milk in the first few days after the birth. It can make your breasts feel very large, tight, painful and tender (engorged).

Suppressing breastmilk without medication

It is possible to reduce the symptoms of engorgement and gradually reduce the amount of milk you produce. You could try:

• applying ice packs (or a bag of frozen peas) covered in a light cloth to your breasts  
• wearing a well-fitting bra
• using pain relief such as ibuprofen or paracetamol
• expressing small amounts by hand, just enough to ease the pain, otherwise you will encourage the production of more milk
• trying warm showers, which may encourage the breasts to leak naturally.

You may find it helpful to wear breast pads for the first few days if you find you’re leaking milk.

Using medication to suppress milk

You may be able to get medication to suppress breastmilk instead of waiting for it to slow down and stop naturally.  You can’t take this medication if you had pre-eclampsia or high blood pressure. Talk to your doctor if you would like further information.  

Donating breast milk

Some women and birthing people may choose to donate their milk to a milk bank. The Human Milk Foundation has further information here on donating breast milk after loss.

 

After-pains/stomach cramps

It’s common to have after-pains as your womb contracts back to its normal size and usual location (down inside your pelvis). They can feel like labour contractions, cramps or strong period pains. Painkillers can help with this.

 

Bleeding (lochia)

You will bleed from the vagina as your body loses the lining of your womb and blood from where the placenta was attached.  

It is likely to be heavy for around 2 weeks and then lighter until around 6 weeks afterwards. At the start, it may have some lumps or small clots in it. It changes colour from red, to pink, to brown. The flow can increase and decrease, so you may have heavier and lighter days.

To start with you will need very absorbent sanitary pads or period pants. It’s best not to use tampons or period cups because they can cause infection.  

If you’re filling a large sanitary pad in 1 to 2 hours or if you are passing blood clots larger than a £2 coin, please contact your midwife, hospital or the named contact that you were given.

 

Getting a period after a late miscarriage (second trimester loss)

It is hard to say when your first normal period will happen. It’s likely it will be about 4 to 6 weeks after giving birth. It can be difficult to tell whether it is the post-birth lochia, or your first period.

Sometimes your first period isn’t like your normal period. It might be heavier or lighter. You may get more severe PMT or find it difficult to cope with emotionally. This is totally understandable. Be gentle with yourself.

 

Support for you

It’s likely to take you some time to recover, physically and emotionally after a second trimester loss. You and your partner (if you have one) may be feeling grief, shock and sadness, possibly for a long time afterwards. Most people will need some time off work. Have a look at our information on rights at work after a miscarriage.

Depression and anxiety following loss is not unusual. If you’re struggling to cope, talk to your GP, who can help you get more support.

Your hospital may be able to offer a specialist midwife or counsellor who can provide support from diagnosis of the miscarriage until well into the postnatal period. They may also be able to offer support in a next pregnancy or signpost you to more specialist support if you choose to try again.

You can find more information here about organisations who can offer further support after the loss of a baby.

You can also talk to a Tommy’s midwife for free. You can call them on 0800 0147 800, 9am-5pm, Monday-Friday. Or you can email them at [email protected].  Our midwives are specialists who can support you with any aspect of pregnancy loss that would be helpful for you.