You are having a miscarriage if you have already had a positive pregnancy test, then get these symptoms:
 | Strong cramps that make you double over
or breathe in a huffy way. Bleeding will usually follow quickly. |
| Heavy bleeding that soaks a pad in a few hours or less. |
| Passage of tissue, resembling large thick
blood clots in the earliest weeks up to pinkish/grayish material, with or without cramps or pain |
A little bit of bleeding without cramping should be okay, but call a doctor. Small darting cramps, even if they hurt, are also okay, usually they just signal the body stretching and pulling to accommodate the growing baby. Lie down and the cramps will usually go away within the hour.
These symptoms can be other things rather than a loss of pregnancy, however, if you are not sure you are pregnant. Check the "I'm not sure I was pregnant" section.
What should you do?
If it is during doctor's regular working hours, call your regular doctor first. They will give you instructions.
If it a night or weekend, first call your regular doctor's after-hours number. Usually this will be on their answering machine or with their answering service. The nurse or doctor on call who calls you back will help you decide if you need immediate attention or not. Don't feel like you are bothering them needlessly; this is a natural and expected part of any OB practice.
If you can't get through, don't have a doctor, and you are afraid, then go to an emergency room. Be prepared for some possibly insensitive treatment. While some hospitals are well equipped for handling this situation and do a good job, often you are left alone in a room for hours, or told to sit on a toilet and catch tissue, or just sent back home because "there is nothing they can do." It may be worth the trip, though, if they draw blood for an hCG test or give you a sonogram.
When I began bleeding heavily on an airplane on a Friday afternoon, I still waited until Monday to see my doctor. I did not want some total stranger telling me the baby had died, or to have a sonogram in an emergency room and be told to "call my doctor for the results." While I was sad about the possible loss of the pregnancy (turns out I lost one of a set of twins at 9 weeks), I was resolved to wait for a comforting, familiar doctor's office.
There is not really a risk to waiting until Monday or the next morning if you are in your first trimester. There is no magic way to stop an early miscarriage at the hospital. What is going to happen will happen. If you are farther along than 12 weeks, though, and you are merely in labor and not bleeding, then you should take quick action to see if labor can be stopped.
If you are passing tissue at home, and it is your first miscarriage, it is not necessary to catch the tissue and take it in. You may do this if you choose, however, and you can store it in a sealed plastic bag in the refrigerator until you get to a doctor. However, it is rare that tissue caught this way will be usable. Tissue from first miscarriages is rarely tested, since it is assumed your miscarriage was due to a genetic defect. The best way to ensure testable tissue is to have a D&C.