Miscarriage in France: What to Expect and Your Rights

Miscarriage is not talked about nearly enough. One in ten women will experience one, with an estimated 23 million happening globally every year, and 200,000 in France alone. Yet the information available in English about what actually happens when you have a miscarriage in France, the medical process, what to expect, your rights as an employee, is limited.

This post is my account of going through a miscarriage in France in February and March 2023. I am sharing it because I wish I had found something like this when I was going through it. I have also included a section on the new rights introduced in France in 2024 for women who experience miscarriage, rights that did not exist when I went through mine.

Key Facts About Miscarriage

• A miscarriage is the loss of a pregnancy before 22 weeks of aménorrhée. Before 13 weeks is a premature miscarriage (the most common). Between 13 and 22 weeks is a late miscarriage. After 22 weeks is classified as a stillbirth.
• Approximately 15% of known pregnancies end in miscarriage. This figure increases with age.
• 200,000 women in France experience a miscarriage each year.
• The most common cause is chromosomal abnormality in the embryo, typically a chance occurrence and not caused by anything the mother did or did not do.
• Spotting in the first trimester does not automatically indicate a miscarriage. Up to a quarter of women experience bleeding in the first 12 weeks of a viable pregnancy.

Important: If you experience any concerning symptoms during pregnancy, unusual bleeding, cramping, or a sudden decrease in pregnancy symptoms, contact your midwife or doctor immediately.

Signs and Symptoms

There is no single definitive sign of a miscarriage. In many cases, including mine, there are no symptoms at all, the absence of cardiac activity is found at an ultrasound. Other possible signs include:

• Spotting or bleeding; note the color, consistency, and volume. Wear a pad or liner to monitor this accurately.
• Cramping or pain in the lower abdomen or pelvic area
• Blood clots
• A sudden decrease or disappearance of pregnancy symptoms such as breast tenderness or morning sickness

My story: My spotting began after an ultrasound at 6 weeks. I monitored it every time I went to the bathroom. When it was consistent and not stopping after three days, I made an appointment with my midwife. She asked me to keep monitoring and scheduled a follow-up for the following week. I did not make it to that appointment. Five days later I began bleeding heavily, heavily enough to soak through a heavy pad in under 20 minutes.

How a Miscarriage Is Confirmed in France

Confirmation of a miscarriage in France is done by ultrasound. Your midwife or doctor will use the ultrasound to assess whether cardiac activity is present, whether the pregnancy has stopped, and whether any tissue remains in the uterus.

If the miscarriage is complete and no tissue remains, no further medical treatment is typically required. If tissue remains, your doctor will discuss the options below with you.

My story: My midwife found no cardiac activity at the ultrasound at 6 weeks. From there I was given a prescription for betaHCG blood tests every 48 hours and a follow-up appointment for the following week. My betaHCG was 2,856 UI/L on Tuesday 21 February and 2,673 UI/L on Thursday 23 February, the declining numbers confirmed the pregnancy was not progressing. Before I could make the follow-up appointment, I began bleeding heavily on Friday 25 February and went to the ER.

What Happens Next: Your Three Options

If tissue remains in the uterus, your doctor or midwife will present three options. The approach taken will depend on how far along the miscarriage is, your clinical situation, and your own preference.

Option 1: Natural passage

You wait for the remaining tissue to pass on its own. This can take a few days to up to two weeks. A follow-up appointment is scheduled to assess progress.

Contact your healthcare provider immediately if during this period you experience: heavy bleeding that soaks more than one pad per hour, a fever, or increasing abdominal pain.

My story: After going to the ER at Hôpital Hôtel-Dieu who redirected me to the OBGYN emergency department at Hôpital Cochin, the ER doctor confirmed the miscarriage was incomplete with tissue and the gestational sac still present. He sent me home to wait for the rest to pass and scheduled a follow-up for 10 days later. On Monday 27 February I passed what I believe was the gestational sac.

Option 2: Medical treatment

Medication is prescribed to cause the uterus to contract and expel the remaining tissue. After taking the medication you may experience:

• Abdominal cramping, similar to but more intense than menstrual cramps
• Bleeding
• Nausea and vomiting
• Diarrhea
• Fever or chills

If there is no change within 24 hours, or if cramping or bleeding continues beyond the expected timeframe, contact your healthcare provider.

My story: At the follow-up appointment on 3 March, the midwife at my doctor’s office found there was still some tissue remaining and prescribed medication to start contractions. I took it on Sunday 5 March. I felt nothing, no cramping, no side effects. I went back to the emergency department for an ultrasound. They still found tissue and referred me for a D&C.

Option 3: Surgical treatment — aspiration (D&C)

In France, a D&C, aspiration endo-utérine, is considered a last step if natural passage or medical treatment has not been successful. It is an outpatient procedure (en ambulatoire), taking place over a half-day in an operating room under local or general anesthesia, performed by a gynecological surgeon.

The procedure involves dilating the uterus and removing any remaining tissue. After the procedure you recover in a monitored room until you can stand safely and are cleared to go home with a designated person.

My story: After my return to Cochin on 15 March and the appointment with the anesthesiologist, I was booked for the D&C on 17 March. I was given detailed preparation instructions: a Betadine rouge moussante shower the night before and morning of, removal of nail polish and piercings, fasting from midnight, and an antigen test the day before. Check-in was at 10:30 AM. I was taken to a changing room, given a hospital gown, socks, and underwear, and then taken to a bed where the anesthetist came to introduce himself. He was kind and funny, we ended up talking about Lord of the Rings because of my tattoos. I was rolled into the operating room, met the team, felt something go into the port in my arm, and was asked to count backwards from 100. The next thing I knew I was waking up in recovery with a dry throat and no idea what time it was. A nurse checked on me several times. Eventually I was walked to the changing room and then to a waiting area with biscuits and tea until Thomas came to collect me.

My Miscarriage Timeline

For reference, here is the full timeline of my experience. I am sharing this because when I was going through it I kept wondering whether what I was experiencing was normal, and whether the process was taking as long as it should. I felt it was drawn out. I hope this gives someone else a point of reference.

• Friday 17 February 2023 — Ultrasound at 6–6.5 weeks. No cardiac activity detected.
• Monday 20 February 2023 — Appointment with midwife due to consistent spotting. Prescription for betaHCG every 48 hours.
• Tuesday 21 February 2023 — betaHCG 2,856 UI/L
• Thursday 23 February 2023 — betaHCG 2,673 UI/L
• Friday 25 February 2023 — Heavy bleeding. ER at Hôpital Hôtel-Dieu, redirected to Hôpital Cochin OBGYN.
• Monday 27 February 2023 — Passed what appeared to be the gestational sac.
• Friday 3 March 2023 — Follow-up with midwife. Ultrasound. Decision to proceed with medical treatment.
• Sunday 5 March 2023 — Took medication. No effects felt.
• Tuesday 14 March 2023 — Follow-up with midwife. Recommended return to Cochin for D&C assessment.
• Wednesday 15 March 2023 — Cochin ER. D&C scheduled.
• Friday 17 March 2023 — Outpatient D&C at Cochin.

Recovery

Once the miscarriage is complete,whether naturally, medically, or surgically, your body needs time to recover. Here is what to expect and what to do:

• Request an arrêt de travail if you need one. If your doctor does not offer one, ask. You are entitled to it.
• Avoid sexual activity for a minimum of two weeks to allow the uterus to heal.
• Do not use tampons for at least two weeks.
• Contact your healthcare provider immediately if you experience heavy vaginal bleeding, fever, chills, or persistent abdominal cramping.
• A follow-up appointment is not always automatically scheduled after a D&C, ask about this before you leave the hospital.

Be honest about how you are doing: The physical recovery is one thing. The emotional recovery is another and takes longer. Do not hesitate to tell your midwife or doctor if you are struggling. You are entitled to support.

Your Rights Under French Law: What Changed in 2024

The Loi n° 2023-567 du 7 juillet 2023 introduced significant new protections for women who experience a miscarriage in France. These came into effect on 1 January 2024. I did not benefit from them when I went through my miscarriage in 2023, but you may.

1. Arrêt de travail without a waiting period (délai de carence)

Before this law, a standard arrêt de travail for illness included a three-day délai de carence, a waiting period during which you received no daily indemnity payment. For miscarriage specifically, this meant women were often financially penalised for taking the time off they needed.

Since 1 January 2024, if you experience a miscarriage before the 22nd week of aménorrhée, your arrêt de travail is paid from the first day with no waiting period. This applies to salaried employees, independent professionals, and non-salaried agricultural workers. Your daily indemnities from the Assurance Maladie begin immediately.

How to access it: Your doctor must issue the arrêt de travail using the specific paper form designated for miscarriage-related leave (not a standard sick leave form). You then send this to your CPAM. Ask your doctor explicitly for this form.

2. Protection against dismissal

The law also introduced job protection for women who experience a late miscarriage. Your employer cannot terminate your contract during the ten weeks following a miscarriage that occurred between the 14th and 21st week of aménorrhée, unless they can prove serious misconduct (faute grave) or that maintaining your contract is impossible for reasons entirely unrelated to the miscarriage.

This protection did not previously exist. A woman experiencing a late miscarriage at 14 to 21 weeks had no automatic employment protection. The law changed that.

3. The parcours fausse couche — psychological support pathway

From 1 September 2024, each regional health agency (ARS) in France is required to offer a parcours fausse couche, a multidisciplinary support pathway combining medical professionals and psychologists, both hospital-based and independent. This pathway is available to the woman and, importantly, to her partner as well.

Consultations through this pathway are reimbursed by the Sécurité Sociale. If you are struggling after a miscarriage, ask your midwife or doctor about the parcours fausse couche in your region.

Important note: The parcours fausse couche is still relatively new and its implementation varies by region. If your healthcare provider is not aware of it, you can contact your ARS directly or check ameli.fr for current information in your area.

A Personal Note

Going through a miscarriage was a punch in the gut. When my midwife said there was no cardiac activity, I tried not to fall apart immediately, but all I wanted to do was cry. What I struggled with most was the feeling that the process was unnecessarily drawn out. From the first ER visit to the D&C was nearly a month. A lot of that time felt like waiting when waiting was the last thing I wanted to do.

I don’t say that to discourage anyone from seeking care in France. Hôpital Cochin was professional and kind throughout. The anaesthetist who talked about Lord of the Rings because of my tattoos made one of the hardest days of my life a little more bearable. But I think it is important to be honest about what the process actually felt like, not just what it looked like on paper.

If you are going through this right now ,I am so sorry. It is hard. You are allowed to feel however you feel about it. And you are allowed to ask for more support than you are being offered.