Natural Miscarriage: Choosing to Wait It Out

A Closer Look at "Expectant Management" or "Natural Miscarriage"

Doctor explaining medical details to a couple
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After a miscarriage diagnosis, most women face one of three decisions regarding miscarriage management:

  • waiting for nature to take its course and the miscarriage to happen on its own
  • taking medication to expedite the miscarriage
  • having a surgery called a D&C (dilatation and curettage)

In some cases, medical circumstances (such as bleeding or infection) will dictate a particular miscarriage treatment. But women diagnosed with first-trimester miscarriage not involving an emergency often can decide which option they would prefer under the guidance of her doctor.

Waiting for a miscarriage without intervention is an approach that doctors call "expectant management" and many women call a "natural miscarriage."

Why Expectant Management May Be A Reasonable Choice

Some women prefer natural miscarriage because they want to avoid medical intervention and prefer to miscarry in the privacy of their homes without the ordeal of checking into a hospital or having an invasive medical procedure like a D&C. Individuals may have extremely strong preferences in this respect, and most physicians will respect a woman's wish to avoid a D&C.

For most women, choosing to avoid a D&C is probably safe as well. In fact, studies suggest that 80 percent of women who wait for a natural miscarriage will be able to do so without unexpected complications. This assumes that a woman is able to wait enough time to pass the fetal tissue (up to 8 weeks). 

Of course, a minor risk exists of hemorrhage and/or infection, but the risk is similar to a D&C.

It is important to note that some women who choose natural miscarriage may end up needing or wanting a D&C later if the tissue from the pregnancy does not leave the uterus in a reasonable amount of time.

What To Expect During a Natural Miscarriage

For women who choose a natural miscarriage, what to expect physically depends on the specifics of the situation.

In a very early miscarriage, the miscarriage will look and feel physically like a heavy, cramping menstrual period, possibly with more clots than usual and a slightly longer bleeding time.

In a later first-trimester miscarriage, the cramps could be anywhere from mild to severe and the woman might pass recognizable tissue, such as a gestational sac or partially developed embryo or fetus (the term for the developing baby).

Natural miscarriages may have an uncertain timeline. In "missed" miscarriages, a woman could have no miscarriage symptoms and no signs of vaginal bleeding, but an ultrasound reveals a baby with no heartbeat or without the expected development. In these cases, the miscarriage bleeding could take anything from hours to weeks to begin—and the wait may be hard to take emotionally.

In contrast, if a miscarriage is already in progress when diagnosed, such as if a woman sees her physician to investigate heavy first-trimester vaginal bleeding, the entire physical process of the miscarriage could be completed in days.

Besides the timeline, different women have different experiences with the duration of bleeding. In most cases, the bleeding from a natural miscarriage should stop entirely within two weeks and should be heavy only for a few days.

Longer bleeding times could be a sign that some of the pregnancy tissue is still in the uterus, so this should definitely be reported to a physician. Significant bleeding, like soaking 2 sanitary pads every hour for two consecutive hours, is also a sign to call your doctor. 

The severity of cramping also varies among women. Some women may have mild or nonexistent cramping whereas others have extremely painful cramps associated with the miscarriage (a physician can recommend pain medication in these cases).

Conceiving After a Natural Miscarriage

Physicians often advise waiting a period of one to two weeks before  trying again to get pregnant after a miscarriage is complete.

This is recommended to reduce a woman's risk of infection. That being said, there is no scientific evidence to support putting off conceiving after an early pregnancy loss to prevent another pregnancy loss or complications during pregnancy. 

A Word From Verywell

The bottom line is that in first-trimester miscarriages without a medical emergency, choosing a natural, medical, or surgical means of managing your miscarriage is reasonable, as any one of the three should result in complete removal of pregnancy tissue. All three also rarely cause serious complications.

That being said, be sure to discuss the decision carefully with your partner and doctor, so you feel comfortable. 

Sources:

American College of Obstetricians and Gynecologists. (May 2015). Practice Bulletin: Early Pregnancy Loss

American Pregnancy Association. (August 2016). Miscarriage

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