A miscarriage is a tragic and heartbreaking event. During this time, many couples are in a state of shock and disbelief. Your healthcare provider will perhaps be asking questions regarding how you would like to proceed with the treatment of your miscarriage. While many times they are explaining to you the options available, it will be difficult to concentrate and resolve any questions you may have. We hope that this section, while uncomfortable for some to read, will help to provide some clarity to the choices you have regarding your loss.

Once you begin to miscarry, there is no treatment that can prevent the loss of your baby. In the beginning of your miscarriage you might have light bleeding and cramping for up to several weeks. You will need to speak with your healthcare provider regarding your feelings of such a prolonged occurrence. Many do not feel they can tolerate the emotional anguish, or are experiencing too much physical pain; others want the process to be natural and as free from medical intervention as possible. As long as you are not risking infection or other complications the choice is yours with the support of your partner.

When deciding on a treatment plan, it may help to work through several considerations. One of the most important is how long you have known about the loss of your baby and the emotional toll it has already taken on you. How far along in the pregnancy and the amount of bleeding which may have already occurred will influence your healthcare provider’s recommendations for treatment. The consideration of tissue sampling for possible information about the miscarriage or future pregnancies may also influence how you choose to proceed with your miscarriage.  For all practical purposes, while you wish the world could quit spinning if only for a moment, life around you does continue and obligations concerning family and home life or the necessity to maintain your job and manage the duties which come with it will factor into the amount of time you are able to take off for your miscarriage. Overall, the strong emotional feelings over the loss of your baby will probably be the ultimate guide of your choice.

The treatments we will discuss have their own list of pros and cons. As long as you remain healthy and stable, there is no right or wrong choice- as long is it is the right choice for you.

There are two common approaches to physically treating miscarriage. You need to discuss the pros and cons with your healthcare provider and make a decision that you are most comfortable with. You are the only one who knows how to best cope with the tragedy during this time.

Your healthcare provider should discuss with you what would be considered a natural miscarriage. It is simply a “wait and see” approach which would involve the passing of your baby and placenta vaginally. This is only practical in the early stages of miscarriage. There are medications which your healthcare provider may recommend to progress more quickly through this process, but can carry the side effects of nausea, vomiting, and diarrhea. Again, this should be considered a personal choice.   

Often a miscarriage occurs fairly quickly, usually over the course of hours or days, but can last up to a few weeks. While all miscarriages are different there are some similarities among them. As discussed previously, bleeding is usually the first sign. In most cases the bleeding will begin to increase in volume, change to a dark pink, red, or dark red, and become thicker. Cramping may increase in intensity and frequency, and at times can be painful. Some women find relief in lying down or sitting, while others feel a need to stand up or walk around. A heating pad on your abdomen may also be helpful. You will begin to pass clots through your vagina which may become quite large. The color may vary. Usually your cramps will intensify when you are passing a clot. It has been recommended that you save whatever clots you pass as your healthcare provider might want to evaluate it or send it to a lab for testing to attempt determination of the cause of miscarriage. Again, whether or not to save the clots is your decision. While this may be helpful, it may also be too distressing.

The bleeding and cramping should begin to slow, and eventually stop. You will still need to be evaluated to ensure that your uterus is completely empty and your miscarriage is complete. In some situations, natural miscarriage simply cannot be considered. You need to seek immediate medical attention if you are bleeding enough to soak through a pad in an hour or less. This rapid blood loss is an emergency. Running a fever of over 100 F could indicate an infection. This is also a life-threatening situation and seeking medical attention is necessary. For many, miscarriage is physically uncomfortable and at times even painful. Severe pain, however, could suggest significant complications. If chosen, a natural miscarriage is often possible.  However, there are times when the uterus does not completely empty.  There are also times when bleeding is so prolonged that the risk of infection is too great.  In cases such as these, it is important to seek medical intervention in the miscarriage process.  

A dilation and curettage (D&C) or dilation and evacuation (D&E) is another treatment of miscarriage. It may be necessary when natural miscarriage is not possible or may simply be your personal choice. Many women find it too emotionally trying or are simply too frightened to manage the physical endurances of a natural miscarriage. The option of D&C or D&E allows for blood and tissue to be removed completely from your uterus with minor surgery. In most cases, for either procedure, general anesthesia is used along with a local anesthetic to numb the cervix. A speculum is inserted into the vagina and a clamp-like instrument is used to hold the cervix in place. A series of tapered rods of increasing widths are used to gradually open the cervix. If a D&C is performed, the ob/gyn will insert a specialized scalpel (called a curette) to scrap the tissue and blood from the uterus. If a D&E is performed, a tube is passed through the cervix and suction is used instead of a curette. The procedure usually takes anywhere from five to twenty minutes. You should discuss the possibility of embryo tissue sampling with your healthcare provider if you desire for testing to be performed. In the absence of any complications, there is usually no need to stay overnight in the hospital. In the days following the procedure you will continue to experience some light bleeding and mild cramping. Pads rather than tampons should be used and intercourse must be avoided as your cervix has not closed yet and anything inserted into the vagina may allow bacteria into your uterus and cause an infection. Ibuprofen of naproxen may be taken to relieve cramps, or your healthcare provider may prescribe another type of pain reliever. You will want to rest for a few days. 

It is important that any concerns you have after you are back home should be discussed with your healthcare provider. You should seek emergency services with any heavy bleeding, fever, foul-smelling vaginal discharge, dizziness, or severe pain.