Natural Miscarriage After First-Trimester Loss

Expectant Management or Natural Miscarriage

Doctor explaining medical details about miscarriage to a couple
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Finding out that you are having a miscarriage means coping with the loss of your pregnancy—and also requires recovering physically. After your diagnosis, you'll need to get treatment for the miscarriage, which entails removing the fetal tissue (also called products of conception) from the uterus so that your body heal and go back to its pregnancy state. Sometimes, this process is a medical emergency requiring immediate intervention, but most often, you'll have treatment options.

Overview

The three main ways miscarriage can be treated include the following:

  • Having a surgery called a D&C (dilatation and curettage)
  • Taking medication to make the bleeding of miscarriage happen faster
  • Waiting for the miscarriage to happen on its own

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 their doctor. Many opt to avoid medical procedures if possible. Waiting for a miscarriage without intervention is an approach that doctors call "expectant management" (also called "natural miscarriage").

Expectant Management

Some women prefer natural miscarriage because they want to avoid surgery or medications, and/or 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. Some individuals may have strong preferences in this respect, and most physicians will respect a woman's wish to avoid a D&C if another option is medically-appropriate.

For most women, opting to go the "natural" route instead of having a D&C is probably safe. In fact, studies suggest that 80% 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. This process can take up to eight weeks. For women who don't want to wait so long for their miscarriage to resolve, other treatment options, such as a D&C or medication, may be more appealing.

Possible Complications

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

For women who choose a natural miscarriage, what to expect physically depends on the specifics of the situation. Key factors that impact the experience including the following:

Timing

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).

Diagnosis

Natural miscarriages may have an uncertain timeline. In "missed" miscarriages, a woman doesn't realize anything is wrong with their pregnancy but an ultrasound reveals a baby with no heartbeat or without the expected development. In these cases, there may be no miscarriage symptoms and no noticeable signs of vaginal bleeding and the miscarriage bleeding may 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 visits their physician to investigate heavy first-trimester vaginal bleeding, the entire physical process of the miscarriage could be completed in days.

Intensity of Bleeding

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 2 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.

When to Call the Doctor

Significant bleeding, like soaking 2 sanitary pads every hour for two consecutive hours, is also a sign to call your doctor. 

Cramping

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 Again

In the past, many women were encouraged to wait at least three months after a miscarriage to conceive again. However, now physicians often advise waiting for just a minimum of one to two weeks before trying again to get pregnant after a miscarriage is complete. This delay 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. In fact, research shows that in the weeks and months right after a miscarriage is completely resolved (as in no tissue remains in the uterus), a woman's chances are optimal for conceiving again—even better than waiting a few months more.

A Word From Verywell

No matter whether your miscarriage treatment involves natural, medical, or surgical management, each approach will result in complete removal of pregnancy tissue. All three also rarely cause serious complications, so you can likely choose whichever option feels most comfortable to you. That being said, discuss your options carefully with your partner and doctor. Also, as miscarriage tends to be a heartbreaking experience, be sure to care for your emotional healing as well.

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  1. Schliep KC, Mitchell EM, Mumford SL, et al. Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait. Obstet Gynecol. 2016;127(2):204-212. doi:10.1097/AOG.0000000000001159

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