Natural Miscarriage After First-Trimester Pregnancy Loss

Expectant Management or Natural Miscarriage

Doctor explaining medical details about miscarriage to a couple

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It's often a shock to find out that you're having a miscarriage. What may come as a surprise is that, in addition to the heavy emotional toll, pregnancy loss also requires recovering physically.

This process can take a few weeks and sometimes medical intervention to complete. A "natural" miscarriage (or expectant miscarriage) is when you let nature take its course instead of having surgical or pharmaceutical interventions to fully resolve the miscarriage.

After a miscarriage diagnosis, you'll usually be presented with various management options. All of these treatments result in the removal of the fetal tissue (also called products of conception) from the uterus so that your body can heal and go back to its pre-pregnancy state. Whichever treatment is best for you will depend on a variety of factors, including how far along your pregnancy was, your medical history, if you are already bleeding and cramping, and personal preference.

Overview

Miscarriage is considered "complete" when all the fetal tissue has been expelled. It is "incomplete" if any products of conception remain in the uterus.

The telltale bleeding and cramping of miscarriage are the body's way of removing the nonviable pregnancy. In rare cases, this process can cause severe hemorrhaging, which can become a medical emergency requiring immediate intervention. However, usually, a miscarriage is not an urgent situation and you'll have treatment options.

Studies show that in women who miscarry before 13 weeks, there are multiple effective management options, include the following:

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

In some cases, medical circumstances (such as bleeding or infection) will dictate a particular miscarriage treatment. But most women diagnosed with first-trimester miscarriage can decide (under the guidance of their doctor) which treatment they would prefer. Some opt to avoid medical procedures, if possible, by choosing natural miscarriage.

Expectant Management

Some women prefer natural miscarriage for a variety of reasons. Their miscarriage may already be well underway, they may want to avoid surgery or medications, or they may prefer to miscarry in the privacy of their homes without the stress of checking into a hospital or having an invasive medical procedure.

Individuals may have strong preferences in this respect. Most physicians will respect a woman's wish to avoid a D&C or medication if expectant management is medically appropriate.

Usually, opting to go the "natural" route is safe and effective. In fact, studies suggest that most women who wait for a natural miscarriage will be able to do so without unexpected complications.

This assumes that a woman is comfortable waiting long enough to pass the fetal tissue. This process can take anywhere from a few days to three or four weeks. For women who don't want to wait so long, other treatment options, such as a D&C or medication, may be more appealing.

Possible Complications

Possible complications of natural miscarriage include a small risk 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 eventually needing or wanting a D&C if not all of the tissue from the pregnancy leaves the uterus in a reasonable amount of time. Retained fetal tissue can result in infection or other complications, which, if left untreated, can impact future fertility.

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 include 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), along with heavy bleeding and larger clots.

Diagnosis

What you can expect will depend on when you are diagnosed with your miscarriage. Natural miscarriages often follow highly variable timelines, meaning you won't know how long yours will take to fully resolve.

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—and may be mostly over before it's officially diagnosed.

In contrast, in "missed" miscarriages, a woman usually 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 noticeable miscarriage symptoms, including vaginal bleeding.

In missed miscarriage, the eventual bleeding and cramping may take from hours to weeks to begin—and the wait may be hard to take emotionally.

Intensity of Bleeding

The duration and intensity of miscarriage bleeding also will vary significantly among women. 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 and/or more days of very heavy bleeding 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 two 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. Now, physicians often advise waiting just a few weeks to a month before trying again to get pregnant. This delay is recommended to reduce a woman's risk of infection and give the body a chance to fully recover.

That being said, there is no scientific evidence that putting off conceiving after an early pregnancy loss is necessary to prevent another pregnancy loss or complications during pregnancy. In fact, research shows that in the weeks and months right after a complete miscarriage (in which no tissue remains in the uterus), a woman's chances are optimal for conceiving again—often higher than waiting a few months more.

A Word From Verywell

No matter whether your miscarriage treatment involves natural, medical, or surgical management, each approach results in the complete removal of pregnancy tissue. All three options have a very low risk of serious complications, so you can likely choose whichever option feels most comfortable to you. That being said, discuss your options and risks carefully with your partner and doctor—and be sure to tend to your emotional healing, as well.

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  2. Meaney S, Corcoran P, Spillane N, O'Donoghue K. Experience of miscarriage: an interpretative phenomenological analysisBMJ Open. 2017;7(3):e011382. doi:10.1136/bmjopen-2016-011382

  3. 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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