WARNING – GRAPHIC CONTENT – Miscarriage Options

I am having a miscarriage, what are my options? Which one should I choose?

This is one of the most common questions when someone is experiencing a miscarriage. I know that when I experienced my miscarriage, it was the first question that came to mind after the initial shock. I remember explicitly choosing to deliver naturally but as the night progressed, I became anxious about sleeping with a dead baby inside me and I just couldn’t go on. It was such a horrible feeling.

I was denied medications to help my anxiety so I began researching my options to keep my mind focused on something else. I didn’t sleep much that night. Just hours before  the doctor said those dreaded words…”I’m sorry, there is no longer a heartbeat.” I found there were three options for miscarriage.

#1 – Deliver naturally at home (expectant management).

#2 – Use medications to induce miscarriage/labor (medical management).

#3 – Dilation & Curettage, commonly known as D&C (surgical procedure).

As I researched each one, I began to weigh the risks and the benefits. I was already in such an intense emotional pain and I just wanted to be numb. I didn’t want to hurt anymore physically or emotionally.

Delivering naturally at home (expectant management of miscarriage) was my first option. The risks were hemorrhaging (excessive bleeding), incomplete miscarriage (not all of the baby and placenta expelled), and infection. Both could lead to the need for an unplanned D&C (surgical treatment) so I would need to monitor my bleeding and monitor myself for infection over the following weeks. There was also the issue of pain, which is often described as having a heavy period but after experiencing the miscarriage (prior to my D&C), I will tell you mine was nothing like having a heavy period.

My issue with this option was the time it would take. There is no research that tells you when the miscarriage will start and how long it will take to complete. This study shows you that this is one of the least effective miscarriage option. I read stories of miscarriage starting immediately and some taking months to start. I had suffered with the anxiety that this baby was going to die for two months and I was done waiting. As much as I wanted to deliver naturally at home, I couldn’t bear the thought of living with a dead baby inside me any longer. I couldn’t wait days or weeks. I was struggling by the minute.

Using a medication to induce the miscarriage (medical management) seemed like the next viable option. As I began to research the medication used and what the experience would be like, I quickly realized this choice wasn’t for me. Many women had used this option and were grateful but I read story after story of women suffering through intense cramping and pain. There is also this study that showed women would not choose this method again if they had another miscarriage. I felt like it would be adding insult to injury.

Let’s talk really quick about the medication. The medication commonly used to induce miscarriage is Cytotec, also known as misoprostal. I had knowledge of this medication from my days as a doula but only in the context of using it to induce labor in pregnant women. The studies showed it could be dangerous when used to induce at full-term but the risks were smaller when used for miscarriage. The benefit was the timing of the miscarriage.

I could take the medication when I was ready to say goodbye and I should miscarry within a day or so. Sometimes miscarriages start hours after the first dose. The medication can be taken sublingually, orally or vaginally with sublingual being the most effective method. There are side effects from the medication though, such as pain, nausea, vomiting and diarrhea. These side effects seemed minimal, well, except pain. The risks are relatively the same as with a natural miscarriage: hemorrhaging, incomplete miscarriage, and infection. Again, these could lead to needing a D&C anyway. There are differing statistics on how effective this method is, with numbers ranging from 70%-90% but this study shows it is not as effective as surgical treatment (D&C).

A D&C for miscarriage (short for dilation and curettage,) is an outpatient surgical procedure. This is sometimes performed in your doctor’s office but is most commonly performed in a hospital or a same-day surgery center. Be sure that your doctor checks and double checks that the baby has passed BEFORE choosing this option. Every baby’s heartbeat starts at a different time. It is advisable to wait at least 1 week between ultrasounds to confirm the baby does not have a heartbeat otherwise, you may be aborting a viable fetus.

Most often you will be given a sedative and then general anesthesia is used but in your doctors office, you would not receive general anesthesia. You will also likely be given an antibiotic to prevent infection.

Your legs are placed in stirrups on the operating table which can be awkward because the you place them there while you are awake (at least that’s what they had me do). The surgeon places a speculum in your vagina and begins to artificially dilate the cervix with instruments. They dilate the cervix just enough so that the vacuum can be inserted. The vacuum is also called “suction curettage” and scrapes the lining of the uterus and sucks out tissue.

The procedure usually takes anywhere from 15 to 30 minutes. It is rare that this procedure requires an overnight stay. This procedure differs from a D&E (dilation and evacuation) which is generally performed for miscarriages over 12 weeks gestation. The difference in procedures is that the surgeon uses a grasping instrument (forceps) to remove the baby (sometimes in parts) and then uses a vacuum to suction and scrape the remaining tissue in the uterus.

There are risks associated with the D&C:

  • Adverse reaction to anesthesia medication
  • Hemorrhage or heavy bleeding
  • Infection in the uterus or other pelvic organs
  • Perforation or puncture to the uterus
  • Laceration or weakening of the cervix
  • Scarring of the uterus or cervix (Asherman’s Syndrome and can lead to infertility)
  • Incomplete procedure which requires another procedure to be performed

Read here to learn your options for a D&C and how to preserve your fertility.

There are benefits of a D&C:

  • It can be scheduled
  • Can provide enough tissue for testing (if you choose this)
  • May bring closure or relief if you have been waiting for the inevitable miscarriage

Here is one randomized controlled trial that compares all three miscarriage options.

Click here to read your options on burial of your baby after miscarriage. If you want your baby intact, delivering at home with or without medication is the only way to ensure your baby is intact. Seeing your very early baby may be traumatizing. Always be sure you have someone with you while you are miscarrying. A Stillbirthday Bereavement Doula can be there for you.

These options are for confirmed miscarriage (baby no longer has a heartbeat or growth) and blighted ovum. These options are not for treating an ectopic pregnancy. Please consult your care provider if you believe you are experiencing a miscarriage. This information should not be substituted for medical advice.

– Breaking the silence of First Trimester Miscarriage

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