Miscarriage – natural management
Read our guide below about the natural management of a miscarriage for women under 13 weeks of pregnancy.
You can also download a PDF version of this patient information by following the link on the right.
We’re very sorry that you or someone close to you has had a miscarriage. This guide will help you choose what treatment to have. Unless you need emergency treatment, you don’tt need to decide straightaway. We’ll give you time to decide what management is the best way forward for you.
What this guide includes
It will help you explain what is going to happen next and how to manage the miscarriage naturally.
Research comparing the management of miscarriage by surgical intervention, medication or natural miscarriage found that:
- the risks of infection or other harm are very small with all three methods
- your chances of having a healthy pregnancy next time are equally good whichever method you choose
- women cope better when given clear information, good support and a choice of management methods.
What is natural management of miscarriage?
It allows your body to go through the process of miscarrying the pregnancy naturally. This means you’re likely to:
- have some heavy vaginal bleeding
- pass clots and possibly tissue
- experience cramping abdominal pain.
How successful is this method of management?
It depends on the type of miscarriage. The success rate is better if the miscarriage is ‘incomplete’ (when you have passed some pregnancy tissue already). This is compared to a ‘missed miscarriage’ (the pregnancy sac is still present and you have had minimal or no bleeding).
What are the benefits?
Some women prefer to allow nature to take its course and there’s no need to be in hospital.
You may feel more in control of the process because you’re aware of the miscarriage happening.
You may avoid an operation and a general anaesthetic, and prefer to be fully aware of what’s happening (to see the pregnancy tissue and maybe the baby).
How you may feel
You may find it difficult not knowing when the miscarriage will happen.
You may feel anxious about how you’ll cope with the pain and bleeding, especially as you will not be in hospital. You may also find the process painful and frightening, although good information about what to expect can help.
You may be frightened about seeing the pregnancy tissue.
Bleeding can continue for up to 3 weeks and you may need a follow-up scan, although this is usually not needed.
You may be too upset to wait for the natural process to start.
If not all the tissue is passed you may need an operation anyway.
What happens?
It may take days or weeks before the miscarriage begins. It’s normal for the bleeding to continue for 3 or up to 6 weeks. The amount of time varies from woman to woman.
What can you expect?
You can lead life as ‘normal’, but we recommend that you’re prepared for the miscarriage process.
Bleeding
It’s difficult to predict when the bleeding might start, or become heavier so it’s better to be prepared. The amount of bleeding can vary and it may catch you by surprise. It’s likely to be more than with a normal period and you’re likely to pass clots. These can be as big as the palm of your hand. You may see the pregnancy sac, which might look different from what you expected.
Generally, if you soak more than one sanitary towel per hour for more than 4 hours, you’re losing too much blood.
We understand that bleeding at home can be very frightening. Call us if you are unsure what to do (see phone numbers below).
After you’ve miscarried (passed clots of blood or tissue) the bleeding should ease and become lighter. Sometimes not all will be passed and you may see some further clots. The bleeding should then become lighter and the cramping should ease.
It’s usual to bleed for 10 to 14 days after the miscarriage. This bleeding should be noticeably lighter, more like a period.
Your first period after the miscarriage may be heavier than usual.
Pain
Most women have period-like cramps that can be very painful, especially when the pregnancy tissue is being expelled. This is because the uterus tightly squeezes to push its contents out like it does in labour.
You’ll need pain relief such as Paracetamol and Ibuprofen. Sometimes using hot water bottles (not too hot) on the tummy can help ease the pain.
If you’re still having pain, contact the Early Pregnancy Unit (see phone numbers below).
Hygiene
Your cervix is slightly opened to allow blood to drain. We want to avoid the risk of infection getting in.
Therefore, we advise you NOT to wear tampons or to have sexual intercourse whilst you’re bleeding. Do not go swimming or to take long soaks in the bath as these may increase the risk of infection.
It’s safe for you to take showers and short baths in warm but not hot water.
Once you’ve stopped bleeding you can continue living as normal.
Work
Going back to work is an individual decision. It depends on how heavy your bleeding is and how you feel generally. The loss of a pregnancy can be a very distressing event in a woman’s life. You may decide you need to take some time off while the miscarriage happens.
Some women need more time off than others. You can self-certify for the first week off work. After that you’ll need to see your GP for a fitness for work certificate. Women and their partners also need support from family or friends at this difficult time.
What are the risks?
The main risks are infection (about 1 to 4 women in every 100) and haemorrhage (heavy bleeding) (about 2 in 100).
Signs that you may have an infection include:
- fever or shivering
- foul smelling vaginal discharge
- tummy pain or tenderness that continues after you’ve taken pain relief.
Expectant management (natural management) is effective in 50 to 60% of cases. If it isn’t, or you have an infection, we may advise you to have an operation or pessaries to complete the miscarriage.
After the miscarriage
In hospital
In our hospital, when a baby dies, in accordance with the Human Tissue Act, we bury the gestation sac/fetal remains sensitively along with remains of other miscarried babies. The hospital’s chaplain attends this service held once a month.
Even if you miscarry in hospital you may want to make your own arrangements for burying or cremating the remains of your baby. You can do this through a funeral director or carry out your own burial at home.
If you’re in a rental property you should not bury the remains in the garden. Find out more below.
At home
If you miscarry at home or elsewhere outside a hospital, you’re most likely to pass the remains of the pregnancy into the toilet. This can happen in hospital too. You may look at what has come away and see a pregnancy sac and/or, the baby, or something you think might be the baby.
You may want to simply flush the toilet. Many people do that automatically or you may want to take a closer look. That’s natural too.
You may want to bring the remains to us and we can check it for you. If you want us to, we can send the remains to the laboratory to confirm this was pregnancy tissue. We can also sensitively bury this for you according to the hospital’s policy.
Find out more below about burying your baby at home.
What happens afterwards?
The Early Pregnancy Unit staff will call you after a week to see how things have progressed. If you’re certain you have miscarried, we don’t need to see you again.
We recommend you do a urine pregnancy test 3 weeks after the miscarriage and contact us if it’s still positive. If you’re in any doubt, contact us. You may need some blood tests or an ultrasound scan which we can organise for you.
What if I haven’t miscarried?
We’d like to see you again to reassess the situation and review your care.
If the miscarriage isn’t complete, you can:
- wait up to 2 more weeks for the miscarriage to happen spontaneously
- have medical management of miscarriage (with pessaries/ tablets)
- have surgical management (operation) to remove the fetal tissue.
If you’re unsure whether the miscarriage is complete, we may ask you to do another pregnancy test to find out whether any pregnancy hormone is still in your system.
Following this we may ask you to come back to the Early Pregnancy Unit for further assessment. This may require a urine pregnancy test and/or an ultrasound scan.
Can I change my mind?
Yes, you can change your mind about having expectant management. The other options are:
- surgical management of miscarriage (operation) under a general anaesthetic
- medical management of miscarriage. Using tablets or pessaries (vaginal medication) to bring on the process of miscarriage.
Call the Early Pregnancy Unit to talk about your options at any time.
When can I expect a period?
Every woman is different in terms of when they’ll have their next period following a miscarriage. This can range from 3 to 6 weeks as your body and hormones can take time to return to normal. Often the next period can be different than ones you normally experience (heavier or lighter). This is nothing to be concerned about but you should call GP if bleeding is very heavy and prolonged.
Contact your GP if you don’t have a period within 6 weeks of your miscarriage.
Do I need to tell anyone about my miscarriage?
No, the Early Pregnancy Unit will send information to your GP and community midwife. We’ll cancel any ultrasound scan or hospital appointments so you won’t need to worry about doing this.
Unfortunately, we can’t stop appointment letters that have already been sent out.
The future
We recommend you take daily folic acid, preferably for 3 months before a pregnancy, and wait for at least one period before you try again. Once you have a period we know that your hormones are back to normal.
We hope this guide provides the information to help you make informed decisions at what may be a difficult and distressing time.
Please remember that nothing is too trivial to talk about. If you’re worried, we want to help.
Contact us
Call us for advice, if you’re concerned or unsure what to do.
Early Pregnancy Unit
01296 316469 (8am to 5pm, Monday to Friday).
At all other times call Ward 15 on 01296 316500 or 01296 316365
Further information and support
Information about burying your baby at home
If you want to take your baby home for burial, please remember:
- you may not always live at that address
- the baby should not be buried near a water supply
- the baby must be buried at least 90cm deep
- if you do not own the land, permission must be sought from the landowner
- others using the land should be informed of the burial
- keep a note of the exact place of burial with the deeds in case you want to take your baby with you if you move.
You may prefer to bury your baby in a simple casket or box, in case you do want to move.
If you bury your baby in a designated place, for example, the Aylesbury Cemetery or Snowdrop Garden, High Wycombe, you will always be able to visit.
For more contact the Institute of Cemetery and Crematorium Manager (Inc.) on 0208 9894661.