1. Have I already started miscarrying? 

Deciding between using medication such as misoprostol / cytotec vs a natural miscarriage, also called “expectant management”, has many considerations.

Personally, if I have already started my miscarriage, I have always let it pass naturally. Depending on where you are at in the process of your miscarriage, miscarrying naturally may be the only option!

If you have experienced a missed miscarriage and your body has not yet started processing the miscarriage naturally, medically managing your miscarriage through medication may be an option for you.

You can read more about my experiences with natural miscarriage at home here and here.  My first miscarriage included a visit to urgent care and eventually the ER, you can read more about that here. I have also experienced one D&C, which you can read about here.  While I have been given the choice of medication for helping to manage my miscarriage, that was never an option I choose.  If you want to read a story using misoprostol / cytotec to manage a miscarriage, read Nicole’s story, here.

2. How far along is my pregnancy? 

A miscarriage at 6 weeks will look and feel very different than a miscarriage at 12 weeks!  I miscarried naturally for my earlier miscarriages, but had a D&C for my 11 week miscarriage.  Keep in mind that an early miscarriage at 6 weeks or less will typically be similar to a heavy period with cramping.  The further along you get in a pregnancy, the more likely a miscarriage can resemble labor with contractions and a more recognizable fetus.

According to the American Pregnancy Association, women can safely miscarry on their own up until 10 weeks either naturally or using a medication called misprostol (aka cytotec), but  a D&C may be recommended for women who miscarry later than 10-12 weeks¹.

3. What is my doctor recommending? 

Always take time to discuss with your doctor and hear their recommendations.  Your doctor will know more about your unique situation and why one option may be preferable to another.

4. Am I experiencing any debilitating pregnancy symptoms? 

You can continue to have extreme morning sickness (nausea & vomiting) even without a heartbeat. Making the decision to wait and see if you will miscarry naturally vs using medication could mean extending these symptoms. With medication like misoprostol / cytotec, any pregnancy symptoms should disappear once your body has miscarried which typically will happen quicker than if waiting to miscarry naturally.

It is important to note that the timeline of how long the medication will work can vary and it does not gaurantee your body will fully complete the miscarriage. A D&C may still be required after using the medical management approach.

5. What are the risks of using medication vs miscarrying naturally? 

While misoprostol / cytotec is a routinely used medication to assist in miscarriage,  it can come with side effects including diarrhea, abdominal pain & headache with other potential side effects (these are rare, see list )².

With both a medicated and natural miscarriage, there is a risk you may end up needing a D&C in the long run. After 10 weeks, a natural miscarriage is more likely to be incomplete, requiring a D&C³.

With a natural miscarriage, there could be emotional risks of unnecessarily prolonging the pregnancy.

6. Do I have any special circumstances that might lead to using medication vs miscarrying on my own? 

This is another question that should be considered with your doctor. Your situation my have special circumstances making one option preferable to another.

7. How might my decision on how to miscarry impact me emotionally? 

Miscarriage can be traumatizing. It is important to think through any emotional impact that your decision might have. It is also important to recognize that when making the decisions in the moment, emotions are likely already high. Try finding a trusted confidant (spouse, friend, therapist, etc) that will listen as you talk through your decision of how to miscarry. Consider joining our Facebook group and connecting with women who have a variety of experiences with miscarriages.

8. Do I know what miscarriage could look like if I decide to miscarry naturally vs using medication?

While every miscarriage is different, it is important to research both natural miscarriages and those using medication so you know what to (potentially) expect.  I suggest when looking for stories of what to expect, also look for pregnancies that are around the same week gestation as you.  As mentioned previously, miscarriages at different stages can look drastically different!

With a natural miscarriage, the timing can be unpredictable while a medicated miscarriage may have a slightly more predictable timing (but can also be unpredictable).  Recovery for both includes heavy bleeding and cramping and you will likely be asked to avoid infection by not using a tampon, avoiding sexual activity and not soaking in water (ie, a bathtub, hot tub or pool). The process and recovery will vary, especially depending on what week of pregnancy you are in.

9. What fears do I have surrounding using medication? 

Explore any fears you have around using misoprostol (aka cytotec). Talk through questions and concerns with your doctor. It might also be wise to consult with someone else who has experience with this medication to hear more about their experience.

10. What fears do I have surrounding a natural miscarriage? 

You will also want to discuss any fears and concerns you have a with a natural miscarriage. Remember that it may take more time for a natural miscarriage to begin and this may have an emotional toll. Again, checking with a doctor and someone who has been through a natural miscarriage may help ease some of these fears & concerns.

Bonus Question: What feels right to me?

Throughout my fertility journey, I have found this question, “What feels right to me?”, is usually the most important one to ask! I recommend asking the questions above and getting the facts, but then check in with yourself and see what option feels best to you.

Is a D&C a Consideration? 

If you are also considering a D&C read this article on questions to consider when deciding on D&C vs a Natural Miscarriage.

Successful Pregnancy is Possible After Miscarriage

The good news is that the chances of getting pregnant after a miscarriage are high.

 

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