If your doctor is leaving the decision up to you as to how to manage your miscarriage, hopefully these pages have been some help. To clarify a bit further, here is a list of the three management methods presented with pros and cons for each.
Expectant Management
To view the full page describing Expectant Management, please click here.
Pros:
- Lower risk to you: If you are generally healthy and do not have any complicating factors (such as a bleeding disorder or preexisting infection) then this represents the lowest risk way for you to miscarry. The risk of heavy bleeding is still present.
- More privacy and ability to control your environment: This is also one of the reasons many women choose home birth over hospital birth. You are laboring and delivering, so this is not significantly different. This is an emotionally charged experience and many women do better with a friend or family member at their side (or within calling distance) in their own home than in the midst of bright lights and several strangers.
- Psychological: You have been pregnant for a number of weeks, sometimes months, and you were doing all you could to provide a safe and nurturing environment for your child. Just because you are not facing the delivery of a live infant does not mean that you have stopped being a mother. Also, for some women, going through labor and delivery provides closure. Especially for a woman for whom this is a first pregnancy, going through the entire process from conception to delivery can reinforce the fact that she was really pregnant, that this is really a child, that she is really a mother.
Cons:
- Psychological: If carrying a child for days or weeks after learning he has died is completely overwhelming (and in all honesty, it will not be easy), then a more rapid conclusion may be best. Whether this represents a D&C or pharmacological intervention, the physical miscarriage will be over and past in a few days (not counting recovery).
- Risk of infection: If it is determined that the baby died several weeks ago, or you have already been waiting several weeks, and you haven’t had any physical signs of miscarriage, then you may be approaching the point at which a D&C is indicated. If you are already showing signs of infection (fever, foul-smelling vaginal discharge, abdominal pain), then you need medical intervention without waiting.
- Heavy bleeding: There is a risk of heavy bleeding with this method especially if the placenta is not expelled.
Medical Management
To view the full page describing Medical Management, please click here.
Pros:
- Psychological: You don’t have to endure as long a wait as you do with expectant management.
- Privacy: If you are in the first trimester you will most likely be able to do this at home. (See Expectant Management: Pros #2 above.)
Cons:
- Side effects of the medication include nausea, vomiting and diarrhea. It works by inducing uterine contractions so you will experience pain that may be more than if you had not taken the medication.
- Hospitalization: If you are not in the first trimester (or even past 8 weeks, depending on your practitioner) you will probably be admitted to the hospital for the induction. If you are well into your second trimester expect to be admitted.
Surgical Management
To view the full page describing Surgical Management, please click here.
Pros:
- Quicker resolution: This is the most rapid resolution of a miscarriage. You could be scheduled as quickly as the next day for surgery.
- Quicker recovery: You generally experience much less bleeding than with any other option, possibly less than a regular period.
*Note: if you have developed an infection or are bleeding heavily or have retained parts, this is not an optional procedure. Similarly, if you have an ectopic pregnancy that is in danger of rupture (or is rupturing), laparoscopy is not an optional procedure: it is necessary.
Cons:
- There are risks of infection, uterine perforation (a hole poked in your uterus) and uterine scarring that may make it more difficult to be pregnant in the future. The risk of scarring increases with additional D&Cs.
- You will not have an intact body as a result. You should, however, still be able to request the remains for burial if you so desire.