Expectant management

If you miscarry early, it’s possible that the pregnancy will come away from the womb naturally and you won’t need any treatment. This is called a complete miscarriage. But if you have a missed miscarriage or incomplete miscarriage, there are 3 ways this might be managed:

• expectant management
• medical management 
• surgical management.
  

Your doctor should talk with you about what may be the best option for you. You should be given some time to think about the diagnosis and what you want to do.

If you lose your baby after the first 12 weeks of pregnancy but before 24 weeks, this is known as a late miscarriage. Find out more about treatment after a late miscarriage.

What is expectant management?

Expectant management means waiting for the miscarriage to happen by itself naturally, without treatment. You don’t need to be at the hospital for expectant management.

You may not be offered expectant management if:

• doctors think you have an increased risk of haemorrhage (severe bleeding)
• you’ve had a stillbirth, miscarriage or haemorrhage in a previous pregnancy
• you are at increased risk from the effects of haemorrhage (for example, if you’re unable to have a blood transfusion
• you may have an infection.
  

How long does expectant management take?

It can take some time for the bleeding to start and this may continue for up to 3 weeks. This may be heavy and you may have cramps.

Contact your hospital immediately if:

• the bleeding becomes particularly heavy
• you develop a high temperature (fever)
• you experience severe pain or cramping.
  

This may mean that the pregnancy tissue isn’t coming away by itself and you are at risk of infection.

You’ll be given a follow-up appointment about 2 weeks later. If the bleeding and pain has settled by then, the pregnancy has probably come away. You’ll be asked to do a pregnancy test a week after this appointment. If it is still positive, you should contact your local Early Pregnancy Assessment Service.

If bleeding doesn’t start within 7–14 days, isn’t stopping or is getting heavier, you will be offered another ultrasound scan. If the pregnancy hasn’t completely come away, your doctor will talk to you about your options. These may include:

• continuing expectant management
• taking medicine to help things along (medical management)
• having surgery to remove the pregnancy (surgical management).
  

How successful is expectant management?

Expectant management is successful in about 50% of cases.

What happens to my body during a miscarriage?

Your body will go through some changes when you miscarry. Find out more about what happens.

Will they do any tests to find out why I miscarried?

Unless this is your third miscarriage in a row, it’s unlikely you’ll receive more tests. This is because most women will go on to have a successful pregnancy in the future. However, different clinics will have different criteria, so speak to your GP to find out what your local policy is. Find out more about tests after miscarriage.

Your emotional health after a miscarriage

Losing a baby can be heart breaking. Your feelings and emotions are your own and no-one can tell you how you should or shouldn’t be feeling. There is no right or wrong way to feel about pregnancy loss. 

Everyone is different. Some women come to terms with what happened within a few weeks, for others it takes longer.

Taking the time you need to grieve may help you move on and think about the possibility of trying again, if that’s what you want to do. There is support available if you need help.

You can also talk to a Tommy’s midwife free of charge from 9am–5pm, Monday to Friday on 0800 0147 800 or you can email them at [email protected]. Our midwives are also trained in bereavement support.

Can I have a memorial for my baby?

If you lose a baby before 24 weeks, you won’t be given a legal certificate for the loss. This can be very upsetting for some parents because there is no legal recognition that their baby existed.

There is no legal requirement to have a burial or cremation, but some women find that having a memorial for their baby helps them to cope with their grief. You can ask your nurse, midwife the hospital chaplain, PALS (Patient Advice and Liaison) officer or hospital service about the arrangements at your hospital. For example, some hospitals have a book of remembrance.

There are lots of other ways to commemorate your loss. Find out more about remembering your baby after miscarriage.