Medical Management for Miscarriage
If you think you may be experiencing a miscarriage, please contact your medical provider as soon as possible. If you have been told you are likely going to lose your pregnancy, we are so sorry. It is devastating to lose your baby at any age or stage, but a particular heartbreak for your little one to be gone so soon. We offer this information as a clinical and ethical resource to aid you in learning more about the medical side of miscarriage.
This information is specific to intra-uterine pregnancy loss. Click here for our pages related to ectopic pregnancy.
According to the Royal College of Obstetricians and Gynecologists, once a miscarriage has occurred and the baby has passed away in the womb, natural delivery of the baby could take up to three weeks. There are three main treatment options for intra-uterine miscarriage, but surgical and medication management Surgical or chemical intervention (options #2 and #3) are not allowed by the Catholic Church if the baby is still alive and has a heartbeat, and may only be used when the baby has died and no heartbeat is detected via ultrasound.
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When a mother chooses watchful waiting during or in anticipation of a miscarriage, most miscarriages will resolve within 2-6 weeks with no higher complication rate than a surgical intervention. This is sometimes called a “natural miscarriage”. There is no way to know exactly when your baby died or will die. You may wait a few days or you may wait a few weeks from the time you begin bleeding. Also, once the active miscarriage starts, it may start slowly and progress over a few days or it may be over in a matter of a few hours. The length of time the miscarriage takes is not related to your baby’s gestational age.
Read more about preparing to deliver your baby at home here.
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Medical management involves the use of a drug, generally misoprostol, to prompt the women’s body to complete the miscarriage. If you choose this option, your doctor or midwife will give you medications to help your uterus contract and expel all the remains through intense cramping. You will also usually be given medication for the pain. Misoprostol may cause diarrhea and nausea. As with any medications, you should discuss the expectations and side-effects with your doctor as well as any complications to consider. A typical protocol would be to take two doses of the medication six hours apart with a goal of being effective within 24-48 hours. Misprostol can be given orally, vaginally, or rectally. You can discuss the options with your doctor as well as the best timing and postures for the medication to be most effective. You should still expect strong, labor-like pain during your miscarriage.
Catholic moral directives require that you be sure that your baby is no longer alive at the time of taking the medication. Item description
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The D&C, or dilation and curettage, is the fastest way to medically manage a miscarriage. It shortens the duration and heaviness of bleeding and it can minimize or shorten the pain of miscarriage, but it can have its own complications. While surgical intervention has been the conventional treatment for first-trimester pregnancy loss, nonsurgical treatments have been increasingly introduced and shown to be effective for certain patients.
Remember, a D&C is not permissible in the Catholic faith until it is confirmed through ultrasound that the baby has already died and there is no heartbeat.
Medication Management
When you choose medical management, your doctor or midwife will give you medications to help your uterus contract and expel its contents. The most commonly used medication is misoprostol, which causes intense cramping of your uterus. Your doctor or midwife will also usually give you a medication for pain. Misoprostol often causes diarrhea and may cause some nausea. Let your doctor or midwife know if you aren’t able to keep the medicine down. You will usually have to take two doses of medication about 6 hours apart. Medical management of miscarriage is generally effective within 24-48 hours. You can expect less bleeding than with a natural miscarriage, but should still be prepared for strong labor-like pain.
Misoprostol can also be given vaginally and, less commonly, rectally. If using vaginally insert the pills as far up in the vagina as possible and lie down immediately afterward. It is a good idea to plan to do this at bedtime. You may also want to take pain medication at the same time. Try to stay horizontal so the pills stay in the right place so they can work. This dose may also have to be repeated. Some women notice less nausea and vomiting with the vaginal method.
If you are past the first trimester, expect to be admitted into the hospital for administration of the misoprostol. Otherwise, you will safely be able to do this at home.
Surgical Removal:
There are numerous places online that detail exactly what happens during a D&C. A good example in layman’s terms can be found here. Technically, few D&Cs (which involve scraping the uterus with a sharp instrument) are performed any more. The usual procedure for emptying a uterus because of miscarriage is called vacuum extraction or a suction D&C. D&C has come to be the generic name for all such procedures. There are also cases in which a combination of suction and curettage is used. Do not hesitate to ask your doctor to confirm that your baby has died. Some mothers may feel fear or doubt that they have harmed their child by having the remains surgically removed. This is not true, but if you need reassurance, do not hesitate to ask.
Remember, a D&C is a surgical procedure. It is appropriate and spiritually beneficial to ask a priest for the anointing of the sick prior to the procedure. You can call your local parish and ask for a priest to come if you are already at the hospital or make time to receive the sacrament prior to going to the hospital. The healing and grace of our Lord Jesus are a lifeline during this heart-breaking time.
What To Expect During a D & C:
Your doctor will instruct you not to eat or drink anything after midnight the night before your procedure. He or she may also discuss what medications, if any, you may continue to take.
Without complications, a D&C is an outpatient procedure. Once you register with the pre-op department, you will be given an IV while you sign consent forms and have your questions answered.
The anesthesiologist and your doctor will discuss sedation with you, whether conscious sedation or complete sedation. Either way, you will feel no pain during the procedure.
You will be positioned in the lithotomy position on the operating table (just like a regular gyn exam). Your legs will be securely propped up so you do not have to hold them there. You will be given oxygen and your vital signs will be monitored. You will have electrodes attached to your chest and arms (this doesn’t hurt) to monitor your heart. At this point you should be drifting off and the doctors will complete the procedure. For a more detailed description of the procedure, be sure to ask your doctor.
Bleeding may last up to two weeks (similar to that of an unassisted miscarriage) but will probably be less than a regular period since most of the superficial lining of the uterus was removed during the procedure. You may be given antibiotics to take to prevent infection. Complications are rare, but be sure to ask your doctor what signs to look for that your healing may not be progressing.
If you desire to receive your baby’s remains after the D&C, you must make your wishes very clear as soon as you arrive at the hospital. This is your right, but it is not common, and medical staff may not be quick to accommodate your wishes. You must insist that your baby’s remains be released to you, your husband, or a funeral home after the procedure and complete this paperwork prior to proceeding with the D&C. If these are your wishes, you need to stand your ground and read all paperwork clearly. The standard procedure is that your baby’s remains are sent to the pathology department and then disposed of. You are not morally obligated to receive the remains, but it is your right to do so. Here is one family’s journey through obtaining their babies’ remains for burial.