Natural or expectant management is when you wait for your body to miscarry naturally without the use of medicines or physical treatment.

The first signs you will notice are spotting and cramping, which will progress to heavy bleeding and more painful cramping or contractions. Depending on how far along you are in your pregnancy, you may pass large clots of tissue.

What to expect

Pain and Bleeding

For most women, if not already, spotting and cramping will start within 7-14 days.  The spotting and cramping will progress to heavy bleeding and more painful cramping or contractions. Depending on how far along you are in your pregnancy, you may pass large clots of tissue.

The pain should improve within 24 to 48 hours when the bleeding will begin to reduce. It could take up to 2 weeks before the bleeding or spotting stops completely.

Medication

Pain relief and anti-sickness medication can assist with the symptoms. In most cases, over-the-counter pain medications such as paracetamol (‘Panadol’) or Ibuprofen (“Nurofen” or “Rafen”) will be enough to help manage the pain.

Recovery at home

What should I have at home?

We suggest having the following at home:

• Pads (not tampons) – you may want to purchase a few packs as you may be changing your pad regularly.
• Pain relief medication such as paracetamol or ibuprofen.
• Time to rest
• Someone to support you if possible – it can be a very emotionally and physically difficult time for you. Having someone with you to help you with practical things such as cooking or going to the supermarket or chemist can be helpful. But we understand that this is not always possible.

Recovery at home

Your doctor will advise you on how to take care of yourself after your miscarriage.  Generally, you will be informed you need to:

• Avoid sex for 2 weeks until the bleeding stops
• Avoid swimming or taking a bath until the bleeding stops
• Use sanitary pads instead of tampons.

When to see your doctor

In some cases, natural management may only partially work; some pregnancy tissue may be left behind.  It is important you go back to your doctor or specialist if you:

• Have a fever which may indicate an infection
• Are experiencing heavy bleeding for more than two weeks

You should have a general follow up appointment with your doctor or specialist 4-6 weeks after your miscarriage to check how you are going.

What happens if I haven’t passed all the pregnancy tissue?

Your doctor or specialist will order further tests to work out whether you may still have pregnancy tissue in your body causing the continued bleeding and/or pain. They will discuss with you the options of continuing natural/expectant management or having medical or surgical management.

• What happens to my baby’s remains?

  Depending on your circumstance and how far along you are in your pregnancy, what you may pass during your miscarriage can be different. The further along you are, the more likely you are to pass pregnancy tissue that looks like an early baby (foetus). In very early pregnancy, however, you may not see anything that looks like a baby. Instead, you may pass blood clots and possibly see a small pregnancy sac.

  If you miscarry at home, you are likely to pass the remains of your pregnancy into the toilet. You may look at what’s come away and see a pregnancy sac or possibly a very early baby (we call this a foetus) – or something you think might be a foetus. If you complete your miscarriage at home, you have no obligation to dispose of the pregnancy remains in any particular way. You might be inclined to flush the toilet – many people do that automatically. You may dispose of the remains the way you usually dispose of sanitary waste; this is a personal choice. No regulations prevent you from doing whatever feels suitable for you. Or you may want to remove the remains for a closer look. That’s natural too.

  If you know that you don’t want to flush the remains of your pregnancy, or your doctor would like to keep the remains for testing, you may wish to place a bowl into the toilet. Some women and families may prefer to bury the pregnancy remains in the garden in a pot with flowers or a tree. Burial, in this way, is not unlawful, provided the person carrying out the burial owns the land or has obtained consent from the landowner.

• Can I undergo testing to find out why my miscarriage occurred?

  In Australia, testing for the cause of miscarriage is not generally offered unless you have experienced recurrent miscarriages or if you have a personal or family history of a condition that may impact your pregnancy.

  However, it is worth speaking with your doctor or specialist if you would like testing done. It is important to remember that while testing can be done to try and work out why you have experienced a miscarriage, unfortunately, it is often not possible to find out the cause.  There may also be out of pocket costs for testing.

• How do I keep my baby’s remains for testing?

  Your doctor or specialist may have asked you to keep your baby’s remains for testing to see why your miscarriage occurred. Some general information is provided in our ‘Keeping your baby’s remains‘ page, however, if your doctor has asked you to do this its important to speak with them about the best way to do it.  Please be aware that even though you may be able to collect your pregnancy tissue, the sample may not be sufficient or suitable for accurate testing.

• Ways to remember your baby

  For many people, having a way to remember or commemorate their baby can help in the grieving process. Regardless of how old your baby was, you are entitled to grieve your loss and honour your baby in any way you want. By the same token, if you don’t feel the need to distinguish this experience, that is fine too – there is no right or wrong way.  There are a number of ways to remember your baby.