A Complete Guide to Empowered Miscarriage at Home By Aviva Romm
Updated: Jun 18
When you’re pregnant, there’s no shortage of happy chatter about becoming a mom, nor shortage of options for childbirth education classes. However, there’s very little that prepares us either emotionally or physically for something that remains a hushed topic, and yet which 1 in 4 women will experience: miscarriage.
In other articles, I’ll walk you through the physical and emotional nuances of miscarriage: why they occur, how to heal physically and emotionally, how to prevent recurrent miscarriage, and much more. But today I want to focus in on what happens in an early pregnancy loss – a miscarriage before 13 weeks – and how to experience a miscarriage at home: why you might want to, the options for doing so safely, and when to seek urgent medical care. This information is especially relevant right now, during this COVID-19 pandemic when staying home, and out of the hospital when possible, is ideal.
Miscarriage remains so absent from conversations, hidden and secret, that few women really understand what it is or what happens. It's also so routinely treated as a medicalized event, that most women believe that it’s a dangerous process that requires hospital treatment. So let's talk about it and bring it into the light.
The truth is that in the vast majority of cases, first trimester miscarriages can happen safely in the comfort of your home, with no complications at all. This is entirely contrary to what you might expect. Many of the numerous women I’ve guided through miscarriage at home over many decades have described their miscarriage as a sacred process that allowed a sense of emotional completion and resolution, rather than the trauma and grief so many found themselves with after a medically managed miscarriage. That's why if it’s an option that my patients are interested in, and there are no medical reasons not to, I consider home the optimal place to be.
Signs and Symptoms of Early Pregnancy Loss
Early pregnancy loss occurs in 15 to 20% of recognized pregnancies and accounts for 80% of all miscarriages. In most early pregnancy losses, fetal demise occurs around 6 or 7 weeks into the pregnancy, though the definition includes any miscarriage through 13 weeks. The most common symptoms that suggest you could be miscarrying include:
Vaginal spotting or bleeding
Low back ache
Abdominal pain, uterine cramping, or contractions
Some women also report noticing a decrease in pregnancy symptoms (for example, they no longer feel nausea or breast tenderness goes away, though this is by no means a definitive sign that you're going to miscarry). If you are having these symptoms, meet with your midwife or OB who can confirm, based on an ultrasound, whether the baby has stopped growing or if there is a heartbeat.
If you’re very early in the pregnancy, it might not be clear on ultrasound whether a fetus has formed, or whether it is still living. In this case, you may need further assessment to help put the question to rest. This might include transvaginal ultrasound, measuring blood levels of beta-HCg, and a repeated ultrasound at a near future date. It may also be necessary to rule out an ectopic pregnancy, a complication in which the fertilized egg implants and begins to grow in one of the fallopian tubes – which needs to be managed either with medications or sometimes surgery.
Sometimes, a woman doesn’t initially experience symptoms of miscarriage, and finds out she’s lost a pregnancy when a routine ultrasound shows that no fetus ever formed, that the fetus has stopped growing, or that there’s no heartbeat.
Know Your Miscarriage Options
There are 3 options for how to go about starting and completing a miscarriage:
A medication approach
Suction (uterine aspiration) or dilation and curettage (D&C)
The first two are ‘at-home’ options.
‘Watchful waiting’ means you do just that – watch and wait for miscarriage to get underway spontaneously. It's the most natural approach, but can take days or up to several weeks between when you learn that you're going to miscarry and the onset of symptoms or completion of the miscarriage. This waiting is frustrating, and for some may feel unbearable. Once it does get actively underway, however, a miscarriage is usually complete within five or six hours. Most miscarriages do not need intervention and can be managed this way. If the miscarriage doesn’t kick in on its own within a few weeks, or you get tired of waiting, one of other options will be required. If at any time, heavy bleeding, persistent pain, or any signs of infection develop, then the 3rd option will be needed.
A medication approach involves taking either a combination of two pharmaceuticals, mifepristone (a progesterone receptor antagonist) and misoprostol (a synthetic prostaglandin), or just misoprostol alone if mifepristone isn’t available, which is sometimes the case. This option allows you greater control when you start the miscarriage process (you can choose which day you want to take the pills) and allows you to expedite and complete the miscarriage process, all of which can be done at home. In 84% of cases, the pill combination leads to a completed miscarriage in two days; if not completed in two days, 89% of the time the miscarriage will be completed within a week. If you can’t obtain the mifepristone, misoprostol alone works within two days 67% of the time and within a week 84% of the time. The medication method is considered safe to do at home through the 13th week of gestation.
Here's how this process works:
Your medical provider will give you one 200 mg tablet of mifepristone at their office, which you can take in the office or at home.
About 24 hours later, at home, you'll insert four 200 mcg misoprostol pills preferably into your vagina (wash hands first, lay down when inserting and remain laying down for 30 minutes after; they can be inserted in any location in the vagina). About an hour before you do this, take 600 mg of ibuprofen – it can really help to buffer the misoprostol's side effects. Sometimes, if the mifepristone is unavailable, you just start with the misoprostol pills.
After 30 minutes, you can just go about your biz – even if the pills fall out it’s okay – you’ve absorbed what you need.
Overall this is a very low risk option and is also the same process for doing a safe first trimester medication abortion at home.
Common misoprostol side effects include nausea, diarrhea, or chills. These symptoms should improve a few hours after using the pills. Mifepristone can cause serious interactions with a number of medications, so discuss use with your medical provider before taking it. If there is no response to the initial dose of misoprostol, a repeat dose may be taken one week later.
Suction (uterine aspiration) or dilation and curettage (D&C) are procedures done in the hospital in which your cervix (opening to your uterus at the top of the vaginal canal) is dilated and one of a couple of methods are used to empty the uterus of the products of conception. A suction procedure or D&C is effective 100% of the time with any type of miscarriage. These methods are the go-to if miscarriage isn’t able to start or be completed spontaneously or with medications, if there is heavy bleeding or any complications, or if you just want to get on with it. In the latter case you schedule your procedure, go in and have it done, and you’re usually back at home in a matter of hours. Suction is preferable to D&C for early pregnancy loss because it's quicker to perform and there's less risk of scarring the uterine lining which can be problematic for future pregnancies. Disadvantages to either of these methods include the need for a procedure in a hospital and the risks of anesthesia.
The Most Effective Treatment May Depend on the Type of Miscarriage
How you choose to handle your miscarriage experience is largely a personal decision, though it may be dictated by medical factors (heavy bleeding, for example) or what type of miscarriage you’re having, which I discuss below.
Miscarriage isn’t a one size fits all phenomenon – there are three main types, each of which influences how long a miscarriage might take to get started spontaneously, and how effective each strategy might be. Your midwife or OB can usually tell you which type you're having, based on an ultrasound, and this can help you decide which approach you’d prefer.
Incomplete miscarriage is when the pregnancy tissue begins to pass on its own. Using the watch-and-wait option, it will pass on its own over 90% of the time, but the whole process can take weeks. With misoprostol, the tissue passes up to 84% of the time in within 2 days, and over 90% of the time within a week.
Fetal or embryonic demise is when the pregnancy has stopped growing but is not passing on its own. Using the watch-and-wait option, this type of miscarriage will pass on its own about 75% of the time, but it too, can take weeks. With misoprostol, the tissue passes close to 90% of the time within a week.
“Empty sac” (anembryonic pregnancy) is when the pregnancy stopped growing before the fetus developed. Using the watch-and-wait option, this type of miscarriage will pass on its own only 66% of the time and may take many weeks. Using misoprostol increases the rate to about 80% of the time within a week.
Many women prefer to start out with a watch and wait approach, but you can choose to switch options if things are just taking too long to get started. An herbal approach can also be considered as part of a watchful waiting approach before going to medications or a medical procedure, but should be done under the guidance of a midwife or physician skilled in herbal miscarriage support.
Empowered, Healthy Miscarriage at Home
If there are no medical reasons not to, and you choose to stay at home, here’s how to create an optimal experience for yourself. Plan for and create:
Time: During your miscarriage, you’ll want to be at home, rather than out at work or running errands, so clear your calendar for a few days, or ideally up to a week, once your miscarriage symptoms have started or on the days you plan to take the induction medications.
Support: I recommend you create a bit of a cozy nest at home. Go about your life as if you had a weekend to yourself to lounge, watch movies, or read a favorite book. In other words, pamper yourself.
Also, have your partner or a close friend with you so you have the support you might need physically and emotionally, but also a watchful eye should problems arise that require you to get quick medical care.
Nourishment: Stay well hydrated, and have light, healthy foods on hand that you enjoy and will help you to stay nourished. Eating lightly is also important if you’re using medications to get the miscarriage going, or if you need to take pain medication – otherwise you’ll get an upset stomach. Sip red raspberry leaf (RRL) tea which many women use to encourage healthy contractions and uterine tone in labor. Steep 4 TBS. of dried RRL and 2 tsp. dried peppermint leaves in a quart of boiling water for 1 hour or use 4 RRL tea bags instead. Strain and drink up to a quart daily for a few days.
Comfort: As cramps or contractions become more intense:
A hot water bottle on your lower back or lower abdomen can be comforting and pain relieving.
Have somebody massage your feet or your lower back, especially applying firm pressure to the area over your sacrum.
Use deep breathing techniques and visualize them emptying your womb, your womb contracting down, and a healing light around your uterus. This is very similar to effective hypnobirthing techniques.
Take warm showers and let the water crash onto your lower back.
If needed, use pain relieving herbs like CBD, cramp bark, and ginger, or take ibuprofen (i.e., Motrin or Advil) 600 mg every 8 hours (take with food to avoid nausea).
Sip relaxing herbal tea like lavender, chamomile, or lemon balm.
As uncomfortable as this may feel physically – and emotionally – try to remember that your body knows how to do this. Understanding the process and what to expect