Expectant management of miscarriage

If you have a missed or incomplete miscarriage, doctors will need to make sure the remains of your baby and pregnancy tissue are no longer in your womb. This is sometimes called management of miscarriage. 

You should be given all the options so you can make a decision that is right for you.

Making this decision may be the last thing you want to do right now. Or you may want to decide quickly and move forwards. Either way, you may be dealing with feelings of shock and grief, or other complicated emotions. We hope this page helps you understand more about expectant management. You may also find it helpful to look at our decision aid here.

On this page we talk about your baby’s body as well as pregnancy tissue. Most people we talk to have told us this is the language they prefer. If this isn’t right for you, we’re sorry. We hope this information will still be useful.

On this page

What is expectant management of miscarriage?

What happens during expectant management of miscarriage?

Preparing for expectant management of miscarriage

Are there any risks to expectant management of miscarriage?

How successful is expectant management of miscarriage?

What happens after expectant management of miscarriage?

Support for you

What is expectant management of miscarriage?

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

Expectant management could be an option for you if you don’t want to take medicine or have surgery and don't mind some waiting and uncertainty about when things will happen.

There are some situations where expectant management may not be the best option for you. It may not be recommended 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.  

What happens during expectant management of miscarriage?

There is no way of knowing exactly when your baby’s remains, and pregnancy tissue will start to come away from your womb. You would usually be asked to go back to the hospital or Early Pregnancy Assessment Service (EPAU) if it still hasn’t started 14 days after the miscarriage was confirmed.

When it does start, you will feel pain and cramping, usually worse than it would be on your period. Some women and birthing people who have had a full-term baby describe the cramping as more like early labour pain and contractions.

You will bleed from your vagina, usually quite a lot. Women and birthing people have told us that they are shocked by the amount of bleeding. You may also pass large blood clots and tissue.

You will probably pass your baby’s body, perhaps in a pregnancy sac. This can be distressing, especially if you are not expecting it. You may want to think about whether you want to keep your baby’s body to bury. Not everyone wants to do this, it's a very personal decision. For example, some people prefer to flush their baby’s remains away.

You should avoid hot baths while you are bleeding heavily. These can make you feel faint. 

Contact your hospital or EPU immediately if:  

• the amount of bleeding makes you feel unwell, dizzy, faint, frightened
• you soak through more than 2 heavy sanitary pads per hour for more than 3 hours
• you develop a high temperature (fever)  
• you experience severe pain or cramping that you cannot manage with normal painkillers.

A doctor or midwife will talk through your concerns with you and help you decide whether you need to go back to hospital.

Bleeding will be heaviest for the first few days after it starts. Then it should get lighter (although you may have times when it feels heavier again) and stop after 2-3 weeks.

Preparing for expectant management

You will need extra thick sanitary pads. It may also help to have old towels available or other material you don’t mind getting stained. You don’t need to stay in the house while you are waiting but have a supply of these with you in case it starts when you are out. Cramps usually start before or alongside the bleeding so have painkillers, such a paracetamol, to hand. Your doctor may be able to prescribe stronger painkillers too.

It’s a good idea to make sure that someone can be with you or able to come home to you when the bleeding starts to get heavier and the pain more intense. At its height you are unlikely to be able to do much. It would be good to have someone on call if you have caring responsibilities or other chores that need to be done.

You may find it helpful to ask your EPU/doctor these questions.

• When is my next appointment and who is it with?
• Who should I contact if I am worried about my bleeding or in a lot of pain or I am worried about other symptoms?
• What if I change my mind and want to have surgical or medical management.
• If I think I have passed the baby or pregnancy tissue, what should I do next? Do I need to contact the EPU?

Can I go to work while I wait for the miscarriage to happen?

You do not need to work while you are having a miscarriage, but some people prefer to continue working until it starts.  

This should be done with understanding from your employer that you may need to stop working at short notice. If possible, working from home is the best option. Starting to bleed heavily and get cramps in an office, factory or shop would not be easy to manage.  

You may also find it helpful to look at our information on your rights at work after miscarriage.

Are there any risks to expectant management of miscarriage?

About 1-3 in 100 women or birthing people who have expectant management will develop an infection. This is a similar number to medical and surgical management.

About 2 in 100 women or birthing people who have expectant management will have a haemorrhage (severe bleeding) and may need an emergency operation.

How successful is expectant management of miscarriage?

Expectant management is successful in about 50% of cases. This means that half of women and birthing people who go through expectant management will have  another form of management as well.

What happens after expectant management?

You’ll be given a follow-up appointment about 2 weeks after your previous appointment.  

If the bleeding and pain has finished 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 the miscarriage start (medical management)  
• having surgery to remove the pregnancy (surgical management).  

Find out more about what happens to your baby after miscarriage and remembering your baby after miscarriage.

Support for you

There is no right or wrong way to feel after pregnancy loss. It is a very individual experience. Many people feel a lot of complicated emotions including guilt, shame, sadness, anger and grief, that can sometimes last a long time. There is support available if you and/ or your partner (if you have one) need it. Have a look at our pages on support after a miscarriage.

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 specialists who can support you with any aspect of pregnancy loss that would be helpful for you.