Missed miscarriage management

Pregnancy ends in miscarriage 20-30% of the time. Sometimes it is a spontaneous miscarriage, where the woman starts bleeding, cramping, and passing everything on her own. Sometimes it is a missed miscarriage, which means that an ultrasound has diagnosed no fetal heart rate after 8 weeks, yet the bleeding and cramping have not started. 
There are 3 options for missed miscarriage management:

• Expectant management-Wait and see if your body will pass the pregnancy. This is usually safe for 2 weeks after the fetus has stopped growing if no signs of infection are present. 
• Medication induced miscarriage-You take medication to start the process of miscarriage. The easiest medication to obtain is cytotec, which can be found at most pharmacies. Sometimes mifepristone is used to increase effectiveness, but is harder to obtain. 
• A procedural miscarriage or D&C-It's a procedure is used to empty the uterus of the pregnancy contents.

We can help you obtain the misoprostol (Cytotec) needed for the medication induced miscarriage. We will need a copy of the ultrasound showing no fetal cardiac activity after 8 weeks. Let us know if there are any other health complications. We will prescribe the cytotec to your local pharmacy and instruct you on its use. We will also give you our cell number to call or text with any questions or concerns during the miscarriage. 
For the miscarriage, you should have large menstrual pads on hand. (Tampons, cups, and discs are not recommended). A heating pad and Ibuprofen or Tylenol would be advised as well. It's best to start the miscarriage when you'll have another adult present for 12 hours in case you feel like fainting. If desired, you could have a strainer to place in toilet or to be used to separate blood clots from fetal tissue.
Usually the heavy bleeding and cramping last 4 hours or under. Many women like to sit on the toilet, the shower floor, or in the bath tub while everything is passing. You should have another adult with you during this time. 
The fetal tissue could be sent to the lab for genetic testing if desired. You could also preserve in a salt water jar for a bit if you want to. 
This website has some practical tips on making it: www.homehospiceassociation.com/post/miscarriage-care-under-20-weeks-at-home

​For at least 1 week after the miscarriage you should be resting at home, lounging in the bed, not doing too much. You will have lost plenty of blood and your body needs rest to heal. 

There are free online support groups via Postpartum Support International for miscarriage and loss. www.postpartum.net/get-help/psi-online-support-meetings/

We know this is a really tough time and are sorry you're going through this. We are here to help if needed. The missed miscarriage package is $200 and includes texts and phone calls with your midwife.