Missed Miscarriage- how long to wait to naturally miscarry?

[Lugh00]

I'm waiting on a missed miscarriage.  This is my 2nd missed miscarriage and I had a miscarriage before that as well.  I have 2 healthy children prior to all 3 miscarriages.

My 1st missed miscarriage was complicated.  I started spotting at about 6 1/2 weeks.  I didn't get in for an ultrasound until 7w5d, the found the baby measuring 6w4d with a good heartbeat and small clot behind the placenta.  I was so relieved.  I had gotten pregnant charting my temp and I continued to do so, originally out of curiosity and later out of concern.  I just knew something wasn't right.  I was still bleeding off and on, and with the dates being off by a week.  When I should have been 10weeks my temp plummeted (it was Friday after Thanksgiving) I got in for an ultrasound the following Wednesday.  The baby hadn't grown at all since that 1st ultrasound, no heart beat.  The gave me 3 options, a D&C, cytotec, or wait it out- he gave me 6 weeks, before I would 'need' the D&C.  
I had been seeing a midwife prior to the 2nd ultrasound, she recommending several herbs to speed things along so as not to need the D&C.  I took them as directed.  I literally passed the last of the tissue the day before the Dr called to force me to schedule the D&C.  Technically I believe I carried that baby after it passed away for about 8 weeks.

This time... I went in for my 1st appt (I was seeing a reg OB, not the midwife) at 7w5d.  It once again measured 6 days behind, normal heartbeat.  They put me on progesterone supplements.  A week later, 8w4d, I just felt to normal, as in not pregnant.  I got an ultrasound for that afternoon, once again saw the baby, measuring 8w1d with a good heartbeat!  They told me it was safe to share the news so I did.  I went in 12 days later for the original follow up to the 1st ultrasound, I had sent my husband on his business trip expecting all to be well.  It wasn't.  The baby stopped growing again and no heartbeat, still measured 8w1d when I should have been 10w3d.  This time the Dr was very kind (different Dr), offered the D&C or to wait for a natural miscarriage, which she warned me could take some time.  I'm now what would be 13w4d.  I've bled off an on since 3 days after the last ultrasound.  I'm guessing I lost this one at roughly 9 weeks, so I'm 4 weeks into my waiting for it to happen.

I know what to watch for in case of infection, I'm really worried about passing the baby and tissues as the last one was very easy without the heavy bleeding, and the 1st one was- while not easy, not terribly difficult either, more like your 'textbook' miscarriage.  I'm just impatient but unwilling to have a D&C unless it becomes medically necessary.  I'm wondering how long most women wait to have a missed miscarriage naturally.  So many people seem to get impatient and have the D&C after a few weeks, not that I'm putting that down, just that it's not the info I'm looking for.  It's certainly a woman's choice, it just happens mine is to do it as naturally as possible.

[Lugh00]

I still haven't miscarried.  Tomorrow is 5 weeks from when they told me, probably more like 6 from when it actually happened.  I stopped spotting entirely for nearly 2 weeks, felt just fine, no pregnancy symptoms or anything.  As soon as my husband came home from his most recent travels, I started my herbs (the same ones the midwife gave me before), I also started rubbing pressure points in both my hands and ankles.  After 3 days of herbs and one of pressure points I had an afternoon of light bleeding and minor cramps yesterday.  Unfortunately when I woke up this morning and the rest of the day it's essentially stopped again.  I am still cramping though, so I'm still hopefully, if emotionally exhausted.  I'm giving it one more week before I call the Dr to schedule a D&C, hopefully- if it's needed- I can schedule for the week following that (2 weeks out) as my husband is back on the road for the next 2 weeks, except weekends.  Fortunately my inlaws know what's going on and live down the street, in an emergency I won't be alone.  

I'll go read your Missed Miscarriage story, in a moment.  I am avoiding the pills because I've had 2 previous c-sections and there are some reports of the pills causing uterine rupture after 10weeks or with c-sections.  Inconvenient I have to say.
I'll update again, whenever it's complete, however it completes.

[jamnavywife]

I just wanted to encourage you to talk with your doctor about the pills, because there are also risks with the surgery. I should have been about 16wks when I took them (my babies only about 8wks) and it went fine, and my doctor was very sure that it would.
There are so many risks with the surgery and if its something you really didnt want to do I would suggest talking more with the doctor.

Here are some of the risks with D&C:

* Hemorrhage: heavy bleeding is a possibility if the uterine wall is punctured or scraped too hard by the curette.
* Infection: anytime an instrument is inserted internally there is a chance of infection. Some infections are serious but most can be cleared up by taking antibiotics.
* Perforated uterus: any instrument may snag or tear the uterus by accident during a D&C. Signs include pain and heavy bleeding.
* Asherman syndrome: as a result of aggressive scraping or abnormal reaction to scraping, thick scarring on the uterine walls may form. Periods stop and the woman becomes infertile.
* Irregular periods and/or difficulty conceiving: even slight uterine scarring can cause an irregular cycle and make it harder to get pregnant again.

Follow your gut and do what you think is best for you!

[shasy03]

Normally the doctors don't like for you to wait too long after knowing the baby is no longer alive to give you a d&c or medicine.  I would say as long as you are not sick or have a fever then you should be okay to wait a little longer.  We waited almost 3 weeks before I had to have an d&c. I was so sick they couldn't put me to sleep to do it earlier because I was not passing it.  Then a week later when I was a little better from a cold I started to miscarry and ended up in the ER and that morning after being there forever I had to have a D&C.  So, take care of yourself and if you notice you are getting sick...do something don't wait.

[Lugh00]

This is why I won't use it.  This sounds lots scarier than the possible risks involved in a D&C, particularly because I've had 2 previous c-sections.  My Dr didn't even offer it as an option.  I'm not knocking those who've used it, but I'm not interested in something that specifically states I'm at a higher risk for uterine rupture.

This is from the package insert for Cytotec:

"Cytotec can induce or augment uterine contractions. Vaginal administration of Cytotec, outside of its approved indication, has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony. A major adverse effect of the obstetrical use of Cytotec is hyperstimulation of the uterus which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism. Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported.

    There may be an increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec; including the manufactured 100 mcg tablet. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery. Grand multiparity also appears to be a risk factor for uterine rupture."

[Lugh00]

Here's an update, it's been 6 weeks and 2 days (today is Wednesday) since they told me I lost the baby, probably closer to 7 since the baby actually died.  I am going to put lots of detail in here, just so that others who have to go through this will have a reference that I had a hard time finding.

We spent the weekend at the Renaissance Faire, nothing was happening more than the occasional spotting, we joked it would happen while we were there since it would be highly inconvenient, although I went prepared.  Sunday evening as we were leaving I started bleeding, a couple small gushes, not quite enough to fill a pad, but a lot more than I'd had so far.  Mind you we were about to sit in the car for 2 hours.  I continued to bleed light to medium, always more if I was on the toilet, until that evening when it tapered to almost nothing.  

Then nothing on Monday, not a drop.  

Tuesday evening around 5ish, it came back, about the same as before, more than lightly, I would guess a medium flow, with small clots and more bleeding when I was on the toilet. This time it didn't stop.  It's now Wednesday, and I was up and down all night, almost every time I went there was blood in the toilet, enough to turn the water dark pink to red, often clots, some small some larger, once I wiped and had tons of little clots on the tissue.  I'm pretty sure that this is it, I don't think it's stopping this time until it's all over.  Now so long as it completes itself and there are no issues such as excessive bleeding or retained tissue, in a week or 2 I'll be good to go back to life as I know it.  

As far as cramping, I've had mild cramps off and on, occasionally a twinge that actually catches my attention but it's generally short lived and not worth taking painkillers for (not that I have a problem with them, Ibuprofen is my friend, lol).  I do tend to have more in the way of back pain vs cramps in my normal period.  There's been back aches off and on since about 6 weeks or so (when they first told me the baby wasn't growing properly).  Some days they're worse, some days nothing.  

Emotionally, this has been more difficult than the last one.  For 2 reasons I think, the first being that this is potentially my 3rd miscarriage definitely the 2nd, so the chances of having a successful pregnancy have dropped.  The second is that I wasn't in contact with a midwife who would be more open to me and expectant management for as long as it took.  I did have an OB but I was saving them for when I needed more than reassurance and needed medical intervention.  Having a midwife available to speak with when I needed that reassurance would have made this easier.   I spent a lot of this time in a mild depression, every time the bleeding started I would perk up have some energy and want to do things, I even painted 2 walls in my house one of those days.  Only to have it stop again and make me all the more frustrated.

I took Black Cohosh, Blue Cohosh and Cottonwood tinctures, according to the directions from the midwife I saw for the first miscarriage.  I also used pressure points, some I knew from labor with my first children, the others my chiropractor showed me when I asked.  His opinion was that if it took 8 weeks to complete the miscarriage the last time, it would like take about 8 weeks this time around too.  I'm not sure if the herbs I took helped or not, they didn't hurt any since I followed the dosage given.  I think they will only work if your body is ready.  If either the herbs or pressure points worked, I'd have to go with the pressure points, I did those for 2-3 days and that's when the bleeding started to get heavier, continuing them seemed to make it continue by causing contractions.  

[Lugh00]

This is it.  It's over completely.  Or at least I'm about 95% sure it is.  It's Friday, yesterday afternoon around 2 in the afternoon my cramps got worse.  By evening they were pretty bad, feeling like contractions.  I was an emotional mess.  I usually have a fairly high tolerance for pain which I still think pain wise is was manageable.  But having to be alone while it was happening had me in tears.  Ibuprofen didn't do much for the contractions but helped the back pain.  I calmed down around 9pm.  

Around 12:30 at night I decided it hurt more to lay in bed than to sit on the toilet, so I relocated, brought a pillow to sit on my knees and rest my head and book to look at in between contractions.  The contractions were coming nearly on top on each other.  About 15 minutes later or so, I checked the toilet, the water was solid red, it didn't look diluted anymore.  It made me a little nervous, but I flushed and waited again as the contractions were still coming.  I checked again 10-15 later and while the water was red, it wasn't like before, the bleeding was slowing down.  Flushed again and waited, I read a whole (short) chapter!  I realized the contractions were slowing down and getting less intense, otherwise I wouldn't have managed to actually read!  I checked again and the bleeding was minor, some but not much.  I figured it was safe to crawl into bed.  It was about 1:30am.

I called my husband in Kansas (on business, we live in CA), told him I thought the worst was over.  I just needed to talk for a bit.  We talked until about 2:45am.  I continued to contract for maybe an hour or so and actually fell asleep for a bit, I woke about 3:30am, a stronger cramp, not as bad as before, just not something to sleep through.  I went to the bathroom.  Very little blood, mostly when I wiped really.  Fell right back to sleep, woke about 5:45 thanks to my dogs wanting out, went to the bathroom before climbing back in bed, just like the last time, very little blood, mostly when wiping.  

Now it's 8:15 in the morning.  Been up since 7.  Had to get my oldest off to school (grandpa drove him for me, but I still needed to make lunch and get him dressed) and while I was hoping my youngest would sleep in so that I could crawl into bed, no such luck.  I feel fine, aside from super tired, no cramping, a vague ache-ish type feeling from my lower abdomen, which given the workout those muscles got last night doesn't really surprise me.  My back ache is mostly gone, not completely but not bad, not worth taking painkillers over.  Bleeding is still fairly light.  I think it's over.

I hope all this detail helps some one else sometime in their lives when they need it.  It can take a while for a missed miscarriage to happen naturally.  It could be almost totally painless like my first or it could be pretty miserable like this one.  I don't recommend letting it happen while you're alone though, that was the worst part.  I had my phone, by me the whole time, my inlaws are 6 houses away.  But what I wanted was my husband with me, that would have made a world of difference to me.  But it's over, it over the way I wanted it to be over.  I'm safe and he'll be home late tonight.  I can finally move on to the rest of my life.  I can finally decide if we're going to try again or not.  Good luck to all you out there that might be going through something similar.  I'm just trying to give you information I couldn't find myself.