Natural / Expectant Management

Choosing natural/expectant management means allowing the baby and pregnancy tissue to pass naturally without medical intervention. You can return home and wait for this process to occur. The timing can vary significantly—it may happen soon or take several weeks.

A follow-up appointment is usually scheduled 7-10 days after your initial consultation. You may need a blood test to monitor your Beta HCG levels. Additionally, a pregnancy test may be recommended approximately three weeks after the natural process begins. If the test remains positive, it's important to consult your healthcare provider.

In the event of an incomplete miscarriage, where some tissue remains in the uterus, further treatment may be necessary. This could include medication to assist in completing the process or surgical management. Your doctor or specialist will guide you in choosing the safest option for your situation. Ensure you have your healthcare provider's contact information readily available for any additional support or advice you may need.

There may be circumstances where natural management cannot be offered, such as if you are experiencing severe bleeding and significant blood loss, having a heightened risk of hemorrhage or being unable to receive a blood transfusion, showing any signs of infection, or possessing an intrauterine device (which would need to be removed).

What to Expect with Natural / Expectant Management

Bleeding

When the passing of your pregnancy begins, you will likely experience bleeding that may be like a heavy period or more intense. The bleeding may come in waves (start and stop) and last for weeks (3-4 weeks). You may see blood clots and clumps of tissue, which may appear white or grey in color. The color of blood may vary from dark brown blood/mucous to bright red fresh blood.

If your pregnancy was early in gestation (5-8 weeks), it is unlikely that you will see a distinct embryo, as it may be reabsorbed by your body or appear as part of the blood clot. In later stages (8-10 weeks), the fetus may be more recognisable. After 10 weeks, the fetus will typically be fully formed and more easily identifiable.

During this process, you will need to use sanitary pads rather than tampons or menstruation cups. The bleeding will be contained in the sanitary pad or will occur when in the shower or when using the toilet. You may wish to flush, which is okay, or you may wish to collect the baby and pregnancy tissue that will pass. The Soul Collection Kit can assist you to achieve this with dignity.

If you choose to collect your baby and pregnancy tissue, place it in the provided jar from the Soul Collection Kit, and store the jar in a refrigerator until you have decided on the next steps for your baby's remains. If you have had multiple pregnancy losses, your healthcare provider may also suggest sending the baby and pregnancy tissue for testing.

Pain

You may experience pain in the abdomen, pelvic region, lower back, or tip of shoulder. This pain can vary from mild period-like cramps to strong labor-like contractions and may come and go in waves. You will likely be advised to take analgesics such as Paracetamol or Ibuprofen according to package directions. Heat packs may also help provide some relief.

Hormones Decreasing

As your hormone levels decrease (at a rate that varies from woman to woman), you may experience headaches, emotional changes including feelings of sadness, mood swings, and tiredness. Morning sickness will subside, and breast tenderness will diminish.

Some women may experience milk production, which can be managed by minimizing breast stimulation, avoiding expressing milk, wearing a firm-fitting bra, and using cold packs for relief.

Natural/Expectant management can be emotionally challenging, as the process may be prolonged and unpredictable. Feelings of sadness, anxiety, or grief are common, and seeking emotional support may be helpful during this time.

Managing Your Baby's Remains

If you have experienced an early pregnancy loss under 20 weeks, and the baby was born with no signs of life. The following options can be considered:

• Returning the remains to hospital for communal cremation, staff may be able to tell you where remains will be laid to rest
• Private burial or cremation arrangements through a funeral director (fees may apply)
• Burial in a garden or pot plant, consider the ability to transfer when moving house and also Local Council guidelines

When Should I Seek Further Medical Assistance?

The need for medical assistance can vary from person to person, but you should generally seek help in the following situations:

If bleeding does not begin within 14 days of your diagnosis, or if it begins but doesn't stop or becomes heavier (you may need an additional ultrasound). Other signs to watch for include heavy bleeding where you're soaking through a pad in 30 to 60 minutes, passing large blood clots (golf ball-sized or larger), feeling faint or dizzy, experiencing intensifying pain that isn't relieved by pain medication, noticing an unusual smell or color in your vaginal discharge, developing a fever (temperature above 38°C), or if your breasts become painful, red, inflamed, or feel hot to the touch.

If you need to go to the hospital because you are concerned about excessive bleeding, you may require an internal examination. The doctor will place a speculum in your vagina (similar to a pap smear) to check for active bleeding or if any tissue remains in your cervix. Sometimes the baby and pregnancy tissue can get caught in the cervix and cause bleeding. In some cases, women may need urgent surgery to control bleeding.

If you are concerned about your health, please seek advice from your healthcare professional.