Missed Miscarriage: What to Expect When You Miscarry Naturally

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[Disclaimer: I am not a doctor or medical practitioner. Any medical information is strictly my opinion based on research and personal experience, and not to be taken as advice. Always seek the advice of a licensed physician for your medical needs. Read my full disclaimer here.]

When I found out I had a missed miscarriage at 9 and a half weeks, I knew almost instinctively I wanted to wait for it to pass naturally. And I also knew the wait would be excruciating. What I didn’t know about a missed miscarriage, however, was what to expect when you miscarry naturally. (That was despite having miscarried before at 7 and a half weeks. I had a feeling this would look and feel much different, and I was right.) How much blood would there actually be? For how long? How painful would it be?

The problem, I realized very quickly as I scoured the internet, is that miscarriages can be totally different. And not just because women lose babies at different weeks. Even for women whose situations seem to be identical — the baby measuring a certain amount of weeks, miscarrying at a certain number of weeks — the miscarriage itself could still be totally different.

Regardless, though, I wanted to read stories of other women who had gone through this. Even if I didn’t know exactly what to expect, it helped to read about all of the possibilities. And so here is my missed miscarriage story, in the hopes that it will also help someone out who is waiting to go through the same.

I organized this post by the questions I had throughout this pregnancy and miscarriage: Did anything seem off right away? Were there other signs you were going to miscarry? What options are there when a doctor tells you your baby has no heartbeat? How long after you started spotting did you actually miscarry? How much bleeding will there be? And how long does it take for the worst part to be over? How painful is it? For how long did you bleed afterwards? How long did it take for your HCG levels to go back down to zero? When can you try to get pregnant again (if you want to)?

Just remember, though, like I said earlier, that everyone’s situation and experience is totally different. So while your experience might end up being different from mine, I hope this somehow helps a little bit with what to expect when you choose to miscarry naturally after a missed miscarriage.

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Did anything seem off right away?

I always find out about my pregnancies very early. I don’t even have any symptoms really, although with the first two I had early spotting — I’m thinking implantation bleeding — that caused me to take a test (the first one ended in miscarriage; the second in a healthy baby boy). This third pregnancy, though, I just had a feeling that I can’t explain. Sometimes I think you just instinctively know that you’re pregnant.

So at 3 and a half weeks pregnant, after I got a positive test, I went in for two HCG draws two days apart, and my levels were doubling perfectly. When I had miscarried before, they didn’t. So I was feeling very optimistic going into my 7 and a half week ultrasound.

Then suddenly I wasn’t optimistic anymore. The baby was measuring 6 weeks, 3 days, exactly a week behind. The ultrasound tech found a heartbeat but wasn’t able to track it to measure it. When you go through years of infertility and tracking your ovulation, you know your dates are right on. So although the OB was very optimistic (even though I reiterated over and over that I knew the date I conceived, and that it didn’t make any sense unless something was wrong), I prepared for the worst. (Sure enough, she would tell me at my next appointment, she had assumed I was off on my dates, which is why she was optimistic.)

Two weeks later at my follow-up ultrasound, at 9 weeks, 4 days, the baby now measured just 6 weeks, 2 days, and no longer had a heartbeat.

Were there other signs you were going to miscarry?

Up until that first ultrasound at 7 weeks, 3 days, I didn’t have any signs that would’ve made me think anything was wrong. As I said, I never really have any pregnancy symptoms, so me feeling fine didn’t worry me. Looking back now, I remember I did get sick at exactly 6 weeks pregnant — what felt like a 24 hour flu. I never took a Covid test, but I felt exactly how I did when I had Covid years ago. Whether or not that was a coincidence, I have no idea. They say that the majority of the time miscarriages happen because of genetic abnormalities beyond your control, so maybe this sickness had nothing to do with it.

Then, the weekend before I found out about the miscarriage, at 9 weeks pregnant, I woke up two consecutive nights in the middle of the night with some cramping. It was nothing super painful and I know that can be normal in pregnancy, but because I was afraid I might miscarry, I wondered if that was the start of my body starting to recognize that the baby had already died. I guess I’ll never really know.

What options are there when a doctor tells you your baby has no heartbeat?

When the doctor told me I had miscarried, I knew my options already. Not only had I researched them a bit previously (like I said, I was not optimistic), but I’ve had friends who have had D+Cs, as well as friends who have taken the medication and miscarried at home. I actually don’t think I know of anyone who chose the option I did. So I didn’t have anyone to ask about what to expect when you’re waiting to miscarry naturally after a missed miscarriage.

This is not a post about what option to choose; maybe I’ll post something on that later. This is a post, though, if you’ve already decided on the waiting-to-miscarry-naturally route, or if you are thinking about it and want to know what to expect.

As I said earlier, you probably already know that the wait will be brutal. For me the wait was worse than the actual miscarriage. Especially if you’re someone like me who is up in front of people all day (I’m a teacher), the anxiety of beginning to miscarry in front of my students was quite terrifying. Not to mention, I just wanted everything to be over so I could move on.

Note/update: After I miscarried, my OB had me come in for an ultrasound a week and a half later. She thought there was still some tissue left (how?! I asked), but couldn’t be 100% sure. She urged me to take misoprostol to help me pass the rest, because she didn’t want to risk infection. I took it very reluctantly. The dosage she had me take was to insert 4 tablets vaginally. Nothing happened. My HCG still went down…so either there wasn’t actually any tissue left, or my body was able to reabsorb it. I regret taking it — and told me doctor so. She still thinks it was the best choice for me to make. Looking back, I wish I would’ve asked her if I could’ve monitored my HCG levels for a week or so first.

How long after you started spotting did you actually miscarry?

My OB said she would allow me 2 weeks to wait to miscarry naturally. That was after the miscarriage diagnosis. In hindsight now, I’m glad my second ultrasound wasn’t until 9 weeks, 4 days. I have a feeling the baby’s heart had stopped long before that, and even though the two week wait between my first ultrasound and my second was hard, I’m glad it was two weeks because it gave my body that extra time to miscarry on its own.

I think different OBs probably have differing opinions on how long to wait for a natural miscarriage. It sounded like mine used to allow a longer period of time, but she said after two weeks she had a woman develop a serious infection when her body still hadn’t passed the baby. Now two weeks is her personal rule of thumb. She couldn’t really tell me what to expect, however, when waiting to miscarry naturally after a missed miscarriage. Everyone’s experience is so different, she said.

The day of my second ultrasound, a Tuesday at 9 weeks, 4 days, I had just the tiniest bit of spotting. And by spotting I mean no one would even notice it. It was just one time, right before my appointment, when I wiped and it looked like there was the tiniest bit of light brown discharge. I would’ve missed it had I not been half-expecting it.

Then, Wednesday, I had just a tiny bit more. Not enough to even wear a pantyliner, but more noticeable light brown when I wiped. Thursday the spotting had turned dark brown; I definitely needed a liner now. And Friday was more of the same, but almost seemed lighter again. (Much to my annoyance; I just wanted it to be over.)

I was going on 4 days of spotting when the miscarriage started.

How much bleeding will there be? How long does it take for the worst part to be over?

(This part gets a little graphic.)

Saturday, at 10 weeks and 1 day, I had a feeling the miscarriage was going to happen very soon. I’ve read that for some people the miscarriage happens the same day spotting starts. For others it happens after a week of spotting. For me it took 4 days. Mid-afternoon on Saturday I could tell my dark brown spotting was beginning to turn red, and by dinnertime I had switched to a pad rather than a liner. Then, around 7pm, I suddenly felt clots coming out of me when I would stand up. I actually felt oddly relieved that it was finally happening.

My husband and I were at my parent’s house, so we waited about an hour to get things ready for my son for bedtime (who we decided to leave at my parents for the night) and then drove the 30 minutes home.

By the time we got home, I was bleeding quite heavily. As soon as I got out of the car, I felt some giant clots fall out of me. Blood was coming down my legs and onto the garage floor (this was with wearing one of the biggest, heaviest duty pads). I immediately showered and probably stayed in there for 30 minutes, passing more tissue and clots.

From what I had read, for most people the biggest clots and tissue are passed within 3-5 hours. I figured if this started around 7, I would try to go to bed around 11, hoping the worst was over. It took much longer for me. Every time I would stand up from laying down, I would feel more clots coming. Then I’d rush to the bathroom. This was my experience — and one I didn’t necessarily expect — when you miscarry naturally after a missed miscarriage: Not bleeding heavily nonstop, but instead passing large clots and tissue in waves.

I think I slept from about 11 to 12:30 or so, and then for another hour around 3 to 4, and then at 6 I finally fell asleep till 9.

In between I alternated between laying down and reading, and going to the bathroom. I always wondered what was normal for size of clots; it’s hard to say because I tried not to look. Maybe a little smaller than a golf ball. (A couple of times — I think because I was looking — I did feel lightheaded and dizzy, and once I had to lay down on the bathroom floor because I was afraid I might pass out if I tried to get back into bed.)

When I woke up at 9, I got up and passed a rather large gray piece of tissue — not unlike ones I had passed earlier. I have no idea exactly what it was (at 6 weeks nothing resembled a baby at all that I could see, although admittedly I didn’t inspect too much), but after that my bleeding lightened up a lot. I’ve heard that once you pass the last of the sac and baby, the bleeding lightens up a lot. I passed a few small clots after that, but nothing like before, with the exception of another bigger one two days later. I still wore the giant pads out of paranoia, although I could’ve gotten away with normal-sized ones at that point.

All in all, it took more like 12 hours for the worst part to be over for me personally.

How much pain can you expect when you miscarry naturally after missed miscarriage?

You may have noticed that I haven’t said anything yet about cramping or pain. That’s because I didn’t have a whole lot of it. I had read some experiences of women not having much pain, but I figured that wouldn’t be me. When I miscarried at 7 and a half weeks, I remember having very strong, very painful period-like cramps. I had to expect that to miscarry naturally after a missed miscarriage at 10 weeks it would only be worse.

I was wrong. Although I had very mild cramps here and there, honestly it was not bad at all. I would actually largely describe the process as pain-free, physically anyway. The only really rough part was feeling dizzy and lightheaded because of the amount of blood. (Doctors do tell you to go to the ER if you feel dizzy or lightheaded — I just had a feeling for me it was because I was seeing so much blood, rather than because I was losing so much, if that makes sense.)

There are a couple things that make me think that maybe this is why it wasn’t that painful for me: 1. Since my first miscarriage, I delivered a healthy, full-term baby. I have to imagine that might’ve had an impact on this not being super painful? 2. Since I didn’t take the medication to force it to happen, my body reacted naturally and did what it knew how to do. 3. I really didn’t fight losing this baby. In fact, when the bleeding started, at first I felt only relief. In my previous miscarriage, it was almost as if I fought it and tried to will it to stop. (The circumstances were much different and I didn’t know if that baby was going to make it, while this time I knew the baby had already died). I do think fighting the pain vs. welcoming it made a difference.

In reality, though, these are all just guesses. I really have no idea why I didn’t feel cramping or pain. I’m not really sure there’s anything you could do to prevent it…and from stories I’ve read, I think I’m in the minority.

For how long (and how much) did you bleed afterwards?

Currently, at the time of writing this, it’s Monday night — 2 days after the worst part — and I am bleeding still, but actually lighter than a period. I thought I was done passing tissue and clots, but I just passed another large piece of gray tissue.

Now, Saturday evening — exactly a week later — I’m still bleeding, but it’s still continuing to get lighter.

Update: The following Friday, so just a day less than two weeks, the spotting stopped completely. (I also had taken misoprostol on that Wednesday to pass any of the remaining tissue — of which there didn’t seem to be any, since I didn’t do anything more than continue to spot a little or pass anything else after taking it.)

How long did it take for your HCG to go back down to zero?

I’ll have to update this later. I have an appointment for an ultrasound on Tuesday to make sure everything has passed. Then my OB said she would also monitor my HCG levels until they got back down to zero.

Update: As I’ve mentioned a few times earlier in this post, the ultrasound was inconclusive as far as if there was any tissue left and so my OB had me take misoprostol. If I could do it over again, I would definitely wait two weeks for an ultrasound. (Initially the scheduler wanted to get me in less than a week after I started miscarrying — when I was still bleeding quite heavily! — and I had to push for it to be a week and a half! Don’t get me started on my frustrations with the medical world.)

As far as my HCG levels go, they were at 88 a week and a half after I began bleeding. A week later, they were at 13. I have to go back one more time (hopefully just one more time) next week.

When can you try to get pregnant again (if you want to)?

The answer to this question depends. Obviously, ask your doctor first. I did a lot of research about that after my first miscarriage and wrote a post on it here. Again, I will update after my doctor’s appointment on Tuesday to see if I have anything new to add!

Update: My OB recommended — as I expected — to wait one cycle. I challenged her on that, because through my own research the only reason seems to be for dating purposes. She acknowledged that I was right, and that yes, I could actually get pregnant without extra risk before my next period — provided that my HCG levels were back to zero first before trying.

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