I'm not writing to tell you what to do. For one, it depends on a lot of different factors and everyone has different physical and emotional needs. For two, I'm not your doctor or midwife, so I can't tell you with any authority what you need in your case. This is just a run down on the comparison of the two (without graphic details) from my recent experience.
Why I originally chose to just let things play out at home:
-I don't like being put under as it makes me feel out of control
-I don't like surgery ... because again it makes me feel out of control
-The thought of delivering at home didn't make me feel emotionally freaked out and seemed natural
-I was not in a rush to conceive another child
-We use a health savings account along with insurance and I thought it seemed financially a better choice as long as it was safe and I stayed in contact with my OB/GYN
-I was not currently anemic or ill so the natural rigors of miscarriage seemed doable
-I didn't want my cervix manually dilated (of course because it felt out of my control ;) or my uterus scarred or damaged (very rare)
-I don't really like hospitals or drama and just wanted to be home during an event like a miscarriage
What would have made me more apt to consider a D+C (surgical removal of the pregnancy)
-If I had been ill or anemic
-If my OB/GYN had been completely apposed to a natural miscarriage for some reason
-If I was at risk for an infection for some reason
-If I had a history of hemorrhage
-If I wanted to conceive again as fast as possible
In my case, not everything went wrong with my natural miscarriage...but just about. How I didn't get an infection while training in pools for 8 weeks and swimming in open water seems to be a testament to the resilience of the human immune system (or a small miracle). But, I'm not sure I would change how I chose to do things even in retrospect. When deciding to do things at home naturally, you may risk a lot of blood loss. That seems to be a common risk across the board from talking to other women who have been through it. You will also need to be very sensitive to the signs of infection and too much bleeding in case there is retained tissue from the pregnancy. One thing I may have done differently, would have been to call into the OB office faster and let them know my "at home" pregnancy tests were still very faintly positive. I hadn't done that because they kept getting lighter and lighter and were sensitive tests, so I had planned on it taking several weeks or even months to be completely negative (when blood work was done, I still tested at about 3 weeks pregnant from retained tissue before the D+C, so very low). Had I called in, they probably would have done blood work to check my hormone levels and then followed that up with an ultrasound to make sure the miscarriage was complete if they weren't dropping fast enough or low enough. As it was, I just talked with the nurse over the phone and since I had no symptoms to indicate an incomplete miscarriage, I didn't go in for follow up blood work. When my first cycle after the miscarriage involved heavy bleeding I could have been concerned, but first cycles after a miscarriage are often characteristically heavy or longer than normal to clear out any tissue that needs to be flushed out, so I didn't really worry much since the heavy bleeding was in episodes not continual. I also partly blamed it on the fact that I taxed my body quite a lot with the training and racing the triathlon and felt like I had it coming from possible overexertion. :)
The picture Laura sent Luke out on the golf course...of me passed out, with my shirt sloppily edited to cover midriff (and see..I have my phone right there by me...you know...in case I needed help)
At this point, I felt like I was in labor only with very little pain and more dizziness/weakness...which actually...I kind of was in minor labor without realizing it. I was dilated to 4 cm and was shaky
(every picture of me in the hospital during labor looks strikingly just like this-the "I need lip balm and space stare")
After getting blood work back and having an exam, a D+C was recommended. Luke said that I possibly could have been handled by extraction without being put under (opinion being stated without doing the exam himself and hearing what the NP (and another doctor later) said while doing it)...but my hemoglobin was at an 8 and no one seemed willing to do anything that would cause me to start bleeding again. I was sort of stable so...why mess with a good thing before the OB doctor and other staff on call got there? They kept pounding the fluids and got the docs on call headed our way to start the surgery. I asked Luke to call my OB in Indy, but after missing a call back in all the commotion, he made the decision that moving me with hemoglobin levels reading low and with active bleeding, wasn't worth the risk of being at a bigger hospital. Being wheeled through the doors into surgery (without Luke) got me to a mental place of letting go and letting God work through all of these people around me. I really need to learn how to let good people help me when it's needed. I'm not so great at it. As I was being put under, I was surprisingly calm after praying that I would let go of control in this moment. The anasthesiologist said "okay I'm going to give you the good stuff" and I, feeling jolly, lifted my free arm and fist and said "yea...I didn't come to French Lick for nothing!" The D&C may have been one of the easiest the OB has ever performed as I was already dilated and ready to go. He told Luke that everything locked down just right as soon as the extraction was done. I asked for genetic testing to be done if possible, but the odds are very very low that we will get information back at this point. It was worth a shot. :) I'm feeling good if not fatigued two days later. It will take another week to feel like myself and then probably several months to build up my iron levels again. But I'm on the mend. The human body is pretty fragile and amazing all at the same time.
So...should you get a D+C or go all natural... I can't give you that answer. :) But I wish you all the best and hope you never have to make that decision...or have to do both.
Soon to follow...lovely pictures of our stay in French Lick that will make it seem like none of this even happened. ;) ;) Also as a side note...Luke and Caleb got vouchers to redo their round of golf and the hotel comped our room the second night. The customer service was quite outstanding. :)