Managing Miscarriage: Understanding Your Treatment Options in Malta

Miscarriage is an incredibly difficult and personal experience — one that no woman should have to go through alone or without clear information. Yet in Malta, many women are not aware that they have choices when it comes to managing a miscarriage, and often simply follow the instructions they are given without knowing there are different options. This article aims to shed light on the various approaches used locally and abroad, enabling women to feel informed, supported, and empowered to make the choice that is right for them.

Based on research and conversations with women and healthcare professionals, this guide outlines the most common methods for managing miscarriages used at Mater Dei Hospital. It highlights a modern option, Electric Vacuum Aspiration (EVA), which, although not currently available locally, is widely used abroad.

Above all, it is your right to know your options and to advocate for the treatment that aligns with your needs, both physically and emotionally.

One of the women WHAM spoke to shared:

“I had no idea there were different options — I only know now because I went through three miscarriages and experienced all of the different methods available in Malta. The medical one was the easiest for me, although it was also the most painful.”

Hearing from women who have experienced this first-hand reminds us how vital it is to be fully informed. Below is a breakdown of the most common methods currently available in Malta, along with a look at one option used abroad.

1. The Expectant Method

The expectant method is a non-interventional approach, where the body is allowed to naturally expel the pregnancy tissue without medical or surgical intervention. While this method can allow for a more natural process, many women face unique challenges:

• Emotional and Physical Stress: Women may feel anxious and uncertain as they wait for the miscarriage to complete, which can take days or even weeks. Physical symptoms like heavy bleeding and cramping can be intense and distressing.
• Risk of Incomplete Miscarriage: Sometimes, not all of the tissue is passed, which may require additional medical or surgical intervention.
• Isolation and Lack of Support: Because the expectant method is largely a waiting game at home, women may feel unsupported or unprepared for the physical experience. There may also be societal stigma around discussing miscarriage, adding to the isolation.

2. The Medical Method

In the medical method, medications such as misoprostol are used to help the uterus expel the pregnancy tissue. This method is often used if the miscarriage has been diagnosed but the body hasn’t yet passed the tissue on its own.

• Less Waiting, More Control: Many women find this method helpful because it allows the process to be somewhat controlled and completed within a predictable timeframe (usually a few hours to a few days).
• Physical Discomfort: The medications can cause cramping, bleeding, nausea, and vomiting. The process can feel similar to a natural miscarriage, but is often more intense due to the medications.
• Follow-up Care: After taking the medication, a follow-up appointment is often necessary to ensure that all the tissue has been passed. If the process is incomplete, surgery may be required.

3. The Surgical Method (D&C and D&E)

The surgical method involves a procedure called D&C (dilation and curettage) or D&E (dilation and evacuation), where the cervix is dilated, and the pregnancy tissue is removed from the uterus using surgical instruments. This method is often recommended for women who are unable to wait or have incomplete miscarriages.

• Quick and Controlled: The surgical method is usually done under general or local anaesthesia, and the procedure itself is typically quick (about 10–20 minutes).
• Lower Risk of Prolonged Bleeding: Since the procedure removes all of the pregnancy tissue, the risk of prolonged bleeding is reduced compared to the expectant method.
• Recovery and Risks: While the recovery time is typically short, there are risks associated with surgery, including infection, injury to the uterus, and scarring. Emotional recovery can also be difficult for women who feel that they didn’t have the chance for a natural closure.

4. Electric Vacuum Aspiration (EVA)

Electric Vacuum Aspiration (EVA) is a specific surgical method that is often used in the management of early miscarriages. It’s a more advanced and less invasive form of suction curettage compared to traditional D&C.

• How It Works: EVA uses gentle suction from an electric vacuum device to remove pregnancy tissue from the uterus. It’s typically performed under local or general anaesthesia and can be done more quickly than other surgical options.
• Minimally Invasive: Unlike traditional D&C procedures, EVA is generally less traumatic for the uterus and has a lower risk of uterine perforation or scarring. It’s also a quicker recovery procedure compared to some other surgical options.
• Quick and Effective: EVA is highly effective in removing all pregnancy tissue in a single procedure, thereby reducing the need for follow-up procedures.
• Less Emotional Stress: Because it is a controlled and precise method, many women find the process less emotionally taxing, as it provides a clear and definitive end to the miscarriage process.

Emotional and Practical Considerations Across Methods

• Expectant Method: Women may feel unprepared or unsupported, and the waiting can delay emotional closure.
• Medical Method: While it provides a more controlled and predictable timeline, the physical discomfort and side effects of the medication can add stress.
• Surgical Methods (D&C, D&E, and EVA): These offer more control and a quicker resolution but may leave women feeling less connected to the natural process. EVA, in particular, offers a gentler alternative to traditional D&C with fewer risks and faster recovery.

Miscarriage is an incredibly personal experience, and each woman’s journey through it is different. The choice between the expectant, medical, or surgical method depends on various factors, including physical, emotional, and personal preferences.

Electric Vacuum Aspiration (EVA) offers a more modern and less invasive surgical option, providing many women with a quicker and more effective resolution, along with fewer risks. Whether you choose the expectant, medical, or surgical method, it’s crucial to have open conversations with healthcare providers, understand the benefits and risks of each option, and ensure emotional support is available.

Whatever path you take, remember that healing is not just about physical recovery; it is also an emotional journey that deserves compassion and support. With the right information and care, you can make the choice that best honours your body, your well-being, and your personal needs.