When a baby dies in the womb, the method used to deliver depends primarily on how far along the pregnancy is. In the first trimester, doctors may offer the option of waiting for the body to pass the pregnancy naturally or performing a brief surgical procedure. In the second trimester and beyond, the two main approaches are a surgical procedure to empty the uterus or induced labor, where medication helps the body deliver vaginally. The choice between these options depends on gestational age, medical circumstances, and in many cases, the preferences of the parents.
First Trimester: Before 14 Weeks
At this stage, there are generally three options: expectant management (waiting), medication, or a surgical procedure.
Expectant management means allowing your body to pass the pregnancy on its own. Given enough time, up to eight weeks, this happens successfully in about 80% of cases. It is generally considered safe only during the first trimester, because the risk of heavy bleeding increases at later gestational ages. During this waiting period, your care team will monitor you with follow-up visits to confirm the process is progressing safely.
If waiting isn’t preferred or isn’t progressing, medication can be given vaginally or orally to help the uterus contract and pass the tissue. The other option is a surgical procedure called suction aspiration, where the cervix is gently opened and the uterus is emptied using suction. This is a short outpatient procedure, typically done under local anesthesia or sedation.
Second Trimester: 14 to 24 Weeks
After 14 weeks, the approaches shift because the pregnancy is larger. The two main options are a surgical procedure called dilation and evacuation (D&E) or medically induced labor.
Dilation and Evacuation
A D&E requires the cervix to be gradually opened beforehand. This is done using thin sticks made from seaweed material (laminaria) or synthetic versions that work the same way. These sticks absorb moisture from your body and slowly expand, widening the cervix over several hours. Laminaria typically need 12 to 24 hours to reach full expansion, while synthetic dilators work in about 4 to 6 hours. The insertion itself takes about five to ten minutes, and you’re awake for it. A numbing medication is applied to the cervix to reduce discomfort.
Once the cervix is adequately dilated, the actual procedure is performed under sedation or anesthesia. The doctor removes the laminaria, then uses suction and surgical instruments to empty the uterus, guided by ultrasound. The procedure itself is relatively quick, and most people go home the same day.
Induced Labor
The alternative is inducing labor so the body delivers vaginally. Before 28 weeks, the most effective method uses a medication placed vaginally that causes the uterus to contract. This medication is given in doses every few hours. Studies show it is effective in achieving complete delivery within 48 hours in virtually all cases, though most people deliver sooner than that. In some situations, a different medication given through an IV may be used instead.
Induced labor for a stillbirth feels physically like labor at that gestational age. You’ll experience contractions and deliver vaginally, and pain management options including epidurals are available. Some parents choose this route because it allows them to see and hold their baby afterward, which can be an important part of grieving. Others prefer the D&E because it is faster and avoids the experience of labor. Neither choice is more “correct,” and your medical team can help you think through what feels right.
Late Second and Third Trimester: After 24 Weeks
When a baby dies later in pregnancy, induced labor becomes the primary approach. The process is similar to what’s described above, though the labor may take longer and the experience more closely resembles a full-term delivery. Cesarean section is generally avoided unless there is a specific medical reason, because it carries greater surgical risks for the mother without a benefit to the baby, and it affects future pregnancies.
Why Timing Matters
When a fetus has died, there is no immediate emergency in most cases, and waiting a short time to make decisions is safe. However, prolonged delay does carry medical risks. If a deceased fetus remains in the uterus for an extended period, roughly 25% of women develop a serious blood clotting disorder within five to six weeks. Laboratory changes can begin appearing even earlier. This is one reason care teams discuss a plan for delivery relatively soon after the diagnosis, even while giving families time to process the news.
Tests After Delivery
After delivery, your medical team will likely recommend testing to try to determine why the baby died. The placenta is sent fresh to a pathology lab, where three key tests are typically performed. First, it’s tested for infection, since infection remains a significant cause of fetal death. Second, a tissue sample may be stored for metabolic studies if something unusual is suspected. Third, tissue from the umbilical cord or placenta is sent for genetic analysis to check for chromosomal abnormalities. A fetal autopsy may also be offered. These results don’t always provide a clear answer, but when they do, the information can be important for understanding the risk in future pregnancies.
Physical Recovery Afterward
Regardless of the method used, your body goes through a postpartum recovery. Vaginal bleeding is normal and typically lasts four to six weeks, becoming lighter after the first two to three weeks. Bleeding that remains heavy beyond one to two weeks warrants a call to your doctor.
One aspect that catches many people off guard is breast milk. Your body may begin producing milk, even after a loss in the second trimester. If you want to suppress milk production, the key is to avoid pumping or expressing milk regularly. Instead, hand express just enough to ease discomfort, wear a supportive bra, and use cloth-covered ice packs on your breasts for 10 to 20 minutes several times a day. Ibuprofen or acetaminophen can help with the discomfort. Avoid applying heat, which can increase milk production. The milk supply typically dries up within several days to a couple of weeks.
Hormonal shifts happen rapidly after delivery. A pregnancy test may still show positive for several weeks as hormone levels decline. These hormonal changes can intensify feelings of sadness on top of the grief you’re already experiencing, and that combination is completely normal. Your body needs roughly four to six weeks to physically recover, though the emotional timeline is its own process entirely.