Personally, I didn't realize there was a choice. I was far less enlightened then than I am now since joining MDC.
When I lost my first in 2005, it was so early, nothing was ever suggested to me -- that loss was at about 5-6 weeks. I never POAS with that, just had a beta done at the OB office on a Friday at end of business. On Monday morning they called with a "Congratulations," but I had already been bleeding for a couple of hours. Because I wasn't in distress or anything, they never suggested I may have been. They just had me come back in to verify my HCG levels were dropping normally, and they were. So that loss was natural without me ever realizing there were other options.
My second loss with Ainsley was at 8w5d. I called my OB with cramping and bleeding, and they said not to worry, but to come in to be checked. Immediately after the call, I passed an intact sac with baby floating inside, and then began literally hemmoraging. I bled so much and passed enormous clots -- I cannot tell you how much I bled. In retrospect, I seriously do not know how I survived. I had never experienced that sort of thing before, so even though I was freaking out from all the blood, I somehow thought everything would be ok. After I got to the OBs office, I lost conscoiusness twice and when the OB was finally able to revive me, he said an ambulance had been called, but I didn't have time to safely wait. I realized then things were worse than I thought. The hospital was across the street, and I didn't have time to wait for the ambulance. Four people helped me to my mom's car and she got me there. They wheeled me in, immediately squeezed bag after bag of saline into my veins to get my bp back up and made me sign releases to accept blood transfusions if they became necessary. Fortunately, my bp stabalized and I began to slowly regain color (evidently, I looked very gray). My OB was right there, and I was immediately wheeled back for a D&C. He said later there was still an incredible amount of tissue still inside, though I had been passing softball sized clots one after another for more maybe two hours by then. After my D&C, I had minimal spotting, and was able to sort of move forward and begin the healing process.
Zachary was not a miscarriage, but a second trimester birth that ended in demise due to extreme prematurity.
As for the decision I would make now -- if I conceived again, and had a missed miscarriage, I would opt for a D&C. I personally would wait a few days only to verify that baby truly was no longer living and have a followup scan or two, and then would go straight for the D&C. I had one that turned so bad and I believe nearly killed me that I personally wouldn't risk it again. For me, I was fine one minute, and things were really frightening in less than a half hour. I think the major risk associated with a D&C is the loss of a uterus, and in my opinion, I'd lose it in a minute rather than have my family lose me. I know there are anesthesia risks, but again, that seems far more controlled to me than the risk of hemmoraging alone.
Personally, I know I wouldn't like to handle the emotional pain that accompanies a drawn out miscarriage. I commend all the mommies who go that route. But that's a back burner issue for me. I did it once because I didn't know better, but if I had to do it again (which I pray I don't), I would choose the D&C.
Now, my situation is very probably unlike anyone else's. I have a progesterone issue for which I take supplements during pregnancy. I take very high doses, which is probably the cause of all the bleeding and enormous clots. On the one hand, that fun when I'm 8 weeks pregnant, and look like I'm 4 months. My maternity clothes get tons of use! On the other, it keeps me on my toes in an effort to prevent a repeat of that scary October afternoon.
I think the bottom line is that we each have to make our own decisions, no matter how hard they are for us or others to understand. No one wants to decide what method by which to have a miscarriage -- I think we'd all like to avoid them altogether -- but if they're imminent, I think the method by which you're most gentle with yourself is the best method for you.
I'm sorry for your loss...