I've read a few posts on here with people asking about MVA (manual vacuum aspiration) under local and i thought it might be useful to share my experience. I'm going to share stuff that some might find a little detailed so if you're squeamish or sensitive, best not to read on. When i was trawling through these boards before my MVA, I really appreciated any posts that were upfront and told it like it was, so that's what i'm going for here.
Before i start, i want to say how sorry i am for anyone who has experienced a miscarriage, at whatever stage of pregnancy. It is a truly horrible and upsetting thing to have to go through and my heart goes out to you all 
So, two days agi I was diagnosed as having a missed miscarriage at 7weeks+6 with my first pregnancy - they thought it is likely to have stopped growing at 6 weeks. I am 38 and the pregnancy happened quickly and was something of a happy surprise! I had gone to the GP in the morning to get referred for my antenatal booking appointment, but mentioned to the doctor that i had some very light spotting that morning, and had experienced mild cramping for the duration of the pregnancy - two things that could easily be deemed as normal for the first trimester. More importantly i had felt that my pregnancy symptoms had lessened over the past week, so she referred me to the walk in EPU clinic that same day.
I was seen by a clinician a few hours later, who gave me an internal scan (vaginal probe, easier than a smear test, but similar set up) and confirmed that there was no heart beat and just a sac remaining. He was incredibly sympathetic and explained everything to me including what to do next.
The options were: letting nature take it's course and allowing the miscarriage to occur naturally (for a MMC this could take over a week); Taking medication to speed up the miscarriage process, which would usually take 24-48 hours (if the medication works first time, which isn't always the case); and finally surgical intervention, either under general or local anaesthetic, which would be a quick, simple procedure using a vacuum to clear the uterus, taking less than half an hour (like i say, apologies for those who may find this sensitive and upsetting. I am simply stating the facts, and trying to take the emotion out of it, as that is what i find most useful for me where i am searching for answers and support!)
I went home, head spinning, to think about my options but after an hour or so, i decided that i wanted to get the whole process over and done with as quickly as possible, so that my boyfriend and i can move on and TTC again sooner rather than later (I'm not getting any younger!! 
I am not keen on general anaesthetics, and decided to choose and MVA under local. I rang the EPU and they booked me in for the procedure the next day.
Of course, I then made the mistake of googling MVA under local, and there are (as expected) a number of negative stories about this process, and i'm not denying that a number of women have really had a horrible time, but all the more reason why i wanted to share my experience and redress the balance.
Now, i have to point out that I have a high pain tolerance and am perfectly comfortable with hospitals and medical procedures, including gyneacological stuff and injections etc., so i am already at something of an advantage compared to those of you poor ladies who hate all things 'hospital'. I would like to point out now, that if you do struggle with medical procedures, or find smear tests traumatic, MVA under local is NOT the option to choose.
So what follows if the procedure - sensitive details to come.
The morning of the mva, i was told not to eat/drink anything after 7am, take pain killers at 8am and had to be in the clinic at 9am. The clinician then inserted a device into my cervix that dries the area and then gently dilates the cervix. I would describe this insertion process as being uncomfortable, but not painful - there was a point where he checked the device was secure by gently pulling on the uterus, which was an odd feeling but nothing traumatic. It took a matter of seconds. Once the device was fitted, all i felt was similar to mild period pains. Nothing you can't handle! There is always a nurse there to who can hold your hand and give you a reassuring squeeze should you need it! I was then sent home for a few hours to let the device do it's thing, and told to come back at 3pm.
I brought my boyfriend along for the afternoon appointment, as i was advised you may want someone there with you afterwards, in case you feel a bit woozy etc. Your partner/friend can come into the room with you for the procedure if you want (i chose not to have my BF there) but they should be aware that if they do come along, they will quite possibly be able to see the material that's been removed (something the patient can easily avoid by simply not looking, staring at the ceiling or closing your eyes) so just a warning.
SO, here's the gritty bit. The mva itself. Firstly you have a speculum inserted, exactly like a smear test. No bother. Then the doc injects the cervix with local anaesthetic. This feels like nothing more than a scratch. He then did two more, and i was numb in seconds. This does NOT numb the uterus, just the cervix. All the way through, the doctor told me exactly what he was doing at every stage, and reassured me that if at any point it was too painful or uncomfortable then he would stop. After that the nurse uses an ultra sound scanner on your tummy so the doc can see what's going on, and they insert a tube into your uterus. Not painful, but uncomfortable, i would say. It is like your body is going 'Hold on a minute, you shouldn't be going in there!', IYSWIM. Just odd. Next the doc then uses a syringe, and this is where the cramping will happen. He vacuums the material, let's call it, for 5-10 secs, maybe three or four times. When this happens, there is pain to a degree, but it is very short lived and similar to sharp period pain or, for those of your who have experienced it, ovulation pain. Again, nothing that you haven't already felt before, and nothing you can't handle. Once the doc had removed all the material, it's over. The whole thing probably took about 15 minutes, with the 'vacuuming' taking less than a minute. I'm not going to lie, I was utilising my mindfulness breathing techniques during the vacuuming, but more because of my anxiety about what was about to happen, rather than anything to do with pain.
After that, they take your blood pressure, and put you in a room with a sandwich and a hot drink for an hour to check that you are OK, and that you aren't bleeding too much. I was out of there and at home with a plate of Camembert by 5.30pm. I did experience a bit of bleeding, similar to the first day of my period for a few hours after the procedure, but by bed time it was down to some spotting and intermittent cramping. All normal things to experience following an MVA. This all happened yesterday, and today i am still having some cramping and spotting, but nothing a couple of paracetamol can't fix.
All in all, the whole thing took less than 24 hours from finding out i had miscarried to being at home, everything over and done with. I am glad that i chose the option of MVA under local. I felt like i was in control of everything throughout, which is important for some folks, and I cannot praise the staff at UCLH enough for being totally amazing - friendly, reassuring, sympathetic, informative and completely brilliant I LOVE the NHS (and didn't stop telling them that whilst i was there!)
Emotionally i have been OK - I have approached this whole thing rather philosophically, since the way i see it, nature decided that this pregnancy wasn't viable and did it's thing. This embryo was never going to become a healthy baby, so i am not grieving as such, however, i am feeling sad for the lost future and hope me and BF had for our potential child. However, i was pleased to know that we could conceive, and will be TTC again once AF is back. I did have a weep today, which came out of nowhere, but i know that it takes a while for your hormones to settle down so not unexpected. I'm just going to be good to myself over the next few weeks and allow my emotions to do their thing until they are settled.
So, after this Looooooooong post, my main points would be that MVA under local is not for the faint hearted, or those who hate hospital procedures, but i would recommendit. It is quick, the recovery time is fast and has no more risks post procedure than the other options. Those who fear the pain of MVA, i think i'd rather experience a little pain and discomfort for 10 minutes, rather than over a few hours, or even days if i was to miscarry naturally. If you are feeling very emotional about your miscarriage, this option may be a bit too clinical for you. They are medical professionals, so discuss the embryo/foetus in medical terms, so be prepared for your lost pregnancy being referred to as 'retained products of conception' - although neither the doctor or the nurses directly referred to it as this to me (just on paperwork). SO that's it. I hope this is useful/informative/reassuring for those of you who are considering this procedure, and do direct message me if you want to ask any questions. Miscarriage is still such a taboo subject that i feel the more we all take bout what is SUCH a common occurrence, the more we can support each other and get through what is a really miserable thing to have to go through.
We are all in this together, and here's hoping for happy future pregnancies.