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*TRIGGER WARNING* The following is a discussion of pregnancy loss and complications.
In a perfect world we’d never have to discuss the possibility of miscarriage or the need for medical interventions to complete miscarriages. But we live in a fallen world and positive pregnancy tests don’t always result in bouncing babies. Between 15-25% of pregnancies end in miscarriage. Even though so many women have this experience it’s largely shrouded in mystery, especially if your body doesn’t realize something is wrong right away. Most women will never discuss what their doctor told them or what intervention was deemed appropriate when the ultrasound revealed no heartbeat. So many women go around thinking that they only had one option, a D&C; or to be more precise, dilation and curettage.
Dilation and curettage is a surgical procedure by which the cervix is dilated so that a curette (a spoon shaped instrument) can be inserted into the uterus to scrape the uterus of tissues. While this procedure has become relatively safe it does carry risks including scarring the uterus, perforation of the uterus, excessive blood loss, and infection. Even with these risks for many doctors it has become a reflex to offer a D&C when things don’t go quite as planned in early pregnancy. I’ve spoken to several women over the course of my two losses who told me they were never told there was a pharmacological alternative or that they could simply wait and see if their bodies would miscarry on their own. Moreover, even if an invasive procedure is necessary to remove pregnancy tissues, recent studies how found that a manual vacuum aspiration (MVA) is more effective than a traditional D&C. Not only are there less risk of complications compared to D&C but the procedure itself is more cost effective. Due to these differences some have begun to theorize that the only real reason many doctors jump straight to D&C is because it’s a procedure that can billed for. The typical cost of a D&C is between $2,700 to $6,820, whereas a MVA is usually under $1000 and does not require anesthesia. Bottom line: it’s your body and you deserve to be told all the available treatment options and the risks that come with each one before you make a decision. Informed consent cannot be achieved if doctors don’t do the informing part.
So here’s my story:
On November 19th I received two ultrasounds to follow-up on the previous week’s ultrasound where my doctor was unable to locate anything that looked like an embryo or detect a heartbeat. Both ultrasounds concluded that I had pregnancy tissue but there was no heartbeat. Thanks to lots of prayer leading up to this news, I was very calm when I heard this. My doctor told me I had two options, I could take Cytotec (misoprostol) or I could opt to schedule a D&C. Having previously had experience with Cytotec with the loss of Sprout, I chose to take the Cytotec. I chose that option because I was not experiencing any signs of miscarriage and my HCG levels were high. I did not want to have a D&C done because at my age, soon to be 36, I did not want to risk any of the potential complications that come with that procedure unless absolutely necessary. My doctor called in the script but asked me to get one more HCG test before leaving the office.
Before picking up my prescription I went to Target and I picked up some of my favorite snacks and bought two new pairs of pajamas. I wanted to make sure that I felt comfortable as I knew it was going to be very uncomfortable; I would describe the feeling more like a mild birth than a heavy period. So I just wanted to have things that made me feel good. Full disclosure, I bought regular Coke and I drank it. I bought peanut M&Ms and I relished it. I didn’t have either thing in excess but I had some and it was great and helped me so much. I highly recommend you get things, foods, films that you enjoy before going into this.
Later that same day after I had already administered the Cytotec (it can be administered vaginally or taken orally – I was told to administer it vaginally this time), I got a phone call from the on-call doctor at my doctor’s office. She tells me that she’s concerned about how high my HCG is. It was 52,000 which is pretty normal for the number of weeks gestation I should have been. And she tried to get me scheduled for a D&C that Monday telling me that she thought, based on those numbers alone that it could be a molar pregnancy. I told her that I had already administered the medication and that at this point there was no going back and we would have to wait and see how that transpired. I told her I was already bleeding so I believed the medication would be effective, but that I would check in with the office and let them know how things went.
Taking Cytotec can be a miserable experience. To the point that my doctor wrote me a prescription for opiate painkillers (I didn’t fill it). Your cervix dilates and your uterus contracts. It typically starts working within 4 hours. I started it at 4:30pm and by 7:30pm had started bleeding, 30 minutes after that I started passing clots. I spent most of the night awake and so as not to disturb my husband or my son with my multiple trips to the bathroom I stayed downstairs on the couch in the living with our cat Lando. He was a great companion through the whole process. I passed several clots with tissue in them that first night.
Twelve hours after my first dose I administered my second dose, which was honestly very hard to place since I was bleeding heavily at that point. I think one of the four pills fell out. Regardless it was enough to keep things going. Saturday the 20th was spent on the couch running to the bathroom every hour. On Sunday the bleeding slowed and I sent my doctor a message via the portal letting her know that I felt the medication had been successful and I would go in for our predetermined follow-up appointment in two weeks.
On Monday morning, I received a phone call from the nurse that works with my doctor telling me that the doctor wants me to come in that very same day and that I’ve been prescheduled for a D&C. I tell her that I’m not coming in to do any such thing because I’m still actively bleeding and don’t feel that it’s necessary yet. I tell her that I’m monitoring myself for signs of infection and know what to do should I spike a fever or experience excessive bleeding. She tells me that I need to go get more bloodwork done. I tell her it’s been too soon since starting the process and that the blood test probably wouldn’t tell us much and that I think it’s unnecessary. I tell her I’m comfortable with waiting until my appointment on December 3rd.
Around noon that same day I get a phone call from doctor. She tells me that she really wants me to come in. That she’s concerned because she wasn’t expecting my HCG to keep rising. I tell her that we already started on the Cytotec path and regardless of what the tissues may be comprised of, it’s possible that the Cytotec was enough to deal with it completely since I’m still so early. She insists and so I have to push back with data. I tell her that typically molar pregnancies would have HCG levels above 100,000 at this point. I tell her that my pregnancy symptoms are already gone. And I tell her that even if it’s ultimately necessary I would feel more comfortable giving my uterus and cervix a bit of time to recover than to poke at them after what they’ve experienced over the weekend so I will wait. She tells me she’s going to put a note in my chart stating that I’m refusing to come in. I tell her “fine do what you need to do but what if you’re wrong and you injure me because I came in too soon, my decision may be protecting you too.”
Looking back on it now, I feel it was the Holy Spirit convicting me in such a way. I was so adamant and confident that this was not the thing to do and I was not going to be bullied. Little known fact, Cytotec can take up to 72 hours to reach full efficacy. After I got off the phone with my doctor I started getting crampy. I thought it was just an upset stomach probably from all the things I’d been through over the last 3 days. That night I went to bed with this feeling like I needed poop but couldn’t. I thought it was just constipation and forced myself to sleep.
The next day my lower abs felt achey, almost like I’d been doing lower ab exercises all night. I thought it was the constipation’s fault and took it easy that morning. About 1pm after I’d put my son down for nap, I sat down in the rocking chair in the living room. I worked for about 15 mins before getting this heavy feeling in my pelvis. I got up and rushed to the bathroom and PLOP! The biggest clot/mass of tissue yet came out. It was about two inches long and I knew right when I saw it that the miscarriage was complete. I got down on my knees and I thanked God for being with me and helping me through this; for giving me the confidence to advocate for myself.
I had prayed in the lead up to the ultrasound findings for God to heal my womb and I truly believe He did. At the time I thought that prayer would get me a healthy baby for July but really what that prayer did was prepare me for a future healthy baby. And that thought has given me a lot of peace because God doesn’t always answer our prayers the way we expect but He does work all things for good. So I definitely believe my rainbow is coming.
After the large mass came out, I kept bleeding for 5 more days. The bleeding was comparable to a heavy period, with it tapering off as the days progressed. All together I bled for 9 days. Once my bleeding stopped I started taking pregnancy tests to see if my HCG levels were going down. Sure enough, each day my positive line got a little lighter. With Sprout I got a negative test on Day 18 after beginning the process of miscarrying. This time around I got my negative on day 21. Typically it takes between 2 to 6 weeks for HCG levels to go back down to zero (usually dependent on the length of the gestation at the time of the loss). Because my levels were going down and I wasn’t experiencing any pain or other complications once my bleeding stopped I also cancelled my follow-up appointment and informed the practice that I was going to be switching providers. At this point I just don’t feel comfortable going back there between my experience while pregnant with Rigel, the long unnecessary wait times in the office, the unnecessary tests, and the negative perception of what the female body can do.
Now my focus returns to continue to get fit. I put on 3lbs with this pregnancy (about 5lbs less than what I put on with Rigel in the first 8 weeks I was pregnant with him). Of those three pounds, I have lost 2lb in the last week and figure the rest will come off pretty easily implementing the same things I’ve been doing since summer. We’ll probably try to get pregnant again in a couple months.
Is it right for you?
Remember health decisions are always going to be highly individualized. You might be a wait and see kind of person or you might be a rip it off like a bandaid kind of person. The pharmacologic route works best if you are under the 11 week mark and is the most effective if you’re measuring at about 8 weeks or less, basically before the placenta attaches to the uterus. You’ll want to consider how far along you are when making your decision as well as your age, pain tolerance, and your level of accepted risk. Taking Cytotec is not the fastest option but all of the options will have at least a few days of bleeding and will have some amount of pain.
I hope you never have to have this conversation with your doctor but if you do ask them what all your options are. They include wait and see, medication, manual vacuum aspiration, and dilation & curettage.
If you’re here because your doctor gave you some unexpected news I just want you to know that there is hope after miscarriage. You can go on to make a wonderful little baby. If you leave me a comment below I’ll be sure to add you to my prayer list. I’m sending all those of you reading this with pain in your hearts hugs and baby dust. There will be a rainbow after this storm.
Here if you need me,
