The Miscarriage – From Naivety to Reality: Part 2

After finding out about the miscarriage I sat in the doctor’s office crying, overwhelmed and at a complete loss of what to do.  My initial instinct was to get as far away from any medical technology as possible.  I could not even fathom any type of abortion procedure at that time; it made me sick.  After we had adjusted to our new normal, I realized that I couldn’t wait for the miscarriage to happen naturally.  Being as far along as I was, with my hCG levels as high as they were, it could take weeks for my body to miscarry naturally.  The extra cruelty of a missed miscarriage (as if it could be any more cruel), is that my body thought it was still pregnant.  The pregnancy symptoms I had been experiencing were still in full force.  Morning sickness and exhaustion would be well worth it, if it was for the benefit of my little one growing inside me.  To experience those symptoms knowing that I would never hold my baby was just pure torture.  I had to do something.

After doing some research online and speaking with the nurses at the fertility clinic, we scheduled another ultrasound to be done one week after we had received the terrible news.  If there was no heartbeat and no development at the second ultrasound, we could be sure that the pregnancy was not viable.  As a secondary confirmation, I would also have my hCG levels measured again.  If my hCG had dropped from previous testing then we could be sure of the miscarriage.  There was no way I was ending my pregnancy without full confirmation that it was no longer viable.  I couldn’t live with myself without knowing for sure.

Every time the fertility clinic called to check in, I told them I still felt as pregnant as ever.  I felt so betrayed by my body.  I never had any spotting or bleeding or cramping.  No signs whatsoever of the death that took place.  My baby just slipped quietly away, without me even knowing.

The fertility clinic was such an amazing source of support for me during this time.  Suddenly, the hundreds of dollars of clinic fees seemed totally worth it.  A few days after we found out about the miscarriage I called the nurses to get some more guidance.  I was sitting in my car during my lunch break, as our office walls don’t provide much privacy, and started asking about my options.  I soon broke down into tears.  The nurse was so sweet and understanding.  She listened to me cry and said that it was a terrible thing that was happening to me.  It was the first time someone had said that to me and it felt so validating.  She didn’t try to tell me that everything was okay or that I’d have better luch next time.  It was a terrible thing.

A couple days before the second confirmation ultrasound, I knew I had to figure out what I was going to do if we found out for sure that the pregnancy was not progressing.  We had three options: (1) expectant management (wait and see); (2) medical management with misoprostol to induce abortion; or (3) surgical management with dilation and curettage (D&C).

Each option sounded worst that the last.  I never dreamed that after working so hard to get pregnant, I would have to work even harder to end my pregnancy.

Before I go into how we made our decision, let me say that there is no one-size-fits-all choice for everyone.  Unless there is a medical emergency, there is no “right” answer.  Each option comes with it’s own consequences and each person needs to make a choice that suits them in their circumstances, in conjunction with their health care provider.  I spent hours reading stories about all three options, all with extremely different outcomes.  Reading through the stories of people who have had to deal with miscarriages helped me determine what was important to me, which led me to make the decisions that I did.  My experiences that follow are in no way a substitute for medical advice, nor are they a guide for how every woman should handle a missed miscarriage.  This was just how my story unfolded for me.

Expectant management simply was not an option for me.  I could not imagine weeks of waiting for bleeding to start.  Many women opt for this choice, as they feel it is more natural and doesn’t involve any intervention.  I completely agree and that was my initial reaction to finding out about the miscarriage.  Perhaps if I wasn’t as far along I would have waited.  Based on my hCG levels, it would be weeks before my body figured out that I was no longer pregnant.  The other downside is that there was a risk of infection, as the remaining tissues from the pregnancy would be in my uterus until my body could expel them.  I guess didn’t have the courage to wait it out, and maybe that makes me weak.  I just couldn’t bear it.

The second option of medical management seemed to be the middle ground between an invasive D&C procedure and waiting for the pregnancy to pass naturally.  Using the misoprostol pill, I could have the miscarriage in the comfort of my home (not that there was going to be anything comfortable about it), in my own time and with the support of my wife.  There would have been a day or two of downtime following taking the pill and then we could move on.  The nurses at the fertility clinic said that when the pill works, it works very well for most women.  There is bleeding for 1-2 weeks and then it’s done.  The risks of this option included excessive bleeding, uterine rupture and not fully passing the products of the pregnancy.  If the pill didn’t work, then a D&C would be the next step.

The D&C would have been the fastest way to deal with the miscarriage, but the procedure sounded so awful.  I kept imagining myself, legs wide open on the operating table, vulnerable to the world on the operating table with a doctor digging around in my uterus, scraping out the remains of my pregnancy.  I had horrible visions of only being under conscious sedation (instead of being put totally under) and feeling the pressure and pain of the instrument inside me.  It filled me with such anxiety that it made me cry just to think about it.  I already felt so traumatized by the whole experience, that I wanted to handle the miscarriage quietly, on my own terms.  The risks of a D&C included the usual risks of any surgery (bleeding, infection, anesthetic etc), as well as scarring from the procedure, potentially leading to infertility.  This is known as Asherman’s syndrome, and it is extremely rare, but I didn’t want anything ruining my chances of getting pregnant in the future.

Medical management seemed to be the “best” option for me.

I called the fertility clinic on Friday to request a prescription for misoprostol and a pain killer, to ensure that it was ready for me on Monday after the ultrasound.  If we got the confirmation we were expecting, I couldn’t wait another day for the miscarriage.  I just wanted to move on.  The nurse I spoke to agreed with my decision with gentle encouragement.  The nurses never once told me what to do, but said that whatever I chose would be a good option.  She said that the pill works within a few hours and it was very effective for most women.  I hoped that I fell into that category.

On Monday, our nightmare was confirmed.  My wife and I handled the news in a matter-of-fact way, though our hearts were heavy with sadness.  We were much more prepared for the disappointment.  I don’t think it made anything easier, we just didn’t feel the shock that we had at the last appointment.  We knew the miscarriage had happened, but we wanted confirmation in order to move on.  In addition to the ultrasound showing no progress or heartbeat, my hCG levels had also dropped slightly.  Now we knew for sure.

We went straight to the pharmacy to pick up my prescription.  To make matters worse, the pharmacist could barely look me in the eye when he handed me the misoprostol.  He obviously knew that the medication was for an abortion.  He mumbled something about inserting the pill vaginally and that there would be no side effects because it was a local application.  He didn’t say anything else and awkwardly handed me the bag.  I felt so embarrassed and angry.  I wanted to tell him how much I wanted my baby.  I wanted to scream at him that I never wanted this to happen and that he should act like a professional and give me the information that I needed without judgement.  No side effects?!  How about bleeding excessively or uterine rupture?  How about intense nausea and diarrhea?!  He also told me only to take the T3s if I had pain, as if I was planning on going home and getting high on codeine. I was so upset.  After such a painstaking and devastating decision, to be treated with such disrespect was a slap in the face.

I tried to brush off the negative encounter and hoped that I was maybe just particularly sensitive given my present circumstances.  My wife and I picked up grapefruit juice, a McCain’s chocolate cake and some ice cream.  I knew emotionally eating is really counter-productive.  Given what I was about to go through, I really didn’t care.

At home, I nervously unpackaged the misoprostol and, like a good nurse, carefully read all of the instructions and side effects.  Contrary to what the incompetent pharmacist had said, there were side effects even when the pill was inserted vaginally.  I inserted the 800 mcg dose, which was 4 tablets total.  The tablets were uncoated and awkward to insert.  The medication is actually for stomach ulcers, with an off-label use for inducing abortion early in pregnancy and inducing labour.  The nurse at the fertility clinic told me sometimes it only takes an hour for the pills to work.  I put on a pad and anxiously awaited the effects.  My wife and I got into bed, and started watching Voyager (I may be a bit of a Trekkie) and had some cake.  I was so glad to have her there with me.  I couldn’t imagine going through it alone.

Five hours later I began cramping.  It was worse than any menstrual cramps I have had.  I read that the sensation is very similar to contractions, so I tried to breathe through them, imagining that they were practice for labour later on down the road.  I was glad I had taken a T3 and an ibuprofen earlier.  The cramps were so bad I was just moaning and breathing, lying on my side, hoping they would be over soon.  Then the cramps subsided a bit and I was slammed with a huge wave of nausea.  I jumped out of bed and almost missed the toilet.  I vomited violently five or six times while my wife rubbed my back and held my hair.  No side effects, my ass.

The nausea retreated as quickly as it had come on and I was back in bed dealing with the tail end of my cramps.  The cramps only lasted an hour, thank goodness, but I had not actually bled yet.  It was very late at night, since I was not expecting the misoprostol to take so long to work, and I ended up drifting off to sleep.  In retrospect, this was probably a little bit dangerous as I could have bleed excessively in my sleep.  I woke up in the middle of the night and went to the bathroom.  As soon as I stood up, blood was running down my legs.  I had completely soaked the pad I was wearing and could feel clots and blood passing as I sat on the toilet.

I was both relieved and totally heartbroken.  As I was getting back into bed, I remembered that some women had kept the tissues they passed to bury them.  I felt like I was a terrible mother for not showing more respect for the life inside me.  But I didn’t know what else to do.  I didn’t know what I was supposed to do.

I was so emotionally drained.  I hoped everything would seem better in the morning, but I knew it was probably going to be worse.

I rested for the next two days at home, which I felt guilty about because I needed to save my sick time for the next round of IUI.  But I was exhausted and depressed and still having frequent outbursts of tears.  I was also still bleeding quite a bit and I really didn’t feel like I could deal with that at work.  I watched Netflix and my wife brought me cake when I asked for it and we cuddled.  We did the best we could to grieve and comfort each other.

During those two days, we also received a lot of support from our close friends and family who knew about the pregnancy.  Every text, Facebook message and phone call was so very appreciated.  One of my amazing friends back home sent us a wonderful care package with a vegan cookbook and a kilogram of gummy bears.  You can bet I ate every single one of them in less than a week.  I understand why people want to keep pregnancy and miscarriage private.  At the same time, having all of the support of our friends and family made everything so much more bearable.  Every time someone asked me how I was doing, it allowed me to process and express my grief.  Don’t get me wrong, it hurt like hell.  But I think it was better than hiding all of that hurt in my heart.

______________________

As I said in my last post, the misoprostol did not work for me and I ended up bleeding so much that I soaked through my clothes at work two weeks after taking it.  This resulted in a trip to emergency and a D&C procedure, the details of which will be in my next post.

Despite my initial pangs of regret for telling everyone that we were pregnant, I now am so thankful that we don’t have to hide the pain we are experiencing.  Countless friends and family members have reached out to us, offering condolences, compassion and care packages, for which we are so incredibly grateful.  Knowing that we are not alone has made this dark time in our lives a little bit brighter.  Thank you for reading and for being a part of our journey.

-K

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