This is the last post, in my set of three on each type of miscarriage and my opinions on each type after having 5 miscarriages.

Typically (baring some sort of medical complication) it is the parents’ choice how they want to proceed.

Whatever you choose, make sure you are making the right choice for you. In most circumstances you do not have to make an instantaneous choice the second you find out your baby has died or is dying. Take a few days if you need to. And, remember, the majority of people do not go through this multiple times – in fact 3 consecutive miscarriages occur in 1 % of couples, so while you may have fear trying again, remember that odds are, your next one will work!

I have had 5 pregnancies that have all ended in miscarriage. More specifically my experience is as follows:

• Pregnancy 1 – Natural miscarriage
• Pregnancy 2 – Misoprostol (2 maximum doses) and emergency D&C on day 2
• Pregnancy 3 – scheduled D&C / abortion due to septic infection
• Pregnancy 4 – Misoprostol (4 maximum doses) and multiple in office procedures to suction remaining pregnancy products out of my uterus over the following 29 days.
• Pregnancy 5 – Biochemical Pregnancy/Natural Miscarriage which ended naturally within 48 hours

I have decided to do 3 separate posts on miscarriage options, one post on each type. Today I will focus on Misoprostol.  You can read my past posts on D&C and Natural miscarriages for more information on the other types.

Please remember this is just my opinion and I am NOT a medical professional. Consult with your medical professional to determine the best course of action for your unique circumstances.

Misoprostol / Cytotec

Misoprostol can be taken for pregnancies that have ended within the first trimester.  The idea is that misoprostol will kick start the miscarriage and force your body to expel the products of pregnancy.   The risks associated with this drug are often minimal, as they really just kick start the natural process. Most often this is done within the comfort of your own home. You should experience passing clots and eventually a roundish-whitish sac which would contain your baby. It should work relatively quickly – within a few hours. And you may be given a second dose the next day if the first dose did not work. If you choose this approach, you will be instructed to watch for excessive bleeding and to get to an emergency room for care if the bleeding is excessive or the pain is unbearable.

Note, that typically the medication works 80% of the time, and the other 20% the women will end up not passing everything and will require a D&C to remove the remaining products.

My two experiences were different, but the common element between them is that I am in that 20% where the drugs to not work properly. I have been unable to pass the products. So, my experience has been far from ideal. Here are

• Our first experience was also our second pregnancy. We required 2 doses of 2 pills, on 2 consecutive days (a total of 4 pills). We were sent to the Early Pregnancy Loss clinic in our city. In my humble opinion this clinic was one of the absolute worst experiences we’ve had with our five losses, to the point where I have simply refused to ever go back. The clinic itself was cold and felt like we walked inside a 1950’s mental institution. We never even saw a doctor and we were pretty much given the drugs and told to go home, hope for the best and come back for a follow-up the next week sometime. The nurse was determined to make my husband and I cry and wanted to talk about every single emotion as if we had been friends for 30 years – this was not an approach we appreciated. I was given the option of having a nurse insert the pills, or doing it myself at home. I chose to do it myself as there was no way I was letting that nurse touch me. Day one, virtually nothing happened. There was a small amount of bleeding and pain that was managed with Tylenol 3’s. The second day, I took the pills and within a few hours I was in significant pain, but still there was very little bleeding. The pain continued to get worse but the bleeding did not. The Tylenol 3’s did virtually nothing to help control the pain and it was unbearable. The clinic did not tell us what to do if this happened, so at some point my husband decided it was time to go to the hospital. After a long night in the emergency room, some morphine to control the pain, I was admitted to the hospital and an emergency D & C to remove all the pregnancy products / products of conception.
• Our second experience was entirely different. It was our 4^th pregnancy loss and we were now at the local fertility clinic and were supervised daily by an RE – this made a world of difference for us, as we knew we were being closely monitored. I did not want to use the drug, and asked for a D&C instead. However, as I have already had 2 D&C’s they made a very stern recommendation that I do not have a third due to the increased risks for asherman’s syndrome. So, I listened and agreed to try one misopristol one more time. Once again, the experience itself was less than ideal as the drugs did not work properly. I ended up with 2 doses, daily for 4 consecutive days – this is the maximum that the RE would ever do, and she almost never does more than two days’ worth of the drugs. This mean we had 8 doses total. Each day I went in and the RE did a trans-vaginal ultrasound and then inserted the 2 pills. The RE was able to monitor what was going on inside and she also gave me decent pain killers (OxyContin).
  • After the 4 days, my body was still not passing enough clots. Therefore, the RE determined that I was corked and used some sort of a plunger device to remove blood clots from my uterus that were unable to pass naturally. (We have never opened a bottle of wine in quite the same way since that description was used). I do not know the name of the plunger procedure, but I can assure it was not fun! I found it incredibly painful the first time it occurred, but the intense pain only lasted a few minutes and then I was uncomfortable for a few hours afterwards. I ended up having this done once a week for the next 3 weeks, and I became much better at managing the pain and did not require pain medication to help me out.
  • It took 29 days before the miscarriage was considered complete. I never did pass the white gestational sac in one piece, but my body slowly broke it down with the combined help of the drugs and the draconian plunger. I passed multiple clots throughout the first 3 weeks and then the bleeding drastically reduced during the last week.
  • As our previous pregnancy turned into a septic miscarriage, I took a lot of comfort in being monitored by an RE throughout the process. I think it helped my sanity and Mr. MPB’s as well.

If the medication works properly, I’m told that the intense pain only lasts for a few hours while you are passing the sac. And, I suspect that it would be very hard to deal with seeing the gestational sac. It can fall into the toilet, and this can be hard emotionally for many women. However, as this is not been my experience, I cannot speak to this. I suggest reading this blog post from A Calm Persistence and this blog post from Laughs N’ Love to read the experience of a more normal misoprostol experience.

My Opinion:

• I hate this drug. I absolutely hate it. It has resulted in intense pain which I deem unnecessary as I don’t see the point in sitting in extreme pain for the sake of it. It today’s modern world, I don’t understand how the best solution to miscarriage is to send someone home with these drugs and basically say good luck. It seems cruel and almost inhumane.
• These drugs have lower risks then a D&C because there are no risks of developing asherman’s syndrome when you use this medication (see my post on D&C for more information on this). This is why we tried it the first time.
• When the drug doesn’t work correctly, and it took 29 days for the miscarriage to be deemed complete, life generally sucks for 29 days. It drags the entire physical process out, which for me, delays the emotional recovery from even starting.
• With our second time using this medication, I ended up spending almost 2 full weeks high on various powerful pain medication (usually some combination of Percocet, T3’s and Oxycontin). My life was put on hold until I was able to come off the pain drugs and manage the pain on my own. This meant no working; no being left at home without being supervised by another adult; no walking my dog; etc. This is simply not a fun way to live for my husband and for I (although, I suspect I had more fun than he did given that I was high).

What Would I Choose Next Time?

First, let me state, that I hope every single day that there will never be a next time. But, I know statistically, we have a higher than normal chance of having another miscarriage.

And, I also know that no matter what method you chose, it will be a hard experience. There is nothing easy about having a miscarriage.

That said, if the choice were mine, I would have a D&C. I like it because it is relatively painless and it is quick. The physical aspects of the miscarriage are over and done with, so I can move onto the emotional healing.

That said, I know because I’ve already had 2 D&C’s there is almost no-way I will have be given another one, unless my husband and I decide to stop trying or it becomes an emergency situation. So, if we were to try again and end up in a miscarriage situation again, I will likely take the misoprostol and hope that it works properly and that my body expels everything within a few hours.

My fear of this drug not working properly again is actually one of my biggest fears of trying again. And honestly, I’m also a bit afraid of it actually working, because I have no idea what the pain of passing the gestational sac intact would be like. But, I know, either way, I will survive it if I have to.

For further information on my miscarriage experience, you may find these post helpful:

12 Things I Wish Someone Told Me about Miscarriage

Owning Our Darkest Moment

How to Have A Miscarriage – The Practical Way

Miscarriage Options – Natural

Miscarriage Options – D &C

A Calm Persistence – Using Cytotec: 4th Miscarriage

Laughs N’ Love – Taking Misoprostol for Miscarriage

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