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 4th 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.
- 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:
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In my mind we’ve been slow to embrace adoption as our route to having children – we first started to seriously consider it back in March/April 2014 after our 4th miscarriage. In fact, my very first post on the subject was on April 9, 2014. It seems like some people just know that they will adopt a child(ren). For better or worse, we were not those people at all!
1 year ago, even 6 months ago, we were more fearful of adoption than anything else. We were scared of all the scary things:
- Significant developmental delays due to alcohol or drug consumption by the birth mother
- Too much birth parent involvement in day-to-day events
- How to make hard decisions on the typically taboo subjects like:
- Race – which races are we willing to accept? Which are we not willing to accept?
- Gender – do you really get to choose the gender? Seriously? Who gets that choice in real life? And would people really care? (this raises all kinds of questions for me about the ethics of gender selection in utero…I guess if you adopt you can make gender selection)
- Letting potential birth parents know the most intimate details of our lives – i.e. finances, etc.
We/I spent a lot of time educating ourselves on adoption. We asked questions like what are the major differences between open adoption and closed adoptions? Do closed adoptions still exist in Canada? What are the pros and cons of international adoption vs local open adoptions? What are the costs? What are the wait times? How do we approach questions about race?
We actively sought out advice from couples who have completed local open adoptions, and people who have completed international adoptions. We are truly thankful to those who opened there hearts to us and have been willing to share their unfiltered experiences – both the good and the bad.
After all of this, we then chose to take a break from all things adoption. We did this for a few reasons. First, we needed to focus on one more try to have a biological child – not because we cared about the biological aspect, but because we cared about the elimination of any risk of alcohol and drugs. This has been one of our biggest hang-ups with choosing adoption, and one of the main reasons we continued to try on our own.
As it turns out, while we took our official break from everything adoption, we have come a long way to learn that having a child on our own, is likely out of the question. Financially, we simply cannot justify spending $100,000 just to increase our odds. Emotionally, I’m truly afraid another loss will break me. It’s time to move on and embrace an alternative route to children. Right now, I’m glad we took the break to investigate thoroughly our ability to have a successful pregnancy – the reality is that I needed to know that having a biological child was not in the cards for us. I needed to know, with certainty, that it is time to give up and move on.
So, now what? We’ve discussed surrogacy and gestational carriers. And at the end of the day, I’m not sure I can go there, at least not right now. I will share on this subject at some point, but just not today.
But what I am sure of is that, adoption is certain – we will get our child. There is a child out there that needs to parents, and we will find our way together and become a loving family. We don’t care in the least where our child comes from, and we’ve decided that the health risks of adoption are worth it. Simply, we would rather take the risk and adopted, then not.
We know adoption requires patience. Part of me thinks, what’s another few years of waiting, when we are already over 2 years into trying desperately to have children. The other part of me recognizes that it is an average 3 year wait for a local adoption. This is very daunting and I’m already dreading it. Heck, we have to be patient just to attend the next adoption seminar, as the next one with space available is in January (unless we score a cancelation spot in an early seminar). I’m holding onto the hope that it will be worth it in the end.
I cannot neglect to mention that we received a small glimmer of hopeful news last week as we were speaking with our local adoption agency. We have learned that if we choose an international open adoption through the USA, the wait is usually only 1 year for an infant! Evidently Canadians are very attractive adoptive parents to USA birth parents – who knew? The one drawback is that the cost will be substantially higher, but not beyond our ability. While we need to do a lot more investigating, on the surface this seems like it could be the ideal route for us.
For the first time in years, rather than being fearful of stepping inside the already painted baby room, part of me is actually looking forward to decorating our child’s nursery. I am not ready to go start buying little baby things today or tomorrow, but I can see a bit more excitement on the horizon. I know that once all the paperwork is done and we are officially on a wait list, we will be ready to begin buying the basics and putting together a wonderful little room for our child to spend their first years.
Yes, it took us some time, some may say we are slow to make a decision, but in the end, adoption does seem like our path to becoming parents. We still have many more decisions to make and months of paperwork, but at least we’ve already done our homework and know what to expect.
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