Warning – this is a little bit graphic.
But I wanted to write about what a miscarriage is really like and what options you have in case it helps someone else. Those NHS leaflets in my opinion don’t give you the info you need to make a choice about what method, they give you no sense of the reality, of the pain (physical and emotional) or the blood.
My choices this time around:
1) Wait it out. I didn’t consider this an option. I know from friends experience it can take weeks (something the NHS leaflet underplays) and I am full of progesterone and oestrogen which may well prolong things. I waited it out my first 2 miscarriages but as they were very early (about 5 weeks) they happened quickly once I came off meds and were like a very heavy, painful period (with big clots). I can’t wait 2+ weeks for something to happen and I don’t want to be out and about when it starts. Waiting it out is too unpredictable for me.
2) Surgical management. My views on this are coloured by my last miscarriage. I wanted surgery because I wanted the embryo tested and I wanted the miscarriage over very quickly. My hospital couldn’t fit me in for surgery under general anaesthetic for 8 days. I knew I couldn’t wait that long so I opted for a local anaesthetic. I do not recommend this to anyone. It was one of the most horrific experiences of my life and took nearly 3 times as long as they told me it was going to take. The Dr could not ‘get’ the embryo and the repeated attempts became very painful. Eventually they got a senior consultant in and she performed the procedure straight away. But no one warned me about the contractions I’d get when they removed my embryo. As a result I went into shock. I ended up having to stay in this horror of a room with the heating turned up as high as it could go and blankets piled up on me with a student midwife who looked like she was almost as shocked as me. The only plus side of the whole thing was I physically recovered incredibly quickly – I had very little follow up bleeding and was out running 2 days later – and they were able to test the embryo. Unfortunately it turns out the procedure very likely scarred me and I had to have a minor op earlier this year to remove adhesions which may well have affected my ability to get pregnant in the year between my surgery and the scarring being discovered. I therefore didn’t want to take this route again.
3) Medical management. This means taking pills to soften the cervix and cause a miscarriage. It usually works but sometimes it doesn’t meaning you need to have follow up surgery. I know from friends experience that whilst painful and messy taking the tablets usually results in your miscarriage being over in about 24 hours.
I found a very useful thread on mumsnet (not my usual reading material I confess) which prepares you physically for going through a miscarriage at home with lots of practical tips about wipes (kinder then toilet paper), pads, towels (to sleep on), fluids (drink plenty), hot water bottles, baths, painkillers, warning signs of losing too much blood, the amount of blood etc. I wondered why this type of info isn’t in the NHS leaflet. All it says is take painkillers and come in to hospital if too much pain / blood.
I took the four tablets vaginally on Thurs morning at 8am. And waited. And waited. And waited. Eventually after I’d read 2 books (I didn’t want to leave the house) at 8pm I started to get period pains, nothing too bad, and a bit of bleeding. Eventually at 10pm I had a gush of blood and heavy bleeding for about 1 hour. Then it tailed off. I waited again and eventually went to bed (on a towel clutching a hot water bottle) fully expecting to wake up in a pool of blood – I didn’t.
Fri I was just bleeding lightly so phoned the hospital. There was no way I’d passed the embryo. The hospital wanted me to sit it out until Mon as bleeding had started so they thought it might yet work. It didn’t. On Fri night I went to the pub for a drink with my sis and hubby (which was great, I felt normal for a little while), on Sat I went to Pilates, and bizarrely 3 of the tablets fell out later on that day – I pushed them back up. On Sun I was barely bleeding at all so I went for a run. Shortly after I started to bleed more heavily (but only like a normal period) but still didn’t pass anything.
On Mon I had to sit in the Early Pregnancy Unit yet again, surrounded by pregnant women (I really think women having a miscarriage need to be in a separate waiting room). Eventually I was seen and scanned and of course the embryo was still there, as I had told them on Fri. The hospital really pushed me to have surgery but I was adamant that due to my previous experience I wanted to try medical management again. They reluctantly agreed as apparently if it hasn’t worked once it’s only 60% likely to work the second time – also the tablets hadn’t dissolved in me properly the first time so might not again. As a back up I was booked in for surgery on Wed, under general rather than local.
The tablets started working a bit more quickly this time and within 3 hours I had period pains, I started bleeding heavily about 8 hours afterwards and then it developed into gushes of blood, these came when I sneezed, when I moved quickly, and eventually even if I was just sitting down. I had to change pads frequently and spent a lot of time just sitting on the toilet or on the bathroom floor. Again the tablets fell out – 2 of them and I pushed them back up. The painkillers didn’t work so well but a hot water bottle made quite a positive difference. I started to feel a bit sick but didn’t throw up. By about midnight the flow whilst heavy was no longer coming in thick gushes. But I still hadn’t passed any tissue. I went to bed.
I didn’t bleed that heavily during the night but when I got up something didn’t feel quite right. I wasn’t in pain but I was uncomfortable. It felt like I was getting thrush or cystitis, and like there was something stuck inside me. And there was. A huge piece of tissue was half in half out of my cervix. I spent about an hour trying to push it out – the whole experience made me feel sick and I was getting shivers. It moved a bit but I could feel how big it was and it was still firmly wedged – it was going to take hours to get it out at this rate – particularly as I wasn’t having any cramping so it didn’t feel like my body was helping at all. I didn’t want to pull it out but thought I might have to. The hospital phoned because they wanted to know if I needed the surgery. I explained what was happening and they told me to come straight in.
Yet again I was sitting in the EPU surrounded by pregnant women. I got seen fairly quickly though and the Dr used a speculum to open up my cervix and said she was going to pull the tissue out. It hurt quite a lot and I have no idea if I’d have been able to push it out myself – she said it was pretty stuck – so I was very pleased I’d gone in.
For me I still think medical management was the best route but it was more bloody and prolonged than I expected. If I wasn’t so scared of being scarred then I would definitely chose the surgery (general anaesthetic only).
The tissue has been sent off for testing which I wanted. Even though we’ve had PGS I’m still keen to get it tested. It’s possible (though quite unlikely) that the embryo developed a chromosomal problem after it was implanted, or it could be an abnormality the PGS didn’t pick up (in which case the hospital is unlikely to find anything) or it could be an immune thing. I’ve been referred for the recurrent miscarriage screening but I’ve had that done before so I don’t expect anything to show up, plus I was on clexane so I don’t think it was a clotting issue. The only other test I can think to get done is my thyroid so I’m off to get a blood test soon.
It’s now 2 days since the removal. I’ve had on off period pains and on off bleeding, but it seems to be tailing off now. I worked from home today. I know I haven’t really grieved because I’ve been dealing with the physical side of things but I need to try to get back into a routine. Moping around the house is the worst possible thing for my mental health I know from previous experience. I’m really struggling to get out of bed in the morning at the moment. I’ve been out a bit for the odd coffee etc. When I see a baby or mums with their young children my heart breaks a little but it’s bearable. The worst thing for me right now is thinking about dates and what might have been, I would’ve been 9 weeks pregnant now, I can’t stop thinking about that.
I’m absolutely desperate to get back to exercise. I’ve been out running twice (wearing a pad) and been fairly cautious in only running short distances but it’s been fine. It’s the best thing to help me feel better. Running saved me after all my other miscarriages and I’ve put on a ton of weight from not exercising lately. I need to get me back. Proper grieving will come in time.