Monday, 5 August 2013

My Medical Miscarriage

With my last post I was at home waiting to go into hospital for medical management of a miscarriage. I have decided to share what happened to give other ladies an idea of what to expect. This is my miscarriage story of a medical miscarriage.

My hospital currently offers medical management of a miscarriage as an outpatient. The regime is 4 pessaries, wait 15 minutes and the home to miscarry. Other hospitals will offer different regimes and it is still quite common to be given a tablet and then admitted to hospital 48 hours later given pessaries and then miscarry in hospital. I'm sure there are other regimes out there. I thought it pretty important to mention this at the beginning as the exact order the medication is given will differ from hospital to hospital so I cannot tell you exactly what to expect.

My appointment was booked for Thursday morning at 11am. The nurses had asked that I have someone there to drive me home and stay with me so my husband had taken the day off work. Since he was both chauffeur and baby sitter the children had to come with us as well. We explained to Abigail that Mummy needed some special tablets to get out some yucky stuff that was stopping Daddy from putting a baby in Mummy's tummy. I didn't want to lie to her, and this seemed the most age appropriate way of explaining what was going on. Mention of a "baby" would have been upsetting to her and much harder to explain. She accepted this explanation well though has been quite stern a few times with her father, "Daddy, you need to put a baby in Mummy's tummy!". During the actual appointment the rest of the family went to find the hospital cafe.

I had a full blood count done the day before to make sure I was not anaemic. With a medically managed miscarriage there is bleeding and a risk it can be quite heavy so they needed to make sure I was fit enough to cope. They informed me my results where good and we were able to go ahead.

After that I saw the doctor. A Medical Management of a Miscarriage is a procedure and therefore needs consent. After all, they are ending you pregnancy so its important that you understand why they are doing this and agree to the procedure after giving informed consent. There are also risks of pain, excessive bleeding and the drug itself can cause shivering, fever, nausea and diarrhoea. The doctor explained everything to me again, even though the nurses had been through it all with me the day before and I'd read up a lot.

The next few paragraphs contain the details of the procedure and the miscarriage. If you don't want to read the whole thing then please start reading again after the picture.

Once I was consented the doctor left me with the two nurses. The pessaries were 4 tiny little tables of a drug called Misoprostol which is a synthetic prostaglandin. I lay down on the bed and the nurse inserted the pessaries. I felt no discomfort at all. I'm 33 and this is my third pregnancy so I've had plenty of internal examinations and this was just a gentle internal.

I waited 15 minutes on the bed. During this time I chatted to the nurses who were both lovely. They helped a horrible experience be a little less horrible. By the end of the 15 minutes I was started to get cramps that felt a bit like period pain and a bit of discomfort inside my vagina, I'm guessing cause by dilation of the cervix. I put on a pad and my husband drove me home.

When I got home I went straight upstairs and got into my nightie to lie down. I went to the toilet and was already starting to bleed approximately 30minutes after the pessaries. I put a towel doubled over on the bed. The advantage of being at home is the privacy but the clear disadvantage is the potential mess. Within 90minutes of the pessaries I began to pass large blood clots. The mushed up remains of the pessaries also came out.

I decided I would feel more comfortable in the bath. I used a blend of aromatherapy oils and rubbed them into my tummy. I didn't feel a great deal of pain. I was expecting the pain to be constant like period pain, or the contractions to be like early labour but the only pain I got was very mild contractions with no pain in between. I passed more blood clots in the bath. Our toilet is next to the bath so I was able to fish the clots out and put them in the toilet, but I still found I needed to change the water after a few minutes. I used the shower to refill it as the warm water was pretty comforting.

The clots died down for a bit and I got out and went to lie on the bed. There was no real pain. Contractions were pretty mild. I felt uncomfortable more than anything. I found pad's needed changing every half an hour or so and I made frequent trips to the bathroom were I passed more clots.

About 4 hours following the pessaries I felt very uncomfortable and passed a lot of clots in one go. I decided to go get back in the bath. The whole thing was pretty messy and at least in the bath I could shower everything away. In the bath I passed a mass of tissue about 4cm by 2cm. I believe this was the pregnancy. It was not recognisable to be as the pregnancy. I knew I wouldn't be able to see the baby at only 3mm, but I thought there would be something recognisable like a sac, or placenta but it was just a mass of tissue. At the time I thought there must be more to come and that it would be more obvious so I flushed it. But after I'd passed the tissue mass the clots slowed down and it became clear this had been the pregnancy.

It's probably a good thing I didn't recognise at the time this was the pregnancy as it would have presented me with a bit of a conflict as what to do with it. As the sac must have broken during the miscarriage I don't know where the fetal mass ended up or when it passed. I had thought about burying it in the garden but the "baby" might still not have been there. I do like the line from the miscarriage association leaflet which says about imagine the baby being washed out to sea and looking up at the stars.

I didn't take any pictures of the actual miscarriage.It's not hard to google pictures if you are interested in what it will look like and I didn't feel graphic pictures would be in keeping with the rest of Nom Monster. This story has a good description of miscarriage and links to pictures half way through the story. These pictures are similar to what I experienced. 

Over the next couple of hours following passing the tissues mass the contractions disappeared and the blood clots stopped. By 6 hours since the pessaries everything was over.

I didn't take any pain killers. I used water and aromatherapy to help with the pain and when not in the bath I wore my amber necklace. The aromatherapy blend I used contained Clary Sage, Neroli, Sandalwood, Geranium and Chamomile. I think my experience was less painful than is normal. I was provided with Ibuprofen and Co-coadamol to take. The information leaflet stated that some women need to return to hospital for pain relief. I do think that being at home helps decrease pain to an extent. Miscarriage is messy and uncomfortable and having privacy means I was more comfortable and less anxious which helped me cope with the pain better.

Bleeding was very light on the first day after the miscarriage, but since then its been the same as a heavy period. Pain has remained minimal, though I have experienced after pains when breastfeeding Theo.

The day afterwards I was very tired, but was home alone with the children. Hubby checked up on me every hour with a text message and came home at lunch to feed the children. By the time he got home that evening I was exhausted and went to sleep almost straight away. I'm gradually getting less tired now, but 8 weeks of pregnancy followed by a miscarriage has drained me.

My hormones have responded in a similar manner to post baby but on a lesser scale and quicker too. Saturday I felt very low and got sad following a family incident perhaps a little more than I usually would. Everything became a little too much and I spent a couple of hours crying uncontrollably. I felt very alone and empty and everything seemed a bit pointless. The pregnancy was over, the miscarriage was over and there was nothing to show for the last two months of my life. It was a similar feeling as baby blues, sadness made worse by hormones.

My milk supply appears to be increasing already. Theo is taking advantage of this my demanding more than usual and its clear from his nappies that the milk content of his diet has increased. If only it didn't cause me pain.

First thing this morning I received a planned call from the EPAU to check on my progress. The nurse feels that I have probably passed everything based on my verbal account of the miscarriage. I will have a follow up scan after we get back from holiday. Ironically this will be the same date, almost the same time as my 12 week scan had been booked for.

Right now I'm trying to look forward and we will be back to trying to conceive pretty soon. Hopefully it won't be too long until I'm pregnant again and hopefully this time things will go better.

Please note, my medical miscarriage was not 100% successful and after this post was written I found out there was some tissue left behind in rather dramatic fashion. Please see my post Miscarriage- what happens when you bleed heavily and end up needing surgery for more information. 

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