The route that we decided to take when we learned that our baby was no longer living was an induced miscarriage at home using misoprostol. I found it very helpful to read experiences of others who had gone through this experience as I was making my decision and also found the stories helpful while in the thick of it. I can only hope that my story will help someone in a similar situation.
As a means of warning to those unsure whether they want to/should read on, this post contains loss, grief and the process of a misoprostol induced miscarriage in detail, which may be considered graphic to some.
Thursday August 27th 9am, I entered an imaging room at Mission Hospital for a routine dating ultrasound. I had had some minor spotting the weekend before, and again the evening before my ultrasound. To date, a heart beat had not bee found using a doppler, but this is not unusual at the stage of pregnancy I believed myself to be at (around 11 weeks). As I observed the ultrasound screen I saw images of our baby which looked very similar to the images I had seen of our daughter Jo at her dating ultrasound around 12 weeks. The ultrasound tech soon informed me that she couldn't find a heartbeat which was not a good sign at this stage. She showed me where on the screen we should be able to see the flicker and I saw nothing there. Because my husband is in school full time and unable to join me at the appointment, I had asked a good friend to accompany me and had looked forward to sending my husband images while he was in class. Once the ultrasound tech had told me what she had found she asked if I wanted her to invite my friend in. I did, and she explained once again what she saw and also told us that based on the probable ovulation date I had provided it looked as if the baby had stopped developing a week or more before the ultrasound. Because Mission hospital has no obstetricians on call, she informed us that she would have to call over to Abbotsford hospital and send the OB on call there the images she had taken and inquire as to what the next steps would be.
When the tech first left the room there was a sense of shock and disbelief. My mind began to grasp at straws and try to reason out of the situation that had just been laid before me. My friend stood by me, comforting and seemingly in a similar state of mind. When the ultrasound tech came back her words were a bit of a blur, but I left knowing that my images had been seen by an OB who had the same opinion and I would have some choices to make about how to proceed. My friend walked me to my car, and after a long a somber hug, I left to head home and give the news to my Mom who was at my home watching my daughter.
As I approached the house my Mom knew by my face what had happened and was an immediate comfort. At that point, I will admit, it hadn't fully hit me yet. I went inside and decided that I wanted to call and talk to our midwife to see what she had to say about how to proceed. I learned that I had three options to consider. One was to do nothing and wait for my body to recognize what had happened and shed our baby on it's own. Two was to take a medication called misoprostol which would induce the miscarriage process to start (which would require a consult with an obstetrician). And three would be to undergo a D&C. After our conversation, I knew that for me, a D&C was something that I wanted to avoid if I could, and that too much waiting would likely be a very painful scenario for me. I felt that I would like to give the process another couple of days to start and if that didn't work, that I would likely want to move the process along so that I could begin to heal in my own timing. By the evening I was feeling like I would like to have the option of misoprostol handy even if I decided to wait a while to use it, so I talked with our midwife again and she arranged for my husband and I to go in and have a consult with the OB on call at Abbotsford hospital. A beautiful friend and our doula from Jo's birth had brought us homemade comfort food for dinner, and we finished that up and headed to the hospital. Just before that another beautiful friend had dropped off our CSA box for us and brought us a flowering plant (Mums) with a giant hug attached. If there's one thing I can recommend, it is letting a few of the people closest to you know and letting them comfort you. The process had really only just begun, and we already felt so supported by those around us. I honestly think this would have been a lot worse without the support we have felt around us.
The consult consisted of the OB reviewing my scans again, and giving us his opinion that the baby had likely stopped developing roughly two weeks before, a pelvic exam (which I was not expecting and was not prepared for), a blood draw (also awful for a needlephobe like myself), and then discussing the options once more. Once I told him that I was thinking about using the misoprostol but might wait a little while before doing it, he was on board with that and described the whole process to me in detail (which sounded quite brutal), and then sent me home with a prescription for the misoprostol and tylenol 3s. I was told that he would call me by tuesday to check in and see what decision I ultimately made and how we were doing with everything. The whole experience was a shaky and at times tearful one, but there was some relief knowing that the ball was now in my court. We went home, and my husband picked our daughter up from our in-laws. After getting her to sleep for the night and talking things over with my husband I felt a notable shift in my emotions and there were a lot of tears. I had really started to accept that our baby was gone.
I know the decision of how to proceed is a very personal choice, but the feeling that I had waking up on Friday morning confirmed that for me, the misoprostol would be the right decision. I had such a sense of despair knowing that even though our baby was gone, it was still with me, and I knew that having to wake up to that for the foreseeable future until my body started to take over would be too hard. My husband knew as he woke what was going on and emailed his mentors to let them know he would not be in attendance for the day. I asked my Mom to come and take Jo for the day and we headed off to the pharmacy to get the prescriptions filled. Based on the stories I had read of others' experiences, I also picked up heavy overnight pads, baby wipes and nice thick toilet paper. I had my hot water bottle on the ready and Netflix cued up to pass the time before the inevitable cramping would begin.
The instructions I had been given by the Obstetrician were to insert 4 200mcg tablets of the Misoprostol vaginally, ideally in the morning, and then to do another 4 tablets 24 hours later. He also suggested that it would be a good idea to take two T3s about 90 minutes after the first dose of Misoprostol so that the pain relief would be in place when the worst of it hit.
I inserted the first dose at 10:30am friday morning. This in and of itself was an emotional process. I was really deciding to do this. To fully let go of this baby physically. I got through it, and tried to have a snack so I would have something in my belly. I was apprehensive about the pain I knew I would feel, but tried my best to relax and wait. By 12:30 I hadn't felt anything substantial. There was a bit of a feeling of pressure in my belly, but other than that nothing too substantial. By 1:00 I took the t3s in preparation, though it felt odd considering I hadn't really felt much of anything yet. I was getting antsy and anxious, and having not been outside much was also feeling a little house-bound. I decided it would be good for me to take the dog for our usual neighbourhood walk to get some air and hoped that some movement might help bring things on. I wanted to be alone and suggested that my husband try to get some school work done while we were waiting. I took my phone with me just in case, and headed out for a walk with the dog. A few minutes into the walk I noticed that my palms were itching, and I was slightly concerned that this could be the beginning of a reaction to the misoprostol. I tried to google this, and came up with nothing. After about 20 minutes the itching subsided, and I was nearly home from the walk. I started to feel some cramping and bloating around 1:45. Not too bad at first, but irritating. I then got extremely nauseous and began to dry heave. I had been drinking watered down mango juice and had eaten a peach and eventually much of that came up. The cramping really ramped up and became quite severe by 2:40. I had my daughter naturally at home, and feel that I coped quite well with the process of labour. Having that experience to reflect on and compare this with, the cramping that I experienced between 2:40 and 4pm was just like labour pain, but without the breaks between contractions. I was looking at the clock regularly anticipating the next dose of t3s that I could take at 4pm. I didn't make it that long. I took them at 3:30. Emotionally I was having a very difficult time in the peak of the pain. During labour I had a focus of meeting my baby, but during this experience I could only focus on pain and feeling sad. I just wanted it to be over. My husband was there with me, supporting me trying to provide me with what I needed, but I really didn't know what that was. I rocked on the toilet, walked around our room, squatted and swayed, one thing I couldn't be during the peak of it was still. Once the t3s started to hit me, I was able to be more still, and laid down with a hot water bottle in our bed. I asked my husband to put on Netflix as a distraction, but still had to rock my hips a bit in bed to cope. About 4:20 I felt a lot of pressure and a notable popping sensation and then a gush of warm fluid. The pop didn't really register at first, I just sprung up and hobbled over to the toilet trying not to leak. When I sat down there was a gush or fluid into the toilet, and I realized that it was mostly clear. I then realized that this was just like when my water broke with Jo. I then started to bleed, though not heavily as I had expected based on what the OB had told me and what I had read in other women's stories. I had a lot of relief from the cramping after that, things became more mild again. It was close to 5:00 when I passed the first tissue. I felt some pressure again and had to go to the toilet and push. What came out was about the size of a hacky sack and clear. It was what I assume to be the gestational sac. With a very primal need I examined the sac to see if there was anything recognizable as my husband and I had agreed that if there was we would opt to bury it rather than flush it. I asked him if he wanted to see, and neither of us thought there was anything recognizable. About an hour later I passed something of similar size, but this to me, looked exactly like placental tissue. Beyond that I had some light to medium bleeding for the rest of the evening and overnight. We went for a short walk in the evening, as I was concerned that there hadn't been more bleeding or tissue passed and hoped that moving would help things along (it didn't really do anything). My parents offered to have our daughter overnight, but I really wanted to cuddle her to sleep, so they brought her home before bed time and this was a great comfort to me. I feel really awful for women whose first experience with pregnancy ends up in miscarriage. I am eternally grateful for the comfort our little girl has brought me in this time.
The next morning my mother-in-law came to get our daughter for the day so we could continue the process. I inserted the second dose at about 10:30am after doing a little bit of light yoga. After an hour or so my husband and I went for a walk in hopes that the second dose wouldn't take as long to work. This dose caused no nausea, but I had some mild cramping for a couple of hours before having stronger but still manageable (I only took ibuprofen the second day) for a short time, maybe 40 minutes, and then mild cramps for the rest of the day and the evening. My bleeding was light throughout the whole day and I did not pass any more tissue. Based on what the OB described and what I had read in other people's accounts, I started to really worry that the misoprostol hadn't worked well enough.
Sunday was another day of light bleeding and some cramping here and there, and I began to develop a headache in the late afternoon that stuck around until I went to sleep. We went for a walk in the woods which did a lot for my mood. I knew my husband needed to get some work done and so I took my daughter over to my parents' house and spent the day there, trying to do something normal and get out of the house. Early that evening as I was getting ready to head home my daughter for the first time ever requested a sleepover at my parents house (she sleeps there often, but this was the first time she out and out asked to do it), so I came home to Darryl by myself. We spent the evening relaxing together, which was what I felt we needed, but when bedtime hit, I got a serious case of the feelings again. Everthing felt like it hit me hard all over again and I began to really worry that the misoprostol hadn't worked all the way and I would have to end up going in for a d&c anyways. I had to wait until Tuesday to talk to the OB, and started to drive myself a little crazy in the meantime. I kept on reliving the images on the screen at the ultrasound, and the fear and anxiety around possibly trying for another pregnancy also began hitting me. I released a lot of emotions as my husband held me in bed and I needed him to rub my back until I fell asleep.
I woke on Monday morning feeling more together. I still had some light bleeding and minor cramping here and there, but was feeling on the mend overall. I went for a nice walk in the woods with the friend who had come with me to the ultrasound appointment and had a chance to talk about the weekend with her, and process some more feelings before heading to pick up my daughter and spend the day with her and my Mom. Again, I can't say enough how important a support network is. That night I described the process of the weekend to our midwife and she said that it sounds like the process likely worked and thought that the OB would order an ultrasound to be sure when I talked to him the next day. This made me feel hopeful, though I still had lingering worries that there may be more to come. I also had another headache that started around 7 and lasted until I went to sleep.
It is now Tuesday, I talked to the OB early this morning and after describing the process to him he said he feels its probable that it worked. His instructions were to wait 4-5 weeks and take a pregnancy test. If it is negative, good, if positive, call and make an appointment with the office he has been filling in for (that he would no longer be at). This left me feeling very unsettled.
I feel very grateful that I have been able to be in regular contact with our midwife (we are very fortunate to have had the experience of serendipitous life events that since the birth of our daughter have turned our midwives into not only our care providers, but our friends). After expressing my concerns to her and relaying the conversation I had had this morning, she reassured me that she could order and ultrasound for me in a couple of weeks (doing it now would be likely to show there is still some tissue, that will likely pass on it's own as I am still bleeding), and it will hopefully come up all clear. In the meantime we may also order bloodwork to see that my pregnancy hormones are going down as they should be. I'm hoping that anyone else going through this has an ongoing good relationship with their care provider or can be transferred to a trusted family doctor for follow-up as this has made a world of difference for us. At this point, I am feeling cautiously optimistic that I had just had a less brutal physical experience than what the OB described and some of those I have read about and that things will come up all clear. After talking with the OB this morning and before talking with our midwife, I went outside to blow off some steam by raking up some of the cedar boughs from the crazy wind storm we had this weekend, and ended up having to come in the house after 10 minutes due to bad cramping. I also noticed my bleeding picked up. I guess I need to take it easy. This whole experience has been interesting mentally. I am usually someone who is extremely trusting in my body and able to allow time and nature to take their course with grace. This has not been one of those situations for me which has been confusing. The need to move the process forward has been very strong, the need for closure is substantial.
I intend to update this post as I learn more. In the meantime, I hope that it helps someone out there who may be going through the same thing, or encourages someone else to reach out and not suffer their loss alone. Writing this entry has been a healing experience for me, and I hope that encourages less of a taboo around miscarriage and loss. It's awful, and it's hard, but you are not alone.
If you've been here before, please feel free to comment.