I have really turned over and over in my mind how in the world I was going to write this post. This is my second miscarriage at home, and in the time since my first miscarriage over a year ago, I have gotten questions from many people in my circles (infertiles) about what to expect. Currently, I have two people in my support groups that are in that space between losing the heartbeat and actually expelling the remains. There are a lot of decisions that need to be made. Do we do D&C, do we take the Cytotec to make the miscarriage happen, should we do the genetic testing, do we just let nature take its course…? There are so many different scenarios, and much of those answers depend on the person asking the questions and going through this horrible experience. I felt that writing this in an informative way could help other people deal with something that is so rarely discussed from a frank and unrestrained point of view.
For me, getting the chromosome testing done is absolutely paramount. It will dictate whether or not our attempts at having a second child have come to an end, or if we still have hope that the immune treatment will give us the baby of which we have been dreaming. If you do not want to read about the actual miscarriage process and how to pass the remains at home for testing, then STOP READING NOW.
Given that I had gone through one “successful” miscarriage with Cytotec, I decided to go that route again. I feel like I am already at a fertility disadvantage with everything else going on, and I did not want to risk potential scarring with a D&C (I know several who have had to have scar tissue removed as a result of this procedure). My OB that I trust is also on vacation for two weeks, and I have not had good experiences with the doctor filling in. Now, before people jump up my ass about the safety of having a D&C, I chose to avoid that path because it is what felt right for ME. The Cytotec carried less potential long-term risk. If the miscarriage was “incomplete”, I definitely could’ve ended up with a D&C, but it was a second choice for me. I was set to cross that bridge if need be.
In preparation for the shitty events of the evening, I stocked the bathroom with rubber gloves, baby wipes, large pieces of gauze, sterile specimen cup (provided by the perinatologist that gave us the crappy ultrasound findings), a roll of paper towels, and a small wire mesh strainer with a handle. The strainer is weird, but essential (and definitely discarded afterward).
I learned from experience that inserting the Cytotec before bed was a good idea. Thankfully, the doctor on call prescribed 800mg Motrin along with Hydrocodone and Acetaminophen. Within 15 minutes of inserting the tablets, I started to feel cramping a lot like menstrual cramps, and I started to bleed. I ended up taking the pain medication and trying to sleep. In preparation for the situation, I bought “extra heavy flow” pads. I will tell you that this is one of the few things that made me laugh that day. No joke; these pads were at least 15 inches long and those bitches had TWO sets of wings! It was almost from my belly button to the top of my butt crack! I have never seen a pad quite like it, though it was a good thing I accidentally overachieved with this purchase. Even with these horse pads, I bled through and onto a towel that I had placed over the bed sheets. I wasn’t sleeping well as I could still feel the cramping, but it was good enough considering.
At 3 am, I woke up to use the restroom. If you are reading this because you are in this situation, then this next part is important. If you’re not reading this for your own necessity, I suggest that you skip ahead or abandon ship! I lined the strainer with gauze so that it was covering the bottom. I urinated into the strainer over the toilet. When you pee, your pelvic floor muscles relax and contents will be expelled from your vagina (sorry…gross but true). This is exactly what happened and a very large clot and some tissue was caught in the gauze while the urine was able to pass through. I placed the strainer on several pieces of paper towel so that I could clean myself up with the baby wipes and get away from the toilet. I used the rubber gloves to take the contents of the strainer and place them in the specimen cup (I know now that I should have asked for a sterile container with FORMALIN). Two of the Cytotec tablets were also in the strainer. Because I was not sure if everything had passed, I reinserted the two tablets. I thought it was possible that I had expelled everything and went back to bed. I continued to feel a great deal of pain and cramping, so I took the pain medication again and went back to sleep. At 7am, I needed to use the restroom again. Even though I thought that I had possibly gotten everything out before, I used the strainer and gauze again just in case. It was a very good thing that I did this because there was a repeat performance, and another large piece of tissue and clot passed. I added this to the specimen cup and placed it back in the refrigerator. I continued to cramp and bleed throughout the rest of the day (and several days after), and also used the strainer and gauze the next couple of times using the restroom just in case. Bleeding lasted for the next five weeks.
“Products of Conception”
This is what they like to call the remains of a baby after a miscarriage. It sounds so neat and tidy and unbelievably impersonal. I had to drop off the “specimen” at the OB, and I also needed to have them do an ultrasound to be sure that the tissue had passed and that the miscarriage had been “complete”. I clutched my paper bag containing what was left of my pregnancy as I walked through a room full of pregnant women (no exaggeration; they were ALL visibly pregnant–seriously was nobody in the first damned trimester?!). I got to the front desk and mentioned my name and that I had a “sample” that I needed to give them for testing. I had called earlier to make the ultrasound appt. and let them know that I was going to bring in the remains for chromosome testing. Nevertheless, the woman at the desk asked quite loudly what kind of sample it was. I looked behind me, and every woman was looking at me and waiting for a response. Again, this was NOT my imagination. I tried to whisper that I had miscarried, but in a room this small, there was no privacy and also no way to avoid hearing what I had said. I had never hoped for loud elevator music before this moment. The receptionist said okay and asked me to sit and wait. I sat there with my little bag on my lap while every woman in that room avoided looking at me.
I was eventually called back to an exam room. Unfortunately, my usual OB/Gyn was at the beginning of his two week vacation, so I got some insensitive pain in the ass as a crappy substitute (I have had a couple of prior negative experiences with her though she still said, “Nice to meet you,” as though we had never met). Never have I ever wanted so badly for a doctor not to be on vacation. I know with 100% certainty that he would have handled a lot of this situation with much more compassion and care. Something that was also very important was to get a piece of the placenta to take to my immunologist for immune testing. This would be essential in determining if my body had rejected the pregnancy or if maybe something else was the cause of the miscarriage. The person that I talked to at the immunologist’s office made this seem really routine and normal for an OB’s office to do this. When I got to see the doctor, I explained in detail the situation and the importance of getting placenta as it would help to determine the future of my family. After I explained my situation twice, the she asked, “Why didn’t you just do chromosome testing before IVF?” Seriously? Why don’t I “JUST” do chromosome testing before IVF??? Hmmm…maybe because I have no history of genetic issues in my fertility struggle, you have to have 5-day embryos to do this (mine are only 3.5 day embryos), it costs THOUSANDS of dollars, it is never covered by insurance, and it is NOT considered “standard” by any means! She also tried to tell me that they wouldn’t be able to distinguish placenta at this gestation (9 weeks). I can tell you that this is crapola because my amateur eye could see with both miscarriages exactly what was placenta. At this point, the baby is a couple of centimeters, and the report for my last miscarriage at the exact same gestation said that my placenta flattened out to 6 cm (sorry to be graphic but we’ve come this far, so why not?). I continued to impress upon them how important it is for them to TRY to get a piece of placenta in formalin so that I can take it for more advanced testing with the immunologist. She and the rude nurse then took the sample to get it ready while I waited again in the waiting room. When they returned, she handed me a small clear container in a clear plastic bag and says, “Well, we just decided to cut the whole sample in half and hope that each half has what they need to do the testing.” Maybe I am overly sensitive at this point, but how insensitive can a “medical professional” be? I was totally in shock and just focusing on making it through the day, but in hindsight, it makes me very angry (though a lot of things do at the moment).
This leads me to the placenta…in my purse. I was given my little container to bring to the immunologist. No discreet paper bag. This time, it is a clear container in a clear plastic bag. I didn’t even want to look at the women still remaining in the waiting room. I cannot even imagine what they were thinking at that point. Probably thanking God that they weren’t met. I quickly tucked the bag into my purse before anyone else had to see it. By the time I left the OB’s, the immunologist’s office was closed. Because it is in formalin, it does not require refrigeration. I also did not want my husband to have to see this in the refrigerator or stumble upon it by accident. So, I kept it in my purse. I went to work, I ran a few errands, I dropped my son off at a camp, and I went about my day with my placenta in my purse. At some point, I was mystified that this was my “normal” at that moment. My life has become so skewed by this entire experience. I sat in my car and laugh/cried at the ridiculousness and horror of it. What else do you do when you’re going about your life with your placenta in your purse?
If I stop to think about all of this, I feel sad or angry. I don’t understand how it can be so easy for some people, and so unbelievably hopeless for others. I’m trying to come to grips with the fact that it is very possible that this is the end of the road for us. If my body rejected the baby even with all of this immune intervention, then what else is there to do. I don’t know if I can keep going through this experience. Surrogacy would be our only option, and without knowing someone with an available uterus, the cost is just too much. With this failed pregnancy, the costs are in the thousands just from the labs and testing to be sure that everything is going smoothly. To test the placenta and chromosomes it will be even more. We are running out of options quickly. We will continue to wait and worry and wonder what is next for us until the chromosome and placenta testing are complete. Hopefully, my dope on a rope OB stand-in didn’t fuck it up so much that we won’t get answers. Yes, I am projecting some anger here. I know that my regular OB would have handled things so differently, it was just dumb luck that he was not in town.
I hope that this post helps at least one person going through this crappy circus. I also hope that it didn’t jumpstart a vomit for anyone else who managed to make their way through the whole thing. This shit isn’t for the faint of heart.
I hope to get my ass back on the paleo wagon soon. I know that it makes me feel better, but right now I’m having a hard time wanting what is best for me. Beating the crap out of my body seems to make my mind feel less heavy. Makes no sense, but then again, nothing does right now anyway!