Miscarriage is never an easy journey, and we want you to know you do not have to go through this alone. In this blog post, Nurse Suzie will walk through three different ways to approach miscarriage management.
A miscarriage can come with many questions, from “Why is this happening?” to “What now?”. The first thing to know: Miscarriage is a lot more common than you might think. One in four pregnancies end in miscarriage. Most of these occur in the first trimester, often before the 12 week mark.
However, just because they are common does not mean they aren’t painful, especially if you had a hard time getting pregnant in the first place. Experiencing miscarriage is a deeply personal experience that does involve a period of grief, and each person may choose a different course of action when it comes time to manage the loss.
3 Types of Miscarriage Management:
Many women choose to proceed with a surgical procedure called a dilation and evacuation, or D and E. A D and E is a surgical procedure, usually performed with anesthesia, where a surgeon will dilate the cervix and then remove the contents, such as the products of conception or the gestational sac. Some clinics can perform the D and E with local anesthesia or none.
A majority of first trimester miscarriages are caused by genetic defects of the embryo. The miscarriage is Mother Nature’s way of ending a pregnancy that is not compatible with life. These embryos are called aneuploid. A D and E is extremely useful when you want to test the tissue of the sac and embryo to determine the genetic make-up and see if this was the case.
Is a D and E for me?
Maybe! If you know that genetic testing of an embryo will help you heal or give you data you find important, this is a good course of action. The procedure is quick and it can accelerate the process of miscarrying a pregnancy, which can take a while. If you hate anesthesia or want your body to experience that passing of the pregnancy, then a D and E may not be the right fit for you.
Other things to consider before this surgery:
- Call your insurance company to see where you may get this and how much it could cost you.
- Who will perform the surgery? Can your OBGYN do this or should you go to an REI. Make sure you are confident in your doctor’s surgical skills before you let them do a D and E on your body
- Know that other people are involved: When you go to a hospital it will feel like a very medical procedure and there may be doctors or nurses caring for you that are pregnant. That’s life no matter how much it sucks. So, check in with yourself and see if you are OK to be around other people during your time of grief.
Misoprostol is a drug traditionally used in labor and delivery to dilate the cervix and help move a delivery along. When used for miscarriage management, the drug works the same way: it dilates the cervix and helps push out the products of conception. Not all clinics use this approach for miscarriage management and may recommend letting your body naturally pass the pregnancy or going forward with a D and E.
Should I take misoprostol?
If you do not want to wait to start bleeding on your own but you’re not up for surgery, then yes, cytotec is a good option. This gives you the ability to time your miscarriage and take off work (if needed) so you know when everything will happen. Misoprostol can also help flush out the gestational sac quicker than going through a natural miscarriage.
Other things to consider before taking misoprostol:
- This drug may cause extreme pain in many women because of the mechanism of action. It is almost like going through natural childbirth at home. Because of this effect, many doctors do not like to use this for miscarriage management.
- Did your doctor provide you with any pain medication? You should ask how they plan to help you deal with the pain from the medication, as well as other side effects like nausea.
- Like a natural miscarriage you might experience severe diarrhea and intense uterine cramps.
- Get a support person! Consider hiring a doula if you think you need more than your partner during the process.
- While misoprostol causes you to pass the pregnancy sac, it may take up to 6 weeks for the bleeding to stop and for your pregnancy hormone levels (HCG) to fully metabolize and go back to negative. If waiting is not your thing, consider a D and E instead.
- Do you want to see the pregnancy sac? Miscarriage is already hard enough and if you don’t think you can mentally or emotionally stand to see the pregnancy sac, talk with your doctor about other options.
Not everyone gets the luxury of choosing how to manage a miscarriage. For many, a miscarriage occurs out of the blue and progresses naturally. However, for those with the ability to choose it helps to know all the available options.
Should I let my miscarriage pass naturally?
If you want to feel the process and do not like any medical intervention, then letting a pregnancy pass naturally is the best fit for you. This allows you to be in control of the process and be in the comfort of your home.
Things to consider with a natural miscarriage:
- You will experience pain. If you do not do well with pain, make sure to talk with your provider about pain relief during this process like OTC pain medicine
- Get a support person. Just like with cytotec, make sure someone is with you to help you through the process.
- You might see the pregnancy sac. If you are not emotionally prepared to do this, talk with your provider about other available options.
- Some women experience a lot of pain and may need to go to the ER.
In the end, how you deal with miscarriage is up to you. Make sure you talk openly with your provider about all the options and weigh the considerations. Remember to seek the support of a licensed therapist for emotional support during this time and consider taking time away from work to heal and avoid triggering events. If you need additional support or just want someone to talk to, know that our team at Binto is available any time. Just shoot us a message in the chat or schedule a telehealth consultation here.
About the Author:
Suzie Devine is an women’s health nurse, founder of Binto, fertility advocate and miscarriage survivor.