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SMM/ERPC/D&C at Chelsea & Westminster, London

(3 Posts)
Turi1983 Wed 05-Aug-15 18:57:49

Hi all

This is my first post on mumsnet.

On Thursday 23 August, I had a procedure called Surgical Management of Miscarriage (SMM) under general anaesthetic & I am sharing my experiences for anyone else who is uncertain of what to expect. SMM is also called Evacuation of Retained Products of Conception (ERPC) or D&C.

The first day of my last period was Monday 18 May. I ovulated on or around Thursday 28 May. I started to feel queasy on Monday 8 June & had a positive pregnancy test on Tuesday 9 June. We were delighted & acknowledged that we were very lucky – it was our second month of trying & our first pregnancy.

More typical pregnancy symptoms swiftly followed – constipation, bloating, stomach aches, tender breasts, an increased cup size, bleeding nose & gums… the list goes on. There are several sets of twins on my side of the family & I was convinced that the rate & intensity of my symptoms pointed towards the possibility of me carrying twins.

On Thursday 16 July, I had some mild spotting when I went to the loo/wiped. I called my mother, who reassured me that it was a common occurrence in pregnancy. The spotting grew slightly darker & I started to feel rising waves of panic. I made my way to Chelsea & Westminster Hospital (C & W).

I called the Midwife’s Office en route who got in touch with the Early Pregnancy Unit (EPU). Minutes later, the EPU called me to tell me they would be able to perform an early scan. My husband met me at the EPU & we waited for about 40 minutes. I had a transvaginal (internal) scan – it was not uncomfortable but of course it was a horribly tense few minutes. The Sonographer said nothing. My husband kept squeezing my hand. I looked at him. I think we both knew. Eventually, the Sonographer told us she needed a 2nd opinion & another nurse entered the room. They continued to move the scanning instrument into different positions inside me & murmur between themselves – we heard clicking noises – I think they were taking snap-shots of each image.

They asked me to get dressed & gently told us that they thought I was having what is known as a ‘delayed miscarriage’. The embryos – yes, I was carrying twins after all – were the size of 5 – 6 weeks, rather than 8 – 9 weeks. Together, we went over my dates (last period, ovulation, etc.), & whilst I wished there was a possibility I’d got my dates wrong & was simply not as far gone as I’d originally thought, in my heart of hearts, I just knew. I asked if, because there were two embryos, they were smaller but the nurse explained that the gestational sac was the correct size for my stage in pregnancy which indicated that I was correct about my dates & that the embryos had not thrived. Lastly, they explained that they could see a haematoma (a bleed) next to the gestational sac, hence the spotting.

The nurses told us that they could not take any action until a second scan was performed a week later. It seems to be common procedure to wait a week to ensure there has not been any change or development in order to avoid ending a healthy pregnancy. The nurses firmly, but kindly, said that they did not wish to encourage false hope. We were given some sheets of information & were sent home.

I worked from home for the week – I had hollow dull aches & pains in my stomach & was petrified that I’d started bleeding at any given moment. Emotionally, I was all over the place: one minute I would have forgotten our awful news (I still felt pregnant); next minute I would be ok; the next I would be howling on the floor; I spent hours on Google searching for misdiagnosed miscarriages; I scoured the Miscarriage Association website for information; I looked over my calendar again & again, in case I had made some kind of mistake; I tested my emotional capacity, forcing myself to watch ‘One Born Every Minute’ so I would stop feeling so numb; I spent hours staring off into space… the torturous sense of limbo was just awful.

Five days passed & I had not miscarried naturally but there was no doubt in my mind that this was the end – the pains I’d experienced indicated something was wrong, of course, but also my pregnancy symptoms were starting to fade. On Wednesday 22 July – the day before my scheduled scan – I called the EPU & asked that they schedule me in for the SMM directly after my scan. Initially, they said I would have to wait until Monday 27 July, but after some persuasion, they found a way to make it work.

Thursday 23 July my husband & I returned to the hospital for a morning scan. It was confirmed: this pregnancy was over. The Sonographer couldn’t even make out the embryos on the screen. I’d been worried that I’d be saddened all over again – that a secret part of me would have been holding out for some miracle news but no. At that point I was thankful that the nurses had been so honest about their expectations the previous week.

We were asked to wait in reception & half an hour later, we met with the Doctor who took us through the consent forms for the SMM procedure. She asked us to go directly to phlebotomy on the LG floor & then to the Treatment Centre on the G floor at 12pm. She gave me four tablets & instructed me to insert them into my vagina when I got to the Treatment Centre. She explained that the tablets would soften my cervix, ready for the procedure.

My husband was not allowed to enter the Treatment Centre with me because the waiting areas are single sex. We reluctantly said our goodbyes & a nurse gave me two gowns, a pair of compression stockings, a pair of regular socks & a pair of paper pants. She pointed me towards a changing cubical & told me where to wait. I asked her if I should insert the tablets now. She said ‘no, not yet’. She told me there were four patients having the procedure today & I was forth in line.

After changing, I waited for about half an hour & was seen by the Gynaecologist. He ran through my family history & the basics of the procedure. I asked him about the tablets – he told me to insert them at 1pm. He said the tablets may cause cramping & bleeding & it was only when I returned to the female waiting area & a man sat next to me screaming, crying & moaning with what looked like his mother (I though relatives were not permitted?) that it dawned on me that I’d been offered no pads or privacy.

At 1.30pm, the nurse from earlier in the day took me to a private waiting area with a bed. She asked me to confirm that I had met with the surgeon. I told her that I had not met the surgeon. She told me that once the time of my surgery was confirmed, I should insert the tablets. I told her that I had already been told to insert them. She said that I might start contracting & going into labour & left. I was terrified.

Ten minutes later, the anaesthetist came to see me. He said that I was fourth in line for the procedure. I told him I was starting to cramp & was in pain – he said that I shouldn’t have taken the tablets yet & that he would try to move me from fourth to second in line for the procedure.

At 2pm, the anaesthetist’s assistant collected me & I went under general anaesthetic for the SMM. I came around at approximately 2.45pm. I was shaking & crying. A nurse came over & asked, ‘Why are you crying? What is wrong?’ I was bleeding & in a lot of pain & not one of the nurses comforted or touched me.

Later in the afternoon, I was moved to a mixed ward. I was told that my husband had been called & that I could go home once I had got changed & had been to the toilet. I asked for a pad – none were offered – & made my way down the hallway to the toilet. I was bleeding so heavily that I dripped on the floor & the back of my white gown was sodden. No one accompanied me & I got lost trying to find my way back to the ward. Eventually, after I approached a nurse I was returned to my ward.

I got changed & was taken to a waiting area where I was met by my husband. One of the nurses took my blood pressure & said that I could not leave until it was slightly higher. A male nurse said to her, ‘you’re supposed to be on your break, you know’. She left soon after. No one came to re-check my blood pressure so my husband & I left.

A few days after the operation, I spoke with the EPU over the phone. I told them of my treatment & I was encouraged to make a complaint. I have so many unanswered questions:

Why is there no mixed waiting room so that partners/relatives/friends can wait with you? Why is this not a hard & fast rule? Why was I given the wrong information regarding when to insert the tablets? Why was I not offered a private waiting area directly after inserting the tablets? Why did I not meet the surgeon, before or after the surgery? Why were nurses so unsympathetic? Why was I moved to a mixed ward given the intimate nature of the operation? Why was I not offered pads when I went to the toilet? Why did no one accompany me to the toilet?

Perhaps my experience was an unfortunate, unusual anomaly but when I read this back, it’s like a horror story. I found the experience traumatic at an already difficult time in my life & it has affected my trust in the hospital as a whole even though the staff at the EPU itself were faultless.

After the SMM, I had awful cramps for two days & heavy bleeding. People compare the cramps to period pains - I found they took my breath away. Once the cramps had subsided, I started to get shooting pains in my rectum & couldn’t sit or lie on my back for two days. The pains were so bad I was in constant tears and eventually I was left with piles. Eight days after the SMM I had pains in my left ovary & wondered if I was ovulating. I used an ovulation stick which indicated that I was – excitement! Then did a pregnancy test which was also positive – bitter sweet. I hadn’t realised that ovulation tests can pick up on any kind of hormonal change in your urine.

It is now 11 days since the SMM & pregnancy tests are still positive. I am mentally & physically exhausted & still so sad. I try to remind myself that things could have been a lot worse – I could have miscarried later or I could have found out I cannot conceive at all – but nonetheless, I think this is going to take a long time to move on from. I am hoping that falling pregnant again will facilitate the grieving… that said, I wanted these babies...

twinsandapenguin Fri 14-Aug-15 22:12:38

I am so sorry to hear what you have been through. I had the same procedure at C&W just 5 days after you and it was a completely different experience, even down to DH being allowed to wait with me until I went into the anaesthetic room.
Did the midwife give you a number to call? It sounds like you need to talk to someone about what happened.
Again, so sorry to hear of your bad experience. I don't think that this is the norm at all

Turi1983 Mon 17-Aug-15 12:11:27

Hi twinsandapenguin

Thank you for posting.

I am so sorry to hear that you had to have an ERPC as well - there are no words, are there?

However, I am content to hear that your experience was better than mine - and relieved too. Hopefully, this indicates that my experience was just an unfortunate anomaly.

I wrote a letter of complaint to C & W, on the advise of the EPU, ten days ago. Still waiting to hear back...

Best wishes and fingers crossed for both of us next time...

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