Hi all,
This will be a longish post as I wanted to provide as much detail as possible for anyone looking for information on using medical management of their miscarriage using pessaries/tablets of misoprostol. I came across a lot of negative stories about using the medicated approach before I went into hospital for the procedure and was starting to panic that I should have gone for surgical management. I had a relatively positive experience of the medicated route compared to some of the horror stories published on forums and really wanted to share our story to balance out the views a little. Please be aware there are some graphic details in this post which may not be suitable for some people to read.
When my husband and I managed to get pregnant on our second round of IVF, we were absolutely delighted. The 7 week heartbeat scan was looking good but sadly at the 12 week scan, our little boy had stopped growing by 8 weeks. It was a big shock as I had had no symptoms. It was likely that the progesterone I was prescribed as part of my IVF regimen had been keeping the pregnancy going and I was diagnosed as having had a missed miscarriage.
When we went in for our standard 12 week scan on the NHS, the sonographer could not see our baby very well by scanning me abdominally and asked me to empty my bladder so she could scan me vaginally. When she scanned me vaginally, her next words were, ‘I’m so sorry’ and that’s when she told us that our baby hadn’t made it. As per hospital procedures, she had to ask a second sonographer to double check and was very sensitive about it. The second sonographer came in soon afterwards, explained the process briefly, turned off the monitor so that we didn’t have to stare at our baby on the screen and she carried out the scan swiftly before confirming the news. We were absolutely devastated but they had been absolutely brilliant throughout the process.
We were escorted and transferred swiftly out from the maternity unit to the early pregnancy unit. We were so grateful to be given a side room to sit and cry in that was separate from the other pregnant ladies and were seen within a couple of hours by a specialist nurse. She was kind and sensitive and gave us the information we needed about the three options: to wait for the miscarriage to happen naturally, to use a medicated approach which they called medical management, or to go for a surgical approach. She explained briefly what each would involve, how we would let them know and told us that we could decide in our own time as to which approach we would prefer to take.
When we went home, we carried out some research into each option and decided to go for medical management. It seemed to be the least risky given that we had trouble conceiving in the first place and it would also be the most ‘controlled’. I had heard of some women choosing to let nature take its course and who have subsequently had horrendously painful periods appear suddenly. With my work, it’s not easy to take time off suddenly and so I opted for medical management.
After a couple of days of doing our research, we rang up the early pregnancy unit to book in for medical management. Our local hospital arranges it so that medical management takes place at the gynae ward on a weekend, which means they will usually be able to provide you with your own room and allow you to stay in all day as a day patient - and obviously overnight if there are any complications. We booked ourselves in, went in on Friday for the pre-op visit at the Early Pregnancy Unit to go through some final questions and consent, and then on Sunday we turned up at the gynae ward to start the process off.
All in all it had been 6 days between having the scan and going for medical management. I actually found that time helpful - it allowed me and my husband to digest the information, to gradually come to terms with losing our baby and to say goodbye on our own terms before any intervention, and also to prepare ourselves for what was to come. I was obviously upset during those 6 days but I went back to work quickly and became quite numb. At times it felt like it was happening to somebody else and not me. I had already stopped the progesterone a few days before the scan but it hadn’t left my system fully and I was still feeling pregnant from both the progesterone and the HCG in my system. My breasts were still huge and tingling and I was still feeling queasy. I couldn’t look at myself in the mirror all that week because I had developed quite a bloated bump and I just didn’t want to see it. I found taking a shower really upsetting and traumatic as all I could see was my bump and I couldn’t bear to be thinking of my little boy that we were no longer going to get to meet - at least in this lifetime.
We had been told our hospital wouldn’t provide lunch or dinner to me so we had prepared something for us both. In the end, our hospital did provide both meals to me which I was grateful for. We had read on some forums about other things to pack and found these things most useful:
- Chilled water (it was a very hot day on the ward)
- Juicy fruit (clementines, oranges)
- Scones and a couple of ham sandwiches
- Fruit pastilles and polo mints
- Overnight bag in case you need to stay over
- Spare set of clothes
- Pyjamas or something else you don’t mind getting soiled
- The thickest sanitary towels you can buy for when you go home
On the Sunday we were booked in at the gynae ward and were given a private en-suite room on the ward and assigned a nurse who we now think was specially trained in dealing with bereaved parents and babyloss. She was absolutely wonderful and came in with a beautiful memory box that had been donated by another bereaved couple via the charity 4Louis and which we could use to collect memories of our little boy. I broke down in tears going through the items in the box and especially reading through the little book ‘Guess how much I love you’ that had been included in the little box. It was really sad, but we felt ready to face the music and knew we had to go through with it.
The consultant had approved of five lots of misoprostol in total for me so we were hoping that things would get going before the end of the day - otherwise I’d need surgery which I wanted to avoid if possible. I took the first dose vaginally at around 9.30am. The nurse asked me to ensure that all my stools, blood and urine were collected in the bed pan so that they could keep track of blood loss. I put on the biggest sanitary pad that they had given me expecting the worst but nothing happened in the first few hours. About 3 hours later I started to feel a little abdominal pain and felt hot and dizzy. I also felt quite nauseous and when they gave me the next dose at around 1.30pm, I also asked for an anti-emetic and for paracetamol. I vomited a few times in the next hour or so and in that same hour, I felt a huge gush and knew I would need to pass the first of the blood clots. At first I passed straw-coloured fluid which may have been the amniotic fluid. Over the course of the next hour or so, I experienced abdominal cramps which was the same as bad period pain for me and passed a lot of blood and some fairly large blood clots - the largest were about as big as the palm of my hand.
Because everything was being collected in the bed pan, I could see everything that was coming out. With another gush, I could see something that wasn’t a blood clot in the bed pan and saw something bean-shaped and realised it was my little baby. I had agreed with my husband before our visit that we probably wouldn’t want to see our baby if he was amongst the tissue. But I didn’t have a choice at this point and when I saw him and realised it was him, I just felt an indescribable love and joy and deep adoration for him. He looked so beautiful and so at peace, I just can’t quite describe the feeling. I called for my husband who was waiting in the room as I was on the toilet, ‘Babes, he’s here! Do you...want to see him?’ My husband put his head through the door - he was now crying. He looked confused as he saw me - my face apparently had the biggest and proudest smile on it. ‘He’s here?’ he asked. ‘Yes. He’s beautiful. Do you want to see him?’ And so he did.
After a few minutes, I called for the nurse and she took him away, confirmed that it was our baby, and asked us if we wanted to see him again. We said yes and she kindly cleaned him up and came back with him, lying on a tiny knitted blanket and in a Moses basket with a little cuddly toy. We said hello and our teary goodbyes to our little boy and got to spend a little time together with him. Our nurse talked us through sensitively about arrangements for him - we got the choice to have him cremated or disposed of respectfully, a communal or private service and so on. Before the visit, we had prepared a little certificate for the nurse to sign as a way of acknowledging his existence - we were really glad we were able to prepare in this way from all the reading we had done through the Miscarriage Association and to have the time to think in advance if we wanted to name him and if so, what name to give him. When we said our last goodbye to him, the nurse offered us one of two teddy bears for him to be sent away with so he wouldn’t be alone, and so he left with a teddy from the hospital and a card that we wrote for him during those few hours at the hospital bed.
I had to pass the placenta next and after another hour or so, this was discharged. Because I had passed this before my next medication time was due, I didn’t need any further tablets which I was relieved about. Next they wanted to wait for my bleeding to become lighter - they left us to it at this point and gave us the space to be together in that room. Once the bleeding became a lot lighter, we asked if we could be discharged and they agreed it would be fine. After completing the paperwork and having a chat with a different nurse, we left the hospital. We came home and when I sobbed on my husband’s shoulder, ‘We should be coming home with a baby, not a box of our memories of him.’
Over the next few days my bleeding became gradually lighter - I didn’t need any extra painkillers at all and could go about my day as normal. I took another day off and went back to work the day after. I felt like I needed the rhythm of work to help me through it, and although it might not be for everyone, it helped me through the grieving process. I was advised to take another HCG test 3 weeks afterwards to check full discharge of all pregnancy tissue and this came back negative. My period came bang on 28 days after this and was totally normal with very little clotting and was actually a lot less painful than my periods prior to my pregnancy.
I’m not sure all women would describe it in this way but for me, I really felt like I had gone through the stages of birth, and although we didn’t have the joy of being able to take my baby home with me, it was a strangely beautiful process. I genuinely felt like a mum when I left the hospital that night and felt so grateful to my boy for the short time that he was here on this earth to help me and his daddy dream about our new future and for reminding us how it felt to be hopeful for the future again. It was one of the saddest days of my life, but it was also one full of love and compassion. I was so grateful to be able to spend it there with my husband and with the support of an amazing team on the NHS who dealt with us compassionately, respected our privacy and who acknowledged our little bean as our baby. I wanted to share our story to help people realise that opting for medical management is not a terrible ordeal like some women’s experience has been and that with the right support, something strangely beautiful can totally come out of a deeply sad experience.
Whatever option you go for, I am sorry you are having to go through this - it’s so sad that some babies just don’t make it and I am so sorry for your loss. The grieving process takes you through a rollercoaster of emotions and even though people may say the wrong things to you, I have found comfort in knowing that they usually don’t mean it and that they have just not gone through something like this so can’t really understand. I’m very fortunate to have access to a bereavement midwife and to a group of other couples who have unfortunately gone through this sad process. I’ve found talking about it with other people, especially my husband and close friends who have taken the time to listen, has helped me feel far less lonely in the whole process and to help me see that there’s hope again for a fulfilling future, however things turn out for us.
For me, even if we never get pregnant again or never have a child in our life through other means, I feel that this process has helped me feel like I will always be a mummy to our little boy who is waiting for us up in the stars for when my and my husband’s own time comes. Sending all of you much love.