Having a miscarriage is complicated and confusing and so difficult on so many levels... not least when you're asked to make a choice about what to do next. Sadly I've been in this position a few times and when I wasn't sure what to do, I turned to this forum to read other's experiences (thank you for sharing so openly and honestly!) and now here I am, hopefully giving something back by sharing mine. I've had five miscarriages so far, and all very, very different from each other, so this is going to be a long read...!
#1, #2, #4: Expectant management
I had my first miscarriage during one of the 2020 lockdowns. I was 10 weeks and noticed light bleeding, mostly on wiping; however, I also had a burning sensation when weeing. I wasn't sure what this was, so called my GP who told me that light bleeding isn't necessarily a sign of miscarriage and that the burning might be a sign of infection. They sent me a test for infection to do at home, which turned out positive, and then they prescribed antibiotics. I didn't get well with the antibiotics, they completely knocked me out and spent most of the time I was on them, sleeping; the miscarriage happened during this time and was pretty much like a long, crampy period...
Physical pain: 7/10
Emotionally, I was sad and confused for about two or so months after, it felt like the hormones took ages to clear...
Next period: about five weeks later
My second miscarriage (9 weeks) started again with light bleeding. Having seen it all before, I once again called the GP who suggested I get in touch with my local EPAU. They offered me an appointment during which they made me give a urine sample for a pregnancy test, took blood to do an hCG test, and gave me a scan. During the scan they could not see a pregnancy, so they suggested this might be a 'pregnancy of unknown origin'. Was sent away and asked to return after two days to repeat the hCG test and scan. Because this was happening over a bank holiday weekend, I was scheduled to have my follow-up appointment at the hospital rather than EPAU. They repeated the test and saw the level decreased over the two days, while the internal scan showed bleeding. The conclusion was that I am just about to miscarry naturally so was sent home with best wishes. What followed was a week of agonising pain (I've not given birth, but I imagine that's what labour is like!), severe cramping and bleeding. I was assured this is normal and I could manage it by taking paracetamol and hugging hot water bottles. Needless to say this was much more difficult than the first time, but has allowed me time to be by myself and process what was happening, so when I returned to the world - about two weeks later - I was ready to move on.
Physical pain: 9/10
Emotionally, I recovered much better than after my first miscarriage; I was back at feeling myself in about three weeks since it all started. That first agonising week and the one that followed were horrific though as my hormones were all over the place and I felt very much pregnant still!
Next period: about four weeks later
My fourth miscarriage started on our honeymoon abroad (I was approx. 8 weeks), again with bleeding on wiping. I didn't feel anything else, no cramping, no pain and was definitely having all the pregnancy signs, so continued to enjoy our special time together, thinking about what the GP told me the first time - bleeding isn't necessarily a sign of miscarriage. Once we were back in England, I called the EPAU and they offered me a scan. This must have been about two weeks after the bleeding started. At the scan they could detect a faint heartbeat, so they suggested I take progesterone and come back in a week, which is what I did. The following week there was no heartbeat and the pregnancy looked as if it had already started being reabsorbed by the body. I was told to go away and come back a few days later - by this time, there was no baby visible. I was offered all the usual miscarriage management options, but was told that given there was already some bleeding visible when they did the internal scan, it's likely it will all happen naturally shortly. So I decided to just go with flow, and I had what felt like a very heavy period about two weeks later, but with no more pain than my usual periods.
Physical pain: 3/10
Emotionally, I bounced back really quickly, possibly because there were a lot of good, joyous things happening in my life at the time.
Next period: about four weeks later
#3: Medical management
I found out I was pregnant at the end of October and as I have already had two miscarriages before, I was referred to the recurring miscarriage clinic; they offered a reassurance scan at 8 weeks (which by now was mid-December) and that showed a healthy baby. I started having some light bleeding two days before Christmas, but because of the festive period, all the services were closed. I got in touch with the EPAU after Christmas and was offered another scan in early January which showed that there was no heartbeat. They asked me to return again for a second scan; at that later appointment, I was given the usual literature about all the miscarriage management options. I knew I wanted to get it all done and over with as soon as I could: by this point, I had been bleeding for three weeks, but this was still quite light and didn't really look like the miscarriage was happening. The nurse told me they would advise against waiting much longer than a week for expectant management, and that if it didn't happen in a week, they would strongly suggest I choose one of the other interventions. However, because of the Christmas closure, the waiting for surgical management was more than a month, so the whole situation seemed to head towards medical management, which is what I opted for in the end.
On the day, I went to the clinic at 9am; the paperwork, obs and bloods etc took about an hour, possibly an hour and a half, after which I was given the mifepristone orally and misoprostol vaginally (this is the medicine that will trigger the cervix to open and the womb to empty), and diclofenac as a suppository (this is pain relief medication). I was sent home with paracetamol and codeine, some heavy duty pads (absolutely amazing, curved to follow the contour of the body, really comfortable!), a couple of absorbent, single-use mats to use on my sofa/bed to protect them from bleeding, and a very cryptic 'some women prefer the bathtub' comment from the nurse...
I started bleeding a bit on the way home already (by now it was about 11-11:30am), so something was already happening! I had lunch when I got home and went to bed to read - about 1pm I had this awful pain in my bowls, incredibly painful cramping, but still not much bleeding. After emptying my bowls (I was howling in pain while this was happening, it was simply next level pain, I cannot even describe it!), I was so exhausted I went to bed. I woke up about 3:30-4pm in a pool of blood (thankfully all on the mat I was given and not my sheets!) and with the singular thought of 'I need to go to the bathroom'. When I got up, I could just feel a flood coming down between my legs - I literally hopped to the bathroom as any movement of my thighs would have let it all out - at this point, I understood the nurse's comment about the bathtub! There was some cramping, and it was getting more and more gradually and I really felt that squatting and pushing would relieve it - again, I understood what she meant about being in the bathtub (but why did she not explain!?). Anyway, we were going to try and save some pregnancy tissue for genetic testing, so I had one of those clear plastic punnets used for fruit nearby, and used it to capture all the tissue that came out pretty much in one go once I was in position (on the loo, legs raised so that they created a squatting position and resting on a 12-pack of toilet paper which just happened to be the right thing at the right time!) and started pushing. Once the bulk was out, I had a bit more cramping, but went back to bed, exhausted again and woke up around 8pm when we took the tissue we saved to the hospital.
What did I learn/would have liked to know before?
-> it was very painful at times, but happened relatively quickly especially when compared with miscarriage #2 which was very painful for a week!
-> I should have taken the codeine the moment I got home; maybe it would have made things less painful later on
-> I should have put on one of the big pads the hospital gave me even before there was much bleeding (by the time I was bleeding to justify the big pad, it was all over my bed)
-> Pregnancy tissue - ie the sac and the embryo, as well as the placenta - are a light grey-pink and they really stand out against the rest of the tissue which is a much darker (burgundy) colour
I continued to bleed and release smaller clots for about a week after (I even had to go to the GP for them to extract one of the clots that was stuck in my cervix and was pressing on my bladder and pelvis meaning sitting down was extremely painful!). I had a scan about four days after the meds to check that the womb was clear - this showed a small bit of placenta left behind, so was offered surgical management. I was given an appointment at the end of that week, but when I went in the consultant took one look at the scan and said it's very little and will all come out in the next period, so it was up to me whether I wanted to go ahead with the procedure. I decided against it and was on my way. I continued bleeding lightly for about three more weeks at which point I had a period. All in all, I bled for pretty much two months (end-December to end-February), which was really hard on my body...
Physical pain: 10/10, but intense pain was only for a short time; however, I felt uncomfortable and had cramps and bleeding for quite some time
Emotionally, this was very tough. Possibly because of it being in the depth of winter, then the long process to manage the miscarriage, bleeding for so long... in any case, it took me a long time to come back to feeling like myself. This was the only miscarriage where I felt I could benefit from counselling and had a couple of sessions with someone recommended by the recurrent miscarriage clinic; it helped!
Next period: about four weeks later
#5: Surgical management with local anaesthetic
When I found out I was pregnant again, I called the recurrent miscarriage clinic and they prescribed progesterone which I started taking pretty much as soon as. I also booked in a reassurance scan which was supposed to be at 8 weeks, but because they didn't have any availability that week, was scheduled when I was 9 weeks. On the day the pregnancy was 8+3 weeks, I got up from a chair after dinner to feel a gush of blood; I put in a pad, decided to call the clinic the next day. I woke up in the middle of the night knowing something was very wrong - got out of bed to very heavy bleeding (so heavy, I had to ask my husband to bring a bath towel for me to fashion a nappy out of so I don't stain our carpets on my way to the bathroom). Got in the bathtub and undressed - my pad was soaked in blood and two huge clots (each about the size of my palm!). Knowing what I know about the colour of pregnancy tissue, I checked the colour of the tissue - nothing pink, all burgundy, so I thought maybe there is still hope... This was on a Friday, and my reassurance scan was on Monday morning, so I just did the best I could to manage myself and my thoughts until the scan. At the scan, a sac with embryo was clearly visible, but there was no heartbeat; they made another scan appointment at the EPAU for the following Monday. That second scan didn't show any improvement (there was still no heartbeat!) so I was offered the regular miscarriage management options. This was at a time when work and life in general were very busy and I wanted everything to be done as quickly as possible, so although I was terrified by the idea, I opted for surgical management with local anaesthetic as this would be the quickest. I was given an appointment a couple of days later.
On the day, I went to the clinic at 8:30am; had obs and bloods taken, then was given some paperwork to sign (less than with the medical management!) and then was given two tablets of misoprostol to keep between my gum and upper lip for an hour (and swallow afterwards), one diclofenac suppository and one anti-sickness pill to swallow. While I waited for the misoprostol, I went for a walk in the nearby park; when I returned, I had another 15 mins wait until I was asked to empty my bladder and go in for the procedure.
The procedure consists of a speculum being inserted, then the local anaesthetic is given by injection in a few different spots around the cervix (I think she said four or five?); the cervix is then dilated. Once this is complete, a syringe fitted with a tube is inserted and used to suck the pregnancy tissue out of the uterus. This is done at the same time as being externally scanned - the scan directs the movements of the tube/absorption. For me, the most excruciating moment was having the speculum inserted - I already knew this would be the case as I've learnt over the years with smear tests - I didn't feel anything when the anaesthetic injection was given. Afterwards, when the tissue was being aspirated, I had cramping, but nothing as painful as during miscarriages #2 and #3. The whole procedure lasted about 15 minutes and ended with an internal scan that showed a clean lining. I was then taken to a separate room where I had a cup of tea and some biscuits and had to wait about 30 mins for my obs to be taken again and do a wee. I had some cramping while waiting and was given paracetamol and was advised to use a hot water bottle if the cramping persists. I was ready to go home at around 12:00 noon. I had bleeding for another two-three days (like the last two-three days of a period) and some occasional cramps, but nothing serious.
Physical pain: 6/10, but for a very short time
Emotionally, I was back to feeling like myself pretty much the next day after the procedure.