Friday, January 27, 2006

Miscarriage - What to Expect?

This post is to give you a guideline as to what to expect at the various stages of pregnancy and miscarriage. I am not a doctor, but have done lots of research in addition to speaking to may women about their experiences. I hope this can help you.

Before 12 weeks
Losing a baby before 12 weeks happens to 30% of all pregnancies. This is normal and should not happen to you again. If it does demand to be tested for low progesterone and blood clotting disorders.

You will have 2 choices once you discover there is no heartbeat: a D&C (dilation & cutterlage) or do it naturally on your own.
Naturally The baby is less than 2 inches and can be passed naturally, at home. You will have moderate cramping and bleeding for up to 2 weeks. Your period will return 4 to 6 weeks later. If it takes longer than that ask your doctor for Prometrium or other similar drug to induce your period. It is also possible that part of the 'fetal material' remains in your uterus. That is why your body isn't starting on its own. And ultrasound can be done to confirm that. However, once your period returns you can physically get pregnant again right away.

D&C
This option is nice because it is a half-day procedure. You will go into the hospital, be put to sleep and wake up no longer pregnant. The fetal material is removed by your OB. You can request pathology to be done to find out the reason for demise. That will be helpful in deciding on getting pregnant again and/or treating your next pregnancy. Doctors recommend 3 months before getting pregnant again. Although this is usually for emotional reasons. However, because of the scraping your uterus endures implantation may fail if you try to get pregnant before 3 months.

After 13 weeks

A devestating loss. You thought you were in the 'safe zone' and you discovered the baby's heart had stopped beating. There are 3 choices; a D&E (Dilation and Extraction), induced delivery, or natural delivery.
D&E
Many OB's prefer this method because it is easier for them. Also, the old school of thought was that this was safer for the mother. This is not true. You will be sent to an abortion clinic, put to sleep, your cervix will dilate and the fetal material will be removed in pieces. The material is treated as medical waste and disposed of. This can be a half-day to day long process.

Induced Delivery Your doctor will admit you to Labor and Delivery. You will be induced to deliver your child. You will be given cervidil (a pill inserted into the vagina) to dilate your cervix and begin contractions. You may be given pitocin. An epidural and other pain medication will be offered. You will only be allowed clear liquids (including jello) during your labor. This can take anywhere from 12 to 36 hours. The difference between this delivery and a live birth is you will not have to dialate to 10 cm, only about 4 or 5 cm since the baby is so small. Also, they will be more liberal with pain medication since there is no danger to the baby and you are grieving.
I was told that the babies would "fall out" and if I felt something simply buzz the nurses. That is exactly what happened. Afterwards I had a D&C to remove the placenta. Since I had an epidural I didn't have to be put to sleep. That was a blessing.

Natural Delivery will be very similar except you go home and wait for your water to break or the contractions to start on their own. The delivery will be much the same.

If you choose delivery I suggest a few things. It is better to do these things than regret not doing them later.
Take lots pictures of your baby (sooner rather than later as your child's coloring will change)
Dress, hold and clothe your child
Spend as much time as you want with your child
Have a priest and other family members visit and see your child
Get foot and handprints

You will be given the choice to 'claim' your child and have a burial or the hospital will process your child as medical waste. You will also be given the choice of having a pathology report on your placenta and an autopsy on your baby. I suggest you do this too. Many women regret not having done this. It provides some peace in the following days.

After 20 weeks you should get some sort of certificate (depending on your state); fetal demise, stillbirth certificate, or death certificate.

A fantastic book to read either before your delivery or immediately afterwards is "When Hello Means Goodbye" by Pat Schweibert.

This is an incomplete guide to miscarriage and fetal death. But in conjuction with the other resources on this site I hope you find the peace and support you need in this difficult time.

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