Misoprostol to induce miscarriage

**REMINDER**  It's not pretty.  It's rather graphic and I don't hold anything back.**

There is not a lot of information out there about inductions of miscarriage in the second trimester.  I wanted to put some information out there about MY experience with misoprostol (generic for Cytotec).  Obviously every person's experience is different, but I wanted to share what happened for me when taking this drug to induce labor for a miscarriage.

I was exactly 16 weeks when I went in to be induced.  I found out just 2 days prior that the baby I was carrying didn't have a heartbeat.  My Dr. suggested we induce with with a medication called misoprostol.  It's a pill that they insert vaginally that is meant to thin the cervix.  A plus to this is that it also causes contractions.

***FYI- Misoprostol (cytotec) is NOT approved by the FDA to be used on pregnant women.  My Dr. made me very aware of this but assured me that it is the drug of choice to induce miscarriage and the risks of other procedures outweighed the risks TO ME of cytotec.  For the record, I am very much AGAINST the use of cytotec to induce labor in full term pregnancies for healthy, living babies.  It can be dangerous to the mother and baby and there are other, more natural alternatives that can be used before trying such a strong drug.***

I arrived at Labor and Delivery (yes, I was in the same place as mothers in labor and those who had just given birth to their babies) at 3am.  I was told to come in very early so that I could be home by that evening.  My Dr. assured me it shouldn't take more than 2 doses.  The first dose was inserted at 4am.  I had a bit of cramping about an hour later but nothing bad.  About 4 hours later or so, I started spotting.  Again, nothing bad.  Just a little bit.  4pm rolled around and nothing had changed.  My cervix was still closed and long.  So they inserted another dose.  (The protocol stated that they could do 200mg every 12 hours until "labor" started.)  This dose gave some more cramping but again, nothing to write home about.  I had amazing nurses who checked on me often.  Josh was there with my for most of the day but since our boys had spent the prior night at grandma's as well as the entire day, we didn't want them to stay there another night.  We both felt better about Josh going home that night to be with the boys. 

I was able to get some sleep that night but not much.  I was too "worried" and anticipating something happening.  But nothing did.  At 4am, I was given ANOTHER dose of 200mg.  At this point I was frustrated that nothing was happening.  There was a definite rhythm.  For approximately 3 hours following each dose, I would have consistent contractions that were about 8-10 minutes apart; however after those 3 hours were up, everything stopped and I felt normal again.  Clearly my body was not ready to give up on this pregnancy.  By 9am I was so discouraged and in tears.  I was done.  I didn't want to do this anymore and I just wanted this part to be over.  I begged my Dr. to just do a D&C (dilation and curettage).  This is a surgery that is performed, usually with first trimester miscarriages, that physically opens the cervix and scrapes the "contents" (I HATE that word!!  It's a baby!!!!) from the uterus.  I'm not sure, but I believe it's about an hour procedure.  Even through all of my tears, I was told that it would be a much riskier procedure in the 2nd trimester as it could cause trauma and damage to my cervix and uterus.  But that wasn't all.  Not only was it a riskier procedure, but there were NO obstetrician's at our hospital that were skilled enough to perform a 2nd trimester D&C.  So if that was the choice I made, I would need to be transferred to another hospital (the closest is 30 minutes away).  I was very frustrated about this my my Dr. said that after he did some more research and talked with another OB, they thought it would be more effective to double the dose of misoprostol and give it every 6 hours instead of every 12.  Obviously I agreed to this as I didn't really feel like I had any other options.  So at 10am they inserted 4 pills (400mg).  This dose definitely caused some discomfort and contractions, but again, they didn't last.  After about 5 hours, they died down and stopped.  So again, at 4pm, another dose was inserted.  This was the dose that finally worked.  I instantly felt consistent contractions.  What my nurses and Dr. did NOT tell me, was that I would bleed.  A LOT!  I figured I would bleed some, but holy hell!  I felt like I lost half of my blood supply.  Everytime I moved, coughed, sneezed, I felt gushes just flowing out of me!  That's the weirdest, grossest feeling in the world.  I really wanted just sit on the toilet the entire time but the nurse wanted to "see" how much I was bleeding to make sure it wasn't too much.  So I just got to sit in bed.  And bleed.  FUN!

At about 6:30 the contractions were really strong and painful.  Mind you, I have given birth TWICE to full term babies with ZERO pain medication.  This time, I really didn't care and I wanted some relief.  My Dr. had fentanyl on order if I needed it.  So at about 8, I asked the nurse for some pain relief.  She gave me the fentanyl and 'my-oh-my' it was lovely.  I wanted to bottle that stuff and take it home with me!  By about 8:30 it had worn off and I could feel everything again.  I continued to bleed and I could feel some pains and pressure in my cervix.  The nurse checked me and said I was definitely dilated and could feel the bag of waters bulging.  At 8:45 my water broke.  I was still bleeding a lot.  At 9:05 the baby was delivered.  I didn't have to push, he was so small that he just came out.

My Dr. showed up about 2 minutes after he was out.  They looked him over (and I looked for a bit) and told me he was a boy (my IP's really wanted to know the sex so I was happy they could tell).  And then they worked on getting the placenta out.  This was a challenge.  My nurse was pushing my my belly to try to get my uterus to contract.  After about 45 minutes nothing was coming out of me except gushes of blood.  I was feeling pretty dizzy and weak.  They hooked me up to pitocin and iv fluids to try to get my uterus to contract enough to expel the placenta.  After nothing was happening my Dr. was concerned so he decided to take action.  He literally shoved his hand up me and got my placenta.  HOLY SHIT!  That was probably one of the most painful things I've ever felt in my life.  After 3 or 4 "sweeps" he was pretty sure he got all of it.  (Since it was early, my placenta didn't want to detach and come out so it came out in pieces.)  After everything was out, I was still bleeding a lot.  The Dr and Nurse were discussing how much blood I had lost.  They estimated that I lost about 900 cc's of blood.  Honestly, I didn't know what that meant.  Good?  Bad?  Normal?  They seemed somewhat concerned but not a lot.  I was originally told that I would be able to leave 3 hours after delivery, however my Dr. said I needed to stay the night and be monitored since I had lost so much blood.  I reluctantly consented. 

At midnight I really had to pee.  I was told by my nurse to let her know if I needed to get up to use the restroom because they would help me.  (I still had the pitocin drip so I was attached to an IV pole).  I called a nurse in to help me to the bathroom.  She came in and helped and then waited outside the door while I peed.  Afterward I passed an ENORMOUS blood clot.  It was about the size of a softball, I think.  I stood up and instantly felt faint.  I went to wash my hands and couldn't stand up so I quickly opened the door and told the nurse.  The next thing I remember I was laying in my bed with an oxygen mask on and 4 nurses around me checking my vital signs.  It didn't take long for me to come to and my vitals were pretty normal.  BP was low but my pulse was normal.  They said between the blood loss, me not eating for 2 days (I think I had a bagel and cream cheese that day, but that's all), and not drinking much water or any juice, my body had just had enough.  I spent the next hour chugging some orange juice and eating graham crackers.  I was able to get some good sleep that night and was home by 10am the next morning.

This was not experience that I enjoyed (I think that's obvious) and I wouldn't wish it on my worst enemy.  It was truly heart-wrenching and physically painful as well as exhausting.  My hope is that reading this will give other women who might have endured something similar comfort in knowing you aren't alone.  While my situation was somewhat different since I was a surrogate, the physical experience might have been the same.  Big love and hugs to any woman who has had to experience anything like this.  My heart goes out to you all.

Miscarriage

 10-25% of all recognized pregnancies end in miscarriage.  That number is actually low.  Many miscarriages occur before a woman even knows she is pregnant which would bring that number to more than 30%. 

It is a heartbreaking reality that happens all too often.  So why is it not talked about?  Why do we not acknowledge the very real existence of pregnancy loss?  It’s taboo to talk openly about miscarriage.  It makes people uncomfortable; especially those who have never experienced it.  But the reality is, NOT talking about it makes the women who HAVE experienced miscarriage feel ashamed and embarrassed.  As if they did something wrong.  NOT talking about it makes us diminish the life growing inside of us.  Life and death are realities that we all encounter throughout our existence.  Miscarriage happens to be about both life and death as well.  And it doesn’t just happen to women.  Yes, physically.  But emotionally, it happens to men too.

On February 11^th, 2011, at 16 weeks pregnant, I delivered my surrogate baby.  A sleeping baby boy.  It was not something I or his parents ever thought would happen so early.  As someone who has just been through this devastating reality, I urge you to reach out to those who have been through a miscarriage.  Offer an ear to listen, a hand to hold or a shoulder to cry on.  It takes time to heal, but eventually, we will want to talk about it.

When I was in the hospital there was a card on my door with a leaf cradling a teardrop.  It signifies loss and suffering.  I recently found a poem that explains its meaning and I want to share it:

A growing leaf, green in color, has fallen prematurely. It has separated from the tree of life and landed in a pool of water, of many tears. It is a dark moment. A human tear lingers on the freshly fallen leaf... before it turns brown.
Fallen.
Drifting aimlessly
on a sea of grief and pain
the leaf cradles a teardrop.
Offers refuge.
Embodies hope.
Just as winter awakens to spring,
our deepest sorrow harbors the seed of hope renewed.
Hope renewed.

by Susan Ring.

"Why are YOU sad?"

For some reason I feel guilty about being sad.  Like I'm not allowed to be sad because I was "just a surrogate".  I find myself crying at the drop of a hat and then turn around and tell myself that it's not okay to be so sad about the loss.  It wasn't my loss, after all.  It was R and C's loss.  I keep hearing that it's normal and totally okay to be sad, but there is little support/people out there who have been in my exact situation.  I feel like if I try to "relate" to someone else who has had a miscarriage, they are thinking that I have no idea what they are going through.  And maybe I don't.  I've always been sure that it would be a million times harder if I had lost my own baby, but that doesn't mean it's not still hard, right?

It is so hard to explain to my friends and family why I feel so empty.  In a matter of hours, my body went from pregnant, to un-pregnant, and I can't imagine my hormones knew how to deal with that.  So for now, I keep chalking it up to hormones.  And while I believe in my heart that I'm truly sad about the loss, their loss, my loss, whatever you call it, I'll continue to blame in on hormones for those who just can't seem to understand my heartache.

More to come

I just wanted to update to say that I plan to continue to write about my experience.  The last few days have been a whirlwind of events and I truly believe they are too fresh to write about yet.  I need some time to process everything that has happened, but I will be back.  I have a lot to say and a big audience to address it to.

My journey has come to an end

This is not the type of update I wanted to make today.  It's all very surreal.

I went in for my regular 16 week prenatal visit today and came out a completely different person.  After 15 minutes of the Dr. using the doppler to find a heartbeat, he was puzzled as to why we couldn't hear anything.  He sent me to another OB's office (just one floor up) to use the ultrasound to find the heartbeat.  He started the ultrasound and I knew right away.  I could clearly see that the heart wasn't beating and there was no fetal movement.  I am beyond devastated but not for myself; for R and C.  They wanted this baby so much and they DESERVED this baby.  It is so hard to deliver such sad news to such wonderful parents.  And they are parents.  They had a child.  They lost a child.  It may be "just a miscarriage" to some, but it's a loss.  I truly cannot even begin to imagine the heartache they are experiencing.

I am so happy to have had the pleasure of meeting such wonderful people and building such a strong friendship with them.  I don't know what lies ahead for all of us.  To be completely honest, I don't know if I can do this again.  I want sooo much for these guys to be daddies; more than anything in the world.  But I HAVE to think about myself here, too.  And this was a really tough journey for me.  With the bleeding and loss at 6 weeks, and now, just 10 weeks later, another loss.  My mind and heart are definitely not in sync.  Obviously it will take some time to heal, physically and emotionally, and perhaps after a little time, I'll know whether or not I want to do another journey.  And whether or not THEY want to do another journey with me.  I know they want to be parents.  It's their dream.  And they will be AMAZING parents one day.  But I don't know if I'm the right person to make that dream come true for them.  I'm doubting myself and my abilities to carry another baby for them.  It will take some time and a lot of thinking, so I don't want to count myself totally out.  But it's something we'll need to discuss at a later date.  And if I do decide to do it again, I would like to wait at LEAST 6 months.  I'm not sure they'll want to wait that long and honestly, I wouldn't blame them.  I am and will be completely happy with whatever they decide, but for me, I need time. 

15 weeks!!

Well, I'm officially 15 weeks!  I feel like this pregnancy is going by so fast compared to my past pregnancies.  I'm finally feeling good; great actually!  I've had a few braxton hicks contractions but nothing alarming.  Each week I send a new picture of my belly to R and C.  They really enjoy seeing the bump grow and knowing it's their little baby inside getting bigger and bigger.  I haven't felt any movement but I'm not surprised as I didn't feel anything with the boys until after 18 weeks.  I also have an anterior placenta this time and with the boys it was posterior.  Apparently the anterior placenta makes it so you don't feel movement as much or as distinctly.  Just a waiting game now :)