**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.