The Ugly Details

Well, fail three.  I had been writing about this baby again like the other ones but I don't think I can bear to publish those stories right now.  I wrote a lot about how I'm feeling on the main blog so I'm going to let that be what it is and I'm going to talk through logistics over here.  I don't know that anyone really reads this or if it even matters but now that I've been through three completely different kinds of miscarriage processes I think I need to explain what I went through this time.  I'm going no holds barred here so if you don't want gory details, my advice is to click away now. 

My options this time were different because the baby was 13 weeks old when it stopped growing.  That's too big for a D&C and not super safe for an at home miscarriage.  The doctor said that he could either admit me to the hospital and induce labor and I'd essentially have to deliver the baby or he could recommend me to a clinic that does a procedure called a D&E which is similar to a D&C but requires more dilation of the cervix and the extraction of the fetus is done with a vacuum.  It's what we've all heard described when we hear about second trimester abortions.  The fetus is softened and broken up into pieces to allow it to come out and be disposed of.  And in Arizona, the only places we could find that did this procedure were abortion clinics...kindly called family planning clinics.  There was one doctor's office that does it too but the red tape to get a referral over there would have taken weeks and they do very few procedures and my doctor felt that the chances of complications were much lower somewhere that performed the procedure often.  It sounds like this is only an option for about ten weeks, between weeks 12 and 22 and it's pretty rare to have fetal demise during this period of time in a pregnancy which is why most OB/GYN's don't do a lot of them, if any at all.  D&Cs are much more common due to the frequency of a first trimester miscarriage.  So, I hated my options but they were what they were.

After hours of crying and mental trauma, we decided to go with the D&E.  It was a difficult decision for me because on one hand, the thought of having to deliver my dead baby made me want to throw up.  On the other hand, I am Pro Life and having to step foot in an abortion clinic and then handing them $550 also made me want to throw up.  As a small aside, I DO NOT like to talk politics or on my blog and I have no desire to have an argument with someone who may feel differently than I do about the topic of abortion.  I needed to bring up my personal feelings because they relate to the experience I had but if you disagree with me, please understand that I get that there are many who do and I respectfully disagree.  I have educated myself on the topic and at some point when I'm mentally doing better if someone wants to discuss why I feel the way I do, I may be willing to go down that path.  Right now is not the time and if I get any emails, they will be ignored.  Aside over.  We ended up choosing to go with the D&E because of the mental ramifications of delivery in the hospital.  I just didn't think I could handle that if there was another option.  The D&E was going to be quick and the sedation they use has you awake during the procedure but you are not supposed to remember anything.  I liked the idea of having less chance of side effects and I liked the idea of being done with this quickly.

Friday morning we had to stop at the doctor's office and get a Rhogam shot.  My blood type is 0- so I have to get this shot every time I miscarry or eventually, when I give birth to prevent my blood from mixing with the babies which might be positive.  After that we headed straight to the clinic.

There was a line outside of the office before they opened at 8 am.  There was another couple that looked as though they were in our same boat.  She was very obviously devastated and had NO desire to be there.  With everyone else it was hard to tell for sure, but most looked like they were there for abortions.  Heaven help me, I tried not to judge.  I tried so hard not to hate these women who were willingly giving up what I wanted so badly but had been denied three times.  Sitting in the lobby of the office was hard but I was treated with nothing but kindness and respect by the staff.  They had my chart from my doctor and they knew of my situation.  I was consoled and lovingly touched and told multiple times how sorry they were for my loss and for my previous losses.   I have no complaints about the way that I was treated in the office despite my personal disagreement with their practice.

I was given an ultrasound to determine the size of the fetus as well as the size and placement of the placenta.  Sometimes the D&E is a two step procedure where they place dilators in the cervix and then send you home to allow it to open overnight then perform the extraction the next day.  In my case, luckily the baby and placenta were small enough that they were able to do the procedure that day.  Arizona law does require a 24 hour waiting period for an abortion after consulting with the clinic, but since fetal demise was confirmed, I was outside of these requirements and the waiting period was waived.

After a small wait I was taken back into the procedure room.  Matt wasn't allowed to come with me which I'm sure is related to the goriness of the procedure.  My one complaint about the clinic is that I was left alone in the room for about five minutes.  Granted, it was so I could get undressed from the waist down but being alone in the room with the baby vacuum (NO idea what the technical name is, sorry) sitting right next to me, in a place where women willingly give up their babies every day was almost more than I could bear.  Luckily the nurse came in quickly to sedate me so I wasn't alone for long.  I was given an IV and then the doctor came in and administered the Twilight Sedation which causes you to be awake and able to follow simple commands during the procedure but causes you to forget everything.  The last thing I remember is scooting down the table and putting my legs in VERY cold stirrups.  Well, there's about thirty seconds in the middle that I remember some slight discomfort and a loud noise but then the next thing I knew I was walking out the door in a lovely pair of mesh undies.

I was taken to a recovery room that had several lawn chair type beds and two couches.  I think I remember four other women in there and I remember the nurses saying that two of us were fetal demise which means the other two weren't.  I remember the nurse steering me toward a lawn chair and somehow I convinced my brain the couch was better so I plopped myself down there.  Then I started cramping horribly and then I remember that I was FREEZING.  I swear I've never been colder in my whole life.  The cramping made me feel like I had to go to the bathroom RIGHT THAT SECOND but they wouldn't let me.  Then I told them I was in a ton of pain from the cramping so they gave me an 800 mg Ibuprofin and finally someone thought to give me an extra blanket.  I remember moaning and my teeth chattering. The poor girl next to me probably thought I was dying or something.  I'm told that the freezing is a common reaction to sedation so that's probably why I was so friggin' cold.

By the time I came to and little bit and stopped shivering, everyone else in the room was gone.  They led me to the bathroom to check on my bleeding and told me I needed about fifteen more minutes.  I was given some water and then the doctor came to check on me and say good-bye.  He explained that the cramping I'd experienced was from a drug they'd given me to help expel the contents of my uterus.  I flashed back to miscarriage #1 and the cytotec and realized the cramping and inability to move from the pain had been familiar.  I told him about this and he said that he had in fact given me four cytotec tablets rectally (UM, something I wish they'd told me they were going to do beforehand!) which explained the need to go to the bathroom, and then they put a diaper on me (wish I was joking.  They were fresh out of mesh underwear) and sent me out into the hall where Matt was waiting.

Within about thirty seconds I was sobbing uncontrollably.  I had held it together very well until that second but the weight of where I'd just been and what had just happened was more than I could bear.  I will, unfortunately, have flashes of the ultrasound of my dead baby, the machine that would suck it out of me and the reality of what happens in that office every day that will stick with me for the rest of my life.  I cried all the way home and since then I've been ok for the most part.  I opened a drawer where the copy of the ten week ultrasound pictures were and had a total melt down.  The moments when I'm alone in the shower or right before I fall asleep I always shed some tears.  I think when the hormones start crashing soon I'll have some harder times.  I'm planning on asking for a mild anti-depressant due to the postpartum I know I suffered last time.  I want to prevent it if at all possible.

The physical recovery has been a breeze.  They gave me vicoden but I haven't even needed half a pill or even an ibuprofin.  I have been tired but not excessively so.  There's been some minor cramping and I've been bleeding but it's nothing huge and more like a monthly cycle. 

Despite some of the mental trauma involved this time, I can say that I wish I would have gone with a D&C the last two times.  The hours of cramping and excessive bleeding from the other two were much harder than this.  The second one took two weeks and that was especially hard.  This took a few hours and some rest.  Definitely a better choice, at least for me. 

So there you go.  All the yucky details for any of you who wanted them.  Hopefully this will be of some help to someone and maybe purging some of this from my brain will help me a little, too.

I am now going to use this blog to chronicle the process of the infertility testing, just in case that helps anyone.  Hopefully it's a somewhat simple fix and not anything permanently wrong.  I guess we'll see.