I don't read fiction very often. I read scientific journals, non-fiction works, autobiographies and the like. I'm not much for the un-real. I've never been invited to join a book club and would certainly decline the invitation unless it was for non-fiction works (or there was good food or wine, in which case I would fake it).
Anyway, I have read a few Barbara Kingsolver's (fiction) novels. In one she wrote: "A miscarriage is a natural and common event. All told, probably more women have lost a child from this world than haven’t. Most don’t mention it, and they go on from day as if it hadn’t happened, so people imagine a woman in this situation never really knew or loved what she had. But ask her sometime: how old would your child be now? And she’ll know.”
For me this is accurate. I've had my share of miscarriages (3 in total) and I found them to be heartbreaking and lonely. I found them this way, even as I understand why, how and when they happen. Even knowing that miscarriages are supposed to happen when there has been a chromosome or other error in the creation of the embryo rendering the embryo unhealthy, they were still crushing.
For political and emotional reasons I can't call the miscarriage a loss of a "baby," I call it an "embryo." I think it helps to call it "embryo" as the connection we feel to an "embryo" has not been developed or socialized fully. Saying you lost your embryo feels much less painful than saying you lost your baby, but in so many ways it is the same thing.
About 5 times a week I tell a woman/couple they are miscarrying. Half the time they knew because of bleeding, a change in their pregnancy symptoms, or just a "gut feeling." The other half of the time the couple is completely blindsided. Those who are blindsided are sometimes angry and sometimes simply do not believe me. Most of the time the miscarriage is diagnosed by ultrasound. Ultrasound is very accurate in diagnosing a miscarriage if the pregnancy is more than 7-8 weeks along. Those that are 6-7 weeks along can be mis-diagnosed as the embryo is so very small (millimetres in size), so we will usually ask the woman to return between 7-8 weeks or later to confirm our suspicion.
If you are diagnosed as having a miscarriage and the embryo and/or other pregnancy tissues are still inside your uterus there are some options for how to proceed. You can:
"wait and see" if your body will pass the tissue on its own
take a medication called misoprostol. Misoprostol is a pill that brings on uterine cramping to pass the pregnancy
have a dilatation and curettage (D&C) or IPAS - surgically removing the pregnancy tissue from the uterus
They aren't exclusive options. You can start out "waiting to see" but if you do not pass the tissue on your own, then take misoprostol or have a D&C.
I've taken misoprostol three times. For many women it is fine, but I had considerable side effects: vomiting, diarrhea, chills. It did work each time, though. A recent study reviewing the effectiveness of misoprostol confirmed that it is very successful - over 80% of the time the pregnancy will pass after misoprostol is used. It is best used at a dose of 800mg (can be repeated), in the vagina and the tablets should be moistened first. Reference: Raymond EG, Harrison MS, Weaver MA. Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review. Obstet Gynecol. 2019 Jan;133(1):137-147.
A D&C is a bit harder to organize here in BC so patients often have to wait several days to access one. We are working on a way to help make the process easier for patients who do want or need a D&C for their miscarriage - details to follow. A D&C is a surgical procedure involving the pregnancy tissue being suctioned out of the uterus. It comes with some (small) risk of infection, uterine perforation and post-operative scarring of the uterus. The advantage of a D&C is that it is quick, usually painless and completes the miscarriage entirely at once.
If we diagnosis a woman with a miscarriage at Olive we guide the woman through these options and help her figure out which one makes sense for them. We will also explain the importance of collecting the pregnancy tissue so we can analyze it for abnormalities like chromosome errors. Knowing there was an abnormality in the embryo can be helpful in the healing process, help us prognosticate your chances of another miscarriage and help us decide if we need to dig deeper to look for the other non-embryo causes of a miscarriage.
Miscarriage is heartbreaking. Knowing your options and the value of testing the pregnancy tissue might help with the physical part of the process. In my experience not much helps with the emotional part except time. With time, it is also my experience that you are stronger for having been through a miscarriage. As Barbara Kingsolver also said "the strength of motherhood is greater than natural laws." This much I know is true.