My blood was drawn Friday—a “stat” order I might add—and I slowly watched my lab results appear online. CBC with differential and ferritin, thanks for boring me. The only result I wanted to see was the only result I was unable to. I managed to distract myself well enough that I didn’t stew about it, though I was starting to get anxious as Monday afternoon approached and I still hadn’t heard anything.
Worth the wait: Friday beta hCG was 121. I may yet avoid a D&C! Cheers to that!
Bloodwork later this week to determine if it’s decreasing satisfactorily.
I think I knew it wasn’t over, even after my second round of 1600 mcg misoprostol (Cytotec). My pregnancy symptoms have lessened dramatically but some never completely went away. My breasts still feel too full.
But wait, don’t I KNOW it can take awhile for levels to drop? Yes. I know this. But when my hCG levels dropped so rapidly after losing the twins that I ovulated exactly 4 weeks after birth, I expect ever faster results with a measly blighted ovum. Okay, perhaps not measly. That sucker was still growing and happy inside my womb when I first tried to evict it around 8.5 weeks pregnant. I would now be 10.5 weeks.
My spotting is light. “That’s a good sign,” the ob/gyn beamed at me before my ultrasound today. My regular ob/gyn was booked. The backup ob/gyn, who canceled yesterday afternoon in a voicemail I didn’t see until the clinic was closed, apparently came down with pneumonia. I refused an appointment with Dr. Is-That-Okay.
This new-to-me ob/gyn was actually great. You can always recognize a good doctor when they have to give bad news. It is what it is, let’s not beat around the bush. Tell me flat out what I want to know and don’t try to lead me on and delay crushing my hopes.
“That doesn’t look good.” My character flaw is that I pointed it out while I’m sure she was still forming in her mind how much to tell me or how to break the bad news to me.
“No, this looks great,” she gestured to the clear area above it. Duh, but you know what I’m talking about, I think back to her. What ultrasonographers call “echogenicity.” Two little chunks of… whatever.
Moments later she called the spots “concerning,” but also said it might not matter if my β-hCG is low; the tissue could be shed later or reabsorbed. I was already mentally combing my calendar for a convenient day for a D&C. Don’t want to dwell and foolishly hope. She admitted she thought I would need a D&C. It’s Friday though, so I wanted specific thresholds. I will see my beta this online weekend, whereas she won’t check until Monday… I want to mentally prepare.
Some people are more anxious when overloaded with information. I am less anxious when I am armed with information for all possible contingencies so I know what to expect.
β-hCG < 100 – Another blood test Friday. Wait and see approach.
β-hCG 100-200 – Blood test Monday afternoon. If rapidly declining, wait and see.
So… if you follow my blog, you’ll know I recently fell off the blog challenge wagon because of my recent miscarriage. I’m hopefully fully on the other side—pending ultrasound confirmation in about 1.5 weeks.
Maybe because after we lost our boys all we did was cry all the time. I cried when we found out our most recent pregnancy wasn’t viable, but I didn’t cry at all while I was actively miscarrying.
Today a coworker asked why I’m frontloading my work year. I found out I was pregnant in August, so all I’ve done is work and organize myself to prepare for possible bed rest or preterm labor. She’s not thick, so I suspect she thinks I’m pregnant, which isn’t far off, but her email is about three days too late… because suddenly my work year has opened up. Especially considering it’ll likely take us awhile to conceive again. I was complaining to coworker 2 about busybody coworker 1, and I said out loud something to the effect of, “I’m not pregnant right now,” and it hurt to admit it out loud.
I came home to the kindest card. And I cried. Am crying. For my boys, who I feel like I failed. For the fertilized egg that failed to become a person. For suffering more loss–really, you RPL ladies are the strongest. For not knowing how long it’ll take to conceive again. For knowing that even if we conceive again our track record isn’t great. Still angry at myself for being so naïve to think I had everything planned out… that I would have a child by age 31. So grateful to know kind women who have passed through to the other side.
The months tick by. 3 cycles to conceive the blighted ovum (we thought we were SO lucky this time), 2 months carrying the blighted ovum. I know my extended family are watching me, especially now. I’m so tired of being secretive, but nor do I want anyone trying to discuss TTC with me unless they open with their own story of loss.
Childless-by-choice SIL is hosting a party in October and is inviting DH’s extended family. They’re local, so it would be a grave faux pas if we skipped it. Naturally there will be speculation on my fertility status whether or not I go, but at least they generally have the good grace to discuss me behind my back rather than interrogate me. I HATE PARTIES. Particularly parties that center around getting shitfaced, which this party will be. I should qualify that I didn’t always hate parties, but going out to get drunk no longer holds the same appeal it did in my twenties. Even if I’m not pregnant when the party comes around, I can’t have more than one drink or I risk becoming maudlin. What’s a poor babyless introvert to do? Go anyway, and grumble and gripe on Twitter of course.
For my own amusement, for a personal record, and to help others who are considering a misoprostol-induced miscarriage, this is my account of my two-day experience saying goodbye to my blighted ovum so I can move forward and heal again. I generally refer to misoprostol by its generic name, but it is also marketed under the brand name Cytotec (PSA on medication: generic name = not capitalized, brand name = capitalized).
Disclaimer: Possibly too graphic for some, I do discuss bodily fluids. Also, results probably not typical.
I am a lot more emotionally detached from this miscarriage experience than most people. I am upset, angry, all the normal feelings, but to a lesser degree. After we lost our twin boys four months ago, this just can’t compare. In fact, this blighted ovum has really only contributed to grieving the boys more. I grieved hard over this loss when we found out last weekend, but now I am ready to move forward and hopefully begin to TTC again. We need all the time and tries we can get.
Overall, because I needed a second dose of misoprostol and because I experienced very few side effects, I would caution readers to plan for the worst side effects. I didn’t need my Zofran, and although I took some, I really don’t think I needed the Norco either, but I’m glad I had both just in case. I’m glad my ob/gyn gave me enough for a second round of misoprostol as well, so I didn’t have to waste time asking for it.
Friday, September 18
Reluctant to get up. Reluctant to shower, though I tell myself I’ll be grateful later. Skip coffee because I figure it’s pointless if I’m going to be pumping opioid painkillers into my system today. I blowdry my hair but skip mascara for obvious reasons.
Sitting and waiting with 2 other women. I think first appointments begin at 8:30am, which is the same time the receptionist starts. Why would they tell me to check in at 8:15 if the receptionist isn’t even here yet? Suspect my ob/gyn might’ve double-booked herself. And older, clearly perimenopausal woman is hmphing and sighing. I’m anxious. I just want to get in, get out, and go home. I’m also unusually paranoid I’ll run into a coworker in the pharmacy on my way out. I always run into people I know there, it’s kind of awkward. I can hear staff talking behind a closed door but I’m too apathetic to bother to eavesdrop. The receptionist appears, a fourth person shows up. At least two of us look less than thrilled to be here.
The receptionist arrives. My insurance is weird. All prenatal visits and ultrasounds are free, but my misoprostol counseling appointment today? $50.
The medical assistant takes me in. My blood pressure is lower than normal, but of course I skipped the coffee. The fluorescent lights are too bright. Everyone is bustling around on what is for them a normal Friday. I’m grumpy and recoiling. In the exam room, she has to ask:
“So what brings you in today?”
“Cytotec counseling,” I reply without emotion.
Unsure of herself, she asks me, “…so you’re just talking today…?”
Of course, it only now strikes me as odd that I’m not at least partially disrobing in my ob/gyn’s office. I’m overwhelmed with the desire to just go home. I check my work email on my phone. Two emails express condolences for my vague illness and missing work. Wondering if they think I’m faking—is she taking a 3-day weekend? Nope, I’m going to have a miscarriage. Don’t be jealous.
Ob/gyn comes in, gives me a hug. She’s very earnest, always.
“Any bleeding?” she asked, hopefully.
“None.” I tell her I’m continuing to have what feel like occasional growing cramps, because my body clearly isn’t getting the picture.
She’s delicate, but I assure her after losing the twins, this doesn’t compare. It sucks, but I’ve already been through so much. We go through the formal consent process. I’m instructed to take the misoprostol no sooner than 2 hours before DH is expected home today. I’m already apologizing in my head for being a noncompliant patient—I plan to take it at my earliest opportunity. You’re supposed to be supervised due to risk of hemorrhage once the misoprostol begins acting, which for more women is no sooner than 4 hours after placing the pills, but for some women can occur as soon as 2 hours after placing the pills. She’s prescribing me two doses—4 tablets for today totaling 800 μg, and another 4 tablets for tomorrow in case I don’t start bleeding today.
No line at the pharmacy, how did this happen?! I beat the rush! ….and beat my medication too, apparently.
“I’m here to pick up all kinds of fun things,” I announced to the pharmacy clerk. He laughed and said it’s all in the eye of the beholder. He looked up my prescriptions and instructed me to sit and wait for my name to appear on the electronic ticker. Silly me, of course she wouldn’t ask the pharmacy to fill my prescription until AFTER I signed the consent. The pharmacy is freezing. I pick up some folic acid while I’m here because it’s cheaper than anywhere else. Buying folic acid at the same time as my miscarriage drugs… it’s kind of amusing in a sick, twisted way, but then again I am feeling pretty snarky going through this experience.
This is taking FOREVER. But of course it is, they have to fill my:
• misoprostol (Cytotec) to ripen my cervix and induce uterine cramping
• ondansetron (Zofran) for nausea
• hydrocodone/acetaminophen (Norco 5/325) for pain
I have reserved 3 DVDs at my local Redbox kiosk to pick up on my way home. I realize I’ve been here for 30 minutes and there is no reason it should take this long. The pharmacy is PACKED now and I’m very irritated. I was THE FIRST PERSON here. I’m antsy.
When I’m told my medication is already ready for me and THEN I have to wait 45 minutes only to hear my ob/gyn never filed the correct paperwork for my Norco? ANGRY. The pharmacy could’ve lost it. Or my ob/gyn, who doesn’t routinely have to prescribe controlled substances, didn’t realize what she had to do. From our discussions, it seems that most people opt for D&Cs; I get the feeling I’m unusual for wanting to suffer in the privacy of my home.
Sometimes you just have to advocate for yourself. Drugs in tow, my mood is instantly improved. Goodbye, crowded pharmacy. Some last-minute errands before my incarceration.
Stress eating. Arranged my bed and changed into easily removable shorts. I hear a package get dropped off on my porch, which is weird because I don’t remember ordering anything. It’s a huge box of formula samples for my twins, who would be about 3 weeks old today. HOW FUCKED UP IS THAT? Now what am I supposed to do with this?
I open the bottle of misoprostol. The hexagonal pills look a bit scary to me. I fumble with my first unwieldy, enormous pad.
11:15am (misoprostol administered)
When it’s finally go time I hesitate, scared, but suck it up and stick the little suckers up as far as a can reach. I feel guilty because DH isn’t expected home until about 4pm so I am medically unsupervised. I pop a movie in and lounge in bed.
I wish I had a window to see what was going on down there. My uterus feels warm and a little tense, but not crampy like a period or even like labor. Minor chills, using a blanket.
Just the slightest hint of spotting. Heating up some soup.
Blow my nose and can feel a difference in my uterus. First preemptive Norco down the hatch.
Rising from the chair in the dining room to head back to bed, I have the first remarkable cramp. Congratulating myself on taking Norco before things get bad. It should start to hit me in about half an hour, hopefully right on time or just before contractions really get underway.
I feel leaking, though I want to avoid getting up to check for as long as possible. My movie is at the climax!
Taking a Norco early was a good idea. Clots have begun to pass and cramping is slowly becoming more intense. Taking a second Norco because why not? She gave me a TON, no need to suffer.
Sleepy. Changed my pad one time so far. Pretty disappointed. It’s been quite tame, though I have taken a total of two Norcos today.
I’ve had more than 4 liters of fluids today… So if nothing else is true, the thirst is. A few minutes of cramping make me wonder if I should take one more Norco before bed, but I decide against it. Maybe I’ll take one when I take a midnight pee trip. I change pads even though my current one isn’t saturated.
I was sleeping hard, but DH tells me I talked in my sleep twice, ten minutes apart: “Ow ow ow ow ow.” Perhaps I should’ve taken a Norco, but then again I slept through this and have no memory of it, so maybe it was fine after all.
Saturday, September 20
Pee trip. I am extremely grateful I got these huge pads for their coverage if nothing else. I change my pad and have a cramp—the Norcos have worn off by now. I take another, just in case, even though I don’t really feel like I’ll need it. I feel like this misoprostol hasn’t dramatically affected me.
Woke again, feeling wet. Changing my pad again. Maybe it’s possible to sleep through a miscarriage after all? It’s been like a heavy period. Thirsty, more water. Still tired from whatever Norco is in my system. Back to bed.
Cat wakes me up. I drink a protein shake. I don’t really need to change my pad but I do anyway. I go to wipe and there tons of clots and chunks, it weirds me out because I didn’t feel anything. No greyish sac yet though.
Leaning towards another dose of 800 μg. My ob/gyn instructed me that I should really only need it if I don’t start bleeding after the first round, and although I have bled, I haven’t had a complete miscarriage yet. The downside to using the second dose, she explained, is an increase in side effects. I’ve had no diarrhea, no vomiting, not even any remarkable pain to speak of. The more I think about it, the more I consider going rogue and doing it.
10:30am (second round of misoprostol)
2nd set of four hexagonals on board. It was the first time I stuck my fingers in since the first dose yesterday—my cervix felt normal. Though my ob/gyn is cautious, it seems that many people take a second dose within 24 hours so I’d rather just go for it, especially since it wasn’t bad the first time around. No Norco on board, maybe I’ll take one in a couple hours if needed.
11am (+30min from 2nd dose)
First twinges. DH jokes, “Want to do it?” and I’m chuckling. No sex for at least another two weeks of course.
Very scant bleeding all morning. Not terribly shocking because I had very light bleeding after the twins as well. Wondering if this second round of misoprostol was pointless.
Hello, anything going on in there?
Maybe I did miscarry fully yesterday and somehow missed the sac. I’ve had zero cramping. Good to know that extra misoprostol doesn’t do much.
Ah, here’s some cramping. Wonder if there’s anything left to pass? Unmotivated to take any pain medication today.
Minor bleeding has finally resumed after a quiet day. Chills continue.
I say to DH, “I hope I don’t have to have a D&C.” Shortly after cramps briefly get more intense and I can feel more leaking, but nothing like the regularity of labor cramps.
It’s hard to describe except it felt like when my water broke with the twins, except on a much smaller scale. Or perhaps it was the sac detaching from the uterine wall. It was a strange sucking feeling, a change of pressure inside my uterus. I briefly wonder if I should finally take a Norco but decide against it. I keep expecting the cramps to get worse, but they don’t consistently. However, if what I felt was my tiny water breaking, I know I should expect more cramping in the next few hours. I’m almost excited. I was starting to really fear my body wouldn’t let go of this thing on its own, and now I’m hopeful I might pass it tonight.
I take my first Norco of the day. I’m so hopeful that things will move along now. Mere minutes later I begin to pass more clots and the sac.
I am SO GLAD I took the second 800 μg dose. I am still passing blood and clots, and I’m actually relieved. Two days and a total of 1600 μg of misoprostol and I finally feel like I can say I’m having a “successful” miscarriage. D&C fears are lessened now, though of course I will still have an ultrasound in about two weeks to confirm everything passed. I consider myself lucky. I didn’t vomit. I had no diarrhea, rather I think the Norcos have made me constipated, but I think that could also be a side effect of eating complete crap for these past two days. I think I could’ve gone without the Norcos, but ah well. Generally I hear miscarriages are very painful, so I’m surprised how little pain I’ve had.
Getting ready for bed. Everything seems to have slowed down again. I almost hope I continue to expel stuff in the middle of the night… Maybe because I’m more afraid of a D&C than bleeding.
Very minimal bleeding again. Hope everything’s out.
Sunday, September 21
Painful cramp from an overfull bladder, immediately better once I relieve myself. I’m thirsty again. I estimate I drank about 5 liters of fluid on day 2. Back to bed.
Wow, I slept about 10 hours. I’ve also peed a lot more overnight than I’ve drunk—but I think this happened after the twins too. My body has decided it can stop retaining water. I’m feeling sleepy and lazy still, but I definitely feel like it’s behind me. I’m now experiencing what feels like a light period.
Still have “pregnancy boobs.” Wonder when they’ll deflate. With the twins they never deflated because my milk fully came in, so I have no idea what to expect.
Very minor bleeding all morning. Today is technically CD3 now. We have been instructed not to TTC until my next normal period comes. I will probably ignore this advice, but it won’t really matter anyway because nothing will implant. My first cycle after losing the twins, I could tell my lining wasn’t adequate because the first natural period was extremely scant.
In about two weeks I will have an ultrasound to check to make sure I have passed everything. Worst case scenario would be that a D&C would be necessary at that time. Hopefully it won’t be.
Last night, I emailed my ob/gyn with my deduction and request for instructions and pain medication. This morning, she officially confirmed no ectopic and a blighted ovum—zero embryo, but a sac and placenta embedded in my lining.
I was also informed I have to come in for formal counseling. No couch—advisement on risks and instructions to go to the hospital if I hemorrhage… you know, no big deal. Friday morning I’ll head over to sign on the dotted line that I know what I’m in for, pick up my misoprostol (Cytotec) and Norco (a lower-acetaminophen version of Vicodin), and probably swing by the grocery store to pick up some pads and treats for myself.
It’s weird. They say women nest before giving birth, and I’ve been nesting this week. Knowing I’m going to be laid out this weekend, I’ve been more diligent with chores and have been trying to create a nicer environment for myself to roll around miserably in.