Friday, July 24, 2015

D+C vs miscarriage at home...

I'm not writing to tell you what to do.  For one, it depends on a lot of different factors and everyone has different physical and emotional needs.  For two, I'm not your doctor or midwife, so I can't tell you with any authority what you need in your case.  This is just a run down on the comparison of the two (without graphic details) from my recent experience.

Why I originally chose to just let things play out at home:

-I don't like being put under as it makes me feel out of control
-I don't like surgery ... because again it makes me feel out of control
-The thought of delivering at home didn't make me feel emotionally freaked out and seemed natural
-I was not in a rush to conceive another child
-We use a health savings account along with insurance and I thought it seemed financially a better choice as long as it was safe and I stayed in contact with my OB/GYN
-I was not currently anemic or ill so the natural rigors of miscarriage seemed doable
-I didn't want my cervix manually dilated (of course because it felt out of my control ;) or my uterus scarred or damaged (very rare)
-I don't really like hospitals or drama and just wanted to be home during an event like a miscarriage

What would have made me more apt to consider a D+C (surgical removal of the pregnancy)

-If I had been ill or anemic
-If my OB/GYN had been completely apposed to a natural miscarriage for some reason
-If I was at risk for an infection for some reason
-If I had a history of hemorrhage
-If I wanted to conceive again as fast as possible

In my case, not everything went wrong with my natural miscarriage...but just about.  How I didn't get an infection while training in pools for 8 weeks and swimming in open water seems to be a testament to the resilience of the human immune system (or a small miracle).  But, I'm not sure I would change how I chose to do things even in retrospect.  When deciding to do things at home naturally, you may risk a lot of blood loss.  That seems to be a common risk across the board from talking to other women who have been through it.  You will also need to be very sensitive to the signs of infection and too much bleeding in case there is retained tissue from the pregnancy.  One thing I may have done differently, would have been to call into the OB office faster and let them know my "at home" pregnancy tests were still very faintly positive.  I hadn't done that because they kept getting lighter and lighter and were sensitive tests, so I had planned on it taking several weeks or even months to be completely negative (when blood work was done, I still tested at about 3 weeks pregnant from retained tissue before the D+C, so very low).  Had I called in, they probably would have done blood work to check my hormone levels and then followed that up with an ultrasound to make sure the miscarriage was complete if they weren't dropping fast enough or low enough.  As it was, I just talked with the nurse over the phone and since I had no symptoms to indicate an incomplete miscarriage, I didn't go in for follow up blood work.  When my first cycle after the miscarriage involved heavy bleeding I could have been concerned, but first cycles after a miscarriage are often characteristically heavy or longer than normal to clear out any tissue that needs to be flushed out, so I didn't really worry much since the heavy bleeding was in episodes not continual.  I also partly blamed it on the fact that I taxed my body quite a lot with the training and racing the triathlon and felt like I had it coming from possible overexertion. :) all hit the fan when we got away for two days with Caleb and Laura.  Poor Laura seems to always be playing nurse for me when I'm at my worst. :)  We enjoyed our first day in French Lick IN and on day two, the boys went golfing and Laura and I went on a 2 hour horse back ride in the morning.  apparently that's the way to freak a uterus out...going up and down hills bouncing around on a frisky horse.  I started bleeding heavy again and was concerned but thought it was because...again...I had over done it on the horseback ride and just needed to lay down and let my body chill out and heal.  Laura went to get some filtered water and I called my OB office to give them and update on my current condition.  The nurse gave me the run down on when I needed to head to the ER and told me to take another pregnancy test but a normal sensitivity one from a drug store and follow up in the office the following day when we got home.  Laura got back with the water and iron supplements...I was seemingly okay and settled in she turned around for a return trip to the drug store to get me a pregnancy test per my convo with the nurse.  She asked if I wanted to ride with her in case I felt sick... I didn't really want to get out of bed and said I would keep my phone on me "I promise" ;)

The picture Laura sent Luke out on the golf course...of me passed out, with my shirt sloppily edited to cover midriff (and see..I have my phone right there by case I needed help) 
From around 3p to 4p it was really bad.  When Laura got back with the rest of the drug store purchases, I was laying on the floor by the bathroom feeling very light headed.  I didn't feel like I passed out as I remember laying down on my own (and putting my arms up like that because i could breath easier), but Laura said I wasn't making sense when I talked and mumbled so she quickly got me water (shoved a straw in my mouth ;) and called the front desk for EMS to the room.  I remember seeing a bunch of feet at my eye level.  Like ten people piled in with black shoes on and navy pants and I think two fire fighters as well...some guy asking me questions..."have you eaten recently..." oxygen saturation was good but my heart rate was elevated and I couldn't stand without getting dizzy.  EMS said I needed at least two bags of fluid.  I got very emotional and kept saying I didn't need an ambulance transport.  I supposedly kept saying "I think it stopped, if I don't bleed anymore I'll be fine". No one in the room looked too convinced.   Luke (and Caleb) arrived back from the golf course in a flurry (due to the picture of me laying on the floor looking dead).  Luke picked me up and stuck me in a wheel chair after I signed a paper refusing ambulance transport and we headed straight to the hospital with me still repeating "I think it stopped".  We arrived at Paoli hospital (yes, the smallest hospital in the world) and when they found out that Luke was an emergency doc, they all seemed a bit on edge.  Luke had only said he worked for IU when they asked if he had a job and about insurance at check in, so they must have looked it up or something came up on our records.  He sat in the corner and let them do their thing since it wasn't his department, which I respected.  I know at times he probably wanted to shove people out of the way and just try to fix me as nurse practitioners came in to do exams and IV lines failed to go in on the first try.

At this point, I felt like I was in labor only with very little pain and more dizziness/weakness...which actually...I kind of was in minor labor without realizing it.  I was dilated to 4 cm and was shaky
(every picture of me in the hospital during labor looks strikingly just like this-the "I need lip balm and space stare")
After getting blood work back and having an exam, a D+C was recommended.  Luke said that I possibly could have been handled by extraction without being put under (opinion being stated without doing the exam himself and hearing what the NP (and another doctor later) said while doing it)...but my hemoglobin was at an 8 and no one seemed willing to do anything that would cause me to start bleeding again.  I was sort of stable so...why mess with a good thing before the OB doctor and other staff on call got there?  They kept pounding the fluids and got the docs on call headed our way to start the surgery.  I asked Luke to call my OB in Indy, but after missing a call back in all the commotion, he made the decision that moving me with hemoglobin levels reading low and with active bleeding, wasn't worth the risk of being at a bigger hospital.  Being wheeled through the doors into surgery (without Luke) got me to a mental place of letting go and letting God work through all of these people around me.  I really need to learn how to let good people help me when it's needed.  I'm not so great at it.  As I was being put under, I was surprisingly calm after praying that I would let go of control in this moment.  The anasthesiologist  said "okay I'm going to give you the good stuff" and I, feeling jolly, lifted my free arm and fist and said "yea...I didn't come to French Lick for nothing!"  The D&C may have been one of the easiest the OB has ever performed as I was already dilated and ready to go.  He told Luke that everything locked down just right as soon as the extraction was done.  I asked for genetic testing to be done if possible, but the odds are very very low that we will get information back at this point.  It was worth a shot. :)  I'm feeling good if not fatigued two days later.  It will take another week to feel like myself and then probably several months to build up my iron levels again.  But I'm on the mend. The human body is pretty fragile and amazing all at the same time. 

So...should you get a D+C or go all natural... I can't give you that answer. :)  But I wish you all the best and hope you never have to make that decision...or have to do both.

Soon to follow...lovely pictures of our stay in French Lick that will make it seem like none of this even happened. ;) ;)  Also as a side note...Luke and Caleb got vouchers to redo their round of golf and the hotel comped our room the second night.  The customer service was quite outstanding. :)
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sandra said...

WOW!!! You have been through the ringer. Hope you start an upward mend quickly and have no more complications with this. Take care of yourself!!!

smw said...

i am not good with medical stuff and am not the most stable person at this point, so maybe i should not have read this, but it sounds so so awful and hard!!! i am exactly the same way about needing to step back and let go of control and 'let good people take care of me'. I want to be all educated and informed about everything so i can take care of it (your know, i trust myself), but really it's sort of overwhelming trying to work through the two totally opposing views on almost everything. :)

L, Ann and boys said...

Aw, Shar, I am praying for you and have been thinking of you. I missed you at family camp for sure.

smw said...

Thanks a ton, Ann. We really missed being there. :(

sarah.flyingkites said...

Oh girl!!! So glad you are thru it!!