miscarriage choices
March 14, 2013 1:13 PM   Subscribe

I went for an eight week ultrasound today and my doctor found that the embryo had stopped growing a week ago. She gave me three options: D&C, RU486 (the abortion pill), or to wait things out naturally. She was against the D&C because she was afraid at this early she might not get all the tissue and also the possibility of scarring. I trust her so I have ruled out the D&C. So that leaves the two other options. Even though it's supposedly very painful, I'm leaning toward the RU486. I just want this over. I'm just wondering if there's anything else I have not considered. Thankfully, I have nothing important going on at work (no meetings etc.) until March 25th. But I do need to go out of town for a meeting in Arizona on the 25th, so that's another reason for wanting to get things over with. Just wondering if there's anything else I should take into consideration when making this choice that I haven't thought of. Thank you.
posted by anonymous to Health & Fitness (31 answers total) 5 users marked this as a favorite
I'm so sorry. This must be very hard.

If I were you, I'd opt for the RU486. You can arrange to be in a comfortable place, and you can manage any pain you may have with it. Discuss options for pain management with your doctor, or even arrange to do this on an outpatient basis if it's possible. (and if you're afraid.)

I'd avoid a D&C as well, especially if your doctor isn't keen. As for waiting things out, that sounds inconvenient and frankly, I'd rather just get it all done and over with.

Normally, I'd go to the internet to review stuff, but I wouldn't trust it on this.
posted by Ruthless Bunny at 1:19 PM on March 14, 2013 [4 favorites]

I'm sorry for your loss.

Remember with the RU 486, you will need a check-up in about two weeks. If that conflicts with your business trip, you might want to figure that in.
posted by roomthreeseventeen at 1:20 PM on March 14, 2013

Oh dear, I'm so sorry.

I'm a guy, so, obviously, have not been through this personally (although those close to me have), but one advantage of RU486 is that things will happen on your schedule and not at some random, unpredictable, time. Going through with the natural process can be painful too, and you have the disadvantage that you don't know when it will happen.
posted by It's Never Lurgi at 1:29 PM on March 14, 2013

I'm so sorry for your loss. I have had two miscarrages, one at 7-8 weeks and one at 15 weeks. Both ended "naturally", and both were basically like having a particularly crampy, uncomfortable, heavy period. (Of course, your body may be different.)

The other part, though, is that your body is going to go through some profound hormonal changes at the same time, so you may experience some very wild mood swings. So, since you are likely feeling a profound loss anyhow, your hormonal end-of-pregnancy changes can make those feelings somewhat more intense than they otherwise would have been. I know other women who experienced their combination of grief and hormonal changes as intense rage, or really profound depression. The hormonal/emotional changes are something that folks don't talk a lot about, but they're very real.

This may be a point in favor of the RU486, if it means that you can hide away for a few days while you go through this.
posted by anastasiav at 1:31 PM on March 14, 2013

I was in your shoes about eighteen months ago. I'm so sorry--this is a horrible decision for anyone to have to make.

Waiting things out naturally can take weeks. I didn't have the emotional fortitude to continue through that, and, honestly, the emotional fallout from a miscarriage is bad enough that I don't know I'd risk making it worse.

Which leaves RU486, which is what I did. I did not need a checkup two weeks later--my doctor basically said that if I was still spotting or experiencing side effects in a week, I should come back, but otherwise it was done. They handed me the prescription and sent me on my way. YMMV.

It did take me two doses, 48 hours apart, to clear everything out. Ask your doctor about the possibility of this--mine didn't actually mention it, just wrote it on the prescription, and I ended up calling the pharmacy and doctor's office in tears, trying to get someone to explain what 'repeat in 48 hours if necessary' meant.

RU486 is quite painful, in my experience. That said, of the people I know who've taken it (several), I was the only one who didn't get pain medication with the pills. If your doctor doesn't offer, ask--it seems that there's a slim chance you'll be turned down (mine wouldn't do it), but a decent chance that you'll get something to make it more tolerable. Other things that make it more tolerable: eating before you take it, and, if your flow's not too heavy, taking the pills it as a vaginal suppository. (My understanding is that all misopostol can be taken vaginally; obviously, check with your doctor or pharmacist.)

Also, if you can allow yourself a week off of work to deal with this, I strongly, strongly recommend that. Even if you take the pills on a Saturday or Sunday, my experience was that I spent several days after the fact not feeling great, and several more feeling ok physically but not really functioning on any higher levels.

I'm so sorry. Please feel free to memail me if you'd like a sympathetic ear.
posted by MeghanC at 1:43 PM on March 14, 2013 [10 favorites]

Hi. I am sorry this is happening to you.

I've had two miscarriages: one with RU486 and one without. The former was at about 10 weeks and the latter about 15.

I didn't find either painful, and really they weren't much different. In both cases I had heavy bleeding, cramping and dizziness for about 48 hours. I felt weakish for a few days afterwards. So if I were you, I'd go for the RU486, because the timing will be more predictable. As you say, it will get it over and done.
posted by Susan PG at 2:18 PM on March 14, 2013

A friend of mind did get RU486 for hers and she said it was horrible and excruciatingly painful. Furthermore, it went on for hours and she wished she'd gone the surgical route at a clinic or hospital.

Go for the D & C. Being in that kind of pain at home is traumatizing unless you have a close and loving friend with you who can take care of you (not that a male spouse or partner can't---it's just that they may not be able to empathize with that level of pain or may just shut down after awhile, if he's not been socialized to nurture and care properly and thoughtfully when you're in so much pain).
posted by discopolo at 2:24 PM on March 14, 2013 [2 favorites]

I had a very similar experience with a miscarriage at 8 weeks back in June of last year. I was in no shape emotionally to wait for anything to occur "naturally". It was a silent miscarriage - no cramps, no bleeding, no nothing.

I wound up getting a D&C, and the surgeon missed a large portion of matter during the procedure. I went back for a second D&C a week later, and the got the lot the second time round.

It was a huge relief emotionally to not have to sit about and wait for material to pass. It was painful, but once it was done, it was done. I could mourn properly and work on healing. Even though I wound up having a second one, it felt almost, I don't know, like an afterthought. I'd had my time to process it.

The first, partial D&C put me off my feet for about a week. The second, clean one was more like three or four days.

As for the infertility thing...it's a very, very small percentage of women who have that experience. After those two D&Cs so close together, I fell pregnant accidentally on my first cycle after I'd finished healing and have had no complications since. There's no reason why a quick procedure that allows you to get on with your life should be avoided, especially if you really do have things you need to do.
posted by Jilder at 2:37 PM on March 14, 2013 [1 favorite]

From a MeFite who would prefer to remain anon:
RU486 veteran here. I wish I had chosen the surgical route. RU486 felt to me like a 48-hour-long process versus a few hours with the surgical option. I know there is recovery time, etc., and they probably turn out about equal in terms of hours/days of discomfort, but I felt that RU486 wound up being more emotionally draining. I was very conscious of the process going on inside me for what felt like an interminable amount of time. It seemed very . . . slow. I did it over a weekend and was back at work on Monday, but I regret not getting the outpatient procedure, going home, and starting the healing process. Instead I never knew when things were "over" or where I was in the process. Also it made being at home in the months following difficult. That may have been the hormones talking, but I never looked at my bathroom the same way. I would rather go through the worst part in an anonymous hospital/clinic environment.
posted by jessamyn at 3:43 PM on March 14, 2013 [1 favorite]

Based on my personal experience, if you go for the misoprostol, I urge you to plan to be in excruciating pain for many hours.

Demand pain meds. Have someone who can offer you unceasing support in the ways that help you best. Please don't rely on anyone who reacts to your pain and your needs with anything less than total care, comfort and concern.

I'm so sorry for your loss.
posted by waterisfinite at 3:47 PM on March 14, 2013 [3 favorites]

I've had the same experience. Here is what happened, hope it helps.

My doctor recommended D&C, curiously for the same reasons that yours recommended against, i.e. not to miss anything. He also said I could wait it out but I didn't want to walk around with a dead fetus in me. I wasn't very emotional about it, just thought it was gross. (Numerous female friends and a cousin who worked at a fertility clinic really brought into perspective just how common this is).

D&C was easy and quick. No complications except an epic migraine a couple days afterwards. Probably from anesthesia.

I got pregnant again as soon as possible without time travel and had the most perfect baby.

Remembering how easy my D&C was, I would recommend it over RU486. Given that my (extremely experienced) doctor recommended D&C for exact same reasons yours recommended against one, maybe get a second opinion?
posted by rada at 3:48 PM on March 14, 2013

I worked in a pharmacy that refused to sell RU486 because of their religious beliefs. Even though those sanctimonious pigs would approve of your reason for using it, you don't want to have to justify yourself to people like that. If you go that route, ask your doctor to recommend a pharmacy and then send someone else to pick it up for you.

I vote for the natural route. I know it is hard and I am sorry for your loss. Your body knows what to do here. It just seems like the recovery time would be gentler if your body is allowed to do what it needs to do.
posted by myselfasme at 3:49 PM on March 14, 2013

I had a natural miscarriage and one that was resolved with a D&C. The former wasn't terrible but it did take quite a long time and I wasn't even aware that that's what was happening until I was just about through with it (I ended up going to the ER because of the massive amounts of blood - I hadn't known I was pregnant).

The D&C was quick, and while I wouldn't call it easy, it was as not-awful as it could have been. I kind of wish I had chosen to be sedated (I only had the gas) but even not being sedated I think it was better than the natural route.

I'm so, so sorry you're dealing with this, and for your loss. Please feel free to memail me if you have any questions or need anything.
posted by cooker girl at 3:54 PM on March 14, 2013 [1 favorite]

I would get a second opinion. Though I've never miscarried a wanted pregnancy (and I'm so sorry for your loss) the OB-GYNs I have had have been advocates of D&Cs in this kind of situation.

I would definitely not wait it out, because of the possibility of complications, and more importantly so that you can begin the processes of physical and emotional healing ASAP. I would also worry about a non-induced miscarriage disrupting your trip later this month, though that's probably a lesser concern for you.

My sympathies to you, and my hopes that you will get good care and support.
posted by Sidhedevil at 4:04 PM on March 14, 2013

From another MeFi member that prefers to be anon:
I have had two D&Cs and one experience with RU486. For RU486 I had narcotic pain meds (Percocet or vicodin - I don't remember which). I would NOT do it without that, if for no other reason than for the relaxing/calming effects. If you don't respond well to narcotic pain meds, YMMV. It wasn't super awful painful, but it wasn't great either. It took about 12-18 hours for the process to complete. I have also had a "natural" miscarriage, but I found out I was miscarrying when I started bleeding. My natural miscarriage (at about 8 weeks) was not painful. My D&Cs were uncomfortable but very fast and easy to recover from.

I agree with others that it might be worthwhile to get a second opinion about a D&C. Eight weeks is not that early for a D&C (and in fact they are commonly done at that gestational age). I'm not a doctor, and you doctor may have very good reasons for suggesting you forgo the procedure. But it is definitely the least stressful way to handle this situation.

Best wishes to you in this difficult time.
posted by mathowie at 5:00 PM on March 14, 2013

I had a miscarriage at about 9 weeks and went the misoprostol-only route. I really preferred curling up in my jammies with a hot water bottle and watching bad TV in the privacy of my own home to having a surgical D&C (which, like yours, my doctor recommended against.). I had a few hours of bad cramps (basically as bad as my worst menstrual cramps) that passed quickly once the yolk sac passed. My doctor did give me some Tylenol #3 that made the process easier.
posted by The Elusive Architeuthis at 5:28 PM on March 14, 2013

I'm so sorry for your loss. I also agree that it may be worth your while to get another opinion about a D&C, specifically from a gynecological surgeon.

If you decide to go ahead with RU486, ensure that you are well-cared for and demand strong pain medication like Percocet or Vicodin.

Please be gentle and kind to yourself; this is a very hard thing to go through.

And this is not the time to look to the internet in general for answers (although you can always trust us here). You will read way too many horror stories and can become unnecessarily upset.
posted by kinetic at 5:51 PM on March 14, 2013

I'm so sorry you are going through this.

I had a missed miscarriage almost exactly a year ago. I found out at 7 weeks that my pregnancy wasn't developing, and waited almost 4 weeks after that for a natural miscarriage before taking misoprostol, which I think has a similar effect to RU486. I don't recommend waiting. It was grueling, and in retrospect made the whole experience much more traumatic.

I do recommend going the chemical route rather than having a D&C. The whole experience of not being aware that my pregnancy wasn't viable and the waiting, waiting, waiting, made me feel very alienated from my body, and I think that would have been aggravated by going through surgery. Being at home with my husband while I went through the miscarriage wasn't easy, but it made it feel like "my" process rather than something that was being done to me. The whole thing, from taking the first dose to passing the embryo and all of the tissue, took about 4 hours. It was pretty painful, and the Percocet I was prescribed didn't help much, but it was manageable. I had cramps and a little bleeding for the next day or two, and then had a normal period 5 weeks later.

Other people have said to stay off the internet in general, but I found this blog post and its many, many comments very helpful. My story is on there too.
posted by apricot at 6:20 PM on March 14, 2013

I had two missed miscarriages in the 1st trimester and each broke my heart. The 1st was in the 8th week and the second was in the 9th week. I wouldn't wish either on my worst enemy.

I had D&Cs with both and would do so again. I was given the option of passing everything naturally but the idea of carrying around a dead fetus and waiting to have it pass was just too much for me. With the D&Cs I was also able to have genetic testing done to determine the cause of the miscarriage (which in both cases was reported as a monosomy).

If you do end up going the natural route, you might want to read this first hand account.
posted by Leezie at 7:07 PM on March 14, 2013

I had a miscarriage at 9 weeks and discovered the embryo had stopped growing at 6.5 weeks via ultrasound. I was offered to go naturally which might have taken weeks, or the D&C. I gave myself a day to decide and every time I went to the bathroom was causing me to get upset all over again, so I picked the D&C. It was quick and painless physically. I woke up from the anesthesia and didn't even realize anything had happened and it was performed as an outpatient procedure, so i was home within a couple hours. I'm so sorry for what you're dealing with.
posted by chiababe at 7:23 PM on March 14, 2013

I tend to have weirdly objective thoughts during crises as my way of dealing with overwhelming terrible situations. I vividly remember sitting on the toilet during my natural miscarriage (11 weeks) and thinking that I was really glad that, if it had to happen at all, it happened extremely suddenly with no prior knowledge that anything was amiss. For me, finding out and then sitting around for days or weeks on end waiting for it to "happen" would have made an awful ordeal into mental torture. The actual physical miscarriage was honestly not that big of a deal; I passed material steadily for about 11 hours and at the end felt shaky and weak but more or less fine; no pain other than some cramps at the very beginning. Emotionally, however, it was a complete mindfuck. If I'd had to deal with a bunch of dread leading up to it with false starts any time I felt a slight bit of dampness in my underwear.. ugh. I personally would have found that far, far more traumatic than dealing with additional physical pain.

I'm so, so sorry that this happened to you.
posted by gatorae at 7:47 PM on March 14, 2013

Natural miscarriage has nothing going for it. last thing you want to do is pass the fetus in the toilet at work and then figure out what to do for the rest of the day (I went back to work, that was a bad choice).

So sorry you have to make this decision.
posted by crazycanuck at 9:14 PM on March 14, 2013

I'm sorry you are going through this. It sucks. It will get better. It's ok to cry.
I had two miscarriages at 8 weeks and went with the D&C both times. I read scary accounts of doing the pill thing at home and it sounded way more awful than a trip to the hospital. My doctor also recommended the procedure because he says that way it can be done calmly and on a schedule instead of an emergency D&C after freaking out at home from too much blood or pain. Memail me if you want any more details on the D&C, it wasn't bad at all, except for the this-is-freaking-sad part.
posted by CrazyLemonade at 11:21 PM on March 14, 2013

I really feel for you.

RU486 felt to me like a 48-hour-long process versus a few hours with the surgical option. I know there is recovery time, etc., and they probably turn out about equal in terms of hours/days of discomfort, but I felt that RU486 wound up being more emotionally draining. I was very conscious of the process going on inside me for what felt like an interminable amount of time. It seemed very . . . slow.

This was my experience with RU486, almost exactly. The pain was...extraordinary (and I've walked on a broken leg for a week before having it set, my pain threshold is that high). I wasn't sure whether to post this, but I don't want you to be taken by surprise the way I was.

Take care, I'm really sorry for your situation.
posted by Salamander at 12:22 AM on March 15, 2013

This is more a voice of sympathy and concern than a vote. My first miscarriage was spontaneous as sucked. My second was silent and I opted for the D&C (RU486 wasn't offered). The D&C was quick, painless and a fast recovery. The only caveat is that I had placenta previa with my son and had a c-section at 36 weeks when the placenta separated for good, and he ended up with a 16-day stint in NICU while he figured out the whole eating and breathing thing. He's fine now, but I think if I had it to do over again I'd skip the D&C and wait things out, to minimize the chance I scarring.

Please be kind to yourself. So many of us have been there and know what you are going through, and we love and support you. Memail me if you need anything at all.
posted by tigerjade at 3:03 AM on March 15, 2013

I'm so sorry you're going through this, anon. The same thing happened to my wife about a year ago, and her OB advocated for a D&C. I think it's the best choice we've ever made—the surgery is short and very low-impact (I got shooed out of the room just long enough to go buy breakfast in the hospital cafeteria), and my wife was back on her feet in 24 hours, having never been in any more discomfort than she would during a bad period. The nurses, OB, and anesthesiologist were the three warmest and most helpful people I have ever encountered in medicine (if you are anywhere near Boston, I cannot speak highly enough of Brigham and Women's Hospital), and we managed to avoid the indeterminate amount of time that it would have otherwise taken for the miscarriage to clear itself naturally.

Also, while this is probably a really dark time for you, I can promise you that things get back to normal very quickly, and there's probably no ill impact on your fertility or the chances of this happening again. My wife miscarried 11 months ago, and we're now in week 28 of a healthy pregnancy.
posted by Mayor West at 5:14 AM on March 15, 2013

I know someone who took RU486, albeit in the UK where it is given by a nurse at clinic rather than collected at a pharmacy. She was given codeine as well, but despite this the pain was no more than a regular period. It sounds like this was an unusual experience given the above, but the idea of being able to be at home and for it to feel more 'natural' than a surgical procedure was a big winner. At eight weeks, things are pretty small, so I wouldn't worry too much about 'seeing' anything.

Make sure you take someone with you if you can. Tell them to take you home, make you a hot water bottle and order in some pizza. As another poster said, hormonal changes will happen and you need to be as relaxed as possible.
posted by mippy at 5:25 AM on March 15, 2013

Emergency physician here. Sorry this has happened.

I see many women with miscarriages in the emergency department, and hopefully you already know this, but this is not your fault. A lot of women blame themselves. This is not that you went running, or had sex, or ate something you shouldn't have. This fetus would never have become a baby; there was some genetic abnormality or implantation problem. This was not meant to be. This is nature's way of protecting you -- stopping things early, before things become more serious and the blood supply increases, putting your body at risk of fatal hemorrhage.

My exposure to mifepristone (RU486) is, like other commenters -- it looks really, really painful. It's available on the street in Haiti, where I worked post-earthquake, and women would come in after having used it to terminate their pregnancies. Obviously some selection bias here, but I certainly had to give them some hefty doses of pain meds. I'd discuss pain control with narotics AND motrin with your doctor; motrin typically works really well for uro-gynecologic pain, but does very slightly decrease your clotting ability (making you bleed easier/more). I found one study suggesting it does help without affecting RU486's efficacy. (But again, there are side effects when mixing motrin with a steroid like mifepristone; I am not your doctor, you are not my patient, and I am not providing medical advice as I do not know your medical history, and should discuss this with your physician.)
posted by gramcracker at 9:25 AM on March 15, 2013 [4 favorites]

From the OP:
I just want to thank everyone for all the supportive comments. This is a great community that I'm proud to be a part of.   I'm not beating myself up, I know this isn't my fault, and I know that this fetus had some kind of abnormality that made it not compatible with life.  I am very lucky to have the most supportive husband any woman could ask for.  I know by body will heal and we will move on.

I am going forward with the RU486 which will be administered in my Dr.'s Office.  It seems where I live in the U.S. you can't give it at a pharmacy.  I'm also getting a prescription for Vicodin. I listened carefully to the comments about the D&C, but my doctor has performed surgery on me before, knows my particular anatomy very well, is very informed about my medical history.   So while I believe for other women a D&C might be the right choice (and would be my first choice but for my doctor's concerns), I really believe my doctor has good reasons for thinking it's a bad idea in my particular case.

This will not be a pleasant weekend but then it will be over and I thank you all for the kind comments.
posted by restless_nomad (staff) at 1:04 PM on March 15, 2013 [1 favorite]

Thanks so much for updating, OP. You have been on my mind. I hope the process is as smooth as possible, and will keep you in my thoughts this weekend. You are welcome to Memail me if you to talk to talk to someone who has been through it too.
posted by apricot at 6:55 PM on March 15, 2013 [1 favorite]

Thank you from me as well to the people who commented in this thread; it helped my wife make her mind up in a similar situation, and she specifically asked me to thank you all for this.
posted by dhruva at 6:48 PM on May 22, 2013

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