Thursday, September 20, 2007

what you may expect with an MVA (manual vacuum aspiration) after having a miscarriage

please note:
-disregard the date on this post; it was used so that it is not part of the chronological flow of this blog, but rather as a stand-alone resource for women who may be looking for information on a common post-miscarriage diagnosis procedure.
-all information here is based on personal experience. do not use it as a substitute for professional medical advice.

an MVA, or a manual vacuum aspiration, is a type of suction D&C (dilation and curretage), which is commonly used to empty the uterus after a miscarriage is diagnosed. a traditional D&C involves actively scraping/scooping out the "products of conception" with a sharp surgical instrument and carries a risk of future complications, as the uterus may become scarred or infected, which may negatively affect fertility and possible later pregnancies. for this reason, many doctors prefer to use a vacuum aspiration method (in which the pump can be electric or manual) instead, when either they or the woman deem that the non-invasive option of using misoprostol/mifepristone isn't appropriate or preferred.
my OB/GYN chose to use the MVA to finish my third miscarriage. since there was no evidence of any fetal tissue left -- my body had mercifully taken her back, and all that was left was the yolk sac and uterine lining -- she felt it would be completely safe. also, i was hesitant to use misoprostol again after the experience i had with my second miscarriage. since i trust this OB's skill and decisions, and as the actual MVA procedure is outpatient and takes about 15 minutes, i felt it would be better to have the physical aftermath be over more quickly. i do not regret this decision at all.
you will not be under anesthetic for the procedure, but will have taken narcotics, so you must have someone with you to drive you home. my husband wasn't easily able to come with me, so my best friend stayed with me through the entire thing, even coming into the procedure room with me. whoever accompanies you should be aware that they may be able to see what is being removed even if you cannot.

when i checked in, i had already (as instructed) taken one dose of anti-anxiety/relaxant medication; the nurse decided i needed to take another. i was on a table in stirrups; i recommend dressing warmly, because as the medications kick in, you may start to feel cold. although the procedure itself was not exactly physically painful, it was definitely not comfortable either. of course your practitioner's personal style and skill will come into play here; my OB/GYN and her nurse were supportive and gentle, and made encouraging comments along the way while giving me an accurate idea of what sensations to expect next or how much longer we had to go. they were mercifully sensitive to the emotional impact of the procedure as well.
i would also recommend bringing an eye cover of some sort, like a sleep mask, so that you can block out the light and concentrate on relaxing your muscles in the pelvic area, and also so that you do not have to risk seeing what is being removed, the instruments being used, or what is being used to clean you. apparently there is a great deal of blood, fluid, and tissue, and if your doctor is sending samples to pathology, there is a chance you will see what has been saved. you can ask for all of this to be removed from the room before you remove your eye covering.
after the procedure, you will need to start taking antibiotics. you may need additional prescription painkiller; that is your choice. i opted to use over-the-counter ibuprofin, mainly because i know my body responds well to it. you will still be groggy from the narcotics, but do not go to sleep yet! you will need food in your stomach for the antibiotics, so either have something easily digestible and nourishing (like your favorite variation on chicken soup) ready at home, or perhaps the person who took you home can make you a meal.
it is helpful to already have a heat pack -- either an electric heating pad or a microwaveable one -- available; you may have residual mild cramping from the procedure, and it is also soothing to have the heat on your pelvic area. make sure you let yourself sleep afterwards; you want to not only give your body a rest, but also sleep the rest of the narcotics off.
you will need to use sanitary napkins -- no tampons -- for the next few days to a week, as there will still be menstrual-like bleeding. you will also have to abstain from sex for awhile; your doctor will tell you how long. if you have a strict work schedule, i would highly recommend taking two days off for this procedure if you can; both the day of and the day after. you may still feel quite weak and in need of bedrest and recovery; you will certainly want the time to fully experience your emotions privately.
for me, this procedure was a great deal easier (physically) than my experience with misoprostol. my recovery time was faster, and i had significantly less days of bleeding afterwards. of course, i was also blessed to have a skilled and sensitive OB/GYN performing the MVA, which i'm sure made a huge difference.
if you are reading this to prepare for an MVA, know that i truly do hope this post -- or anything on this blog -- will help you during this time of sorrow and loss. know that you are strong enough to get through this -- physically now and emotionally over time -- and that you are not alone in your grief and pain. my wish and prayer is that you will find the comfort and healing you need in your continued journey towards family.

please feel free to post in the comments about your experience if you feel it will help other women looking for more information.

Wednesday, September 19, 2007

what you may expect with misoprostol (cytotec) after having a miscarriage

please note:
-disregard the date on this post; it was used so that it is not part of the chronological flow of this blog, but rather as a stand-alone resource for women who may be looking for information on a common post-miscarriage diagnosis procedure.
-all information here is based on personal experience. do not use it as a substitute for professional medical advice.

misoprostol, or cytotec, is a drug that can be used to "expel the products of conception" when your body is not doing it naturally. it can be devastating to know that your baby has been declared not viable, without a heartbeat, etc. and yet still be carrying him/her. in addition, if you wait too long, you can risk infection and potential uterine scarring, or you may have to have a more invasive D&C.
i believe misoprostol's main advantage is that you do not have to go to the hospital, but will experience your baby's physical passing in the privacy of your own home. the main disadvantage is that it can be incredibly painful and debilitating, and takes at least 48-72 hours to complete.*
if you google "misoprostol" or any related terminology, you may find a lot of information about its use as an "abortion pill" to choicefully terminate unwanted pregnancies. i am warning you about this because for many women, who did not want their baby's life to end, the use of the word "abortion" can become very emotionally upsetting/triggering. you may also see this word on your medical records: "spontaneous abortion," "incomplete abortion," or "inevitable abortion" to name a few phrases. remember: this is medical terminology. if you miscarried, your baby's death was not intentional and you did not choose it or cause it. it is not your fault. 

i had to use misoprostol with my second consecutive miscarriage. the first one happened naturally, and was complete by the time i got to the doctor. however, with this one, it was confirmed there was not a viable baby at 10 weeks, but my body showed no signs of figuring this out. i was offered the drug immediately, but because of the experience of my first pregnancy loss, i wanted to wait. however, when I got close to the 12th week with no changes, i had little choice unless i wanted to risk my own health and/or chances of future pregnancies. the prescription order was placed, and i was given two doses (4 tablets) and a bottle of tylenol 3 (tylenol + codeine) at the pharmacy. i was instructed to insert two tablets vaginally that day, and two more the next day, and to use the pain medication as needed.
some women may have no problem dosing themselves, as they may feel like they just want to get this all over with. others may feel that they are proactively ending their pregnancy, and have a strong emotional reaction to taking the physical step necessary to begin the passing of the baby. both reactions -- and anything in between -- are normal. just stay honest with yourself and don't minimize what you are doing: taking care of your own health for any future children, and allowing your body to safely complete what needs to be done in this pregnancy.
before you dose, be prepared with supplies, as you will be unable to leave the house, let alone drive anywhere.
you will need to have plenty of maxi pads on hand, as well as underwear and comfortable sleeping pants that you don't mind staining. you will want to put moisture-absorbent/resistant pads under your sheets in the bed (you can use old newspaper in plastic bags, pet housebreaking pads, etc.). you will also want to have protein-rich foods available since you will be losing a lot of blood.  do not forget to stay hydrated. a heating pad of some sort may help manage the cramping pains, and you might want a stash of fun movies or books to take your mind off what you'll be experiencing. each woman will react differently to the misoprostol; for example, some women experience bleeding within 20 minutes. for me, after the first vaginal dose, the bleeding started in about 5 hours. cramping started after about 9 hours.
i highly advise taking the pain meds BEFORE you start the misoprostol, and then dose yourself with pain meds regularly. don't wait until the cramping begins. use what works for you; i found that the tylenol 3 was useless, but over-the-counter ibuprofin worked. the heavy bleeding, along with large clots and tissue, had me changing pads every hour. this tapered off after about 17 hours.
the second dose 24 hours later is to make sure that you will pass everything in your uterus. for me the second-day bleeding was never as heavy, but 12 hours after that dose -- and i stupidly did NOT pre-emptively take pain meds -- i had such strong cramping i can only describe it as actual contractions.* it was unbelievably painful. i passed a huge clot/tissue piece several hours later, and then it was over. the bleeding will taper off after that, like a regular period. remember, you cannot use tampons. most likely, you will have a checkup with your OB/GYN soon after, and he/she will make sure everything has passed. 
my last bits of advice:
1) you absolutely cannot be alone and do this. someone needs to be with you around the clock for both emotional support and also because all the blood loss and potential pain can really debilitate you. if your partner can't be there for part of the time, ask a good friend. i was incredibly blessed to have my mother fly in to take care of me.
2) if you can, start the misoprostol early in the morning so that most of the worst bleeding/cramping will be over before bedtime and you can get some much-needed sleep. otherwise you may have to get up every hour to change pads and clean up, or the pain will be too intense for sleeping.
3) i know i already said this, but regularly and pre-emptively take the pain meds, whether it be the prescription stuff you may get or 1000mg of ibuprofin. whatever works. this is not the time to"tough it out." if you know that something stronger, like Percocet, works for you, ask for it.
4) be strong and believe in yourself. you CAN do this, and you will survive it. let yourself have the honest emotional reaction now or later, but know you WILL get through it. 

my heart goes out to you at what i know is an incredibly difficult, scary, and sad time -- i hope that this post, or anything on this blog may help you in some way. i am truly sorry for your loss, and my wish and prayer is that you will find the comfort and healing you need in your continued journey towards family.
please feel free to post in the comments about your experience if you feel it will help other women looking for more information.

*update: since writing this, i  have been surprisingly and incredibly blessed to experience a full-term pregnancy resulting in a natural live birth.  thus, i must add that the intensely painful cramping that misoprostol brings on is, indeed, contractions akin to those in full-on labor.  and having had a natural childbirth, i can tell you that another drawback of using misoprostol is the potential psychological effects.  for me, when i was far along enough to have already been admitted to the hospital to give birth, as the contractions intensified, i found myself mentally in a very dark place that i can only describe as my subconscious/memory confusing the misoprostol miscarriage contractions with the live birth contractions i was having, and i began panicking that i was going to have a dead, unformed baby.  so given the anxieties a woman experiences with any pregnancy after loss, i think this is a real issue to weigh if you have any choice as to how to finish your miscarriage.  

for more perspectives:
the only resource i found online that really gave me anything to use to prepare for my experience was the huge comments section of this post, which is on a blog written by a woman who struggled through infertility and several pregnancy losses before having twins via ART (assisted reproductive technology). take your time to read through as many comments as you find useful, as each woman's experience is different but can help you be much more prepared.
My Experience with a Cytotec (Misoprostol) Miscarriage


    in pregnancy loss communities,  when you have a living child after losing others, that child is called a "rainbow baby."  it&#...