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


Anonymous said...

Thank you for the post.
I just went threw this, yesterday. Still cramping today, i honestly thought the intense cramping was over, until i woke up today in almost the same pain i felt my first and second dose.

When i had be giving these pills, not one doc or phms told me to take any pain pills. I had to even ask if i needed to buy pads.

This was the most painful thing ive ever gone threw.
my baby had no heart beat at 8 weeks, and was not devloping.

I was offered a d&c, but i thought there was still hope, for some reason. Guess i was wishing.

I was already in so much depression and loss, mentally. Then having to go through this pain with no drugs, and watching my baby come out of me in the washroom, was just too much.

I am honestly so scared to even try to have a baby again, cuz i feel i cant take this.

If u need to take these pills, please eat, and take heavy pain meds before the first dose, and agsin before then second one.

dont go threw what i did. Its unnessisary, and just the worst pain someone can go threw, that u do not need too.

I figured since my doc never told me to take anything for.pain, that i wasnt allowed too.

It was terrible.

Take pain pills, drink water, and eat. Oh dont do this at night, i did as well, since the pham told me too.

hadashi said...

oh fellow mama, my heart hurts for you. i'm so sorry you had to go through this. there is always hope, and even though right now the sadness is so crushing, you WILL be able to try again. if you want to talk about it, or just have some encouragement, feel free to email me privately; you can find the address under the "about" tab at the top of the page. peace to you.

Aly said...

Thank you so much for this post. I have just started my second dose of cytotec, and found all of the information to be extremely helpful.

hadashi said...

Aly, i'm so glad it could be of help. hoping that you have a quick physical recovery, and also healing for any emotional/spiritual/psychological pain you may be going through. sending you peace & love.

Unknown said...

Thank you for this post. I too am on my second dose, and this is my second consecutive miscarriage. It is a huge help to know I am not alone in this. Thank you for this post, it is helping more than you know. I took iron supplements and I have been drinking juice to try and keep my blood sugar up. So far the beeding for the second dose isn't as heavy, but the cramps are beyond terrible. My first miscarriage happened naturally, but somehow having the physical pain to accompany my emotional pain is helping in the strangest, weirdest way possible, if that makes any sense. I am hopeful that the next try works and i will be able to eventually see a beating heart on an ultrasound scan in the future.

hadashi said...

hi Megean, thanks for the feedback. i'm so sorry about your losses. i know exactly what you mean about the physical pain helping the emotional pain, and it's not weird at all. my best wishes and prayers are with you -- may you grieve well and heal well. i hold on to hope with you.

Anonymous said...

Thank you for your post. Finally some real information. I wish I had found prior to my first dose. My doctors did not prepare me for this. They told me no eating or drinking an hour before insertion and not to get up for 4 hours ...... by the time I did it was so scary. A few hours later I almost passed out.
I found eating salty foods and protein rich food helped also drinking Gatorade.
Just took second dose at 7:00 and I'm praying it won't be as bad as the first.

hadashi said...

i'm so sorry you have to go through this. definitely keep eating protein & drinking a lot of liquids. be kind and gentle to yourself. i'll be praying with you. may you physically heal quickly, and be able to navigate the emotional healing with grace.

Donna said...

Hi, so i was 10 weeks pregnant when i found out there was no heartbeat :( i inserted 3 misoprostol vaginally last night and bled through the night. Early hours i passed some large clots and some small with bleeding. Cramps have completely stopped and bleeding just like a normal period. Is this normal? And shall i take a 2nd dose? Ive had a miscarriage before and a 2nd dose was never needed.

So sorry for your loss' ladies, its truly heartbreaking. Xx

hadashi said...

hi Donna, i'm so sorry that you are going through this AGAIN. 10 weeks was when I had 2 of my 4 pregnancy losses; i grieve with you.
i would say that you have to ask your doctor; i know that the second dose is to be sure that your uterus has expelled everything so that you can avoid possibly also having to have a manual vacuum aspiration (MVA -- i have a post on this blog about that too). the vast majority of women have "cleared the womb" after the first dose, but i think OBs prescribe 2 just in case you're in the minority. call your doc's office and hopefully you can speak to a compassionate person.
Donna, the love of so many, even all of us who don't personally know you, surrounds you right now.

Sarah Ely said...

Thank you for this post i was actually given this in the hospital because I'm high risk because past surgeries. I was told no eating and I had to stay in bed for 2 hours after the first dose was given. 2 hours later my water broke and 2 hours after that I delivered our 13 week baby girl. This has been the hardest thing in my life. I am just shy of a week and I just took my last dose of cytotec I was given 8 pills to take orally. I had a ultrasound done yesterday and there was something left behind. My heart breaks for all the mama out there.

hadashi said...

oh Sarah, how heartbreaking. i'm so sorry you had to say goodbye to your baby girl. praying for your physical recovery as well as for you to be able to grieve fully and honestly. may you heal and be stronger for it. you are beloved.


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