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Tag: D&C

Miscarriage Series – Birth Day

I have very mixed feelings today. On one hand, I am happy that the baby will be born today. I will be able to start moving forward. It feels like the last four days we have been in suspension, just waiting for this child to come. I do have second thoughts, wondering why this baby hasn’t come on his/her own. Maybe the baby is still alive?

I know the baby isn’t. We have checked twice. There was no blood flow into the baby on ultrasound. I wish things were different. It’s time to start saying good-bye. I just hate the fact that this baby will be sucked out of me in pieces. It is just so disturbing to me.

I have decided that this morning we will make a trip out to The Sanctuary in Sedalia, Colorado. This is a sacred place and has been recommended by friends as a great place to go to after loss. I will release some Love Wildly hearts here. It has rained for over a week and there is probably still snow on the ground from the Mother’s Day Blizzard.

Sanctuary Center - Sedalia, CO

I will add our baby’s name to one of the hearts. This baby doesn’t have their official name yet but they will soon and I can release another heart when we know the baby’s name.

Baby Petrucelli

Hubby is consumed with issues at work. I am struggling with his seeming lack of interest in me. It seems he is more concerned with work not realizing he is off today than anything else. He is spacey and says that he has an upset stomach.

I imagine this is just one part of his grief journey. I know he is sad and he is hurting. I know that I don’t just want to be held either which is his primary love language. I have tried to be more nurturing and touching over the last few days.

Hubby wants to go back to work on Wednesday. Getting him to take Tuesday off was a real feat. I wish he would just take the whole week off but he says he has to get ready to teach a class and he is already behind with work. I can certainly understand that but I don’t like being alone right now. I will probably have to just get through it anyway.

Timmy is a bit out of control. I am not sure if it’s his 2 year molars or if it’s the energy in our house. He is throwing fits I have never seen before and is extremely cranky. I am worried about him.

After getting upset about my husband not taking off the whole week, I go take a shower and get all cleaned up for the procedure. While in there, the surgeon called so I missed his call but hubby said he was nice and was going to call back.

While hubby was getting ready for the day the surgeon DID call me back. I was very surprised. After 30 minutes on the phone with him, I felt much more comfortable about the procedure. He did not use an ultrasound to guide him during the D&C but he explained why and offered to try it with me if I felt more comfortable. He also explained that he is extremely gentle and there would be no need to get aggressive with my uterus.

He explained that he has never had a patient complain about Asherman’s Syndrome as he was in a private practice for twelve years and was in the group practice for twenty-two before coming over to Kaiser. He was confident but not arrogant. He was empathetic and referred to my baby as a baby and not “products of conception.” When I asked about estrogen therapy following the procedure and/or a balloon to help keep the uterus from scarring together, he explained why he doesn’t use it but if I wanted it, he would be happy to provide it.

I seriously could not believe how amazing this doctor was. I thanked him for his time and we left for The Sanctuary Center to spend some time together before the procedure. It was a great filler of time that morning and kept my mind off the surgery. We picked up Joey from school on our way home. By the time we all got home, grandma was here to care for the kids.

I was about thirty minutes late for taking my pre-op meds which was Doxycycline and Cytotec. I had never been prescribed Cytotec before a D&C before. When I talked with the doctor that morning, he said I didn’t have to take it but it would help him dilate my cervix. I was glad I took that medicine late. Within fifteen minutes of taking it, I was cramping.

I hated that I was cramping and I was getting uncomfortable so I am glad hubby and I rushed to the surgery center. I was so worried the baby would come out before the surgery. Once there, I felt safe. Every staff person we came in contact with for the procedure was empathetic and compassionate. They knew we wanted our baby to be buried and they all talked about the baby and not “products of conception.”

I felt like stuff was coming out of my vagina and the pre-op nurse helped me. Once I got to the restroom, a huge glob came out. I studied this glob that was the size of a cherry tomato. I pushed it, rolled it, and studied it to make sure it was just a blood clot. Once I realized I was bleeding, I began to cry. This was it! Our baby would be born soon.

The doctor came in and we signed all the paperwork as well as the paperwork to ensure baby makes it to the funeral home and all the testing we requested would be performed. One of the tests cost $1200 and as much as I wanted to know the sex of this baby, I didn’t want to pay $1200 for it. Hubby though, wanted the test. I just wanted to be put out of my misery.

As the pre-op nurse brought me to the bathroom one last time, I asked her to help me with a situation I didn’t want to be a part of. I asked her if they could put me out before placing my legs in the stirrups. I told her it was degrading and felt like I violation. When I came out of the bathroom, she said they always put women out before placing the legs in the stirrups. Apparently, this was a big difference between the surgery centers. I was getting upset by my treatment at the other surgery center by Kaiser. I tried to focus on how good this experience was and am determined to write to Kaiser and see if they will change their procedures at the other center.

I also talked with the pre-op nurse and explained that we were never offered to bury our baby the last time and that I now write books and help women understand their options during miscarriage. I hope she found my resources helpful.

I was wheeled into the surgery suite (I had to walk at the other surgery center) and transferred onto the tiny operating table. I remember asking where I was supposed to lay my arms and then the anesthesiologist placed a nasal cannula in my nose and everything went dark. Shortly after, I woke up moaning in recovery.

A few hours later, I was released. I felt pretty good at home. I was happy that the baby had finally been born and I was no longer in a “holding” pattern. I could start to move forward and I would no longer have to worry about baby being born at home and not being able to catch the baby for testing.

Photo Credit: Dravas Photography

Photo Credit: Dravas Photography

Grandma had made dinner for the boys at home. As we were preparing to eat ourselves, the doorbell rang. It was Domino’s Pizza. They had a bunch of food for us. We almost turned them away until I asked for the receipt to see who sent the food. I thought it was my dad by checked my phone and saw it was my brother. I came to tears. This was so thoughtful and it was PERFECT for that evening. We had a wonderful meal. All of us sat on the couch for a few hours and then I retreated to bed after pumping for Timmy. Tomorrow, I should feel better.

– Breaking the silence of First Trimester Miscarriage

The D&C for Miscarriage

I am often asked whether or not a woman experiencing a miscarriage should have a D&C (dilation and curettage). I almost always tell them…it depends. It depends on many factors but women must also understand the risks, which are high, when choosing a D&C for miscarriage. This post will discuss just one of the three most common miscarriage options.

It is important to note that if you are beyond 12 weeks gestation, the doctor will likely perform a D&E; which is discussed here. This is a different procedure although carries similar risks. Your doctor may still use the term D&C to describe the D&E procedure; however, these are not the same procedures.

First, why do you want the D&C? Is it to get the miscarriage over with? Maybe you don’t have time to wait for the miscarriage to start? Maybe you can’t spend another moment knowing you have a dead baby inside you? Maybe you want testing done and this is the only way to ensure it? And then maybe, you want to be sure you get the baby so you can bury or cremate the baby?

D&C’s do not come without risk. One of the biggest risks is infertility (primary or secondary) due to scarring which is also referred to as Asherman’s Syndrome. If Asherman’s Syndrome occurs, you will need to have another surgical procedure to remove the scar tissue in order for you to conceive otherwise you will be at risk for further miscarriages.

A D&C procedure is the same procedure used in abortions although the baby has already died. The first part of making your decision to have a D&C is to be certain of your diagnoses. Has the baby really died? Believe it or not, this can be misdiagnosed and you could actually be performing a D&C on your living baby. It is imperative that a vaginal ultrasound (not abdominal) is used and coupled with blood tests to ensure that your baby has, in fact, passed away before moving on to a D&C. Your care provider would note no visible heartbeat and falling HCG levels.

It is recommended that a minimum of two ultrasounds are performed on different days. Keep in mind that if you are very early in pregnancy (less than six weeks) your baby might not be detectable on an ultrasound (living or dead). HCG blood levels typically need to be above 1500mIU in order to see a gestational sac and/or fetal pole and even then, the heartbeat might not be detectable until six weeks three days or longer.

Waiting to find out is very difficult during this already stressful time but this is the time where mistakes are most frequently made. Bleeding can be considered normal during very early pregnancy so bleeding alone is not a good indicator of an impending miscarriage. Bleeding coupled with cramping isn’t even a good indicator, especially very early in pregnancy. It is recommended that you wait until at least seven weeks of pregnancy and have two ultrasounds (at least 1 week apart) to confirm pregnancy loss before proceeding to the D&C. Even so, a miscarriage can take place and you might not even be sure if you passed the baby and placenta due to how early it was.

Besides the D&C, there are other options for delivering a miscarried baby; such as expectant management  and medical management (miscarriage at home either naturally or using a medication to help speed things along).

Having a D&C is a surgical procedure. You will generally undergo a light form of general anesthesia. This procedure is done on an outpatient basis unless there are complications needing you to be admitted such as excessive bleeding. It is becoming more common for doctors to conduct a D&C in their own offices.

Risks to the D&C procedure are:

  • Risks associated with anesthesia such as adverse reaction to medication and breathing problems
  • Infection in the uterus or other pelvic organs
  • Perforation or puncture to the uterus
  • Laceration or weakening of the cervix
  • Scarring of the uterus or cervix, which may require further treatment
  • Incomplete procedure which requires another procedure to be performed
The above risks are located at American Pregnancy.

If you choose to have the D&C, it is highly recommended that the surgeon conduct an “ultrasound guided D&C” instead of the normal “blind D&C.” Using the ultrasound while performing this procedure helps the surgeon to see where they need to use the suction instead of just blindly scraping inside of the uterus and possibly damaging more areas. This also helps reduce the chances of needing a repeat procedure for failing to remove all of the “products of conception.”

Following the procedure, the surgeon may place a “balloon” inside the uterus for approximately two weeks. Some surgeons will refer to this as a splint. This is placed inside and has a catheter that runs out of the vagina allowing bleeding and fluids to come out. Placing this balloon inside the uterus may help prevent the layers of the uterus from binding to each other. The balloon helps to keep all the layers away from each other while they heal. If they are allowed to lay on top of each other, they will heal (scar) together causing Asherman’s Syndrome (which may cause recurrent miscarriage and usually requires surgical correction in order to conceive and carry a future baby to term).

In addition to the balloon, your surgeon may prescribe you estrogen therapy for 2-4 weeks. This helps encourage healing by slowing progesterone production, which builds the lining of the uterus. Normally, it is important to have progesterone to grow our uterine lining as it is an essential hormone needed to sustain a pregnancy but while the uterus is healing, it’s important to reduce the production of the uterine lining so that walls of the uterus do not scar together. Estrogen therapy is recommended in combination with the balloon/splint.

In summary, using the ultrasound while performing a D&C can help the surgeon “see” where they need to work inside the uterus; while adding estrogen therapy and placing a balloon/splint inside the uterus for 2-4 weeks following the procedure will help women have a better outcome and will reduce the chances of developing Asherman’s Syndrome.

Are you or someone you know battling with a miscarriage? Visit Dragonflies For Ruby for support!

– Breaking the silence of First Trimester Miscarriage

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The information presented here is intended to assist you with discussing your options with your doctor. Please seek medical attention if you believe you are having a miscarriage. Dr. Charles March reviewed the section in my book “All That is Seen and Unseen; A Journey Through a First Trimester Miscarriage” before print. The information presented here is from that Chapter.

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