If you've read my blog before, you know that miscarriage has been a part of my life for many years now. My first one left me bereft over seven years ago. It has been followed by four others. Each one was different, and I coped with each in a different way. After so many, I no longer come undone over them. After having the issue of pregnancy loss in my life for so long, I feel only a marginal sadness. I can say this because I have three healthy and vibrant sons. I can say this because I spent most of last year dealing with a pregnancy loss. Yes, I suppose I am a bit jaded by now. But as I waited from April to December to pass a blighted ovum, I finally got the diagnosis that unlocked my miscarriage mystery.
It is with a confusing sense of joy and deep meaning that I tell the story of what is most likely my last miscarriage. I want this story to help so many others. Because I came to this same laptop day after day during most of last year and Googled one question again and again, worded slightly differently every time: How long can a natural miscarriage take? (Just as often, the question was "How long is it SAFE to wait for one.") In whatever phrasing, I now have the answer to that question as it applies to me. I can't answer yours for you, but I can tell you my story and perhaps give you hope and courage when you are having trouble finding it anywhere else.
If you are of a mind and heart to do so, you can absolutely safely wait to have a natural miscarriage. When, last April, my midwife told me that my ultrasound showed a blighted ovum, I asked her straight-up how long can this take? Her answer was "A very long time." No one knows how long that time will be for you. And even if it isn't long, it will feel like much longer. Waiting for the products of a failed conception can be agonizing. It is more so if you are filled with worry.
You are more likely to be worried if you are being pressured by your healthcare provider to have a D&C that you do not want. If you are experiencing this type of worry, read on. There is a beacon of hope for you.
Last April found me waiting for an inevitable miscarriage to begin. I had some spotting from time to time, some cramping. No real progress.
May found me waiting still. Spotting and cramping. Waiting some more.
June found me getting frustrated. With no good answers every time I Googled. I went back to the midwife. I wanted misoprostol, a drug that I used safely in the past to facilitate a miscarriage. She told me that it was no longer a drug that the OB/GYNs at the clinic approved of. She referred me to a doctor who could perform a D&C.
When I went to see him, he told me the risks of waiting for the miscarriage to happen naturally were cramping and bleeding with a slight risk of infection. The risks he listed off for a D&C were certainly more numerous. They included, but were not limited to: a reaction to the anesthesia, hemorrhage, infection, my uterus being punctured, of blood clots forming that moved to my heart or lungs, of the procedure failing to remove the tissue at all. Scary stuff.
But I did not get scared until the day before my procedure when I sat down and Googled "Holistic Healing from D&C." The first page that came up was about Asherman's Syndrome. When I messaged my midwife, she said, "What the heck is Asherman's Syndrome?" I found that comforting. It is rare. But the condition can develop after a D&C when scar tissue causes the walls of the uterus to become adhered to each other. It can be corrected with surgery, but sometimes it leads to hysterectomy. For more info, click here.
If you follow the link, you will read that the risk for developing Asherman's Syndrome increases with multiple D&Cs. When D&C is performed due to a missed miscarriage, the risk is as high as 30%. I had a D&C for retained tissue after my first son was born. Plus, after so many miscarriages, I kind of feel like my uterus is generally in need of extra care and sensitivity. So Asherman's scared me. Plenty. I called the hospital and spoke with the midwife on-call. A different midwife. This one listened to my concerns and told me that I should listen to my body. With that one sentence, she gave me back my confidence in myself.
I opted not to have the D&C. I called the doctor and asked him for misoprostol. He told me that he did not endorse the use of the drug because of the risk of cramping and bleeding, and that I should "make no mistake, D&C was the only course for me."
Maybe I felt personally challenged. OK, YOU BET I FELT PERSONALLY CHALLENGED! But I knew he was wrong. I also know that cramping and bleeding are a normal consequence of miscarriage. Normal and natural. I would never expect to experience a miscarriage without those natural side-effects. I would still have opted for the misoprostol if I could have gotten it. I used it in 2010 and it worked well for me. The miscarriage was more painful than the others, but the bleeding was not really more severe. And there is practically no risk of developing Asherman's after using misoprostol.
So here we are in my story, and it is June and I have canceled my D&C procedure. The midwife I had been seeing told me she could be of no further help to me and the doctor was the most qualified to handle my situation.
Let me make no mistake with you,dear reader. You and you alone are the most qualified to decide what to do with your body once you know a miscarriage is inevitable. In my case, my body told me quite clearly that it did not want a D&C. Is your body saying the same to you? Good for you! Keep reading.
I waited all through June. Spotting, light cramping. July brought some heavier bleeding, more cramping. At some point toward the end of the month, the bleeding stopped. With my first miscarriage, I experienced some heavy bleeding and did not notice passing any tissue. So I thought, Well, that's it! I must be done now.
But I was still tired. A lot. And sore and achy in the places that only hurt during pregnancy. August came and I had a couple days of spotting. September came and I noticed a few more spots of blood. October came and for lack of knowing what to do, I took a pregnancy test. It was positive.
So I went back to the clinic. I asked to see the midwife who I had spoken with on the phone in June. The one who told me to listen to my body. I explained that I did not know whether I was dealing with a new pregnancy or the old one. I had no more spotting at this point. She ordered some bloodwork, which included measuring my TSH (Thyroid Stimulating Hormone.) And I went in for an ultrasound. The mass of tissue was still there.
The midwife described the tissue as something of a scab. She said that it filled the entirety of my uterus. She recommended a D&C, which I flatly refused. She also told me that my TSH was abnormally high. "Has no one ever checked you for thyroid disease?" She asked.
No. No one had ever checked my thyroid. Even though thyroid disorders seem to run in my family, and I had the words "History of recurrent miscarriages" in bold on my medical chart. But this midwife did, finally.
My midwife agreed to monitor me with regular blood draws to check my HCG levels and periodic screening of my white blood cell count,which would indicate if there was any infection, There were no signs of infection, and my HCG was slowly falling, about 10 points lower every 7 - 10 days. In October, my HCG was 170. In November, it had fallen to 120.
I was sent to see an endocrinologist, one who specializes in reproductive issues. The first thing she did was recommend a D&C (Ha! Broken record, anyone?) She also ordered a screening for Thyroid antibodies. She gave me a script for 25mcg levothyroxine, and agreed to monitor my TSH and T4 levels until the end of my miscarriage before determining my long-term dose of the drug.
I digress. But I wanted to tell you, dear reader, that now I know. I know why I have had all of the miscarriages, the emotional upheavals, the reason why every pregnancy makes me into an exhausted and hysterical wreck. I am suffering from Hashimoto's Disease which has brought on hypothyroidism. It explains so much for me. In retrospect, I realize how lucky I am to have three healthy and beautiful sons. They seem even more miraculous now, if that is even possible.
November and more waiting. No spotting anymore. Regular blood work. HCG falling slowly. No signs of infection. It was suggested that I should be on "pelvic rest," a suggestion I did not follow. Regular TSH checks. It too fell slowly.
Slowly, it became clear that my body could not and would not do the work of completing the miscarriage until it had the energy to do so. That is, until my T4 levels were back within the normal range. I had procrastinated about taking the medication. I did not want to be on a script for the rest of my life. I researched all kinds of natural alternatives. But I was tired and I wanted to feel better. More than anything, I wanted a normal life back. I finally started the the prescription after watching this blog post by Dr. Clark.
This has all taken an incredibly long time now. Long for me to endure, long for me to put into words, long for you to read. So I will now tell you about the end. I started spotting again about ten days before Christmas. My last HCG level on December 11th had been 57. Heavy bleeding and cramping began on Saturday, December 20th. By Sunday, the bleeding had slowed to that of a light period. Again, I thought, This is it! Whew, that was easy! But I did not notice any passed tissue.
Monday, I was headed out the door to take my boys to the creek. I felt great. The sun was shining and it was a warmer winter's day. I put on my boots and opened the door and felt a slight cramp and then a tiny feeling of pressure. Then I felt something slid down and out of me. I ran to the bathroom.
I did not find what I expected. What I expected was a mess. Like all my other miscarriages have been. But what I found was something akin to an extra large gray bean. It lay there, almost bloodless. I hesitate only a bit to tell you, dear reader, that it was perfect. Perfectly formed, perfectly complete, and perfectly preserved. So perfect that I was left feeling nothing but an incredible gratitude that I was able to see it, to examine it, and to say, at long last, Good-bye.
And that was the end. No more cramping. Only a bit more spotting and then done. I did not get off entirely easily though. I made up for the lack of bleeding with my first menstrual cycle a few weeks later. It was truly a torrential downpour. Heavy periods may be the new normal for me as a result of my thyroid issues. But knowing that things are natural and normal is a surprising and enduring comfort for me.
The human body is amazing. It can do incredible things, unbelievable logic-defying things. Mine can and does everyday. And yours can too.
If you are wondering if you can do this, if you can have a natural miscarriage in the face of medical pressure not to, I am here to tell you that you can. You can do it safely. You have to be smart and know the signs of infection. You have to take the time you need to do it and take care of you throughout the process as much as you can. You have to be aware that it can take a VERY LONG TIME. Eight months, actually. Perhaps even longer, but I haven't found the anecdotal evidence that confirms this. Throughout the process of my last miscarriage, I encountered medical professionals who had never seen a miscarriage take so long. I invited them to journey with me so that they too would know what happens when a woman just decides to wait. And wait. And wait. Now they know how long a woman can safely wait.
And now you do, too. I hope your waiting is not as long as mine. But if you have found this blog post, my wish is that it has brought you some measure of relief. You are strong and capable and you can do this. When it is done, you can begin your life anew knowing that you did what your body and your heart told you were right.
All my best to you.
For more info on natural miscarriage, please visit my other blog post on the topic. http://www.centervillesworks.com/tiffanys-heart-health/2013/10/12/in-case-of-miscarriage