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Medically induced miscarriage? 

I started spotting this afternoon and got crampy so I called my midwife.

I had a doppler check and 2 ultrasounds. The baby died 2 weeks or so ago. I'm supposed to be 15 wks 4 days. I'll be going in tomorrow morning at 8:30 to have Misoprostyl administered and deliver my Angel :( I want to avoid a 4th D&C. Last m/c was only a partial one and I ended up needing a D&C for the placenta a week later.

All my miscarriages have been missed ones. My body has trouble letting go.

This is my 4 miscarriage and 3rd 2nd trimester loss.

What can I expect with the misoprostyl? That is, if I don't naturally m/c first, which is what happened last time. To make things worse, my regular OB is out of town, but at least my midwife was able to be with me today for my scan.

I was also on spring break with my kids and had to send them to my ex's.
20th-Mar-2009 12:56 am (UTC)
im no help.

im so sorry for your loss. *hug*
20th-Mar-2009 12:59 am (UTC)
I can't answer your question, but I just wanted to say I'm so so sorry for your loss.
20th-Mar-2009 01:07 am (UTC)
I'm so sorry, I had hoped this would work out different for you. *hugs*

I had to use misoprostyl before my scheduled d&c last summer. I used it right around 5am, and wasn't taken back for the d&c until almost 8am, and honestly I never really felt a thing. I never cramped any worse than I already was (very, very mildly) or felt contractions in that amount of time. I'm sure it can be different for everyone, but in my own experience, I never really felt much, if anything at all from it.
20th-Mar-2009 01:12 am (UTC)
Thanks for sharing.
20th-Mar-2009 01:11 am (UTC)
I have no advice but I'm so sorry for your loss :( I'm in the September community and I know you had a lot of scares in the beginning.
20th-Mar-2009 01:31 am (UTC)
I was induced with misoprostyl at 21 weeks. I suggest reading up on it before you go in...I was not fully informed of the risks and I don't know if I would have consented if I had known (though everything went fine for me, luckily!).

For me, they inserted it vaginally every 4 hours until I delivered. It was almost 24 hours from first dose to delivery, but it may be faster for you with your history and/or if your body is preparing to let go anyway. I started cramping pretty instantly and it got steadily worse. I'm not sure how different it will be with a smaller baby/uterus.

I'm so sorry for your loss(es). Have they been able to find a reason for you?
I will be thinking of you tomorrow.
20th-Mar-2009 03:13 am (UTC)

I have Lupus Anticoagulant which was discovered after my 2nd m/c. This pregnancy I was on Heparin and Baby Aspirin and everything was going great despite 2 bleeds and a SCH. I'm not sure there's anything else that can be done for me. The last m/c baby was perfectly normal so I'm actually hoping that pathology shows something wrong to explain all this.

I'm not sure I'll be getting pregnant again though. I have 2 wonderful kids and 2 step-kids.
20th-Mar-2009 07:54 pm (UTC)
I also have Lupus Anticoagulant and have been struggling through my pregnancy.

My thoughts are with you.
20th-Mar-2009 01:32 am (UTC)
My thoughts are with you.
20th-Mar-2009 01:35 am (UTC)
I'm so so sorry my dear.

When I took a full dose of Misoprostyl for my last loss, I was able to take it at home but I was only 8 weeks at that point. I inserted the pills and lay down for an hour. When I sat up to go pee, my body started to violently shake and didn't stop. The cramps began at that point as well and steadily got worse and worse. I *should* have taken my T3s earlier but I had no idea they would get so bad so quickly. In an hour, I was in full blown induced labour and begging for more drugs and/or anything to make the pain go away. After about another hour or so, the T3s finally started to kick in (I waited WAY too long to take them) and took the edge off so I could deal with the pain. I also could not move around because of the shaking, the nausea and the vertigo.

Eventually the tissue passed and the pain subsided. However, I did begin to bleed VERY heavily after that and was worried I might be hemorrhaging. My husband and I went to the hospital just in case but I was sent home after being observed for a few hours.

I won't lie - it was a terrifying and traumatic experience for me. I wish I had been in the hospital because then I could have had some stronger pain medication at least and would have felt safer with the excessive bleeding after the tissue was passed. I would do it again though as the D&C I needed after that created scar tissue in my uterus.

I will be thinking of you tomorrow my dear. I am so so sorry you are going through this. I know how badly you wanted this dear little one. I hope everything goes without complications and that you and your husband are able to spend as much time as you need with your Angel. *hugs*
20th-Mar-2009 03:09 am (UTC)
Thanks. This sucks so bad. I don't think there's any 'good' way to experience this.
20th-Mar-2009 05:38 am (UTC)
I know how you feel. There is no "good" option, just one that might suck a little less then the others. I'll be thinking of you.
20th-Mar-2009 01:36 am (UTC)
I'm so so very sorry. :(
20th-Mar-2009 01:41 am (UTC)
i saw this in your journal, you must bave had it there accidentally. i tried to reply to it before you moved it...

below is my experience with misoprostol, it's pretty frank. just wanted to let you know before you read it...

i used misoprostol with my last miscarriage. the baby died around 8 weeks. i took it around what would have been 11 weeks after my body did nothing to take care of it on its own. i took 4 pills vaginally. it took about 3-4 hours to kick in. i was given percoset for the pain but wasn't sure what to expect so i didn't take it right away. at the 3-4 hour mark i was in A LOT of pain, the worst cramping that i've ever experienced, chills, gastric distress, heavy bleeding with big clots. i took a percoset and it was a lot better. i continued to take the percoset every 6 hours or so that day. the next day i was exhausted but not in too much pain. what was weird was that on the third day i had a more cramping and gastric pain and needed a percoset again. after that things got more and more normal each day. i bled for a long time, probably 10 days.

i think it's good that you're going in for it so you'll be supervised and won't have to go through it at home.

again, i'm so sorry for the pain that you are going through. :(
20th-Mar-2009 02:59 am (UTC)
I replied below, but without as much detail. Mine was similar to this, same gestation. It was so terribly pain4ful that I went to the ER. My stupid doctor had 'forgotten' to give me a vicodine prescription and I had never though to ask about it, figuring he'd let me know if the pain would be thatbad.
20th-Mar-2009 02:03 am (UTC)
I'm very sorry for your loss.

My experience with cytotec was a 1st trimester, at home with pills.
I took the first one late at night, and I woke up the next morning with cramps uterine & bowel. TMI, but I had SEVERE liquid poop (common side effect) I was going to the bathroom every 10 minutes or so, and it involved a lot of blood and tissue. I was exhausted. I was bleeding through pads every 30 mins or so. They felt like severe menstrual cramps (I have endo). The next day I was fine. The day after - I had nasty cramps all day, and was bleeding like a normal period...that evening I got extreme cramps and was dripping in sweat. Crying, screaming, shaking, nausea and the pain was a 10 on the pain scale. My husband came down to check on me (He had been out of hearing range) and moved me to a different bathroom got a fan on me and being supportive...then all of a sudden there was relief, all pain gone. Except the tissue got stuck in my cervix. We called the on call doctor - and he said pull it out or go to the ER. I opted for the cheaper route...I learned at this point my cervix was only about an inch up from the opening. I know that isn't a great story, but that is my experience.

Oh, my NP at the time told me I'd need advil. Yeah - get a script for something powerful.

Edited at 2009-03-20 02:07 am (UTC)
20th-Mar-2009 03:08 am (UTC)
I won't do this if the OB I'm seeing tomorrow sends me home with it.

Thank-you for sharing your experience.
20th-Mar-2009 03:40 am (UTC)
It was definitely a traumatic experience, and I think I'd opt for a D&C if I had to do it again, or to have them put me under heavy sedation in a hospital/managed care setting for the cytotec. I took my pills orally, and I wish I had done more research before hand - and insisted on some painkillers stronger than advil and perhaps done the pills in a non oral fashion.

You will be in my thoughts, there is no easy way to go through it.

20th-Mar-2009 02:56 am (UTC)
I've had one and it's very painful-- make sure you get a prescription narcotic pain med. I too ended up with a D&C to get out what was left.

I am sorry for this and your other losses. I hope you don't take this the wrong way, but many women with missed miscarriages take up to a month or more to miscarry-- as long as there is no infection and you're emotionally okay with it, it's fine to let things sit. It's rare that your body will never let go of the pregnancy; some women just take longer. My SIL miscarried a year ago and found out at 10 weeks that the baby had died at 6 weeks. I believe it took her at least another two weeks to miscarry.

20th-Mar-2009 03:08 am (UTC)
I appreciate your advice. This baby was supposed to be my homebirth baby so I'm usually all for natural when it comes to child birth. I just can't wrap my head around waiting it out. I have 4 kids and work full-time. My first 3 babies died 4 weeks before I found out/had symptoms. With my last miscarriage, I started bleeding heavily right after I learned it's fate and passed the baby into the ER toilet and it was devastating. On one hand, I like the 'ease' of the D&C, but I'm scared of doing more damage if we do decide to try again (I'm thinking not at this point). I'm hoping that being in a supervised environment will help me feel secure with what I'll be going through. None of my miscarriages have had pain with them so I'm scared about that aspect.

I don't even know if I'm making sense right now.
20th-Mar-2009 04:10 am (UTC)
All of what you said makes perfect sense, but I got from your post that you were going to go with the misopristol? Or are you still trying to decide? With mispristol, you insert the pills at home and are pretty much on your own.

Okay.. just went back to reread the post. So, what are you going to do after they administer the misopristol? This stuff takes hours to kick in. I don't think I'd feel comfortable anywhere but at home. If not that, I'd at least want a private room. I certainly hope they don't plan for you to wait in-office while you miscarry. Are they administering it by injection-- is that why you have to go in? From what I've seen, the standard is to administer capsules vaginally, less often orally. I really suggest dedicating an entire day to this and hopefully not have much going on the day after. Also, if you can, have a support person with you. I don't know if I could have gotten through it without my husband

To be a bit more specific-- I inserted the pills vaginally and then lay down. About four hours later I had many of the symptoms described by other-- terrible cramping, gastrointestinal distress. The pain was so terrible that I went to the ER where they gave me demerol and vicodine and a presciption for vicodine. I had the majority of my cramping and tissue passing after leaving the ER in my own home and had some cramping for the next few days.

Good luck!!
20th-Mar-2009 05:43 am (UTC)
The Misoprostol doesn't always take hours. I think it depends on the woman. With my experience, I started getting cramps within the hour. It sucks though that *any* woman has to go through this. :-(
20th-Mar-2009 01:27 pm (UTC)
I know it does! I chose the medical route because I thought it'd feel more natural and have less of a chance of harming me. It did, but I still ended up with a D&C and while it was not painful at all (general anesthesia, not even cramping I could feel afterward-- they were very surprised since they'd given me pitocin), the medically induced miscarriage was very painful.

It does depend on the woman, also on the dosage. I do seem to see more women saying it took 3-4+ hours. I wonder if length it takes to start has anything to do with previous vaginal deliveries or how far along your body had already started miscarrying on it's own.

OP-- I don't want to scare you; once they gave me the narcotics I still wasn't a happy camper and I could still feel heavy cramps, but it was manageable pain and was nothing compared to the beginning. Just try to stay relaxed!
20th-Mar-2009 02:50 pm (UTC)
I'm really not sure what's going to happen this morning. I'm open to talking to the doc about my options. The thought of doing it all at home scares me. I will have my husband with me.
20th-Mar-2009 04:13 am (UTC)
I'm sorry for your loss. I have no advice but you're in my thoughts.
20th-Mar-2009 01:10 pm (UTC)
Unfortunately, I have no experience with this, but I just wanted to say how sorry I am. Truly truly sorry.
20th-Mar-2009 02:55 pm (UTC)
I had a medically induced miscarriage in November of 2007. My loss was earlier in pregnancy than yours, and because my miscarriage was 1st trimester, this all transpired at home, but the protocol should be able the same for later losses in terms of dosage -- the medication works the same way.

In my case, 4 200mg misoprostol pills were inserted vaginally overnight. I didn't have any bleeding or cramping until the following morning, at which time it started slowly, but then picked up steam fairly quickly. I bled heavily throughout the day and passed several large clots. Because the bleeding was making me nervous and I thought (due to the clots I'd passed) I had passed all the tissue already, I took some oral tincture of shepherd's purse -- unfortunately, this caused me to retain some tissue, and I had to take an oral dose of 1 200mg misoprostol the following day to expel the rest of the tissue. I was thankful for the pain medication (codeine and 800mg ibuprofen) I was prescribed, both for the pain management (the cramping was very painful) and the emotional distance it gave me, but you may feel differently and want a different type of pain medication or none at all.

I didn't have to have a D&C after the fact. The misoprostol worked well.

I'm so sorry you're going down this road again. I hope your body and heart can heal well.

Edited at 2009-03-20 02:56 pm (UTC)
20th-Mar-2009 02:57 pm (UTC)
20th-Mar-2009 04:44 pm (UTC)
I am very very sorry for your loss and cannot imagine what you are going through right now. The only thing I can say is that about a month ago I had a ruptured ectopic which required surgery but afterwards they gave me an IV of methotrexate which apparently was to rid my body of any remaining tissues from the baby. I read on the internet that if you have a non-ruptured ectopic then the IV itself could be used without the surgery. I am wondering if it might work for you as well?

Best of luck, my thoughts are with you.
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