Miscarriage Support
If you've come to this page because you've had a pregnancy loss or you are going through one right now, let me first say, "I'm so sorry." Miscarriage is an emotionally and physically intense experience that we usually have little preparation for dealing with. I'll be sharing perspectives I've gained through my two miscarriages and also what I've gleaned from others who have walked this path.
Affirmations for recovery from loss
Affirmations for recovery from loss
Finding Support
You are not alone, but you may feel that way. While miscarriage is common (1 in 4 pregnancies?), it's not a common dinner conversation topic, so you probably don't know how many of your friends and acquaintances have also gone through losses. I have found online support forums to be very helpful in this realm. Posting is anonymous, no questions or thoughts are "TMI", and you can access this support any time of day or night. No one understands what you're going through the way others who have also experienced this do. Here are some active forums for pregnancy loss support:
BabyCenter Miscarriage Support Group
BabyCenter Miscarriage Stillbirth Infant Loss Support
BabyCenter Miscarriage and Recurrent Miscarriage Support
BabyCenter Recurrent Miscarriage Support
BabyCenter 2nd/3rd Trimester Loss Support
Finding support from your friends and family
Before I experienced miscarriage myself, I wondered why it was such a "hush-hush" topic. Wouldn't people get more support if they were more willing to share about it? After all there's nothing to be ashamed about....miscarriage is quite common. Those were my naive thoughts. So after my first miscarriage I shared fairly openly with people I encountered at the time. What I discovered was that I could not be prepared for the things people might say that would be terribly unhelpful. You can google search "what not to say to someone going through miscarriage" and your well-meaning friends and family will probably say most of them. (It wasn't meant to be. It's better off the baby didn't make it because I have a cousin who is gravely disabled..... You can try again! Or, following my 2nd miscarriage, "third times the charm!") In my emotionally raw, fragile state it was too much to bear, hearing words that were jarring or painful. i felt like I was getting punched in the gut over and over again. After my second miscarriage I was careful to only look for support from people who I could more reliably count on being sensitive and helpful. Eventually I opened up more to others and even shared my story with my Facebook community, but that wasn't until long after the majority of the grief had been processed, when I was well into my pregnancy with my rainbow baby. So my advice is to be careful about who you look to for support. People mean well, but in our culture we just aren't very good at dealing with pain and grief.
BabyCenter Miscarriage Support Group
BabyCenter Miscarriage Stillbirth Infant Loss Support
BabyCenter Miscarriage and Recurrent Miscarriage Support
BabyCenter Recurrent Miscarriage Support
BabyCenter 2nd/3rd Trimester Loss Support
Finding support from your friends and family
Before I experienced miscarriage myself, I wondered why it was such a "hush-hush" topic. Wouldn't people get more support if they were more willing to share about it? After all there's nothing to be ashamed about....miscarriage is quite common. Those were my naive thoughts. So after my first miscarriage I shared fairly openly with people I encountered at the time. What I discovered was that I could not be prepared for the things people might say that would be terribly unhelpful. You can google search "what not to say to someone going through miscarriage" and your well-meaning friends and family will probably say most of them. (It wasn't meant to be. It's better off the baby didn't make it because I have a cousin who is gravely disabled..... You can try again! Or, following my 2nd miscarriage, "third times the charm!") In my emotionally raw, fragile state it was too much to bear, hearing words that were jarring or painful. i felt like I was getting punched in the gut over and over again. After my second miscarriage I was careful to only look for support from people who I could more reliably count on being sensitive and helpful. Eventually I opened up more to others and even shared my story with my Facebook community, but that wasn't until long after the majority of the grief had been processed, when I was well into my pregnancy with my rainbow baby. So my advice is to be careful about who you look to for support. People mean well, but in our culture we just aren't very good at dealing with pain and grief.
D&C, Cytotec, or Natural Miscarriage?
If you've had an ultrasound that confirmed the loss but you haven't miscarried yet, you are faced with some choices. Your doctor may or may not offer you all of these options. There are tradeoffs for each, and after hearing advice from my doctors and reading many online posts about women's experiences down each path, my impression is that there are risks with any of the options and the choice comes down to personal preference. (This is not a medically-informed professional opinion. Ask your doctor for the latest medical research indications.)
D&C - surgically completing the miscarriage. This option has the advantage of being scheduled at a time you choose and it's over quickly. You have the safety of being in a medical setting for the procedure. As with just about any invasive surgical procedure there can be complications such as uterine scarring that might impact future pregnancy outcomes.
Cytotec (Misoprostol) - this medication can be taken orally or inserted vaginally to induce miscarriage. One advantage is that you can go choose a time that works best for you and you can go through the process in the comfort of your own home. Disadvantages are that you do not have medical support immediately available if complications should arise and there is no guarantee that the medication will work. It's also uncertain how many times you will have to take it for it to work.
Natural miscarriage - waiting until hormonal changes send the signal for the body to miscarry naturally is also an option. The advantage of this is that you don't risk complications of the other more invasive procedures. The disadvantages are that you won't be in a medical setting if complications should arise, and you don't know when it's going to happen. It might happen tomorrow, or you might be waiting several weeks. If too much time passes there may be risk of infection. There is also a risk that the miscarriage is not complete.
A common question I read on the forums is, "how painful will it be?" With a D&C, the procedure should not be painful as anesthesia is used, but there may be some cramping for a few days. With cytotec and natural miscarriage, it seems that the pain can range from "like moderate menstrual cramps" to "like going through labor." That's a wide range. You can ask your doctor for pain medication in advance.
So, how to choose? Let's be honest here. All of these options pretty much suck. I'm sorry. Sometimes women are told that they must have a D&C if they want to have testing done to determine the cause of the miscarriage. This is not true as you can also get testing done if you miscarry at home, as I'll describe in the next section. With any of these approaches, you can minimize your risks by working with a doctor who you feel confident in and by seeking medical attention if bleeding is excessive (more than a pad an hour) or prolonged (more than seven days). Be aware of the signs of miscarriage complications.
Ultimately the choice comes down to your personal style and your approach to risk. I generally prefer to take the least invasive path. My first miscarriage happened naturally at home and I didn't know in advance it was going to happen, so there were no choices to make. With my second miscarriage, I waited three agonizing weeks after the loss was confirmed, hoping I would miscarry naturally. I got worn down from waiting, carrying around a bag of towels, avoiding traveling too far from home....I eventually chose to take cytotec. As the bleeding wasn't nearly as much as with my first miscarriage, I took a second dose which only led to mild bleeding. I then took a third dose and got nothing but diarrhea. Fun times. My doctor sent me for an ultrasound and, to my surprise, it appeared that fetal tissues had passed, although I still had a thick lining (which I supposed explains why there wasn't as much bleeding as I expected). Every miscarriage is different. No one can predict how yours will go. It can be a tough choice to make. I recommend informing yourself of all the tradeoffs and then consulting your own inner wisdom.
If you have any doubts about whether your miscarriage was complete, I recommend getting an ultrasound to be sure.
D&C - surgically completing the miscarriage. This option has the advantage of being scheduled at a time you choose and it's over quickly. You have the safety of being in a medical setting for the procedure. As with just about any invasive surgical procedure there can be complications such as uterine scarring that might impact future pregnancy outcomes.
Cytotec (Misoprostol) - this medication can be taken orally or inserted vaginally to induce miscarriage. One advantage is that you can go choose a time that works best for you and you can go through the process in the comfort of your own home. Disadvantages are that you do not have medical support immediately available if complications should arise and there is no guarantee that the medication will work. It's also uncertain how many times you will have to take it for it to work.
Natural miscarriage - waiting until hormonal changes send the signal for the body to miscarry naturally is also an option. The advantage of this is that you don't risk complications of the other more invasive procedures. The disadvantages are that you won't be in a medical setting if complications should arise, and you don't know when it's going to happen. It might happen tomorrow, or you might be waiting several weeks. If too much time passes there may be risk of infection. There is also a risk that the miscarriage is not complete.
A common question I read on the forums is, "how painful will it be?" With a D&C, the procedure should not be painful as anesthesia is used, but there may be some cramping for a few days. With cytotec and natural miscarriage, it seems that the pain can range from "like moderate menstrual cramps" to "like going through labor." That's a wide range. You can ask your doctor for pain medication in advance.
So, how to choose? Let's be honest here. All of these options pretty much suck. I'm sorry. Sometimes women are told that they must have a D&C if they want to have testing done to determine the cause of the miscarriage. This is not true as you can also get testing done if you miscarry at home, as I'll describe in the next section. With any of these approaches, you can minimize your risks by working with a doctor who you feel confident in and by seeking medical attention if bleeding is excessive (more than a pad an hour) or prolonged (more than seven days). Be aware of the signs of miscarriage complications.
Ultimately the choice comes down to your personal style and your approach to risk. I generally prefer to take the least invasive path. My first miscarriage happened naturally at home and I didn't know in advance it was going to happen, so there were no choices to make. With my second miscarriage, I waited three agonizing weeks after the loss was confirmed, hoping I would miscarry naturally. I got worn down from waiting, carrying around a bag of towels, avoiding traveling too far from home....I eventually chose to take cytotec. As the bleeding wasn't nearly as much as with my first miscarriage, I took a second dose which only led to mild bleeding. I then took a third dose and got nothing but diarrhea. Fun times. My doctor sent me for an ultrasound and, to my surprise, it appeared that fetal tissues had passed, although I still had a thick lining (which I supposed explains why there wasn't as much bleeding as I expected). Every miscarriage is different. No one can predict how yours will go. It can be a tough choice to make. I recommend informing yourself of all the tradeoffs and then consulting your own inner wisdom.
If you have any doubts about whether your miscarriage was complete, I recommend getting an ultrasound to be sure.
What happened?? Miscarriage Testing
Most likely your miscarriage was due to a chromosomal abnormality (typically an extra chromosome or "trisomy"). These abnormalities happen at all ages, but with increasing frequency as we get older. Beyond age 40, egg quality steadily diminishes, with higher and higher chances of chromosomal abnormalities resulting in miscarriage. Often doctors will tell you to just assume it was a chromosomal abnormality that caused your miscarriage. While that's a fair assumption, it's really not reassuring to me as a woman who WANTS TO KNOW FOR SURE WHAT HAPPENED! First of all, I want to put to rest any doubts that "maybe there's something I did that caused this loss". Of course, it's incredibly unlikely that you had any control over this, but the mind can wander and wonder, and I'd rather remove all uncertainty about this. Second, there are other causes of miscarriage, such as low progesterone or autoimmune problems. If we incorrectly assume that it's a chromosomal issue, we may overlooking another type of problem that could doom future pregnancies. I've heard some doctors discourage testing unless there have been multiple miscarriages and to me that is completely discounting the impact of miscarriage--physically and emotionally. Furthermore, women who are older cannot afford to lose precious time having multiple losses before drilling down to determine the cause. So for peace of mind and diagnostic reasons, I am a strong proponent of miscarriage testing. Some women prefer not to do testing because they would like to do something symbolic with their baby's remains (burial, tree planting.), and they are less concerned about diagnostics. Obviously it's a personal choice that is completely up to you.
If you wish to have testing done, you must get a sample of fetal tissue. If the miscarriage was very early, you might not be able to identify fetal tissue. However, I think after about 6 weeks, it should be possible. If you are having a D&C, your doctor will be able to preserve the tissue and send it for testing. If you miscarry at home, you can also do this. I found that some doctors are actually not aware of the Natera Anora test which allows you to send in tissues collected at home or during a D&C. Results come back in just one week, indicating any genetic abnormalities, the sex of the baby, and whether the abnormalities came from the sperm or egg. Your insurance will likely cover the cost of the test if you've had multiple losses or if you are over age 35. Even if insurance does not cover, you can get a reduced rate from Natera. I believe it was around $85 the last time I checked (2015).
How to collect and preserve fetal tissues
(Sigh. This is the TMI section that needs to be written and sadly, will be helpful to read if you are facing this difficult stage of the process. I'm so sorry you are here. Let's do this though. I'm going to be very frank about some uncomfortable stuff.)
If you've decided you want to attempt to collect and preserve tissues to send in for testing, you will need these things:
(1) A bottle of sterile saline solution. Get the cheap contact lens sterile saline solution at any drug store. If you don't have this when you miscarry just use water until you can get saline.
(2) A cup or a strainer to catch things as they come out. I used a plastic cup as it seemed a strainer would be to gross to try to clean out over and over, but I know others recommend a strainer.
(3) A container to store tissues that you think might be relevant (more on this later). Something like a margarine container will work. You can also use sandwich baggies and put those in a container.
(4) A small paper bag that you can fit your container in, and clearly mark so that no one gets confused when they are looking around in the fridge. (You will want to refrigerate this until you can send it in.)
Every time you go to the toilet whether it's for pee or bleeding (often hard to tell the difference), catch what you can in the cup. Anything that looks more solid you can inspect more closely. You can rinse things of gently....maybe use plastic baggies for this. If it readily dissolves, it's just blot clots and lining. What are you looking for, you ask? What will your baby look like? This is so hard. I know. There is an incredible website that shows photos of fetuses at every stage. I consider this a very sacred website honoring the angels who didn't make it. It might make you feel nauseated, you might sob, or it might bring you a sense of peace, or courage. Whatever you feel, it's totally fine and normal. If you feel it would be helpful to have a look at the images, go to this website: Lost Innocents.
Things you might see during your miscarriage besides blood - (a) large globs I've read described as "like liver", (b) clumps that might be the fetus, (c) clumps that are kind of like sea anemones. If they dissolve in water, it's just blood clots and uterine lining. If it's kind of feathery or like sea anemones, this might be chorionic villus. SAVE THIS! It has the same genetic material as the fetus and can be tested to get results. Here's the best image I could find....look at the material surrounding the fetus: HERE. If it's a blob that has some shape to it that doesn't dissolve, save this. I might be the fetus. When in doubt, save it. If it liquifies after a while, don't save it, it's not relevant.
Ask your doctor to order the Anora test kit from Natera. They will send a kit out immediately. The kit will consist of a container for your sample and a vial for you blood draw. You will need to go to a lab to get your blood drawn, and then the lab will send it all back to Natera.
My miscarriage testing experiences
The first time I miscarried, I thought everything had come out over the course of one long night with many bathroom trips and lots of bleeding. I had collected globs of stuff in baggies which I was keeping in a container in the fridge. Three days later, I was still waiting to figure out how to get the Anora test, because the center I had been going to for maternity care (UC San Diego) was clueless about this test. I had started getting crampy for some reason and I just didn't feel well. I was so confused an lost. I went to the fridge and took a peek at the "tissues" i had collected, one I though looked like it had an umbilical cord attached to it. But when I looked again, it had turned into liquid. I was talking to the baggie of liquid, saying, "baby, I just don't know what happened." Just then I had an urge to run to the bathroom, and out came what was clearly my teeny tiny baby, probably 7-8 weeks along. I called another doctor to get the test kit and thankfully he came through for me. Trisomy 9, female, maternal contribution (my egg was the problem).
The second time I miscarried, I was taking cytotec, I thought I knew exactly what to look for. My baby had made it to about 9 weeks, so I thought it should be like before but maybe bigger. I did catch one clump of stuff that turned out to be the chorionic villus, and thankfully I saved that because I never did find the fetus. It's so strange, because there weren't even the thick heavy globs like the first time, just moderate to heavy bleeding like with a heavy period. I sent in the tissues I had collected and got my results quickly. Another trisomy, also female, also maternal contribution.
It seemed strange for me to send my baby off in a fedex package that first time. But you do what feels right, and I talked to her, explaining that I loved her and I needed to find out what happened to her. The second time it was even stranger to not have anything to say goodbye to. But we make meaning in whatever way works. I found other ways to say goodbye.
If you wish to have testing done, you must get a sample of fetal tissue. If the miscarriage was very early, you might not be able to identify fetal tissue. However, I think after about 6 weeks, it should be possible. If you are having a D&C, your doctor will be able to preserve the tissue and send it for testing. If you miscarry at home, you can also do this. I found that some doctors are actually not aware of the Natera Anora test which allows you to send in tissues collected at home or during a D&C. Results come back in just one week, indicating any genetic abnormalities, the sex of the baby, and whether the abnormalities came from the sperm or egg. Your insurance will likely cover the cost of the test if you've had multiple losses or if you are over age 35. Even if insurance does not cover, you can get a reduced rate from Natera. I believe it was around $85 the last time I checked (2015).
How to collect and preserve fetal tissues
(Sigh. This is the TMI section that needs to be written and sadly, will be helpful to read if you are facing this difficult stage of the process. I'm so sorry you are here. Let's do this though. I'm going to be very frank about some uncomfortable stuff.)
If you've decided you want to attempt to collect and preserve tissues to send in for testing, you will need these things:
(1) A bottle of sterile saline solution. Get the cheap contact lens sterile saline solution at any drug store. If you don't have this when you miscarry just use water until you can get saline.
(2) A cup or a strainer to catch things as they come out. I used a plastic cup as it seemed a strainer would be to gross to try to clean out over and over, but I know others recommend a strainer.
(3) A container to store tissues that you think might be relevant (more on this later). Something like a margarine container will work. You can also use sandwich baggies and put those in a container.
(4) A small paper bag that you can fit your container in, and clearly mark so that no one gets confused when they are looking around in the fridge. (You will want to refrigerate this until you can send it in.)
Every time you go to the toilet whether it's for pee or bleeding (often hard to tell the difference), catch what you can in the cup. Anything that looks more solid you can inspect more closely. You can rinse things of gently....maybe use plastic baggies for this. If it readily dissolves, it's just blot clots and lining. What are you looking for, you ask? What will your baby look like? This is so hard. I know. There is an incredible website that shows photos of fetuses at every stage. I consider this a very sacred website honoring the angels who didn't make it. It might make you feel nauseated, you might sob, or it might bring you a sense of peace, or courage. Whatever you feel, it's totally fine and normal. If you feel it would be helpful to have a look at the images, go to this website: Lost Innocents.
Things you might see during your miscarriage besides blood - (a) large globs I've read described as "like liver", (b) clumps that might be the fetus, (c) clumps that are kind of like sea anemones. If they dissolve in water, it's just blood clots and uterine lining. If it's kind of feathery or like sea anemones, this might be chorionic villus. SAVE THIS! It has the same genetic material as the fetus and can be tested to get results. Here's the best image I could find....look at the material surrounding the fetus: HERE. If it's a blob that has some shape to it that doesn't dissolve, save this. I might be the fetus. When in doubt, save it. If it liquifies after a while, don't save it, it's not relevant.
Ask your doctor to order the Anora test kit from Natera. They will send a kit out immediately. The kit will consist of a container for your sample and a vial for you blood draw. You will need to go to a lab to get your blood drawn, and then the lab will send it all back to Natera.
My miscarriage testing experiences
The first time I miscarried, I thought everything had come out over the course of one long night with many bathroom trips and lots of bleeding. I had collected globs of stuff in baggies which I was keeping in a container in the fridge. Three days later, I was still waiting to figure out how to get the Anora test, because the center I had been going to for maternity care (UC San Diego) was clueless about this test. I had started getting crampy for some reason and I just didn't feel well. I was so confused an lost. I went to the fridge and took a peek at the "tissues" i had collected, one I though looked like it had an umbilical cord attached to it. But when I looked again, it had turned into liquid. I was talking to the baggie of liquid, saying, "baby, I just don't know what happened." Just then I had an urge to run to the bathroom, and out came what was clearly my teeny tiny baby, probably 7-8 weeks along. I called another doctor to get the test kit and thankfully he came through for me. Trisomy 9, female, maternal contribution (my egg was the problem).
The second time I miscarried, I was taking cytotec, I thought I knew exactly what to look for. My baby had made it to about 9 weeks, so I thought it should be like before but maybe bigger. I did catch one clump of stuff that turned out to be the chorionic villus, and thankfully I saved that because I never did find the fetus. It's so strange, because there weren't even the thick heavy globs like the first time, just moderate to heavy bleeding like with a heavy period. I sent in the tissues I had collected and got my results quickly. Another trisomy, also female, also maternal contribution.
It seemed strange for me to send my baby off in a fedex package that first time. But you do what feels right, and I talked to her, explaining that I loved her and I needed to find out what happened to her. The second time it was even stranger to not have anything to say goodbye to. But we make meaning in whatever way works. I found other ways to say goodbye.
Recovery
Grieving miscarriage is complex. First you've got an insane amount of hormones running amok through your body as your body still thinks you're pregnant for a while. Second, what you've lost is somewhat intangible, as it's more about a potential for a relationship and a vision of our future life, than a change to life as it is now. It's kind of like losing everything and nothing at the same time. People around you can't tell that anything has changed. But everything has changed...everything you had been preparing for, everything you had been looking forward to. The broken hopes and dreams can be so devastating to the heart.
Be gentle with yourself. Find ways to honor your baby. Be patient. Let yourself weep. Take time to nurture yourself. You're going through a tremendous emotional and physical upheaval.
When I was waiting (three long weeks) for my second miscarriage, I would watch this video of Andre Bocelli and Sarah Brightman singing Conte Partiro (Time to Say Goodbye). I would bawl my eyes out over and over again, til there were no more tears. And then more tears would come. At the time of this writing, about a year and a half later, I no longer feel that ache, but I have not forgotten. I do believe this is the kind of pain we need to more through, rather than trying to get around it.
I encourage you to find your style of moving through the heartache. There's no time limit and no set way to do this. Just inquire within, "how can I nurture my heart in this moment?" And notice what possibilities arise.
I've written a set of affirmations that may be helpful in recovering from loss: Affirmations
Be gentle with yourself. Find ways to honor your baby. Be patient. Let yourself weep. Take time to nurture yourself. You're going through a tremendous emotional and physical upheaval.
When I was waiting (three long weeks) for my second miscarriage, I would watch this video of Andre Bocelli and Sarah Brightman singing Conte Partiro (Time to Say Goodbye). I would bawl my eyes out over and over again, til there were no more tears. And then more tears would come. At the time of this writing, about a year and a half later, I no longer feel that ache, but I have not forgotten. I do believe this is the kind of pain we need to more through, rather than trying to get around it.
I encourage you to find your style of moving through the heartache. There's no time limit and no set way to do this. Just inquire within, "how can I nurture my heart in this moment?" And notice what possibilities arise.
I've written a set of affirmations that may be helpful in recovering from loss: Affirmations
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