Midwifery Today Community

Hi, Mods, move this if you think there's a better place.

I know there is a place for talking about the more emotional side of loss, but i wondered if anyone else would value a place to discuss the more physical aspects of choosing to miscarry at home...?

I have suffered 4 pregnancy losses, 1 very early, in the 5th week, one in the 6th week, one in the 7th week (which i'm just recovering from, though i suspect the baby died around the 6th week) and one at around 9 weeks.  All but one i completed at home, without medical treatment and i have not yet ever had to have a D&C.  It was because of the terrible care i recieved at the hospital that i became all the more reluctant to go to the hospital without due cause.  Basically a doctor, who did not examine my cervix or even palpate my lower abdomen an did not scan me at all, told me that it was a "breakthrough bleed from th Pill" - i had told him i had positive tests from a week before and hadn't taken the Pill for over 10 months and he said "it can still happen, it's not pregnancy", then a nurse who had done my initial admission and pregnancy test (negative by then, having been so for 2 or 3 days before bleeding began) gave me a massive hug and told me she was really sorry but that i was so young, i would have better luck next time.  When i told her the doctor's diagnosis she said "please see your GP tomorrow".  It was painful and hmiliating and not what i needed, and it made my XP doubt i'd had a miscarriage (even though he came into the bathroom when i was in the bath and saw the bloodloss i was sitting in) which made things emotionally much harder than they neededto be.

I know lots of women must miscarry at home as i prefer to, but there is very little online to help one through such a process.  I have my own "rules" i stick to, which help me to feel safe in completing the process at home.

• If bleeding becomes very heavy (for me that would be soaking more than 1 pad an hour, but i only ever bleed lightly with AF and i believe everyone knows their own "normal") i would seek medical advice.
• If cramping continues continuosly for "too long" (again, very individual, i would think more than 12 hours was too long) i would seek medical advice.
• If i had a vile or pus-like discharge or a fever or chills i would seek medical advice.
• If i felt suddenly very ill, desperate or frightened and the sensation only worsened (i did/do feel panicky at the moment when the baby and/or the pregnancy tissues are passing through the cervix but it passes quickly) i would seek medical advice.
• Because i am taking care of myself i tend to "catch" my loss in either a menstrual cup worn internally or on a pad and i immerse any lumps or clots into cold water and check what they are.  I look out for recognisable things so i that i know how likely it is that the miscarriage is complete.
• If i had red bleeding that wasn't subsiding at all after 3 or so days i'd seek medical advice, and likewise if i had bleeding that wasn't overly heavy but wasn't getting lighter either for more than a week or so i'd seek medical advice.
• I try to make sure there is another adult (ideally DH of couse) with me when i'm cramping, and keep him informed of how i'm feeling and how heavy the loss is, so that if i suddeny faint he knows what it could be and what he should do.

Have i missed anything?  This recent miscarriage has been strange for me.  Usually i tend to lose my pregnancy symptoms, then have a little spotting which grows into fresh red bleeding, hard cramping, complete loss and then the bleeding slowly subsides.  Usually the pregnancy, if it is late enough to have formed in any recogniseable way, comes away whole and fresh.  This time it was about 10 days from the pregnancy ending to the miscarriage beginning, i still have a few symptoms even today, and as such there were a lot of black clots and shredding old-looking membranes.  I had strong cramping and lost most of the tissues on Sunday afternoon and evening, then had continued fresh red bleeding with occasional clots until Tuesday evening when i had a few hours of cramps, another gush of blood and some more shredded membranes.  This morning the blood has turned brown and is much lighter.

As women and midwives are there other things you look for/warn about in this situation? 

 I've only had one miscarriage, but most of what you are doing sounds like what I was advised.  The only other thing I can think to add right now is to stay hydrated.  I tend to be pretty sensitive to blood loss so I get dizzy and faint-feeling easily during heavy periods and certainly during the miscarriage, so keeping plenty of fluid in me helps prevent that.  Try to eat as close to normally as you can, too, and get as much rest as you can. 

Another virtual hug.

Aron

Hi Bec,

All of your guidelines for yourself sound very reasonable.  I've also miscarried all mine at home, though I did see my doctor after my first one (the latest I've had at 7 weeks 6 day).  He prescribed methergine orally for me to take to help me complete the miscarriage because my lining was still thick after I'd actually lost the baby (he checked on ultrasound).  At one point a day or two after I lost the baby, the bleeding and pain got really heavy with a huge clot coming out, and then blood streaming out behind it, and I was really scared, and called the doctor at which point he told me to take a methergine right away, lay down with my feet up, and then take a pill again a few hours later.  He checked 2 weeks later with an ultrasound to see if my lining had been completely shed and it basically had been, so I was in no need of a D and C. 

If you can't get a scan somehow in a weeks or so, I'm guessing, that if you monitor your bleeding and don't have any unusual spotting or bleeding beyond a couple of weeks, that you have shed everything too.  You'd probably have wacky bleeding if a piece of something was left in.  I don't know much about herbs to help evacuate everything, but you could check into that too, to see if there's something to help you clear out, so to speak.

I'm sorry honey.  Please take care of yourself.

All your advice is good.  Four things I'd add:

1. As well as just looking at the blood & clots, I recommend actually combing your fingers through everything that comes out. I once mc'd at 12 wks, and sifting through the clots I found a tiny sac with a 5 wk embryo the size of a pinky fingernail clipping, which might have easily been overlooked if I hadn't been so thorough checking though the clots.
2. If there's anything besides clots that come out, save it so if you have problems and need help they can analyze it at the lab.  I once mc also at 12 wks, and passed a meaty looking blob, definitely not a baby, when my BP went down to 50/30 we headed to the hosp. where the lab determined it was a hydatidaform mole and so did a D&C. It was definitely not the classic picture of a hydatidiform mole, so if we hadn't had it analyzed, we might have been facing the same scenario a few months later! (For those who dobn't know, a Hydatidiform mole is when an egg & sperm come together and start multiplying, but never form a baby. It grows like a tumor. That's why a D&C is recommended; if one single cell remains behind, it will keep growing! The textbooks picture it like a bunch of red grapes, but mine was just one big long chunk.)
3. Before you take any herbal or medical remedies (like Black Cohosh, Cotton root, Methergine, etc.) I'd want an US to be sure you didn't just mc one baby, and still have a live twin in there!
4. If you're having a hard time with the process, call your midwife, I'm sure she will be happy to come to your home and do all the comfort measures she would during a normal labor. Plus she can help with the clean up, take tour vitals and relieve dh of some of that pressure