Caring for Women Who Suffer Birth Loss

I posted the information below elsewhere on the internet in response to a request for advice regarding care protocol for women who experience miscarriage or stillbirth.  I am amazed at how upset I got just writing these seven points.  Women who miscarry or otherwise lose their babies are treated so strangely.  I’ve been reading a terrific book called Motherhood Lost which looks at birth loss from a feminist perspective.  It really speaks to me, so click on the link and check it out.

For what it’s worth, here was my personal advice regarding birth loss “care” – something we don’t always experience when we’re being “treated”:

1. Take women having active bleeding IMMEDIATELY to a room. Don’t make them sit bawling their eyes out around other pregnant women or in a horrible ER waiting room.2. Don’t subject them to unnecessary protocols when they make a request – I was “forced” to accept a heplock, and not only was it completely unnecessary, but the nurse sucked at getting it into place.

3. Don’t tell a woman (especially when you’re not her provider) that she put the pregnancies too close together and that she pushes herself too much. We already blame ourselves enough.

4. Don’t misread ultrasounds. Misread ultrasound leads to misdiagnosis which further complicates care and treatment. Because of this misdiagnosis, I was treated like a woman who wasn’t miscarrying “correctly” instead of a woman experiencing “threatened miscarriage” due to a subchorionic hematoma.  5w4d may be too early to see a fetal pole, and the presence of a yolk sac implies the existence of a fetal pole.  I did NOT have a blighted ovum.

5. If your patient miscarries over the weekend . . . follow-up with her. It’s the least you could do.6. Make the billing process more clear and more simple to digest. I don’t know where all of my bills come from and why I continue to have to pay so much out of pocket. I thought I had insurance???

7. Make sure you have RESOURCES to share with your patients/clients in the form of personal support, support groups/networks, reading materials, etc.

Yeah . . . all of this (and more, I’m sure) I experienced with my 10/07 miscarriage. That was my one and only experience with our local hospital. I won’t be going back there unless I’m seriously dying.

Completed Miscarriage

My ultrasound this afternoon confirmed what I already knew: that I lost the pregnancy yesterday and that I have a fibroid.  The ultrasound technician confirmed what I recently learned – that I was misdiagnosed last week with a blighted ovum.  Not only was it too early to diagnose a blighted ovum, but the presence of the yolk sac means that it was NOT a blighted ovum.  Likely the large subchorionic hematoma lead to the eventual miscarriage.

It’s been a rollercoaster ride of a week: threatened miscarriage, started a new chapter of ICAN, stayed in bed and hid from the world, put off all responsibilities onto other people’s shoulders, posted, researched, prayed, cried, hope, despair, loneliness, overwhelmed, frustrated, angry, confused, trusting, untrusting, and the list goes on and on.

So what’s next for me?  A make-over?  I dunno.  I’ve consented to having the OB monitor my pregnancy hormone levels down to 0.  Then I will have more bloodwork done to see if there’s anything more serious wrong with me.  The fetal tissue will be sent for pathology analysis.  I’ll keep teaching.  I’ll get back to singing.  No choices there.

I’m putting a lot of time and energy into ICAN.  I feel good about that.  I’m in the process of planning a sneak preview of The Business of Being Born.  I’ve been getting a lot of great support from ICAN leaders for both the preview and the start of this new chapter.  And Barranca Productions put me in touch with a woman here in town who was looking to schedule a screening of The Business of Being Born.  Now she’s working with me to help me make it happen.  I’m so thankful to have connected with her and can’t wait to meet her!

What else?  Well, I have a big Halloween Party to attend next weekend.  I may also attend a public discourse conference in Bozeman.  This weekend we were invited to a brunch hosted by the President of the University and to the game, but instead I plan to be at the Farmers’ Market promoting ICAN of Greater Missoula and our inaugural event!

Threatened Miscarriage Update

I don’t have anything new to report, really.  Active bleeding has subsided.  I *think* my cervix is closed, but I’m not very experienced with self cervix checks, so perhaps I’m wrong.  The fact that my cervix was closed Sunday night during active bleeding and Tuesday morning before extreme bleeding and probably is closed today is a good sign, I hope.  Well, that’s all in how you look at it:

SCENARIO ONE – Miscarriage

If I should be miscarrying and my body is not actively expelling the fetal tissue, then this is not good.  My hcg levels can still rise with miscarriage in the near future.  The cervix staying closed means that doctors will be concerned that my body won’t reject the pregnancy on its own.  I am not considering a medical miscarriage at this time.  [Look at my previous posts on this miscarriage for the reasons miscarriage is expected.]

SCENARIO TWO – Subchorionic Hematoma

I myself am not convinced that I have a blighted ovum.  My body still thinks it is pregnant, and I have to hold onto hope.  Had the ultrasound technician at the hospital found a fetal pole, I would assume that I’m suffering from subchorionic hematoma, a scary event that may or may not result in terminated pregnancy.  And indeed I was diagnosed with threatened miscarriage and a subchorionic hematoma.  In my opinion, based on a lot of reading over the past few days, 5w4d might have been a bit early to even find the fetal pole or the fetus might have been hiding.  Until I see that ultrasound on Monday, I am staying hopeful that my pregnancy is still intact.

I regret that I need a follow-up ultrasound.  I’m not confident in the safety of ultrasound in pregnancy.  I had three ultrasounds in my first pregnancy – one at about 11 weeks because the CNM didn’t detect a heartbeat with the doppler and I was nervous; a “big” one in the 2nd trimester; one around 32 weeks to see if the low-lying placenta was going to be an issue in labor and delivery.  My daughter is fine.  But transvaginal ultrasound is more suspicious, in my opinion as the transducer is so much closer to the fetus.

Well, that’s enough for now.  I have a few more posts in the making . . .

Currently Reading and Researching

Since I am at home bleeding with nothing else to do . . . I have been doing a lot of reading and research.  I don’t have the mental fortitude to break it all down into individual posts, so here is the “cluster eff” from yesterday and today:

Homebirth: Safety & Benefits, courtesy of Ronnie Falcao, LM MS – even though her site isn’t stylish, the information is good

Misdiagnosed Miscarriage Site and Forums – lots of food for thought here . . . and very good examples of why women should not do a D&C unless they are unable to miscarry naturally. . . and why women shouldn’t take cytotec to induce abortion.  Check out their Blighted Ovum FAQ.

Please watch this video on the awful things that cytotec induction (in labor and delivery) can do.  Cytotec is an ulcer medication and is contraindicated for pregnant women!!!

Related – “Drugs, Knives, and Midwives: The U.S. maternity care system is in crisis. A grassroots movement to save it is under way” by Elizabeth Larsen, Utne Reader, March/April 2007.  I’ve looked it over but will read it thoroughly today.

I liked this “Helping a Friend Through a Miscarriage“.  Please consider reading it if you’re helping a loved one deal with this tragedy.

I’m certainly more wary of ultrasound these days and regret that I had to have one of Sunday.  (Some may rightly say that I didn’t have to have one on Sunday, but they’re not walking in my shoes right now.)  Yesterday I read Rodgers’ “Questions about Prenatal Ultrasound and the Alarming Increase in Autism” from Midwifery Today, and that scared the crap out of me.  Today I will read Wagner’s “Ultrasound: More Harm Than Good?” and Beech’s “Ultrasound: Weighing the Propaganda Against the Facts”.  I recommend anyone considering ultrasound during pregnancy to look at Kmom’s compilation (2003).

Read some of these testimonials from women who suffered through subchorionic hematoma!  I’ve found this thread very encouraging.

I’m also trying to locate a copy of Lesley Regan’s miscarriage book.  Too bad the local library and the University library don’t have this book.  If anyone I know can loan me a copy . . . I’d sure appreciate it.  Also, feel free to share your favorite miscarriage resources in the comments section.

Will I Miscarry?

I’m so confused!

Today we had a follow-up with the OB (not my regular CP). She said we didn’t have enough info to rule out viable pregnancy though definitely things don’t look good. She did an exam and found the cervix normal and closed. Phew! Some dark blood. She recommended another ultrasound next week. She said we could do repeat hcg test today too but that regarless she’d want the ultrasound done.

I elected to repeat the hcg test.  If my hormone levels are dropping, I want to know.  I don’t want to wait until next week to see an empty yolk sac.

So, I just got a call from her nurse . . . in LESS than 48 hours my hcg has gone from just over 11,000 to over 19,000.  Of course I started bawling.  WHAT DOES THIS MEAN? I’m so confused. Is it possibly that my body still thinks it’s pregnant even if there’s no fetus. Is it normal to have increasing hcg with a blighted ovum?

Well, actually a follow-up call with the OB’s nurse answered that question.  I guess hcg levels can increase with a blighted ovum . . .

My God, I can hardly believe it’s possible that my pregnancy will continue.

STICK BABY.  PLEASE STICK WITH ME!