A Note to My Friend

This morning I received an encouraging e-mail from a friend.  She has been through infertility and recurrent losses, but it looks like she finally has a keeper!  Luckily she has found medical providers who were able to come up with a good treatment protocol for her situation.  She has weaned off of the progesterone shots (daily shots of progesterone in oil – owie!) but is still on heparin, I believe, for the duration of her pregnancy.  She is finally in the second trimester!

She mentioned that her fear of childbirth is abating.  Some of that is because she has experienced natural miscarriage, and she has been told that it is like mini labor.  I wanted to share (most) of my response to her.  Of course I could have said much much more, but I really don’t want to be “that crazy friend” who can’t shut up about natural childbirth.

Just remember that the OB is just a person, not a god.  And what YOU want DOES matter.  Ask about birth plans and how the hospital honors them.  I would hire a doula, someone who will be able to advocate for your needs and your desires.  Seriously, that’s the biggest mistake I made – I thought that having a CNM would “save” me from unnecessary intervention, but it didn’t.  The rest is history.


I thought the childbirth education classes at [name removed] were just fabulous.  My only criticism is that I somehow didn’t understand how life altering the cesarean was going to be.  I’m not trying to scare you – the cesarean was a piece of cake for me, and it didn’t mess with breast feeding at all (in my case).  It’s just that I was so shocked when I went in for my 6-week post-partum appointment with the OB who did my surgery and was told about uterine rupture.^  And then last July-August when I was preparing for baby #2 I learned so much about the failings of our maternal health care system, and that’s when I really “cracked.”  I was just so pissed and became somewhat disappointed in [name removed] for not having been more forceful.*

Regarding labor – I didn’t even know I was in labor.  Granted I had a violent stomach flu . . . but I was surprised that I showed up at the hospital 9cm dilated!  Probably one of the most painful things I have gone through was my second miscarriage.  Supposedly subchorionic hematoma miscarriages are pretty bad, and this one was no exception.  And during my last miscarriage I kept nearly fainting from the blood loss.  Labor?  Piece of cake.  You’ll be brilliant!  Remember that the pain is good – it’s there for a reason.  It helps get your baby out and into your arms.

I am just so excited for you.  I am so glad that you’re out of the first trimester!!  And hopefully you’ll really start feeling great, and pretty soon you’ll start feeling your “lemon” move.  That will bring you much comfort and joy.

^ For the record, every laboring women has a small risk of uterine rupture.  Most uterine ruptures in VBACs were historically caused by labor augmentation and induction tactics.  A “window” or a dehiscence (separate terms in my mind) is not the same as a true uterine rupture.

* One thing I forgot to mention to her is that my husband seems to remember our childbirth educators talking about uterine rupture.  Maybe they mentioned it, but again, it didn’t leave the impression that it should have.  I only pushed for 2 hours and then gave in to the cesarean.  I thought it made sense.  Had I known – really known – what a cloud the cesarean would cast over the rest of my childbearing years, I’d have resisted that cesarean.  My baby would have tolerated it – when she was delivered, her APGAR scores were 9 & 9.  Nearly perfect.  Not a baby in distress as I had been told.

Perhaps what childbirth educators could add into their series is a session on how doctors perceive cesarean scars.  Why the medico-legal culture dominates obstetric practices.  Why certain risks (cesarean surgery, amniocentesis, etc.) are acceptable and others (natural birth, especially after a cesarean) seem foolish.

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.

Post-miscarriage rollercoaster

Because I get so many hits on my site from others who are struggling with miscarriage, I feel compelled to continue blogging about my journey.  I have suffered back-to-back miscarriages this year, a spontaneous miscarriage on August 1 followed by a subchorionic hematoma on October 7 that terminated my pregnancy by October 15.  My DH and I decided to take a break from trying to conceive until we could perhaps discover a reason for the repeat back-to-back miscarriages.  I am now at a point where 66% of my pregnancies (2 of 3) have failed.  I am now considered high-risk for future miscarriage by my care providers.  Some care-providers don’t even sneeze at 2 miscarriages, but I’m glad that mine have been proactive even if they don’t agree on the causes and potential remedies for my problems.

On Thursday I had an herbal consultation with a direct-entry midwife (DEM).  She may become my midwife in the future, but for now we’re working to get my body back on track.  She suspects that dysfunction in one or more of my regulatory systems is preventing me from sustaining my pregnancies.  The systems/organs that seem to be out of whack include endocrine, thyroid, liver, and adrenal.  This lines up with the feedback I get from my chiropractor every week.  She has recommended an herbal tincture comprised of vitex, auralia berry, black cohosh, and a couple of other things.  I should stay on this treatment for three months before becoming pregnant.  Then the tincture would need to be adjusted as some of the herbs are not recommended for pregnancy. 

On Friday I finally had my follow-up appointment with the OB who managed my miscarriage.  She is not the careprovider with whom I planned to establish, but at this point, I’d rather continue care with her should I need assistance from a medical provider.  She’s a nice gal and very supportive of natural childbirth.  She helped my friend deliver her baby vaginally during a placental abruption.  Anyway, she recommended some blood tests (antibody and anticoagulant) and consented to testing my thyroid as well.  She doesn’t believe I have a luteal phase defect even though my last cycle was only 26-days long and I bled in the middle of the cycle.  (I bled during ovulation when I got pregnant this last time too.  The herbalist thinks I may have a progesterone deficiency.)  Instead of doing progesterone tests, she would recommend an edometrial biopsy.  Eeek!  I really haven’t been satisfied with the information I’ve found on the internet.  I’ll probably consent to one if I have another miscarriage, but I think I’ll give these herbs some time to work.  The OB does not recommend chromosomal testing at this time.  If anything conclusive arises from the blood tests, I will post the information here.

That’s it in a nutshell.  The holidays are tough – I have a number of friends who are pregnant or have just had new babies.  I expected to have a cute pregnant belly about now.  I never would have thought I’d be grieving two lost babies this Christmas.  I do have plenty to be thankful for – my amazing husband and lovely little girl, a good job, a loving family, wonderful friends, empowering and humbling advocacy work through ICAN, and a good life.

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.