Tuesday, November 17, 2009

Important information regarding miscarriage

First of all, I would like to say that I will make every effort to be very sensitive about such a painful subject. I myself have spontaneously miscarried twice, once just days after finding out I was pregnant, and once around 8 or 10 weeks. The second time, I actually passed a little sac with the baby and all, and it was heartbreaking. I understand the heart of a mom who has suffered miscarriage, and I am in no way trying to be insensitive. I did not need a D&C either time, and suffered no ill after-effects.

This subject has weighed on my mind since a young lady (an old school acquaintance of my husband) contacted me through my blog to ask my advice. She had been told by her doctor that she had a blighted ovum, and needed a D&C. Her question was whether I would recommend the procedure or not.

Ever since then, I have wanted to share the information I found on my blog here, because I think this affects many women. Every time I set out to write about it, someone would write to me saying they either were having or just had a miscarriage, asking for my advice and/or prayers. I receive about a dozen emails a day from readers all over the world asking me all sorts of things, but the last thing I wanted was for them to think I was singling them out and addressing them indirectly through a blog post. Nothing could be further from the truth. My goal with this post is simply to present information so that women who find themselves in this situation in the future can make their own, informed decisions.

Before I responded to my husband's childhood friend, I spent several hours that night researching the subject on the internet. What I found was shocking. I had never been in favor of routinely performing D&Cs after miscarriage. A friend of mine once was thought to have miscarried, because she was early on and had a period just a few days after finding out she was pregnant. She was told by the doctor that there was no heart beat and that she needed a D&C because her body was not naturally expelling the baby, but she waited for weeks for it to happen naturally, thinking her baby was dead that whole time. Lo and behold, weeks later it was found out that she was still pregnant, and the baby is now a healthy 4 year old.

When faced with a miscarriage, a woman has three choices, called expectant management, medical management, and surgical management. Expectant management means the mother does nothing and waits for her body to spontaneously expel the baby, which in very rare cases could take weeks. Medical management is taking certain drugs to induce labor and/or cause the shedding of the uterine lining (these are higher doses of the same drugs as "morning after"pills and birth control pills). Surgical management is usually carrying out a D&C - the cervix is mechanically dilated and the womb scraped out. It is the same procedure as early abortion. In cases of an ectopic pregnancy, sometimes the fallopian tube is surgically removed.

Even in cases of absolutely certain miscarriage, a routine D&C is dangerous business. It could lead to severe complications such as a punctured uterus, but even when it goes well, the uterine lining will have been stripped to the point where another pregnancy is not safe for several months following, after the uterus has had a chance to build a layer thick enough to sustain a new pregnancy. Unless the mother has a fever and is showing signs of infection, or is losing dangerous amounts of blood, there is no reason to do a D&C, and it is only every risky. Of course, doctor use fear to try to push this procedure, as they do with most anything relating to obstetrics. There just isn't a whole lot of work or money in doing things naturally.

That aside, I do not believe that most cases of miscarriage are really "absolutely certain". During the first trimester, no ultrasound or doppler can ever with 100% certainty say that the baby has died based on the fact that no heart beat was detected. A much more reliable test would be to check the mother's hcg levels twice within a span of several days, and see if the levels have dropped (which would indicate a miscarriage).

What I found so shocking in my research into this subject is how many times women are wrongly diagnosed with a blighted ovum. Sometimes, it is just because the person doing the exam does not know how to use the equipment very well, the dates are off, or the woman has a tilted uterus (this is very common), all of which could lead to there being "no heart beat". In other cases, doctors are simply misinformed, such as telling a woman that a blighted ovum means she was never really pregnant and there never was a baby, when in reality there was a fertilized ovum, but for whatever reason it did not survive. This may seem like an insignificant detail, but for Bible believing Christians it means that they had a child whom they will meet when they get to Heaven.

In fact, there is a whole website dedicated to this subject, The Misdiagnosed Miscarriage. There is much great information, and stories of women who were diagnosed wrongly.

I am sure that most women are diagnosed correctly. Nevertheless, I have felt greatly urged to share this information. If your feelings were hurt or you are upset by this post, I sincerely apologize. Every mother who has miscarried struggles with guilt and the question "Did I do anything to cause this?" The last thing I want to do is contribute to that. At the end of the day, all any of us can do is try our best, to the best of our knowledge.


  1. I also have had two miscarriages and did not go to the doctor for them. As you said, it isn't necessary unless there are signs of distress. The body will naturally expel the tissue.

  2. My MIL was told she had an unviable pregnancy at around 10 weeks and was advised to have a D&C. She listened to her heart and body, and refused the procedure. That "unviable pregnancy" is now my feisty, healthy, successful and very much LIVE 22yo sister-in-law.

  3. This info is important to share. I feel blessed to have known this before my recent D&C. We had several ultra sounds to make sure no baby was even there and it was not a blighted ovum...... I wanted to comment because I just delt and am dealing with a molar pregnancy. I trust my midwife to the core and I am her 2nd molar in 30 years of caring for tons of women............ a molar is rare and your HCG levels will show if it is a molar..... mine were 206,000 and a normal pregnancy is only 25,000 to 45,000....... which is common of a molar pregnancy. In this case though there truly is no baby, there is another type of molar where a baby does form too though, luckily not mine. With a molar it is also dangerous to let it pass on its own because of all the tissue that has grown.....you could lose tons of blood. A D&C is necessary unfortunately and I would never ever reccommend it for a normal miscarriage as your body will deal with it naturally...... oh and another thing about molar..... in the ultrasound there are lots of clusters of spots.... all over. I just wanted to share because though it is so rare it can happen and I want others to know it is not one to let go natural and trust me I wanted to and tried to get it to happen that way but it is too risky. Anyway, D&C's are horrible and risky and dangerous and very rarely necessary but there is a time and place occassionally......had to share.


  4. I see nothing wrong with your post; my best girl friend recently went through a miscarriage, but she luckily did not have to deal with the choice of aborting (is that the proper word?) the remnants. Though I am unmarried and therefore abstinent, my heart goes out to all women who have endured a miscarriage and I do not wish that pain on anyone.

    God Bless,

  5. Thank you all for your feedback.

    Jessica, thanks for all the information on molar pregnancy, I have never yet looked into that because I have never before heard about anyone who had it. I knew you are very educated about these issues. Hope you are recovering well.

  6. It is certainly interesting for me to read that post. Thank you for it. I like such themes and anything that is connected to them. I definitely want to read more on that blog soon.

  7. Thank you for such a sensitive post. I had a miscarriage in July. In my case it started as a missed miscarriage. The baby had stopped developing at about 9 weeks. I was 11 weeks before I started spotting. The spotting turned to bleeding. My midwife (a home birth, do it natural midwife) checked for a heart beat, but couldn't find one. It was only then that she sent me for an ultrasound to double check. The ultrasound confirmed that the baby had stopped developing and there was no heart beat. This was when I was diagnosed with a missed miscarriage. We decided to wait it out, and over the next few days I miscarried most of the placenta and lining, but no baby. I even went into full blown labour, so we had the midwife come to our home to check on me. She felt confident I would be able to complete the miscarriage, but then it suddenly stopped. She sent me back for another ultrasound to check if anything was left inside. Over 24 hours after the labour stopped the ultrasound confirmed that only the baby was left in my womb and was now measuring only 8 weeks. I waited two days to see an OBGYN, and although she confirmed my cervix was still open the actual miscarriage had stopped and was incomplete. The change in size showed that the baby was beginning to decay inside my womb. It was heartbreaking, but the safest option in our position was to have the baby removed, as my body would not complete the process naturally. The next day I had the D&C to complete the miscarriage.

    6 weeks later I conceived again, and this baby is showing to be doing well. I start my second trimester today, and the baby's heart beat was measuring 160bpm on Monday with a doppler.

    I have tried to research missed miscarriages becoming incomplete miscarriages, but it seems most women will have one or the other. I lost a lot of blood during the two weeks I was miscarrying, which being anemic to begin with made it a potentially problematic situation for me. I wouldn't recommend D&C as a standard procedure, but there can be some circumstances when although risky it is not as risky as continuing to wait.

  8. I was pregnant with my fourth and I started bleeding at nine weeks. We had my hcg levels tested, and they were going down every two days. A d&c made me nervous- I didn't want to have to go through a major surgery to top everything off, so I decided to wait it out. Exactly one week after I started bleeding, I went through labor. I had contractions, I lost a ton of blood, and I even dilated. It was one of the worst experiences of my life. Looking back now, I probably should have gone to the hospital. (my doctor wasn't happy with me when I explained to her everything I had went through!) When I went in to see her that afternoon, (by that time, my body had expelled everything) my blood was tested, and she said it was so low that if it was one point lower she would've had to give me some blood! All this to say- looking back, I might have done it differently had I known what was about to come. We knew the baby had died for sure. And my levels of blood were so low after almost hemmorraging with my miscarriage, that we had to wait a few months to conceive- I lost more blood with my labor/miscarriage then I had with any previous deliveries. (the doctor thinks tissue was stuck in my cervix- holding it open, causing me to hemmorrage.) SO not only did I have the emotional pain from miscarrying, but a horrible physical ordeal to deal with also. I know I was unusual- (my doctor said she had never seen someone fully dilate during a miscarriage like I did) but if I had to do it over again... I just might have done the d and c. I thought your article was very gently put, and I do agree we need to be very careful about our decisions. Sorry for my book!

  9. There are times however, because of the mother's mental state, that the D&C is very appropriate.

    With mine, I was so devastated, I needed it to be over so I could grieve. I was stuck in limbo and for me it was unbearable. My levels had dropped, and there were concerns for infection as my cervix was open, so I had a D&C. It was just awful knowing that my wanted baby was dead inside of me, and was slowly leaking out.

    I will say on thing I am very glad I did was DEMANDED that my OB treat my miscarriage like my third one. For some awful reason they seem to think you need 3 to do the medical testing. I demanded that they do all the testing, and they discovered a blood condition which likely caused the miscarriage, did complicate my successful pregnancy. This condition also requires special management of me during surgery or an emergency. This knowledge could very well save my life one day.

    The testing also discovered a uterine abnormality which was surgically corrected. Without this, I would never have been able to have a successful pregnancy. FYI, my daughter was conceived the old fashioned way.

    However, each person has their own path to walk. I wanted answers, but I can understand watching. It wasn't the course for me.

    I don't think OBGYN's push D&C's just because they are money hungry. I credit my OBGYN (a female) with the fact that I'm here alive as well as my daughter. I do admit there are some real losers in the profession, and had to deal with them during my pregnancy.

    I do think your piece was written with great sensitivity and compassion. Oftentimes, another POV on a tough topic is a very good idea.

  10. What do you think about an ectopic pregnancy where the dr. is pressurring you to take methotrexate to terminate the pregnancy before rupturing your fallopian tube. I have had 2 ectopics the first one treated with metho, and the 2nd I didn't know about ruptured my tube. I've been told that I have a high chance to experience another ectopic, and have wondered what I will do. I have felt guilty about taking the metho... The dr told me it was the only way, and I've since thought otherwise. Just wondering what your opinion was.

  11. thank you for this information.

  12. I don't have kids. And I probably won't due to a few medical conditions. That's beside the point.

    Please let me say you guys are amazing. Reading everything Zsuzsanna has posted about pregnancy (& related) education, it's flat out amazing how women do it. Heck reading some of the horror sites, it's amazing that anyone comes through it! (Yeah I'm seriously scared of birthing factories at the moment.)

    To come through both miscarriages and births, well, you guys have my utmost respect.

    With Love,

  13. I have a (female) friend who had a still birth nearly two years ago, which was or almost full term. She and some of her other close relatives have since then continued to miss the baby girl and obsess over memories, photos, etc. and count that child along with living ones. My friend has also since been active in the cause of baby loss, grief, etc.

  14. Zsuzsa, I know this is an old post, but I just remembered it today, searched and wished to comment.

    I have miscarried three times now, and only during my last did I have a D+C procedure. It still haunts me. The reason the doctors advised me to have one, is that I had an infection with my 2nd miscarriage...plus they told me that I wasn't ALLOWED home to allow the baby to pass naturally, just in case I haemorraghed (sp?). I agreed only after witnessing via the ultrasound, my empty womb (everything from my pregnancy had passed the two days previous, but the baby was still at the neck of my cervix). I was heartbroken and was so desperate to go home, that I agreed. I wished I'd have thought about your post before I consented. Not a week goes by that I don't regret my decision...not merely for any danger to my health, but the thought of doctors surgically removing my baby; it breaks my heart.

    Thank you for addrssing this sad and delicate topic, with such love and compassion.


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