Continuing my previous post about the D&C vs. medication for miscarriage- I hope it’s clear that I do give my patients all of the options, and allow them to choose what is right for them. All factors being equal, I prefer the medication over the D&C for the earlier gestations because a procedure has inherently more risk than the medication (or waiting). But the risk is slight, and the medication and spontaneous passage of tissue have risks as well.
I also realized that one factor that is unique to my institution is that we unfortunately don’t have an outpatient procedure suite where patients can be sedated for minor surgeries and procedures. So the D&C option is a little more cumbersome in that if they have it in the operating room, they have to be added on as an urgent case. But occasionally if a more emergent surgery comes in, then they can get bumped. That means they may end up waiting for hours. Not fun when you’re already upset that you’re having a miscarriage.
I often do outpatient procedures in the office, but those patients are still awake. They receive medications to help make them feel more comfortable, but it’s not the same as getting sedation where you’re not aware of what’s going on. We do D&Cs this way when needed, but in my experience it’s not ideal for patient comfort. So those factors play into my decision-making as well.
It’s been 2+ weeks since the miscarriage, and as time has gone on, I’ve had my ups and downs. The week after was really hard. The medical part of it was fine- I had the expected heavy bleeding the first day, and it’s been gradually improving since then. So it’s like an extra long period.
It’s more so the emotional part of it, as well as being physically exhausted, that have been hard. Many of my patients with heavy periods tell me about how tired they feel each month during their cycle. They often have normal blood counts (meaning they’re not anemic from the bleeding), but still feel drained during that time of the month. I felt similarly. I checked my blood count just in case, but it was totally normal.
On top of the physical and emotional drain with the miscarriage, we just moved last week. It’s a local move, but nonetheless we are uprooting our lives, living out of boxes- the usual bit when it comes to moving. I deluded myself into thinking that I could handle all of this. Instead, I ended up breaking down and crying at work one day at lunch. I cancelled my afternoon patients and headed home. And then I cancelled the rest of the week. I had just been so sleep-deprived from the move, from not being able to sleep well at the new place.
Even being off of work, I felt like I was in my own little hell. I was so exhausted, and our new home didn’t feel like home yet. Most of our old furniture doesn’t fit in our new smaller home, so we don’t have a dining table yet, just a counter and bar stools. So my little WZW was initially sitting on the dirty floor to eat. I’m not a germaphobe, but for someone who is used to taking off her shoes in the house, the newly post-move dirty floor was not somewhere I wanted my kid to be eating.
So that first week was tough. In the end, I know it’s the right decision for us to move. But the adjustment period is tough, especially for someone like me who is a creature of habit. In this subsequent week, we’ve been unpacking and making the place a little more livable. My husband made good use of our Roomba to vacuum the above dirty floors. I’ve tried to balance unpacking- which ultimately makes me feel better and more settled- with also having a chance to just rest. This past week, having a usable kitchen and less boxes around have made a huge difference in how the house feels.
Thankfully, WZW has done really well with this move. He’s at an age where we were able to talk to him about how we were going to be moving. He came to the new house a couple of days before the big move. And the day of the move, we picked him up from daycare early and brought him to the empty old house before bringing him to the new house. Aside from some difficulties sleeping in his new room, he’s been fine. He’s never asked to go back to the old house.
It’s interesting going so quickly from pregnant to not pregnant how differently I feel physically and mentally. Physically, I went from feeling nauseous and only being able to eat small quantities to being able to eat normally again. When I delivered WZW, I remember suddenly going from not liking regular water to glugging down tons in the hospital. But since the nausea was more significant with the early pregnancy, the change was much more dramatic.
Mentally, I suddenly feel more relaxed about what I’m eating and using. When I was pregnant, I wondered about the kombucha drinks, which have a trace amount of alcohol from the fermentation, but usually not enough to require the labels that beer and wine do. In the end, after drinking one, I decided not to continue, mainly because I didn’t want to worry about it. Even with skin products, most are ok but some ingredients like hydroquinone and retinols are supposed to be used with caution in pregnancy. So I’d stopped using some of my skincare products, whereas now I feel a sense of freedom in using whatever I want.
By the way, Mother to Baby has a lot of great info regarding what’s safe in pregnancy. Here’s their fact sheet on topical acne medications, and they have a lot of other categories:
And between suddenly being free of nausea, and also feeling a little down emotionally, I’ve been eating whatever I want. I’d lost some weight from the nausea, so I don’t feel as bad about it. I will have to eventually go back to choosing healthier options, but for now I figure I’m allowed to temporarily not worry about it.
At this point, I’m taking it one day at a time. As I get used to our new home and we get more settled in, I am feeling better and better. And emotionally, while it still hurts to have experienced a loss, I’m doing ok. It’s disappointing to have this setback, and to have to spend how many more months going through the process again. Part of me tries to have an emotional separation, kind of like I do with my patients, to protect myself. I tell myself logically that I don’t need to be that upset, because this is very common and that I have no reason to believe I won’t have a healthy pregnancy in the future. But sometimes I have to remind myself that grief isn’t logical, and that it’s ok to be sad about it and to let myself cry when I need to.
WZW’s hair is slowly growing back, and he’s been having fun with all of the boxes used in our move: