Hello Henci,

I have enjoyed reading both Obstetric Myths and the Thinking Woman's Guide. However, since I lost my first (and so far only) child to a miscarriage, I would really appreciate a thorough treatment on the subject. I didn't know much about it before, I was at the mercy of an unknown Dr. immediately after (I miscarried 500 miles from my midwife), and still haven't found much information. I know it may not fall under the category of "birth," but since nearly 20% of pregnancies end in miscarriage, it seems like it should fall under the category of pregnancy complications. I just felt through my experience that I was fed a boat-load of obstetric myths that cost me $1,000 for a completed miscarriage (I only went to the Dr. to get Rhogam). And I didn't even get a D&C!

Questionable statement #1: Your HCG is still really high, so I want to get an ultrasound to make sure there isn't any retained tissue/molar pregnancy/viable pregnancy. At 11½ weeks pregnant, my HCG was 10794 mIU/mL almost exactly 12 hours after the completed miscarriage (defined by me based on the most excruciating cramps, heavy bleeding, and tissue passage that subsided after approximately 2 hours--I knew it was over at that time). My subsequent research has indicated that my HCG was on the low end for that stage in pregnancy. More thorough understanding of how HCGs in general work, and particularly during and after miscarriages, would be helpful.

Questionable statement #2: Either remain completely abstinent for 3 months or use a condom EVERY time because you should not get pregnant for 3 months. While I have found this advice repeated on many pregnancy sites ad nauseum, I can't find a basis for this. The few abstracts I've found seem to be conflicting about whether or not it is advisable to wait or just get pregnant as soon as your body allows.

Any other information about what is "normal" for a miscarriage and what isn't, and what medical interventions are necessary and which aren't would be helpful. The principle for normal childbirth that being informed ahead of time is essential to getting the birth you want is just as true, if not more so, with a miscarriage. You don't expect it to happen, and when you are sitting in the Dr. office numb with grief, exhaustion, and physical pain, you cannot make good decisions and sometimes regret your choices for months to come.

I realize this may not be your area of expertise, but you are so thorough in your research that I would love to see your comments on this topic.

Sincerely, Melanie

I am sorry for your loss. As I know personally, the fact that miscarriage is so common does not make it any less emotionally painful.

I'm afraid, though, that I'm not going to be much help. To provide the kind of information you need would take many hours of time to search out, read, and synthesize the research. You could probably write a book--or at least a chapter in a book--once you were done. What I can do, though, is provide a list of simple questions that are useful to ask in any medical situation where an informed choice needs to be made:

• What is involved in the treatment you are recommending? You should get the explanation in language you can understand. Don't forget to ask if pain or other unpleasantness is involved.
• What are the benefits?
• What are the potential harms? You will also want to know how often they are likely to occur. There always are some with any medical intervention, so the answer "None," or "Not worth worrying about," or any others in that vein is a red flag.
• What are the alternatives?
• What are the potential benefits and harms of the alternatives, including doing nothing?
• Might other tests or treatments be needed as a result of having this one?
• How urgent is it that we begin treatment?
• If it is a test: How accurate are the results?

As for the 3-month waiting period before TTC again, that, I would bet, is a matter of opinion, not research. Common sense says that allowing at least a normal cycle or two to let your body heal and to rebuild your iron stores would be a good idea.

-- Henci

Good list of questions.  I had a 16 week fetal demise situation (baby just died within a day of my OB appointment).  The OB was very kind, but didn't tell me anything right off.  She said, "I scheduled you for a D&E" and told me when to be there.  I regret getting a D&E but was too shocked to stand up for myself.  I had the procedure, and regret it.  I would have liked to have tried labor and delivery.  Only now, when I have a pregancy with low lying placenta, do I know that risks of  placenta previa, placenta accrecia (did I spell it right) go up with any surgery in the uterus including the so called "easy" D&E and D&C.  There were risks to my cervix too, but fortunately, I have not suffered ill effects.  I had options, I had other things I could have done, I was not given these options.  Within the context of care, I was given the best I could get.  My doctors were compassionate, they were just unaware of my need to be informed of my choices.  I also found out that I could have asked for my baby's remains...I learned this too late.  I could have buried my child.  No options are given many times in obstetric treatment, especially in miscarriage where a woman is at her most vulnerable.  I wish OB's would treat women as intelligent adults who can make decisions even in a time when they are at their most vulnerable and even hysterical.  I think the fear for the OB's is having to deal with feeling the loss with the woman.  Therefore, the OB tries to make everything get over quickly and easily with the least amount of physical pain.  It's not pain I fear, it's regret.  It's getting things done to me without my informed consent.

Blessings!

Dawn