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Diary Of A Lost Pregnancy, Part 2: Firing Squad Or Hemlock?

On September 17, 2014, I went for a routine 8-week prenatal check-up. It was the only routine thing I would do for more than two months.

During this time, I e-mailed a small group of people. Some were aware of the pregnancy, some had plans with me that would need to be broken, and still others simply asked after my health on the wrong day. This is the second of 11 such messages. They have been edited to remove identifying information and inside references, but otherwise remain largely unchanged.

October 1, 2014
Dear Friends,

Once again I apologize to those who are only hearing of this now. To recount the circumstances to each individual would require more energy than I have, so a group e-mail will have to suffice.

When I last wrote, I had received confirmation through bloodwork that my pregnancy is not viable. I was told there are three options in terms of how the pregnancy will end: the natural option; the pharmaceutical option; and the surgical option. My midwife, at the recommendation of a consulting OB/GYN, suggested a second, more detailed ultrasound scan to determine the feasibility of each option. That scan was performed on Friday.

There is no good news in a situation like this, but this is as close as it gets:

1. There is nothing wrong with my reproductive organs.
2. My health is not at risk.
3. There has been no further placental development or growth of the gestational sac.

Taken together, this means that all three options remain open to me. The question is how long I am willing to wait.

This question has been a constant buzzing in my ear since I learned there was no heartbeat. I wrote before that I knew this would overwhelm me; I don't think I understood how incredibly demanding it is to be overwhelmed. It's like walking a tightrope covered in broken glass. It requires absolute concentration to stay on, and staying on is awful. I knew I needed to leave the appointment Friday with some kind of endpoint. Ultrasound cannot determine how long my body will take to end the pregnancy naturally. Therefore, my goal was to leave the appointment with either a surgery date or a prescription.

Going into the appointment, I was against the pharmaceutical option. This was based on two factors. First, the drug used to induce uterine contractions (misoprostol) has a poor reputation. It was used in the 1990s in a gel form to "ripen" the cervix as a means to speed delivery. The results were sometimes catastrophic. Second, I had read that misoprostol is often not fully effective. Many women using the option wind up needing surgery anyway.

I should point out, I was not thrilled with the idea of surgery either. It's like choosing between a firing squad and a dose of hemlock; no one wants to poison themselves, but at least you know you won't miss. After speaking with the midwife, I opted for the pharmaceutical option. She explained that the dosage and formulation of the drug are entirely different from those used for cervical ripening. This form has been used to induce medical abortions safely for many years. The success rate for terminating non-viable pregnancies relates directly to the amount of material within the uterus (referred to as "products of conception"). In my case, simply put, there's not much to expel.

I can't exactly explain why this seems the lesser of two evils. I understand and support any woman who chooses the surgical option. It is a very safe procedure and it offers definite proof that all products of conception have been removed. This is not the case for either a natural or pharmaceutical termination. I will have to undergo blood tests on a weekly basis to check that my hCG levels are dropping. If they do not, I may wind up undergoing a D&C anyway. I was also given a secondary prescription for Vicodin because apparently misoprostol is really fun, like riding a rainbow into a pile of kittens. I don't hold any illusion that this will be a positive experience, but the alternative is full sedation; in other words, no conscious experience at all. It seems to me that something of value would be lost if my intellect were suspended. I understand I won't always have a choice in these matters, but while I do I choose to live with the understanding of my physical self whether it is pleasant or not. This is the only way I can see to salvage some kind of meaning from an otherwise abject circumstance.

Getting the prescription has been a tremendous weight off my shoulders. I felt a palpable sense of relief almost immediately. Perhaps because of this, my body has shown signs of ending the pregnancy naturally. Since Sunday I've had fairly consistent spotting and heavier cramps. However, it has been slow progress and there is still no way to know how long it would take in total. I had originally planned to take the misoprostol this Friday. In consultation with the midwife, however, we have decided to reevaluate tomorrow based on how things progress. It may yet be worth waiting things out, although I'm starting to realize even this is a choice between two slightly different tortures - drinking the hemlock or being chained to a rock and left to the elements.

I remain extremely grateful for the compassionate care I have received from the medical professionals involved in the management of my case. I am also very moved by the many expressions of support from my friends. I continue to draw strength from my wonderful and loving family. They constantly remind me that, no matter what the future holds, my life is full of riches.

Best wishes to you all,
nj

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Previously:
* Diary Of A Lost Pregnancy, Part 1: No Fetal Heartbeat.

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Tomorrow: Like The Challenger.

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Comments welcome.



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Posted on January 20, 2015


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