By Georgia Ragonetti-Zebell, MD
My cramps started during an interview. I was wearing a gray suit. The skirt had been too tight that morning, so I was relieved that I packed the pants. This was my second pregnancy, and I had surprisingly gained a couple of pounds already. I must have been 8 weeks or so as I boarded the plane to Tennessee to interview for a residency position in OB/GYN.
I tried not to squirm in my seat as I answered his questions. I felt more nauseated than anything, like the beginning of a stomach flu. I could feel myself sweating under my jacket. Thankfully, the interview was short, lasting only thirty minutes. There was a five minute break between interviews so I ran to the bathroom when it was over.
I was bleeding. I didn’t have any pads with me, so I searched the bathroom. No pads, only tampons. I didn’t want to tell anyone what was happening. I wanted to finish my interviews, so I grabbed a tampon, finished up and went out to the next interview.
Smile. Shake hands. Be polite. Pray. The pain was bearable. I was able to finish. But I went to the doctor as soon as I got back.
The ultrasound showed I wasn’t as far along as I thought. Only five and a half weeks. And there was no heartbeat. The doctor came in and told me what he saw. I held on to the hope that it was just too early. My bleeding had almost stopped. Another ultrasound a couple weeks later confirmed what the doctor already knew. I was having a miscarriage.
In general, there are three options for treating a miscarriage. All have similar risks, so unless there is an emergency, you can choose what you would like to do. The most common risks include infection and heavy bleeding. The first option is expectant management, the medical term for doing nothing. A woman’s body will pass the pregnancy without intervention in many cases, especially if bleeding has already started. You should always be evaluated by a medical professional with any bleeding in early pregnancy rule out an ectopic pregnancy, or a pregnancy that is not in the uterus. Without intervention, passing the pregnancy can take time, sometimes weeks, and there is no way to know when you will pass the tissue. The process takes longer and is unpredictable this way, but avoids medication and surgery.
The second option is medication. Misoprostol, a medicine that is sometimes used to induce labor, can be used to help the body pass the pregnancy without surgery. The medicine can be taken orally or placed in the vagina to stimulate cramping and contractions of the uterus to pass the tissue. This is more predictable than simply waiting for the tissue to pass. With either expectant management or medication, you will have cramping and bleeding and will pass clots and tissue. This is usually heavier than a period, but slows and stops after the tissue has passed. Very heavy bleeding or bleeding that persists should be evaluated immediately.
The third option is surgical management. This is sometimes needed if all the tissue does not pass on its own or if the bleeding is too heavy. The surgery involves dilating or opening the cervix and removing all the pregnancy tissue, often with suction. This may involve additional risks of anesthesia and surgery, but is predictable and complete. Bleeding stops quickly after surgery and you will have some cramping after the procedure.
I chose to wait and let my body process things without intervention. Every day as I drove to the hospital for my internal medicine rotation, I wondered if today would be the day when I would officially no longer be pregnant. During this waiting period, I was supposed to be a bridesmaid in the wedding of a high school friend. The other bridesmaids were thin, wearing thongs under their dresses. My hips were wide from the hormones, my full briefs stuffed with a super pad, just in case I started to bleed during the ceremony. Thankfully, I didn’t. It was weeks after the last ultrasound before I passed the pregnancy. My husband was taking classes at night, so I was home in the evenings with our one year old. After I put him to bed one night in December, the cramps intensified. They came in waves, very much like contractions. But I had no epidural, no motivation of a crying baby to help me through this. My husband wasn’t even home.
I can remember laying in the bed, wearing the biggest pads I could find. It began slowly, cramps similar to before my period. It quickly progressed to a mini labor. The pain would intensify, and I would have a gush of blood and pass clumps of tissue. I would get up and clean myself up and lay back down. Repeat. It went on for maybe an hour. I quickly flushed anything that came out down the toilet. I didn’t want to see anything that looked like a baby. I was still in med school. I hadn’t seen any deliveries earlier than 30 weeks, let alone first trimester fetus. And then, all of a sudden, it stopped. Once all the pregnancy tissue had passed, the pain and bleeding almost completely stopped.
I hadn’t told anyone I was pregnant, and I didn’t tell anyone about the miscarriage for quite a while. I don’t know why. I’m usually rather open. But I had so many emotions about this pregnancy loss. It had taken a year and a half to get pregnant with our first son. This pregnancy happened without even trying. It wasn’t planned, and I had barely known about it before it was gone. I knew enough about pregnancy to know how common miscarriages are, estimated to be one in five pregnancies. Why did it feel like a failure? Why was it such a shock? My mind had jumped to picking out names and decorating the nursery as soon as I had a positive test. How could I even be upset about something I’d never really had? And why did I feel so much relief when it was over even though I very much wanted another child?
What I learned through this experience and through caring for many patients having their own miscarriages is that each experience is unique. It is ok to be sad. It is okay to feel relieved. It is okay to feel different from day to day, and my experience may differ significantly from another woman’s. But it is also very common, and it can be helpful to talk about what you are going through. I wish I’d reached out at that time. We are all on this journey together, mommas. You don’t have to go through it alone.
Georgia Ragonetti-Zebell, MD is an OB/GYN practicing in Upstate South Carolina, and is mommy to four (yes, FOUR) boys. She is a graduate of the Women’s Health Pathway at Drexel University College of Medicine in Philadelphia, Pennsylvania and completed her residency in Obstetrics and Gynecology with the Greenville Health System in Greenville, South Carolina. She has a special interest in natural childbirth, breastfeeding, and alternative methods in labor and delivery. She enjoys yoga, crochet, and reading, but spends most of her free time cleaning up poop while trying not to step on Legos.