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Subject: misc.kids FAQ on Miscarriage, Part 1/3

This article was archived around: 21 May 2006 04:22:36 GMT

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Misc.kids Frequently Asked Questions Miscarriage Part 1 of 3 --------------------------------------------------------------------------- Collection maintained by: Laura Brooks (http://scalos.mc.duke.edu/~brook006) Last updated: March 16, 1997 --------------------------------------------------------------------------- A Little History In the spring of 1994, I had my second miscarriage in a row. Anxious to learn more, I posted a message to misc.kids, asking for information and moral support. I got a lot of both, along with the suggestion that I look at this FAQ. After awhile I consolidated the mail I had received into a large addition to the FAQ, and the woman maintaining it at the time asked me if I would consider taking it over, so I did. I added my changes and made it available over the WWW (http://wdg.mc.duke.edu/~brook006/miscarriage.html). Since then I've occasionally made revisions to the Web version, but not as frequently as I'd like. I have recently made an attempt at reorganizing the FAQ, by breaking it into sections. One section has words of support, one has technical information, and there are also smaller sections dealing with bleeding, molar pregnancies, and how long to wait before trying again. By far, though, the largest section is made of personal stories, sent in by other readers of the FAQ. This brings me to a dilemma. Every story is different, and each deserves to be told. Reading other peoples' stories, I know, is one thing that helped me to not feel so alone when I was going through my own miscarriages. However, the FAQ file has grown so large that it could only be posted to the Usenet in 7 or 8 pieces. Furthermore, it continues to grow, and change, and I don't want to have to limit that growth. Therefore, I have decided to break out the personal stories into their own file. You may access this file at: http://wdg.mc.duke.edu/~brook006/stories.html, or send mail to me at: brook006@mc.duke.edu and I will send it to you. Occasionally people send me mail asking for advice or with specific questions. This is OK, but the only information I'm qualified to give is an account of my own experience, and a little moral and emotional support. I don't have any medical training or special "insider info". I'm just someone who's been there, twice, and lived to tell about it. I'm also happy to report that my third pregnancy was successful, and our daughter Sarah was born in March of 1995. As a result, I'm a lot busier now than I used to be, and wouldn't mind passing the maintenace of this FAQ on to someone new. If you are interested, please e-mail me at brook006@mc.duke.edu. Thanks a lot... How to Contribute If you have information not covered in this FAQ that you feel could be of use to others, please send e-mail to me at brook006@mc.duke.edu, and ask me to add your comments to the FAQ file. Unless otherwise requested, your name and e-mail address will remain in the file, so that interested readers may follow-up directly for more information/discussion. To contribute your story, see the instructions in the personal stories file (http://scalos.mc.duke.edu/~brook006/stories.html). Other Resources There are some very good other resources on the net, which may be able to provide you with more specific data, or interactive support. * The Miscarriage Support & Information Resources page (http://www.pinelandpress.com/support/miscarriage.html) * The Recurrent Pregnancy Loss Testing page (http://www.pinelandpress.com/support/rpl.html) * The SPALS mailing list (Subsequent Pregnancy After Loss) (http://www.inforamp.net/~bfo/spals.html) * The SANDS Home Page Stillbirth and Neonatal Death Support (Western Australia) (http://hedgehog.highway1.com.au/~lawtbm/sandshome.html) * The Growth House Miscarriage page (http://www.growthhouse.org/natal.html) * The Grief, Loss & Recovery page (http://pages.prodigy.com/gifts/grief.htm) * The Usenet group soc.support.pregnancy.loss * The Usenet group misc.kids.pregnancy --------------------------------------------------------------------------- A Rough Table of Contents * Words of Support * Causes and Technical Info * Bleeding During Pregnancy * Molar Pregnancy * How Long to Wait Before Trying Again * Other Resources --------------------------------------------------------------------------- Words of Support --------------------------------------------------------------------------- Just Those Few Weeks For those few weeks- I had you to myself. And that seems too short of time To be changed so profoundly. In those few weeks- I came to know you... And to love you. You came to trust me with your life. Oh, what a life I had planned for you! Just those few weeks- When I lost you, I lost a lifetime of hopes, plans, dreams, and aspirations... A slice of my future simply vanished overnight. Just those few weeks- It wasn't enough time to convince others How special and important you were. How odd, a truly unique person has recently died And no one is mourning the passing. Just a mere few weeks- And no "normal" person would cry all night Over a tiny, unfinished baby, Or get depressed and withdraw day after endless day. No one would, so why am I? You were just those few weeks my little one You darted in and out of my life too quickly. But it seems that's all the time you needed To make my life so much richer- And give me a small glimpse of eternity. By Susan Erlin --------------------------------------------------------------------------- My friend gave me the most valuable perspective on miscarriage and I would like to share it with those who could use it most. Most people believe that when they miscarry they lose out on ever knowing "that child." My mother, who miscarried before having me, always told me that I wouldn't be here if she had not lost her first. My friend feels differently. She says that the souls of children find their way to the right parents, and that miscarriage occurs when the soul of the child was not ready, for some reason, to enter, or renter, the world. When a healthy baby finally arrives, it is the same spirit as the one that was lost, finally ready to join its family. I know it is unorthodox, but it helped me tremendously after my miscarriage. I just wish our child would do what it has to to get ready! Good luck to all of you. --------------------------------------------------------------------------- I was very sorry to hear that you have lost your baby. I can't imagine what it must be like for you and your husband. You had a little being that was growing closer than anything had ever been to you before, and now you mourn because it is no longer there. You will probably be blessed with another child in the future. It will not be the same as this first one that you have lost; no other child will be the same. Time and the closeness you have with your husband will probably help to reduce the hurt. I'm sorry. --------------------------------------------------------------------------- I know the combination of pregnancy and miscarriage and finally my daughter has changed me, deepened me, more than I ever thought possible. I can't say that I'm glad that I lost a child, but I can say that I believe that people who experience life intensely, both the good and the bad, are luckier than those who just drift through. And in that sense we women are lucky, far luckier than men. Men will grieve, and will sorrow, but it's not the same. When I had my miscarriage I think I was most worried about whether there was something "wrong", about whether I would ever be able to carry a child to term. I thought about the IUD I had in for my wilder years. I thought about the years I was too serious about swimming and didn't have periods. I thought about the stretch where I was too thin. I thought about everything I'd ever done that was less than healthy. I suppose the bottom line was that I haven't failed at many things in my life and I didn't like it very much. But then along came my daughter and the misery drifted away, with only a little bruise to show for it. And for some reason I wasn't worried at all during the second pregnancy. I guess the statistics about miscarriages and first babies really don't lie. But in some sick way, it has all helped. When my brother's baby died this year, I knew what to do. And that ability to empathize, to experience all the ups and downs, is what life is all about. Really and truly. --------------------------------------------------------------------------- People say the strangest things when they are trying to comfort me. I suppose you got that too. Why would people tell me it is for the best? How can this possibly help me? Why would they go out of their way to say it isn't so bad for me since I hadn't been pregnant a long time? I know I will get better; I hope I will get pregnant again soon, but I think these things are for me to say, not for them. I know they are trying to be nice, but I don't care if my baby wasn't viable: it hurts just as much either way. I don't care to have my pain minimized or swept away. Someone helped me yesterday: I talked to a wonderful doctor right after I lost the baby (she just happened to be on call). I told her it was quite ironic, but though I had never met her, I was scheduled to talk with her on Tuesday because I was interviewing doctors for OB care. She told me to come on in anyway, even though I lost the baby. I did. She was great. She spent half the time talking to me about this loss, and half the time telling me about her philosophy of labor and delivery and preparation for birth. After I left, I realized that she got me back to concentrating on the future in a very gentle but practical way. She told me I would probably be nervous and antsy when I first get pregnant again and she encouraged me to come in early just to get confirmation and a feeling that someone knew I was nervous and was going to watch me and be aware of my concerns. Don't get me wrong: I am not saying this woman magically fixed everything, but she did help some. I still cried last night, but I feel positive potential in my future. I worry. I will worry. But I hope too. --------------------------------------------------------------------------- I talked a lot to my sister-in-law when I had my miscarriage. She kept telling me the same thing over and over: "Remember, it's nothing you did. If lifting heavy things could cause a miscarriage then there would be an epidemic of 14-year-old female weightlifters in New York City." It's true. If there were anything at all that could cause a miscarriage, desperate people would have found it. And if any sort of bad health habits could set you up for this kind of thing, then the birth rate in inner cities wouldn't be so astronomical. Your body's fine, and you'll be pregnant again before you know it. --------------------------------------------------------------------------- Just thought I'd let you know that my sister-in-law had two miscarriages in a row, and did the same as you, had the fetal tissue tested. For her, it was also the trisomy-16 problem. The doctors told her the same thing your doctors told you. Her third pregnancy was just fine (yea!), and she now has a 9-month old daughter. Hope this makes you feel a little better! (it DID!!!) --------------------------------------------------------------------------- I don't know if this will help you or not, but something you may want to add to the list. I have had several family members and friends who have had problems with pregnancies. One thing that seems to be common is that when a child was lost (still born, cord accidents, etc.), the woman had a miscarriage less than a year later. In some ways, I've always wondered if it was a way of her body just "making sure" since all these women went on to have a healthy child about a year later. It is hard and tragic to lose 2 children in under a year. Support groups and counseling have been what kept some of my friends & family going. The things that were most valuable to them were: a) take time to grieve. You lost a child. It doesn't matter if it was born or not, YOU STILL LOST A CHILD. b) Remember life goes on. If the doctor says there are no problems, wait and try again. Almost everyone who has had a miscarriage hears from women who had one (or more) or knows someone else who had one. An example I use a lot in comforting friends is my mom. There are 6 kids in my family. In 1946 (or 47) my mom had a tubular pregnancy and lost her right fallopian tubes. The doctor told her she'd be lucky if she ever got pregnant again. Eight pregnancies later (6 kids, 2 miscarriages), she asked the doctor to put her on the pill since she felt she was "too old to deal with baby shit." ;) When my youngest sister was born, they brought a bunch of med students/interns in to marvel at the two of them. In my family alone was my mom & her problems. My brother Steve & his wife had a blue baby who died the day after he was born. Mari miscarried 6 months later. They adopted a boy and she gave birth to their second son 1 year to the day after Adam came home with them. They currently have 4 kids ranging from 5 to 13. My brother Gerry's wife miscarried and later had a wonderful and healthy boy (Nicky the human noodle). I contracted rubella in the first trimester of my pregnancy and lost that baby. I now have a healthy 2 year old and I am due in February. My husband's sister miscarried 3 times before they had their first son. They currently have 3 kids (ages 2 to 6) who are healthy and normal. One of my good friends describes herself as "not built for pregnancy." She had several miscarriages and had to have an abortion once when the fetus was literally killing her. Her pregnancy with her daughter left her hospitalized several times in her first trimester, but her daughter is a thriving 3 year old now. Last year, she gave birth to her son and had a hysterectemy immediately after. She claimed it was an easy pregnancy since she was only hospitalized once before her due date. My best friend from college lost her first son. He died as the result of massive birth defects 2 weeks after he was born. She miscarried 9 months later and a year after that had a beautiful baby girl. I could go on, but I won't. I just want to pass on examples of encouragement. I hope they are useful. They seem to have been for some friends. ("Please tell me you know someone who survived this and has children," tends to be the biggest request from them.) One thing that helps too (at least with my friends) is breaking things. Buy a bunch of "yard sale china" and smash it. Take out your anger and frustration on something like that instead of your husband & family. MOST IMPORTANT: The man is grieving too. Many people make sure the woman is fine and forget about the man. My brother Gerry said the best thing that happened to him was receiving flowers from me to him. Everyone seemed to have left him "outside" when it came to comforting. I remembered how much he helped me when I lost my first and wanted to do something for him. When one of my friends had an ectopic pregnancy recently, I sent her husband a plastic fish full of goodies. She said it made a big difference to him. Men grieve too. While the wife goes through medical and emotional trauma, the man feels the sense of loss and helplessness as well. Make sure they don't get ignored. karla Shapiro karla@shiva.com --------------------------------------------------------------------------- I too had three miscarriages in a row. May 93 (12 weeks LMP), December 93 (10 weeks LMP) and March 94 (10 weeks LMP). Now I have a 15 month old. I had the 4 standard tests as well in the spring of 93. I have no advice, just some reassurance that for me, and lots of people I think, the problem resolved its self. I remember how horrible it was to try not to have your hopes up and try not to analyse every symptom or missing symptom. And I hated it when people told me to relax. But what I can say is that the pregnancy that resulted in my daughter was totally unplanned (we were taking a break for the workup and moving to another city/job etc) and I didn't worry about it at all because I didn't know until 8 weeks LMP. Good Luck! --------------------------------------------------------------------------- Causes and Technical Information --------------------------------------------------------------------------- **The following is from an actual M.D. on the net, but he did not give permission to use his name**: First let me express my condolences at your loss. It makes no difference what the gestational age is, there is still the loss of a pregnancy, and this will result in grief and the need to work that through. Trying to find out 'why' is part of the grief work. Let me reassure you that your experience is VERY common. I see similar cases every month in my practice. The problem is that experience with the vaginal probe ultrasound is very limited, and to extrapolate the presence of fetal cardiac activity on vaginal probe ultrasound to previous reassuring statistics about discenment of cardiac activity by abdominal ultrasound (doppler) or earlier auditory auscultation (stethescope) are not valid. Most spontaneous abs occur prior to the 12th week, and a very short time ago, cardiac activity was not discernable prior to the 12th week with any degree of regularity, so the common statement was "Once we hear the fetal heart we don't worry about miscarriage." But now we are using a more sensitive technology and this trueism will not hold up. So I can only encourage you to work thru the loss of this one, and have confidence that you will conceive again with success. And another bit of advice is to wait at least 4 months before trying again. We have good studies that indicate the risk of repeated SAB is much greater in the first three months after a previous miscarriage. --------------------------------------------------------------------------- > I would like to find out more about what the chromosomal test actually > involves, and what they might be able to find out from it. They will count the chromosomes to see if there is the right number (46). They will look to see if the chromosomes are complete, with no missing parts. They will look to see if part of one chromosome has broken off and rejoined another chromosome. They will look for any kind of abnormality they can find. Chromosomes in eggs and sperm are at a somewhat higher risk for getting things screwed up because they undergo a process called "crossing over" where, for instance, chromosome 1 from your father and chromosome 1 from your mother may swap equivalent parts, leading to a new combination of genes on the resultant chromosome 1's. This is good for the species, but when things don't go quite right, it's bad for the individual that will inherit those chromosomes. Most of the time when this happens, the conceptus or zygote is completely incapable of normal development, and either never implants or dies within a few days of doing so, and you never know about it. But some limp along until some critical gene that has been damaged is needed, and then they die in a first trimester miscarriage. Because the chromosomes can be seen with an ordinary microscope, any large rearrangements or duplications/omissions can be easily detected, and the cause for the miscarriage known. > Also I would like to talk to other people who've had tests run on > themselves and/or their spouses. I would also like to hear from people > who's progesterone levels were too low to support a pregnancy (my OBGYN > doesn't think it was that but hasn't ruled it out - I keep wondering about > it because it happened to my sister-in-law). It would be helpful to know when your miscarriages occured. Through most of the first trimester, progesterone is produced by the corpus luteum---the "scar" left behind when the egg popped out of the ovary. It produces progesterone because it detects chorionic gonadotropin (HCG) in your blood. The HCG is produced by the part of the embryo that later becomes the placenta---the trophoblast, in scientist-speak. For the first 10 or 11 weeks, a progesterone insufficiency would be due to either the trophoblast not producing enough HCG, or the corpus luteum not responding with enough progesterone. For instance, my mother miscarried all three times between 8 and 11 weeks, and never had any morning sickness with any of those pregnancies, but she did get it when she had her four children. My personal opinion of this is that the first 3 embryos were not producing enough HCG to sustain the pregnancy for whatever reason, since the first trimester nausea is often correlated with HCG levels. It's difficult to use morning sickness as an indicator though, because women vary enormously in their sensitivity to it. Some women can have raging levels, and have no morning sickness, and some will still be vomiting from the low maintenance levels in the 2nd and 3rd trimesters. Anyhow, getting back to established fact, HCG levels in a normal pregnancy rise dramatically until about 2 months (this does vary though), and then begins to drop off as the corpus luteum ages and becomes incapable of producing hormones anymore. The placenta by this time has become mature enough and large enough to produce its own progesterone, and it ramps up production as the corpus luteum is winding down. If these two events are not quite in sync, you can experience a slight dip in progesterone levels, and since rising progesterone levels (absolute level doesn't matter, it is the rate of change of levels, which is why progesterone levels continue to rise throughout pregnancy) keep the uterus relaxed, contractions that expel the fetus can result, just like at birth. Rates of miscarriage decline the further along in pregnancy you get, except that there is a slight spike right at the end of the first trimester, when this switcheroo maneuver is underway. > And finally, I would appreciate hearing from anyone with any information > about women developing antibodies to their fetuses, and how common (or > rare) this is. And basically, just anyone else who has anything to tell me > at all that might be helpful. It's very rare. It's not precisely known why all pregnant women don't develop antibodies to their fetuses, since they are, after all, foreign tissue. The theory is that the placental interaction between the cells derived from the baby (placenta) and the mother's cells in the uterine wall induces the fetus to produce an enzyme that damps the immune response at the interface. Theoretically, certain "markers" are used to determine where the immune response is supposed to be dampened, and the cells do a little comparison between themselves and their neighbors on these markers and if they are different, then they produce the enzyme. The difficulty (again, theoretically) is when the father coincidentally has the same set of markers as the mother, then the fetus' cells look just like the mother's cells when the comparison is done, and no enzyme is produced. The mother's immune system could care less about these markers, however, and the other differences between mother and fetus trigger an immune reaction and antibodies are produced. Again, this is all theory, nobody knows what the markers are even if they exist, but what is known is that a woman who consistently has an immune reaction against fetuses fathered by one man will be able to carry a fetus fathered by another man (say by artificial insemination) to term quite nicely. The man will also be quite capable of having children with another woman. Your practitioner probably did a blood test that included a white cell count, and possibly other measures of immune system function. If you are rejecting the fetuses, you may experience similar symptoms to an immune reaction to just about anything else---a fever, feeling sick (not necessarily nausea, but the same feelings you get whenver you're battling the flu, a cold, or other infection---being very tired, loss of appetite or a ravenous appetite, etc.), and the evidence of your immune system fighting an invader may show up on your blood test. But it also may not unless it is being explicitly looked for---if some of the theoretical enzyme is being produced because at least one of the markers is different, then the immune response may be weak enough not to show any symptoms, but still strong enough to kill the fetus. I hope this hasn't been too dry and technical for you, and I hope it's been helpful. Myself, I cling to the example of my mother, who had so much heartbreak and then was rewarded with four wonderful kids (if I may say so myself :). --------------------------------------------------------------------------- Ok, so, if we're going to try to look for an answer to why these miscarriages occured, we'll consider the facts. On a gestational age basis, the first embryo died somewhere around 5 weeks old (LMP is approx. 2 weeks longer than gestational age). At this age, the embryo is about 1 centimeter or 4 tenths of an inch long. The second embryo died at about 6 weeks old, and is a little over half an inch long at this age. Important to note is that the embryos died well in advance of being expelled. If there were a hormonal problem, the embryos would have been alive and well, but the uterus would have expelled them anyway. Usually (though not always) in cases of the mother's immune system attacking the fetus, the placenta suffers the most damage, because it is the part directly connected to her. Bleeding from the damaged placenta almost always precedes such a miscarriage. So this is unlikely to be the cause. When the embryo just up and dies like this, it is usually because something has gone wrong (either chromosomally or developmentally), and the embryo is simply incapable of continuing on. It's pretty amazing that development ever goes totally right. The first weeks are an incredibly fast and furious process of cells dividing, migrating, bending, making seams, all having to be highly orchestrated to happen at just the right time. If something doesn't happen quite right, the embryo may die or be born with profound defects later on. However, it's quite unusual to have 2 miscarriages in a row with this cause. There's about a 1 in 20 or 25 chance of this happening in any given pregnancy, and to have it happen twice is like drawing a ball from each of two bags of 25 numbered balls and having both balls be number 25. It's a very low chance, but somebody has to be the unlucky one, I suppose. --------------------------------------------------------------------------- [I sent eMail to someone on the net whom I knew from earlier postings to be a geneticist, asking him about the chromosomal test - his answer:] I am really sorry to hear about this situation with you and I hope that my notes can expand your information base so you can ask better questions to your doctor. To begin with, I would double-check my statements with your doctor/genetic counselor in regards to the SPECIFICS of your INDIVIDUAL case. When a miscarriage occurs, a cell tissue is taken for this test and grows for a period of several days which can vary according to cell type: blood, bone marrow, amniotic fluid. This is called "growing a culture" which will take a number of days. For example, I am learning the procedure this week and last Friday, I took my own blood and let it grow until Tuesday. On tuesday, I activated the cells to grow at the same rate by adding certain chemicals. After that I blew up the Red Blood cells and removed the waste to leave behind only the White Blood Cells. This is done because Reds do not contain any DNA while White do. Thursday, I will take this purified blood sample and fix it onto a slide where I can analyze it. By using a microscope with a computer screen, I cut apart the chromosomes and sort them according to type. This results in creating my 'karyotype' which I will print out & in the case of other people return this data to their doctor. WHAT CAN THEY TELL? Good question. I do not know your age but most expecting mothers over 35 take this to find out if their child has Downs. This is detected by an extra 21 chromosome in the cells fixed to the slide which reflects the baby/patient depending on source. Other errors are able to be detected are extra chromosomal numbers such as 69 or 92 but this is VERY unlikely and I highly doubt this is your situation. I suspect you can not help but suspect the worst but well..wait for the results. In regard to why, they may test you and the father? Well, sometimes about 1 in 200 people have balanced translocated chromsomes which in simple english means that no genetic info was lost but people have a chunk of their chromosome 3, for example, attached to chromosome 5, for example. This looks odd compared to others in a 'karyotype' but the cells do not care so long as all the genes are present. If the baby has a balanced translocation in the test, they will want to know if it was new for the baby or you have it as well. I won't be that surprised if I have this myself so don't panic. But most likely, their is no genetic reason for this miscarriage but a result of other reproduction factors. I MUST STATE THAT I AM ONLY A BIOCHEMISTRY SENIOR AND AM LEARNING THIS PRODEDURE but I hope that this info makes you feel more informed with your situation. --------------------------------------------------------------------------- The hardest thing is finding that there is often no one or no thing to be blamed--it just happens and nobody knows why. Give yourself lots of time, as recovering emotionally is not unlike recovering physically--just because wounds are felt rather than seen doesn't mean that there hasn't been damage that will take a while to recover from. In a real sense, this is a death, so you may need to mourn and grieve for a while. Take lots of time with yourself emotionally as well as physically. And, by all means, if you are uncomfortable with your OB-GYN--you're not getting answers to your questions, etc.--find another one immediately. > And finally, I would appreciate hearing from anyone with any information > about women developing antibodies to their fetuses, and how common (or > rare) this is. This is all very new stuff, so there isn't a whole lot of data around. As I understand it, in order to strengthen the blocking response of the placenta, white blood cells (a half unit) from the (prospective) father are administered to the mother, and then they try to conceive again. While some reports of the succes rate are as high as 70%, I don't know that the sample is large enough yet to be significant. There are, for example, other studies that have shown that psychological counselling was also effective--again, the data sample is small, so it's hard to tell how significant a result this might be. My wife and I had the white cell stuff done in Richmond VA and we now have an 18 month old son. Clearly, *something* worked--even though we didn't have the full course of treatment that the Richmond people wanted. But now, we're having troubles even conceiving again--which wasn't the slightest problem before. > And basically, just anyone else who has anything to tell me at all that > might be helpful. It's not your fault. Even though it happens in your body and to you, it's not your fault. It hurts like hell, but these things just happen, the way asteroids sometimes slam into the Earth. Boom. Stuff flies. Things get killed. It's nobody's fault. It just happens. We pick up and try to go on... --------------------------------------------------------------------------- Last week my husband and I suffered through the pain and disappoinment of a "missed" miscarriage. Simply put, this condition is caused when the body fails to recognize that the cell cluster which has implanted has not become a viable embryo and so continues to go through the motions of supporting a pregnancy. For about a month after the pregnancy test was positive, my husband and I thought about and planned for our baby. The fact that our dream was shattered so soon didn't make it any less heartbreaking. The reason I thought I'd write you, though, is to publicize the method used to help us move on. You see, it was awful enough to try and accept the news that the growing pregnancy sac we kept seeing on the ultrasound monitor was empty and that it always would be. Still worse was the fact that we had to select the method for ridding my body of the pregnancy support system still growing in my uterus. Option one was to let nature take its course. It might have been weeks, though, before my body recognized there was a problem. The choice would almost certainly have ended in a trip to the hospital for an emergency D&C. We did not need the expense nor the trauma of this option. The second option was having a scheduled D&C. We believed that this choice sounded good because of the fact that it would be done under safe, controlled conditions and under the peaceful sleep general anesthetic provides. By contrast, the third option of a reletively new office procedure would cause all the cramping and bleeding normally associated with a miscarriage, induced by a drug not FDA approved for the purpose. We were prepared to choose the scheduled D&C when we arrived at the doctor's office for a final ultrasound. We said that we wanted to make the choice which would be best for my physically AND mentally. He was certain that the office procedure fit the bill. He went on to list the risks of a D&C: perforation, infection, extensive bleeding, and a 2% chance that it would have to be repeated. The office procedure also had a 2% chance that a followup D&C would be required, but there was no chance of perforation or infection since the procedure was non- invasive... and he was ready to do it then and there. (It was a real blessing that we didn't have to go home and dwell on it for a day or two.) At about 6:00 PM the painless, five minute procedure was performed. A small pill was broken into four pieces. (This drug IS FDA approved for other uses, but it was explained that no matter how much pain, suffering, mental anquish and money this procedure would save women, it was still technically an abortion and no drug would be approved for abortion use. The doctor went on to say that the FDA has never approved any drug for use during pregnancy either - not Tylenol, not TUMS, nothing. He added that if doctors had to wait for the FDA to approve everything obstetricians would have nothing to use at all! Procedures and drugs, then, are chosen based on results found in medical journals. This one has been used with increasing frequency and with excellent results.) The pieces of the pill were placed around my cervix - painlessly - and held in with a tampon. I was sent home with a prescription which we filled immediately. I ate a small dinner, took one of the prescription-strength Motrin, and waited. About 8:00 the cramps started. By 10:00 I had become very uncomfortable, but my husband gave me lower backrubs which helped immensely. I was further diverted by a good movie on TV. The cramps were no worse than the intense ones I'd suffered through during my teenage menstrual cycles. (I only took that one Motrin.) I went to bed at 11:00 and slept soundly. In the morning it was over. I was amazed to discover that the bleeding had already tapered off to little more than spotting. At my recheck that evening, the doctor found signs (through ultrasound) of only a small bit of tissue remaining, which he was almost certain would pass on its own. (Sometimes a second treatment is needed, but it results in much less cramping since the uterus is almost emptied and nearly back to normal size). I will have to have weekly QHCG (blood) tests until my level returns to zero (indicating that a D&C will not be necessary). In the meantime, my husband and I are on StressTabs with Zinc and prescription-strength Folic Acid to prepare for our next try. I'll be filling my new Clomid prescription soon, and I already have an appointment for mid-June so my period can be started by injection if it hasn't already done so on its own. In short, we might be pregnant again by the end of next month! (There is no good medical evidence, according to the doctor, that suggests that waiting more than one cycle will improve our chances for a healthy pregnancy. In fact, he believes that the knowledge that we can try again so soon greatly enhances our emotional well-being, a factor that is also very important.) There isn't anything that anyone could have said to make this experience any less heartbreaking for us. We knew we didn't do anything to cause the miscarriage, nor could we have done anything to prevent it. Still, we can't deny the fear that it might happen again. We know that the people who told us "it was for the best" and "at least you know you both work" were only trying to help, but we wanted to scream each time we heard that. In fact, the only good thing about all this was how fast and easy the doctor made it to move on. No hospital visit, no paperwork, no recovery room. It was fast, it didn't hurt (other than the cramping, which is short-lived and not too terrible), we saved a fortune, and my husband and I went through it together in the privacy and comfort of our own home. I don't know under what circumstances the procedure can replace a D&C, but having had both now, I can say that this is DEFINATELY the way to go. We will always be grateful to this doctor for coming as close as any man can to understanding what it's like to be a woman in this position. Elizabeth Foss nfn04287@naples.net