The D&C

A little dark humor: "I survived my D&C and all I have to show for it is some lousy mesh panties."

Wait and see? Or D&C?

I've suffered multiple miscarriages, but my last one, just a few weeks ago, was the first one where I asked for an immediate D&C procedure. I have had one D&C previously, but that was after 4 or 5 days of misery, waiting to finish miscarrying and developing a fever. With my others, I've miscarried naturally.

Based on my own experiences only, I would have to say that having the D&C right away offers many advantages. I bounced right back, and felt like myself again within 24 hours - literally. It was a really easy recovery.

Of course, the down side is that even with "good" health insurance, which I am lucky enough to have, I am sure we will end up paying well over $1,000 out of pocket in medical bills for the procedure once all the bills are counted.

Anyway, here is an interesting overview of the pros and cons of each approach to managing miscarriage.

Previously physicians and midwives have had their preferences, as do the pregnant women involved. Though a new study has shown that the rates of complications like infection are extremely low (2-3%) but consistent among all types of care. The biggest difference was that there were more unexpected admissions and surgeries following the expectant and medical management.

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A miscarriage dispatch: let's begin again

I thought it was today, but my doctor's appointment is actually tomorrow. It will be my first post-(this) miscarriage meeting with my doctor, and basically, I want to throw out everything we've been doing and start over.

I want to start from square one, and for the first time, I want my OB-GYN, as well as the reproductive endocronologist to whom I'll be asking for a referral to see me as a patient with a real, specific, chronic problem - recurrent pregnancy loss- instead of a regular patient who just happens to have had the random bad luck to miscarry over and over and over again. I want to organize a case management approach to my care, with my OB-GYN, whom I really like, acting as point person - coordinating things.

After a lot of thought, I have also decided that if I do get pregnant again, I will not be returning to the perinatal group I've been seeing each time pregnancy has been confirmed previously. I like the doctors tremendously, as well as the office staff. I believe they are really great with high risk pregnancies after 20 weeks - probably the best in town. But they seem completely unwilling to take more aggressive action for me and my earlier losses, even though I am now 41 years old, and have now had eight miscarriages in the past three years. I think that since I have had one successful pregnancy during that time, they just figure that if we keep trying, something will eventually "stick," and we'll get us a baby, but I honestly don't have time any more for that laissez faire approach. For example, they insist that despite my MTHFR and PAI genetic issues, I do not need early treatment with lovenox or heparin because my homecysteine and PAI levels tested normal. But there are many doctors who now believe that all women with recurrent losses, and the pre-existing genetic thrombophilia issues DO need lovenox injections. Additionally, I think I likely need to start taking progesterone supplements BEFORE I get a positive pregnancy test, as opposed to afterward. And they won't prescribe it until I am actually pregnant.

So anyway, I am going to see my OB-GYN tomorrow, and ask that we start from scratch here regarding my problem. I am going to request that we immediately try a low dose of clomid in order to try for a "better" ovulation, and I am going to ask to be immediately referred to a reproductive endocrinologist. If I do manage to get pregnant again, I will need to have my regular OB-GYN help me find another perinatal group who will take a more hands-on approach in managing my care. Again, it will make me sad to leave the group I've used before, because I really do like them a lot. But you can't keep doing the same thing over and over again and expecting different results, right?

Last, I have to say I am pretty nervous about trying the clomid. Some of the possible side effects sound pretty unpleasant, and I will be honest, I do NOT want to end up with twins. But I think the potential benefit outweighs the risks.

Oh, and one more thing. This miscarriage was the first one where I asked the doctor to just immediately do a D&C instead of waiting to see how things would go naturally. I had one previous D&C, but it was after waiting almost a week to see if things would take care of themselves (they didn't). I have to say that I would definitely recommend the immediate D&C route. I had the easiest physical recovery I've ever had after one of my losses. I bounced right back immediately, which was really nice.