Thursday, October 15, 2009

Logistics and Statistics

So tomorrow I go to the hospital for a procedure called "dilation and curettage," which is a type of abortion.  This is my second unwanted abortion, and I'm not happy about that.  Since it makes me feel better to write about all of this, I'll tell you what I know about this process.  (And thank you all for your kind comments.)

In a case like this, where it is discovered that the fetus is not developing before there are any symptoms of miscarriage, there are two choices:  have the D&C, or let things happen naturally.  Eventually, my pregnancy hormones would adjust and my body would naturally expel the contents of my uterus.  The problem with that option is that you don't know exactly when it will happen, it can be very painful, and it is very bloody.  The doctor emphasized, "a lot of blood."  The risks of a D&C these days are minimal, the most common major problem being infection, which could lead to perforation of the uterus and infertility.  But I trust the doctor who advised me yesterday that this risk is very small.  I will be on prophylactic antibiotics anyway, and I've never been prone to infection.  Many times, even if you let things happen naturally, you need the D&C anyway to be sure all the tissue has been expelled.  The other benefit of the D&C is that a genetic analysis can be performed to possibly find out what went wrong.  I'm not sure if my insurance will cover this, so I'm not sure we'll have it done, but it would be nice to know if possible, especially given my history.

The biggest cause of miscarriage is genetic defect.  If the problem is bad enough, the fetus can't get beyond a certain state of growth.  When we are amazed at how well DNA builds such perfect human beings even with all the problems we see in living people, we shouldn't forget that there are a lot of errors - these are the miscarriages.  I read last night that up to 75% of a 40 year old woman's eggs may contain genetic defects.  Unfortunately, the book I have does not include footnotes and this figure sounds ridiculously high.  (The book is also one of those types where pregnant women are encouraged to take no risks whatsoever so I don't completely trust it.  Another source put the percentage of defective eggs at 50, with the caveat that this figure was arrived at by studying only infertile women, so it is probably still high.)  But one hard fact is that the miscarriage rate for 40 year old women is about 1 in 3 and it goes up dramatically as you move towards 45. 

These figures can be depressing, and it is certainly possible that we'll never have another child.  (Here is an interesting personal anecdote from a woman who tried to have a second child in her mid-forties - she eventually did fail.)  But I look at these figures as a way to understand and cope with this miscarriage.  As I said before, it can be seen as "normal" at my age of 39.  And I have to be prepared for it to happen again.  But for now, this is no deterrent.

Tomorrow is going to be a terrible day, and from what I gather, I'm going to be in pain through the weekend at a minimum.  But I want to get it over with.  I've spent the past 24 hours worried sick that things would start happening on their own.  I hope I make it through the next 24.

6 comments:

  1. We'll be thinking about you tomorrow and hope that your discomfort wil be minimal. Visit the website if you need a little sunshine.

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  2. I hope things go well tomorrow. When I had my miscarriage at 10 weeks, I ended up "going naturally" the morning of the scheduled D&C. Because I had taken that pill they give you to prep for the procedure, it was really painful (it's painful anyway, of course, but the drugs didn't help). But I wasn't in too much pain after it was over. Just like a bad period. I'm not sure if I would gave preferred the D&C over what happened.

    And you're absolutely correct that miscarriage is so common, especially as we get older. Even younger women have miscarriage rates around 25-33%. I found some comfort in knowing that this was nature's way of taking care of something that wasn't right. I can only think of one woman who is finished having children who has not had a miscarriage or stillbirth. I hated joining the club myself, but I also was glad not to be alone.

    I'm so glad you're sharing this and wish I had been able to do it at the time, and during my fretful early pregnancy with my last child. Thank you. I'm thinking of you and your family!

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  3. I had a 'natural' miscarriage and it was very painful. And they did check to make sure everything was cleared out (luckily, yes). Will they put you out or do a twilight? Out sounds like it would be better. I hope you get to rest a lot over the weekend.

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  4. Linda, I like that suggestion!

    Jenn, that statement about knowing only one woman who finished having children without a single stillbirth or miscarriage is exactly what I meant about the stories coming out of the woodwork. You just don't really get it until you talk to people.

    Kim, I'm not sure about the anesthesia, but the doctor said I would be "pretty much out of it." I was too shocked to ask more at the time, but I don't like the idea of twilight sleep so I'm going to ask for general.

    It sounds like there is a great range of possible pain and after-effects. I'm glad this is happening on a weekend and Adam is able to stay with me through the whole thing. Thanks for your support.

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  5. Thinking about you this weekend. I hope everything goes as smoothly as possible.

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  6. Thanks for sharing, Amy. I remember several years ago talking to a doctor here at work about his wife's difficult pregnancy (she'd had couple previous miscarriages too) and he told me that a pregnancy without complications (although not necessarily miscarriage) was the exception, not the rule. I remember being surprised by this - I had no idea.

    Hope your recovery is quick.

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