Surgical management of miscarriage

After learning our third pregnancy had failed and our already beloved baby had died at 9 weeks gestation, me and my husband had opted for surgical management of the miscarriage. 

After a natural first miscarriage and the second, an extended loss of a pregnancy of unknown location, this time I didn’t want to be aware of what was happening. I felt cowardly, but knew I just wanted to go to sleep and wake up when it was all over. The fact our foetus could be genetically tested after surgical removal convinced us further this was the best fit for us.

Pre-op assessment

Three days after the ‘no heartbeat’ scan, we went back to the hospital for our pre-op assessment. This involved (as hospitals in the UK invariably do) a lot of waiting around. We eventually spoke to a nurse who could see how nervous I was about the whole ordeal and was incredibly kind, requesting I was first in the surgery schedule the following day. 

At this appointment, we had to select our preferred method of disposing of the baby’s remains. I wasn’t prepared for that and it really upset me, but being told that early loss babies would be cremated together and taken to the baby garden at a local cemetery comforted me, as it felt they were being viewed as babies, rather than as foetuses or embryos.

The waiting room

The following morning, as instructed, we arrived early at the hospital. We were told that the afternoon’s surgery was expected to begin at 1.30pm and that, before then, we would speak to the surgeon, the anaesthetist and a nurse.

We were in a pre-op waiting room with another 12-14 people, around half were women that, we assumed, would be having the same surgery as me. It was a sombre atmosphere. Nobody spoke to each other, each of us so tightly wound up in our own circumstances, dealing with our own worries. 

There was a TV on, presumably to break the silence. As terrible timing would have it, one chat show was speaking to mums about having children and how many they thought was too many. Visibly shaken, one woman asked reception to turn it off. I remember sitting quietly considering that for most of us in the room, one child – the one we were in the process of losing – would be plenty. 

The positioning of the waiting room was also unfortunate. It overlooked the main entrance to the hospital, a maternity hub in Manchester. We saw multiple heavily pregnant women arriving, women leaving with their newborn babies. And one woman that I will never forget, who was hugely pregnant, went outside at least 4 times for a cigarette. This sat really badly with me. As a former smoker myself, I understand how difficult quitting is. But I had done it before I started trying to conceive, knowing the damage it could do to a developing foetus. The fact that I had done what I was supposed to do but had lost my baby, when this woman was smoking heavily and still getting her child, it just seemed so unfair. 

Time continued to pass slowly that morning. I hadn’t been able to eat since 6am and couldn’t drink anything after 11am, so by noon, I was hungry and thirsty and just wanted to go home. 

I was intermittently being called in to speak to each of the medical professionals. The anaesthetist had explained what having a general anaesthetic would entail. The nurse, the same one I had seen the day before, was again lovely, but informed me I had been moved down the list for my surgery and so would be waiting longer than anticipated. She gave me a tablet which would begin to soften and dilate my cervix, making the evacuation of retained products of conception (ERPC) easier. The surgeon had been delayed, but when she arrived, we were called in one by one to speak to her. She was full of reassurance, checking I understood what was happening and giving me an opportunity to ask her about any worries I had. I felt safe knowing she was the one doing the surgery.

Pre-surgery jitters

At around 2.30pm, me and my husband were taken upstairs. We were told to say our goodbyes as I turned right to the surgery area and he went left to the family waiting area. It’s a very lonely experience walking away from your whole support network when you’re feeling so vulnerable. I began to cry and didn’t want to let go of my husband. I was scared and didn’t want to be alone. 

But I followed the nurse and took a seat in another waiting area. I was quickly taken to a side room and told to remove my clothes and put on the hospital issue gown, then return to the waiting room. All my belongings were put in a locker in reception and I took a seat to wait. 

I could feel the medication beginning to kick in and I was getting some vicious cramping. Another woman was wheeled past me, obviously just coming out of theatre, and I began to panic about what was going to happen. I started to feel clammy and overheated and in danger of fainting, but didn’t know what to do. There was nobody in the waiting area and I couldn’t properly see without my glasses, which I had taken off when I got changed.

I leaned over and took deep breaths, trying to slow down my heartbeat, until a nurse came to check on me. She quickly saw I was in distress and took me into a private room where I could calm down. She stayed with me for a good twenty minutes, chatting about everyday stuff, trying to distract me from what was about to happen. I am so grateful to her. I’m sure there were a hundred other things she needed to be doing, but that small kindness made a lasting impression on me. 

Post op

Eventually, I was called into theatre. I lay down, a cannula was put in my hand and a drip attached, the general anaesthetic was introduced and then…I was waking up in the recovery room. 

Knowing that everything had gone as planned was a huge relief. And the fact I didn’t feel sick and could keep down tea and biscuits was a good sign, as it meant it wouldn’t be too long before I was discharged. 

By the time I was transferred to the main ward, I was so ready for a hug from my husband and he was relieved to see me awake and well. There was more waiting for my Anti-D injection (as I am A- blood type), then once I had eaten and drunk again, been to the toilet and could walk around, at around 8pm I was finally discharged and able to go home. 

Overall, the physical experience was fine. The pain immediately afterwards was bad, but manageable with the medication provided by the hospital. The bleeding was heavy for only a couple of days. I did continue to spot for several weeks afterwards, and it took my period 11 weeks to return, but I am told this is different for everyone and my experience was still within the realms of normal.

Emotionally, the recovery was slower. I ended up taking 12 weeks off work and still, 5 months since my most recent miscarriage, I struggle to speak about them without getting upset. I think having gone through this three times in less than a year has taken its toll. And to still desperately want a child, but not having that happen, is becoming more difficult to live with.

Genetic testing results

It took us 4 weeks to get the results of our genetic testing. They showed that our baby boy had an additional chromosome 21 which indicated he had Down’s syndrome. Being told the gender was difficult, but important for me to move on (and you don’t have to find this out if you don’t want to).

Learning it was a chromosome abnormality that caused the miscarriage – and after further testing showed that neither me nor my husband have a chromosome translocation –  has given us hope that perhaps we are just one of the couples who’s had recurrent bad luck. 

We continue to hope that pregnancy number four, if and when that happens, might just be the one that works. 

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