August 17, 2016

Pregnancy Journal: Completing my Miscarriage [UPDATED]

Previous posts from this series include the following entries:

My last consult with the OB was two weeks ago, when my ultrasound was not able to find the heartbeat of the baby. Knowing that first trimester pregnancies are very risky, we were able to accept the loss better than we expected.

However, there is still the case of a dead baby inside me, and how we can safely remove it as not to affect my future chances of getting pregnant.

Option #1: Wait It Out

In hopes of inducing the bleeding naturally, the OB gave me two weeks' worth of waiting period. During this time, all food and activity restrictions are lifted. I can eat raw food again, same for canned goods, preservatives, and alcoholic beverages. I am also allowed to do physically strenuous activities like exercising and lifting heavy objects. In short, I can now get my life back to normal.

The thing is, my life isn't exactly back to normal... and not just because I have lost a baby. Because of the miscarriage, I have been advised by my company to avail of the government's maternity benefits, which included a 60-day leave. Which means, I will not be going to work until October 2016. Because of this, my "normal" routine has greatly been affected, and now a typical normal day involves getting up from bed at around 11 o'clock in the morning, eating, going back to bed, getting up at 3 o'clock in the afternoon, watching TV or surfing the net, cooking, eating, then going back to bed. During my first few days I was still able to do a bit of exercise, but now... the bed beckons.

Suffice to say, I haven't bleed throughout this period. Sometimes I think that maybe, maybe my baby isn't dead at all, but considering all the *bad* stuff I already ate and did, adding to the fact that I have no pregnancy symptoms at all, perhaps it is best to complete the miscarriage and try again.

Option #2: D&C (Dilation and Curettage)

Yesterday, I went back to the OB for a consult. After examining me, she observed that my cervix opened up a wee bit, but not enough to naturally pass the baby. Matindi ang kapit, we all agreed. This means that my womb was able to hold a growing fetus, alas the fetus itself was not able to survive. However, two weeks' worth of waiting is too long and too risky (as I might get poisoning if the dead fetus is inside my belly for too long), so the OB has scheduled for me for a D&C procedure tomorrow.

For preparation, the OB gave me one tablet of misoprostol to induce labor. In actuality, there is an option to complete miscarriage using misoprostol (or any similar medicine) on its own. In this process, you will be given tablets to be inserted in your vagina (four at a time, I think). After a couple of hours, the large dosage of the medicine will cause you to have some intense labor-like cramping, which will eventually make you pass the fetus. In some cases, this option alone is enough to complete the miscarriage, however, there still are some cases when not all of the fetal tissues are expelled. D&C will still be needed for this.

Pretty damn expensive, 200 PhP a pop.

Also, it is worth knowing that misoprostol is an abortifacient; essentially a drug that causes abortion. Because abortion is illegal in the Philippines, misoprostol isn't sold in pharmacies. Doctors need to procure them abroad, and they only give it to patients as needed.

I am to insert the tablet inside me before I go to sleep, also I am to fast for eight hours before the procedure. My schedule for tomorrow is at 7 o'clock in the morning, which means that by 12 midnight I should cease any food or liquid intake.

Well, you've pretty much caught up on me now. I will continue this entry when I come back from the procedure tomorrow (health permitting). Perhaps by then I can explain (in my own words) the whats and hows of D&C. Pray for me!

August 17, 2016

Time check 7:55 PM

Just got back from a nap; I am back home from the hospital some four hours ago. Here are the events that transpired since my last update:

Had my last meal of ginataang bilo bilo at around 11:30 PM last night, and downed a glass of orange-infused water. Inserted the tablet of misoprostol shortly after my nightly routine, and after wearing an overnight pad, went to sleep.

Sleep was rather uneventful; only had a dull sensation of cramping earlier when I woke up at 5 o'clock in the morning. Haven't bleed at all; my first observation of bleeding was already in the hospital when I had to change out of my clothes to their dressing gown.

By 7 o'clock in the morning we were already at Makati Medical, where we directly went to the Delivery Area. Patient registration happened at the reception, as well as the turnover of documents needed for my financial benefits (i.e. SSS, PhilHealth, Generali--my company's HMO), and after a few minutes I was lead into the changing area alone. My husband wasn't allowed inside the area, so I tasked him on the errands of payment and following up on the documents.

Here we go!

First, the nurse instructed me to change my clothes while she interviewed me on my medical history.

  • You are required to take off ALL your clothes, so wear as few separate articles as possible i.e. wear a dress, slip-ons, and no jewelry. HOWEVER, hospital climate is chilly to say the least (maybe they need to make things cold to minimize bacteria?), so wear a layer of sweater or a scarf while waiting.
  • Some of the questions were no-brainers, such as known allergies, family history... the usual ones. Some questions I had a hard time to answer were the date-dependent ones, especially 1) How long was I pregnant (because I lost count when the last ultrasound was not able to detect the heartbeat), and 2) When was the last ultrasound (because I only keep track via pregnancy by weeks, not the exact date).

After which, I had to sit down and wait for quite some time to have my vitals checked. I wasn't wearing any underwear anymore so they gave me a hospital pad thingie to line the chair just in case. After what I think has been half an hour, the nurse directed me to a bed in the Recovery Area, where they started to insert the IV. This part kinda sucked because they made three attempts inserting the needle into my vein as they were having a hard time finding a vein thick enough to handle the needle. It took a good half hour, too, because they had to let my poor hands rest in between insertions. Huhuhu.

While lying down the bed, nurses would come to my area for more interviews (which were just repetitions of previous questions, but asked by different personnel), and to check on my condition. It was quite cold in the room, so I requested for an extra blanket while waiting. Because I woke up early, I spent most of the waiting time dozing off while listening to the conversation within the room--nurses exchanging Pokemon Go tips and tricks.

Maternal-Fetal OR-DR Pavilion (Dr. Constantino P. Manahan Pavilion) [Source]

Eventually a nurse assisted me to the Operating Room, where I had to lie down for a few more preps. An automatic blood pressure monitor was attached to me, as well as the disc thingies to monitor my vitals. Dr. Amelia Reyles, the anesthesiologist, came in first and instructed the nurse to administer a series of three doses of *stuff*, which made me feel drowsier and groggier with each dose, but not yet completely knocking me out as they want me to wait for the OB before sedating me completely.

I remember the sensation of being drugged as a curious one, as I consciously felt my eyes getting heavier and more sensitive to the light, so much so that I had to close them to feel comfortable. I could feel my heart pumping more loudly and my breathing become heavier, but at the same time I felt the lack of will to do anything else (even breathe) as all I wanted to do was sleep. I became a bit conscious about breathing, actually, as I do not want to pass out because of the lack of oxygen.

When my OB, Dr. Sto Domigo, arrived, there were a few exchanges of hello's, then the nurse put an oxygen mask over my face and instructed me to breathe deeply, while another nurse administered the last dose of sedative which knocked me out immediately.

A deep, dreamless sleep, without knowledge of what was happening to me. Peace.

So I guess I won't be able to describe the D&C procedure after all, as I was heavily sedated throughout the process. Needless to say, I think it all went well.

I think it was around 1 o'clock in the afternoon when I woke up in the Recovery Area, where the nurse informed me that it has been an hour since they transferred me to the area. They waited for an hour more for me to regain full consciousness; while waiting I had to sign a few more forms, answer a few more questions, and receive post-operation instructions. After which, they gave me my clothes, waited for me to get dressed, and assisted me into a wheelchair to meet with my husband and escort me to the parking lot.

Time check 9:57 PM

Just took a break from updating this post to eat dinner and to drink my first dose of meds, which are (I hope I'm getting the spelling right):
  • Antibiotic - Cefuroxime 500mg - two times a day with meals (8AM and 8PM)
  • Pain reliever - Mefenamic Acid 500mg - every 8 hours with meals (6AM, 2PM, and 10PM)
  • For bleeding - Methylergometrine Maleate 125mcg - three times a day may be taken without meals (8AM, 2PM, and 8PM)

So far, the bleeding is bearable--just like your average menstrual period. I've been taking Mefenamic Acid on schedule as I want to feel minimal pain as possible, so for now I'm pretty much drugged up in the pain department, haha. If this is anything similar to my HSG procedure, I will be pretty much resigned to bed rest for a couple of days. After that, it's business as usual.

I guess this is it. A chapter of my life has finally come to its end. I'm still too lazy (and on a Mefenamic Acid high) to reflect on this experience. Not in a hurry, as I have the rest of my maternity leave to do that.

So if you will excuse me, it's now time for my scheduled dose of Mefenamic Acid.