I recently made the decision to use misoprostol after it was confirmed at my 9 week ultrasound that the baby stopped developed at 8.5 weeks and no heartbeat was detected.
To prepare myself, I did a lot of searching and reading about what to expect after using miso, and while I found some stories, many of the stories others described didn't match my own. I thought I'd start a thread that might also collect a variety of experiences and recommendations for others making the decision to proceed with miso after a pregnancy loss.
1. Ask your doctor what to expect. Below is just my personal story and certainly not medical advice by any means.
2. Ask your doctor about pain medication options and take those pain meds early. The cramps can be more like labour pains at times.
3. Collect the things that you think you may need for the day(s) to come. This could include - extra towels, baby wipes (very useful between showers), mattress protectors, a good stash of overnight maxi-pads, a variety of clothing (you might get really hot and/or cold at times), water (I got really thirsty at times), snacks (though I personally was too nauseas to eat), garbage bags, container to collect any material (if you are trying to collect and save expelled product - I wasn't prepared for this!). Maybe others can chime in with things to have on hand that might help!
4. Choose the day and time to take the miso purposefully. Mid-morning worked well for me - after we had a decent breakfast. Choosing a day after you're able to get in a good night of sleep is wise - my body was exhausted after going through the miso process.
5. Surround yourself with an appropriate support person or two and don't be afraid to use their help! You could lose a lot of blood, you'll be on pain meds, you'll be exhausted, and you'll be going through an emotionally difficult process. Have support people around you. I thought I could do it alone - and that turned out to be a bad idea!
6. Be prepared for an intense emotional response to hit some time after - in part due to the experience and in part due to the rapidly declining hormones in your body. I was not really prepared for how hard it hit me two days after taking the miso.
I was prepared for the worst, and thankfully, my experience was quite manageable and better than expected. The bleeding for me was surprisingly light compared to many of the stories I read (and was prepared for) on the internet. That doesn't mean that yours will be the same. I think reading about a range of possible experiences will help prepare you for what is to come after taking the miso.
For us, we chose to start the miso on a Saturday. I was prepared that I might have to repeat it on Monday (after 48 hours, as my doctor prescribed/warned). I also knew that I was not prepared to go through this experience in the presence of my son (8 years old) or our visiting student (a teenager) who was with us for the summer. I begged my hubby to take the boys up to the cottage and let me go through this process on my own. In hindsight, I wish we found someone else to take the boys, so that my hubby could be with me. During the process, I got so freaked out that I started writing everything down, just in case the paramedics found me incapable of explaining what was happening. And, I put a call out to my parents to help me through, who thankfully live close by.
We decided to go out for a family breakfast after a decent (but somewhat unsettled) night of sleep on Friday night. I ordered a toasted western sandwich and some orange juice. I figured this would give me some nourishment should I not feel up to eating anything for the next day or two.
At 10 am, once the boys were packed and gone to the cottage, I took my 4 misoprostol tablets. The nurse at my clinic suggested putting a drop of water on a finger, placing the tablet on the drop of water, and inserting it as deep as possible into the vagina - then repeat with the next tablet, and then the next two in the same manner. Needless to say, clean hands would be a good idea.
I laid down for the recommended 30 minutes, but ended up dozing off a bit. In the end I was laying down for almost an hour. I then arranged all of my collected items (which I had purchased or gathered the night before) in my bedroom and in the bathroom I was planning to use. Following a recommendation I read from others on the internet, I decided it made sense to try walking around to get things going. Gravity and the stimulation from walking were the rationale provided for getting things going. I have no idea if this has any medical bearing, but I tried it and it seemed to work for me. I went for a slow walk around the neighbourhood (cell phone in hand, just in case). I returned home for a rest and some water. Then I went out for another slow walk around the neighbourhood. Each walk was only about 15 minutes and I was never more than 3-4 minutes away from the shortest route back to the house.
By 12:30 pm (2.5 hours after taking the miso), I started feeling really tight in my abdominal area. I couldn't decide if it was actual cramps or not, but by 1 pm, I was certain the tightness had advanced to cramps and I had started spotting. I took one of my prescribed Percocet pills. I was allowed to take 1-2 every 6 hours, and it was recommended by my doctor to take the first dose at the first sign of a cramp. Perhaps I waited too long, and should have started at 12:30 when I experienced the tightness, but I wasn't sure and ended up taking only 1 tablet at 1 pm.
Between 1 pm and 2 pm, I made many many many trips from my bed to the toilet. I had many urges and need for both peeing and bowel movements during this time. And I became really thirsty and exceptionally cold!! I couldn't stop shivering. And my palms were so very itchy. I put on extra layers of clothing and used a comforter to keep me warm as I sat on the toilet. I was passing many clots during this time, but they seemed fairly small to me. Not too much bleeding though - I'd say it was light to moderate. But the pain was mounting quickly - the cramps now similar to the contractions I had in labour years ago. I regretted not taking 2 Percocets from the outset, so at 2 pm, I popped the second one. From 2 pm to about 2:30, I was in excruciating pain and was now passing a lot of material. It all ended up in the toilet as I was ill-prepared to collect any of it. By 3 pm, the pain subsided - I guess the second Percocet kicked in - and instead of focusing on getting through the pain, I became really nervous about being home alone, and started trying to write everything down, in case I needed to call 911 and the paramedics found me unconscious or something. Writing helped me cope, actually, and helped me feel more in control of what was happening to my body. My mom lives five minutes away, so I called her and asked if I could sleep at her house for the night, as I became paranoid especially of what was to come throughout the night. She wanted to send my dad over to pick me up straight away, but I just wanted to lay down and rest. She called me every hour from 3 pm to 6 pm, when she finally sent my dad to get me.
I don't remember much between 3 and 6 pm. I slept a lot. I went to the bathroom a lot. I passed a lot more material. I sweat a lot. By 6 pm, I was filthy, sweaty, exhausted, nauseas, scared, and dizzy. I had gone through many baby wipes (they were a blessing to have on hand - soothing and soft and they do a decent job at cleaning up). My dad helped me pack up my things and helped me walk to the car (I was pretty weak by then). I spent the next few hours resting and using the bathroom at their home, but largely feeling much better. By 8 pm, it seemed to be over... and I started feeling much better. I had a long soothing shower, started feeling a bit hungry (mom made me some soup), and was much more coherent. I thought that was just the calm before the storm that would be nighttime. I took a Percocet at 9 pm just to prepare myself for the night, but the storm never came. I slept reasonably well, passed very few smaller clots, and only bled lightly through the night. I woke up convinced the miso hadn't fully worked and I was in for another round on Monday morning.
My doctor had given me his cell phone number and asked me to text him updates, which I had done periodically. When I mentioned I was concerned that it I thought I'd have to take another round of miso because it couldn't be 'that easy' compared to what I was expecting and that the amount of blood shed was much less than expected, he immediately ordered me an ultrasound for Sunday morning at 10:30 am. That ultrasound showed no evidence of any pregnancy product left in my uterus, so they concluded that I was through the worst of it, and didn't need to go through the second round of miso.
It's Monday, now two days after I took the miso, and physically, I'm doing well. I'm still passing the occasional small clot here and there, but they are really tiny now, and I'd say I'm just spotting at this point. I never did experience the heavy bleeding that some have reported, thankfully. I have another follow up ultrasound and blood work booked in 10 days to confirm everything has passed and my beta levels are declining. Emotionally though, I'm a wreck. It really hit me today, 2 days after taking the miso. This, I wasn't expecting to be nearly as bad, but I guess I should have prepared myself for the emotional hormonal decline that comes from a pregnancy loss. It's been an emotional experience like none other I have ever had, and one in which I was not really expecting, so it has caught me off guard. The boys went at school and camp, and hubby stayed home with me today from work, and we grieved and cried together - but I was the one that was an unstoppable fountain of tears and emotions. I'm feeling more settled this evening, but I think there's still a lot of grieving to go through over the next little while.
It can be a tough experience to go through, but I'm a firm believer that knowing what to expect can help tremendously. I hope that this personal experience, and perhaps others that might be shared, will help someone else in the future prepare themselves should they be in the very unfortunate situation of losing a pregnancy and facing a decision of whether to take misoprostol.