Tuesday, September 15, 2009

‘Victims’ in miscarriage headlines are luckier than they think

Oh no. Not another story about a woman who goes to hospital emergency with an impending miscarriage and gets given painkillers and told to go home (click here for 'story'). Or miscarries in the hospital toilet. I don’t know why, but Sydney newspapers abound with such stories. It started off with the famous Jana Horska story. Yesterday I read in the Sydney Morning Herald that women will now be offered D&Cs straight away. OK, I’ve kept silent long enough. When women think that miscarriage and the pain that goes with it are the worst things than can happen to them, I must enlighten them about Asherman’s syndrome. Especially when their complaints have prompted hospitals to consider carrying out even more D&Cs, the number one cause of Asherman’s syndrome.

One in four pregnancies ends in miscarriage. I too had a miscarriage so I know what I’m talking about. I was around 14 weeks into the pregnancy. Mine was a missed miscarriage detected via ultrasound at 11 weeks. The fetus either died (fetal demise) and was resorbed or stopped developing very early on (anembryonic gestation). I was offered a D&C straight away by my ObGyn. I recalled vaguely hearing about the risks of D&C and future fertility. I was 39 and was not about to take a chance. My ObGyn insisted that Asherman’s syndrome and uterine perforation were ‘extremely rare’ (see what the real incidence rates are. Not rare at all!). Still, if there was a chance I could avoid it altogether by waiting to miscarry naturally, I would take that option. I had no other choice as he flatly refused to give me medication (misoprostol). The ObGyn was visibly irritated and disappointed in my choice to avoid a D&C.

The shock and sadness of losing the pregnancy was soon replaced with impatience to miscarry naturally so I could avoid a D&C, and start trying to conceive again with my fertility intact. My goal was to avoid a D&C at all costs. I was relieved when one Sunday morning about 3 weeks later, I finally began to bleed. At first it was like a normal period. As the day progressed the bleeding got heavier, and so did the cramps. By 11 PM I could no longer contain my cries of pain. My husband shut the windows, worried the neighbours might think he was beating me! Finally around midnight when I could no longer stand the pain I sent my husband to an all night pharmacy to get the strongest painkiller available without prescription. He tried to convince me to go to the hospital instead. “Are you nuts?” I retorted. “They’ll just tell me to have a D&C”. Not only that, but I’d have to stifle my moans and sit upright in uncomfortable clothes, surrounded by strangers and without access to a clean toilet. At home I could make as much noise as I wanted in my loose nighty and stand on all fours if that was the most comfortable position. The toilet was less than a meter from my bed and I wouldn’t have to compete with 50 other patients for it while waiting in emergency. He came back with a box of Panadeine forte containing codeine and that took the edge off the labour-like cramps. At some point after midnight I felt a ‘pop’ and instantaneous relief. Instinctively I knew the gestational sac must have burst and I rushed to the toilet. I continued to bleed heavily but was glad everything was coming out.

Later that day I had an appointment with the ObGyn who seemed rather disappointed that I miscarried by myself. Somewhat wistfully, he said that on ultrasound it appeared that there was no remaining tissue. What a relief that was to hear. But for some reason, he insisted I return a few days later to make sure everything was OK. When I returned later that week his story changed. This time he said it appeared that I had large ‘products of conception’ and that I had no other choice than to have a D&C. What??? I asked about drugs again. He refused again, saying they would be ‘ineffective.’ Reluctantly, I had the D&C, got stage 3 Asherman’s syndrome and the rest is history. (Here’s my story).

I’m convinced that the D&C was needless. I lost my fertility for no reason at all.

I wonder if these women who are sent home without a D&C realize how lucky they are to not go through what I did? Instead of noticing something is wrong with their periods, or are no longer able to conceive or miscarry repeatedly… instead of having to find a doctor who believes them and who is aware about the existence of Asherman’s syndrome and is trained to diagnose it with hysteroscopy… instead of having to undergo hysteroscopic surgery and hormone therapy to remove adhesions and salvage any viable endometrium in the hope that they will be able to have a baby in future… they get to try to conceive again right away with any complications whatsoever! And they’re the ones who are complaining! As a victim of D&C, I guarantee you, a miscarriage is nothing compared to the pain of possible loss of fertility and serious future pregnancy complications from D&C.

I wonder, do these women realize that there is absolutely nothing any hospital or doctor can do to stop the miscarriage from happening? They probably miscarried because the babies were not normal and there is unfortunately nothing that can change that. If they really want to be of help, they should insist that hospitals offer medical management with misoprostol and mifepristone in addition to expectant management, which also evacuates the uterus safely. Instead, I fear their indignant cries have resulted in a policy to systematically use D&C to manage miscarriage and will result in an increase in Asherman’s syndrome cases.

When will the lesson be learned? What is the world coming to when no one says a word about the risks of reproductive mutilation from systematic blind D&C, yet C-sections and male circumcision are made out to be the most dangerous,needless and wicked surgery known to humankind?!

Related link:

Here is a youtube clip I made about miscarriage management

This is another website which aims to raise awareness about the risks of D&C: http://www.dandcnow.info/

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