My first clue that miscarrying would hurt was the second prescription I received along with the misoprostol: acetaminophen with codeine, also known as Tylenol 3. Looking back, I’m surprised none of the medical professionals I encountered along the way warned me about the pain or offered coping strategies, because one could easily have been blindsided when the contractions set in.
I was fortunate to find this wonderful blog post by a woman who had a misoprostol-induced miscarriage a few years ago. Her meticulously documented account prepared me for what I was to experience and inspired me to record my own story to help others the way this stranger from 2008 helped me.
When I was in law school, I studied quite a bit of health law, especially reproductive and sexual health law. I know misoprostol well because it has tremendous potential to end unwanted pregnancies in populations that do not have much access to health care, so it was a topic of discussion in many of my classes. I did a clinic project for Human Rights Watch on the off-label use of misoprostol (which is actually an ulcer medication) in countries where abortion is illegal, but there is still some sympathy for women who are so desperate to stop their unwanted pregnancies that they turn to something approximating the stereotypical back-alley doctor with a coat hanger. The word “misoprostol” rolls right off my tongue, I have said it so many times.
How funny life can be. Misoprostol, once associated with rescuing impoverished women from dangerous abortion methods, has twisted itself into the ugliest of words without changing a single letter. It now sat on my bathroom counter in a vile yellow vial, literally with my name on it.
I planned to take the medication in the morning so that I would be rested, and so that I could keep on a normal sleep schedule, as I knew I wouldn’t be sleeping through the pain. On Saturday morning – yesterday – I woke up around 8, drank an enormous fruit and vegetable smoothie with extra protein powder, and took some Floradix, a liquid iron supplement. I also drank lots of water, which turned out to be critical as I was incredibly thirsty for the rest of the day.
At 9:20 am, I pushed four pink, diamond-shaped tabs, one at a time, into my vagina. I marvelled at how something so small can contain so much life-altering power. I also took only one Tylenol 3, despite the instructions saying one or two can be taken every six hours. I should have taken two. My heart was pounding against my lungs, increasing the speed of my breath, as I returned to the couch to wait for the unknown to change everything.
For a couple of hours I felt very little other than some light cramping. I got up periodically to check my pad, but after some initial bleeding, there was nothing to see. I even suggested to my husband that we go for a short walk, but by now the cramping had increased enough that I was more comfortable sitting still with a heating pad. My lower back was also aching, as it tends to do before I get my period.
Around noon, I ate vegan poutine that my husband picked up, one of my ultimate comfort foods. I wanted to eat before the pain got much worse and eating was the last thing on my mind.
By 12:30 pm, I couldn’t quite get comfortable on the couch, which always has to be shared with at least one cat, and we moved into the bed where I could stretch out. (The cats came too.) My husband set up his computer so we could watch The Office to distract me from what was happening, and he filled the hot water bottle so that I could lie with the heating pad beneath my lower back and rest the hot water bottle on my pelvis. But its modest weight was too much then, and that is when I took another painkiller.
Around 1 pm, I could no longer concentrate on anything other than the cramping, and I couldn’t get comfortable lying down. I got up to move around and found myself moving from position to position as I breathed and groaned through the unbearable cramping. I walked, I crouched, I rocked on my hands and knees, I held onto anything I could. My hooded sweatshirt felt like it was choking me, so I tore it off in favour of a long-sleeve shirt with a scooped neck. But then the waistband of my sweatpants was intolerable against my abdomen, so I put on a flannel nightgown. I just couldn’t get comfortable.
And oh, I was so thirsty. I guzzled and guzzled water, and it was never enough. I was thirsty well into the night.
Around 1:30 pm I took another painkiller – my third – and moved into the darkened bathroom where I could labour over the toilet, hanging off of the towel rack, and leaning over the sink. I asked my husband to bring me water, but before I could drink any, I knew I was about to throw up. The entire contents of my stomach gushed into the toilet in five full heaves. I drank more water. I took another painkiller to replace the one I had just lost.
The vomiting gave me some relief, and I managed to lie back down on the bed, easing myself from vertical to horizontal in blocky, awkward stages. Now I could focus on breathing slowly and deliberately. When meditating, it is hard to concentrate on one’s breath without drifting off on a chain of thoughts. But pain commands one’s full and diligent attention. I breathed in and relaxed into the pain, I breathed out and relaxed into the pain. I repeated to myself that pain is housed in the mind and I could think my way out of it: “The pain is in my mind. The pain is in my mind.”
But soon no amount of breathing or mental tricks could help me. Around 2:30 pm, I felt a sensation like I had the worst gas in the world and I needed to relieve the pressure. I moved to the bathroom, but the pressure wasn’t from gas and it couldn’t be relieved. Now I was yelling, crying deep low sounds alternately of pain and frustration. I couldn’t stay still but I couldn’t get comfortable. The pain was inescapable but I wanted nothing more than to escape it, and I tried and tried.
This is when I asked my husband to find that blog post I linked to above and tell me how much longer I had of this. He could tell from her post and from watching me that I was in the worst of it. I told him I felt like I was dying, although that wasn’t really true. I told him I never wanted to have children if this is what labour was like, but that wasn’t true either. I considered calling 911 and demanding morphine. I took another painkiller.
The cramping was so overwhelming, so consuming, that all I could do was reposition myself from horribly uncomfortable to less horribly uncomfortable. My husband called a pharmacist to see if I could take ibuprofen along with Tylenol 3 and got the green light, but I didn’t get a chance to do this.
As I stood writhing around my tiny, dark bathroom, I felt a sensation like a bubble moving along my vaginal canal and asked my husband to pass me some toilet paper – quickly – because I couldn’t move out of the “S” shape I was contorted into. He couldn’t possibly have moved quickly enough, though. I reached my hand down and caught the bubble as it rose (dropped) to the surface of my vagina, to the outside of my body. Blood gushed out too and I stood over the toilet, dropping the contents of my hand into the bowl. I could see now that I had caught the sac that contained what I once thought would become my beloved son or daughter.
“I think that’s the sac. Is that the sac?” I chattered to my husband, my rapid, rolling voice sounding foreign. He looked. He asked me if I felt relief. It was only in response to his question that I noticed that the pain had entirely stopped. Labour was over. It was 3:30 pm.
Now my body was mine again and I could sit on the toilet as we cleaned up the floor and the spattered white towels that I had been using as cushioning for my knees. I felt amazing. I had survived. The worst was over and we had only a bright future ahead of us, whatever it may look like. I was like, “I JUST DID THAT,” euphoric from relief, and we high-fived. We really did.
I bled an enormous amount for the next couple of hours, filling up a pad in less than an hour, and sitting on the toilet pushing out warm clots. The bleeding dropped off to a normal period-like trickle after those few hours, and I felt woozy from the blood loss but not dangerously so. I napped a little, took more Floradix, and ate a daiya grilled cheeze with sauteed iron-rich spinach – another ultimate comfort food – that my husband lovingly prepared. I curled up with the heating pad and we talked to our mothers, who were incredibly worried about us and were suffering as if the loss was their own, and it was in a way, as it was their first grandchild. But now I understand that a mother’s happiness is inextricably linked to her children’s happiness, because I was so close to motherhood that I felt how it will feel.
Today the bleeding is so light, I could probably use a pantyliner. I am not cramping at all and I feel as energetic as ever (which is to say, moderately so). My optimism remains; I feel surprisingly confident that we will have our viable pregnancy in no time. Perhaps my confidence is a defence mechanism against what could otherwise be despair, or perhaps I have just finally accepted that although the worst can always happen, the odds are overwhelming that they won’t.
This experience has brought me to my knees with humility. Our bodies are nothing short of miraculous. Miscarrying was one of the worst things that has happened to me, but it has tested my strength and I have stood my ground, and learning that this is within me has made the experience, in its own way, beautiful.
Today I asked my husband if it was hard to watch me in that degree of pain. He said that it was, but that when it was really bad he knew that it was almost over so it was okay. Worse was watching my emotional pain the day before, because that was long term, not a discrete pain with a foreseeable end.
The emotional pain is certainly more amorphous, and it will no doubt reappear in subsequent pregnancies. But I’m not too worried. I will breathe through it and remind myself that “the pain is in my mind.” It is okay.
If you are going to have a misoprostol-induced miscarriage, I offer you these tips, based solely on my own experience:
- Learn some pain management tips. Read about labour-coping methods. For me, this meant allowing myself to make noises – keeping them low – and moving around as I felt the need.
- Do not start in the evening unless you are normally a night owl. If you start in the morning, you can miscarry and recover over the course of the day and be in bed at your normal bedtime – at least, this was true for me.
- Eat around the time that you first insert the misoprostol. You won’t want to eat later, and you will need your strength.
- Eat iron-rich food and/or take an iron supplement. I like Floradix because it is easily absorbed and doesn’t cause constipation. You will lose a lot of blood and the iron boost will help make you stronger, sooner.
- Take the maximum amount of painkillers that you can. If possible, get something stronger than Tylenol 3, like Percocet or Vicodin.
- Have someone with you. Whether it is your partner, mother, or best friend, having someone around will be both practically helpful and emotionally comforting.
- A heating pad helps with the cramps before and after the pain is at its worst.
- Wear a nightgown, or nothing at all. If you’re like me, you won’t want anything touching your abdomen.
- Remember that when you think you can’t take it anymore and you just might die, you are almost done.
- Above all, remember that your body is doing just what it should be doing – it contains the wisdom of the evolution of our species. You will get pregnant again and you will have a (another) baby.
I wish you safety, optimism, and a swift recovery. You are not alone.