Emma took part in the MifeMiso trial. She shares her experience and reflections here.
After having two healthy pregnancies, I was shocked and very distressed to find at my 12 week scan that my third pregnancy had not progressed beyond six weeks – a missed miscarriage.
As I had not naturally miscarried the baby in the 6 weeks since the pregnancy ended, and surgery seemed so invasive, I decided the medical option and chose to take part in the MifeMiso research trial. This way I could contribute to scientific knowledge and something good would come out of this experience. I also trusted my body; I’d had two normal vaginal births with only gas and air and felt miscarrying a baby was something I could do.
Later that evening I researched other women’s stories of medically managed miscarriage on the internet and was truly horrified. The vast majority of stories described unbearable pain, worse than labour, and uncontrollable bleeding. I became absolutely terrified of what was to come and questioned if I had made the right decision.
My biggest fear was being in unbearable pain, at home, and frightening my children.
The following morning I met the team from the MifeMiso trial to discuss what would happen. I explained how frightened I had become after reading the stories on the internet. My biggest fear was being in unbearable pain, at home, and frightening my children. The nurse and midwife were so kind, and patient, and gave me all the information they could think of in order to reassure me – without saying, don’t worry everything will be alright, because this was something that none of us knew.
With their support I decided to take part in the trial. At midday I was given my tablet (either mifepristone or a placebo), and I was told to return at 10 a.m. two days later for misoprostol.
Emotionally it was a better day. I was mostly able to control the tears, and my grief had been replaced by anxiety of the miscarriage and abject fear of the pain that was to come. I hadn’t slept well, but knowing I didn’t have to work and could take time the following day to take care of myself took much of the pressure away.
The next day I started spotting red blood. I had minor cramping, but there was almost no pain. I took this as a good sign that my body would respond well to misoprostol the next day, and felt a little more hopeful that would lead to a miscarriage of a shorter duration, and lesser pain. I spent the day reading and resting, probably for the first time in about ten years. I packed an overnight bag for my children; if the pain was unbearable following the misoprostol treatment a friend would take the children overnight so my husband and I didn’t have to worry about taking care of them, or about them seeing me in pain. The spotting continued throughout the day, but didn’t really increase in heaviness.
I recognised that I was having contractions every 5 minutes, and I understood that my body was trying to miscarry the baby.
As soon as I woke the following morning the bleeding was noticeably heavier. Once the kids were dispatched to school and preschool I decided to walk round in the hope that (like during labour) this would help things to progress. The cramping was noticeable and I could feel a tightness in my pelvis. Although the pain was not unbearable, I decided to take two paracetamol before the short journey to hospital.
By 10 a.m. when I arrived at the hospital (and about an hour after the cramping became noticeable) I could barely walk because of the stiffness in my pelvis. I could only manage very small steps and I felt very uncomfortable and slightly nauseous. It was also sleeting, and the short walk from the car park to the hospital took a lifetime. Once in the hospital the stiffness remained and the pain in my pelvis and lower back became worse. I recognised that I was having contractions every 5 minutes, and I understood that my body was trying to miscarry the baby. I could breathe through the pain of the contractions, but I felt very uncomfortable and the nausea remained. I started to think that the misoprostol treatment might not be necessary.
After an hour of waiting I needed to walk between wards to see the doctor. I could barely move, and on this short walk and the trip to the toilet immediately afterwards I lost a lot of blood. Approximately 5 minutes later (and still before I had seen the doctor) and realised I felt better. The painful contractions had stopped and the nausea and the stiffness in my pelvis had just vanished. I felt sure that on the short walk I had miscarried the pregnancy sac and that the worse was over. Not long afterwards, the doctor examined me and confirmed that I had passed placental material and that the heavy bleeding had stopped. The feeling of relief was immense. I stayed in hospital for a couple of hours then my husband collected the kids from school and we had teatime, bathtime, and bedtime as normal.
I spent most of the day after the miscarriage in bed reading. A friend came to collect me for the school run and I felt anxious at school, and the feelings of grief and self pity (I had a miscarriage!) were ranging in my head. Seeing three-child families and new babies was tough – but I held it together. My pelvis felt tired, and my daughter complained that we were walking home far too slowly. The bleeding still continued at a far lesser rate, but otherwise I felt mostly fine.
I returned to hospital four days later; as part of the MifeMiso trial you have a scan on day seven to check you have passed the pregnancy sac. The scan showed the miscarriage had completed, and that there was just a little blood remaining in the endometrium. The spotting was already much lighter and had mostly stopped two days later. All in all I bled for only a week. The heavy bleeding was for only a day, and the pain and stiffness just before I miscarried the pregnancy sac last only a couple of hours. In retrospect, I think the pain during these two hours was equivalent to 3-4cm dilation during my previous two labours.
Reflecting on the experience
The MifeMiso trial team offered me so much support.
I think it would have been possibly to return to work the following Monday, less than a week after finding out about my missed miscarriage and only three days after the miscarriage. However, having this week off has allowed me to acknowledge what happened to me, to think about my story, and to reflect on the awful experience of miscarriage in a positive way.
I feel immensely grateful to the handful of friends who knew I was having a miscarriage and filled my house with spring flowers and my phone with supportive texts. I am grateful for the empathy and support from my (mostly male) work colleagues who allowed me to take this time for myself, a couple of whom acknowledged that they too had similar stories.
The hospital staff were truly amazing. The nurses who supported me at the start made me feel like they had all the time in the world to listen to my random thoughts and worries. The MifeMiso trial team offered me so much support and gave me as much time as I needed to make my decision to take part in the trial, and then provided support whilst the miscarriage was medically managed.
My husband looked like a rabbit in headlights for most of the week but was there throughout for our children and me. And myself… I once again am amazed at the strength and resilience of the female body. I know I was brave when I made the decision to have a medically managed miscarriage when I was so frightened of the pain. I am proud to have contributed to the trial which will in time show doctors how best to medically manage miscarriage for other women. The grief and shock on that first day was truly awful, but with the support of friends, the hospital staff and my work colleagues I have had the time and support to manage this miscarriage – not be managed by it.
As for the pregnancy – it just wasn’t meant to be. Abnormal chromosomes in the baby are thought to be the main cause behind early miscarriages. The cruel part for me was my uterus carried on growing after the baby died, so I felt pregnant until the day of the 12-week scan. I have two healthy children, and miscarried a very small baby with relatively little pain. I think it would be much harder to be philosophical if this was my first or second pregnancy, or if the baby was older in gestation.
It was important for me to share this story, to help me come to terms with what happened. I hope this story puts medical management of miscarriage in a more positive light, and is helpful for those who wonder if this is the right option for them.