Incompetent Cervix

Many women lose one or two or even more babies to second trimester miscarriage before their doctor will diagnose them with incompetent cervix. This is so sad!! I have an incompetent cervix and I want you to know something about them so you don't have to have those multiple losses if you suffer from it.

An incompetent cervix is a cervix that can not hold up the weight of a baby. It most commonly shows up in the middle of the second trimester, but that is not always true and it is important that you understand that. With my first child, my water broke and cervix began opening at 35 weeks. With my second, it was about 24-26 weeks, and with my third, 13 weeks! All over the place. So how can you know if incompetent cervix is your problem??

If you are showing cervical funneling (shown on transvaginal ultrasound), cervical shortening, cervical ripening (softening), dilating or effacement before the end weeks of pregnancy without having significant preterm labor, you may have an incompetent cervix. It is hard to tell whether it is your cervix or preterm labor because the cervical opening can provoke preterm labor. There is no real test for this.

Some doctors advocate a wait and see approach. Unfortunately, cervical change can happen very, very quickly and I know moms who appeared to be fine at their appointment and then lost their babies two or three days later. No thanks.

I think it is much better, if IC (incompetent cervix) is a possibility, to do a cerclage anyway. It should be done before 17 weeks and the earlier, the less likely you will have complications or infections. It is a simple, no problem stitching of the cervix and I would a whole lot rather have an unnecessary one than lose a child.

Sometimes, though, the opening is found too late to do a cerclage - it wouldn't be safe for the baby. At that point, there is still much that can be done: a Smith-Hodge pessary, anti-tocolytics (anti-labor drugs like nefedipine or terbutaline), and complete bedrest in the Trendelenburg position (lifting the foot of the bed a few inches). I was too late to get a cerclage with our second child, but with the help of these things was able to get him to 37 weeks anyway. It's much, much easier with a cerclage, but don't despair!

I highly recommend the IC Forum at Healing Our Broken Hearts for support and encouragement if you think you might have this problem!

Raising Your Hemoglobin After Blood Loss

Why did I give this post such a long title? Because when I was looking for information, those were the search terms I used and came up empty. All the medical sites assume that if you lose a lot of blood you have a transfusion. I believe a lot of women lose a lot of blood during miscarriages and the sometimes prolonged bleeding afterwards and they need help recovering!

I wrote about this at the beginning of my recovery process, but I wanted to give you all an update. For one thing, I'm still bleeding, two months later. It seems that my bleeding trails off to mucous, stops entirely for a few days then starts back. It's pretty frustrating, but I believe it's just because I'm overdoing it on a regular basis. I have no clue how to stop doing too much, though, homeschooling seven children and helping my husband in the midst of a business start up! It's just a busy, busy life.

The good news is that my hemoglobin seems to be recovering nicely. A week or two after the miscarriage and hemorrhage, it had recovered to 9.1. About 3 and 1/2 weeks later, it was up to 10.6 even after a weekend with several severe bleeds. I think it is because of my three pronged approach: iron (liquid is supposed to be best), and vitamin C and liquid chlorophyll with every dose of iron. I took iron three times a day at first.

I am feeling much better and my friends say my color is coming back!

Flowering Comfort

Yesterday, I went to Lowe's and bought flowers to plant around the flat stone where the twins are buried. I had a happy thought and got a flat cart and arranged the flowers on it while I shopped - this was great and really helped me to figure out what worked and what didn't. I was worried about the money, as you know, we're in a business start-up with no money out yet, but the Lord took care of that, too. When I got up to the front, the cashier told me that the petunias had been marked down to 10 cents! I got two more of a different variety and spent less than $18 for everything!

Here's what I planted: a yellow Flying Saucers coreopsis, a variegated English ivy with yellow borders, and two Blue Carpet speedwells along the back - they are all perennials. On the left and around counterclockwise are two purple calibrachoa (the purple flowers have yellow centers), two purple "Ride the Wave" trailing petunias, then two purple Ramblin' trailing petunias. It looks wonderful, very old-fashioned.

I felt like it was important to leave it looking like I would like to remember it, since we are seldom down here. When we come back to plant the trees, I'll have to change out the flowers to some that can tolerate shade, but these are just perfect for now.

Burying Miscarried Babies

I promised myself that this blog would share all the things I couldn't find information about online, even though sometimes it's really hard. This is one of those times. I really want to be open about what I can so that others will have a path to follow.

The night I passed the babies, we wrapped the placentas and all in some pretty fabric out of my sewing basket, then placed them in ziplock bags in the freezer. We knew there was no way I would be able to travel for some time after my hemorrhage, so this is the only thing we could think of to do. In retrospect, I would place the fabric-wrapped bundles in a small bag, wrap them in more fabric, and put in another bag.

For the burial, we placed them just like that in a lovely soft blanket inside a waterproof safe about 12" by 12" by 5" that I bought at Wal-mart. I did that so that if the land were ever sold and we needed to move the site, the box could easily be moved.

In case it were found many years later by our descendents, or by anyone else, Hal wrote a letter to place inside it, telling the circumstances and who we were and pointing the reader to the Lord.

Our relatives questioned what were the legalities of the situation. Here's the deal: in most states, a miscarriage before 20 weeks does not receieve a birth certificate or a stillborn or death certificate, so is not considered human remains (I know - what do they think they are??). The good thing is, this means you do not have to go through a funeral home or bury your miscarried child in a cemetary, but are free to bury them on your own property.

After 20 weeks (or a week or so either way, depending on the state) then health regulations come into play. I understand though, that some funeral homes may donate their services in such cases.

Regardless of the circumstances, I encourage you to memorialize your little ones in some way. If you had a natural miscarriage at home, then find a special place to bury them. If you had a D&C and the hospital wouldn't release the remains, or you didn't even know to ask, do remember that our Father in heaven knows exactly where every atom belonging to every person is and will bring forth His people with new bodies that are not subject to corruption! If you don't have anything to bury, you can still plant a tree, or a flowering shrub or a little garden to remember them by. Create something beautiful as a reflection of your faith in the resurrection to come when we will meet our loved ones in the air!

A Tearful Farewell, but Not Forever!

Everything worked out and today we buried our little one's remains in one of our favorite spots on earth. When Hal and I were first married, we expected him to be sent to an active duty station as soon as he was commissioned. We had no idea a budget crunch would derail our plans, but I'm so glad they did. He was notified that he would not be called up and sent to training until over three months after his commissioning. Where would we go? What would we do? Thankfully, Hal's mother offered to let us come stay at their family's lake house. Now that sounds pretty grand, and it is, in my opinion, but probably not in most folks! It's an ancient single wide trailer with a big room that is all windows added on the front facing the lake. Very basic accomodations, until you look up. The view is incredible - As you look out the window, you see copses of sweet gum trees down on the edge of the water, the dear hammock just feet from the lapping waters on the left, a comfortable swing aged to that lovely old wood color in the center, and a dock with a single simple bench on the right. You can hear wild turkeys, see a hummingbird zip by, watch the egrets and herons daintily fishing, and see the comical little ducks following their parents in search of bugs and fish. The glassy water just calms your soul, as you look up at the beautiful green forests and islands and just wonderful peace and God's creation.

Now don't be mistaken, from the spot where we laid the twins, to the left you see our decrepit old trailer, nearly hauled away as scrap many times in the past few years. To the right you see the old brush pile, with a little trash mixed in for good measure - like a twenty year old rubber raft rotting under the branches. But look straight ahead and see soul-refreshing peace. I think this time in our lives is a lot like that: looking straight ahead, we see our dear understanding Lord and the hope of heaven, but when our minds are distracted from Him, we see all the ugliness of living in this fallen world - the days and years without our dear ones, the pain, the hurt from others, the whole crashing burden. Let us seek Him who says, "Come unto me and I will give you rest." Let us keep our eyes on Him!

Today, with a lot of tears and trust, we laid what our twins left behind in the earth, reminding each other again and again that one day we will all meet again. Hal gathered the children around and read the story of David's hope when his baby son died and then the hope of all believers in the return of the Lord and the resurrection of our bodies. This was so hard for my dear husband - he had a difficult time talking through his tears. We prayed and rested in the assurance of the reunion to come. Thank you, heavenly Father, that this life is not the end, but only the beginning and that the sorrows of this present age are not worthy to be compared to the joy to come.

We placed a stone over the spot that Hal's mother gave us. Many, many years ago, at the old church that both our families historically were involved with in the mountains, the graves were marked with uncut stones - perhaps there was no stone mason in the community. A few years ago, the church decided to replace these with marked stones so those graves could never be lost to memory. Hal's mom brought several of the old unmarked stones back home and she gave us one to mark the spot. I was so grateful!

Later in the day, I went into town and bought some lovely flowers to plant there until we could get back to plant the trees. I didn't want to plant the trees in such a dry summer for fear they wouldn't make it. We'll come back later in the year to do that. I'll try to post a picture when we get home so you can see what we did. I'll also plan to post more practical details for those of you dear ladies who are facing this, too.

Love you all!
Melanie

A Universal Need

I had the opportunity this weekend to talk to several dear friends who have experienced miscarriage - one has suffered six miscarriages, one lost a child at 16 weeks, all sorts of experiences. There were several common threads among these Christian ladies: All were tremendously comforted by the hope of heaven - they knew they would see their babies again. All were still moved by thinking about it, even if it happened years ago, tears filled their eyes as they talked about it. All were hurt by those who felt they should just get over it.

I think that grieving alone is extraordinarily hard. Why do we have visitation the night before the funeral when a loved one died? Of course, it is ostensibly an opportunity for everyone else to say goodbye, but I really think the family benefits by knowing others are grieving with them and sorrowing and praying for them. I remember when my mother in law was widowed. She said that she wished it was still the fashion to go into mourning clothes, to wear black for a year. She craved some public statement that she was grieving; some immediate identification that she was hurting. I understand now.

Have you ever just told someone you thought would be interested that you had a miscarriage and had them look at you like "Oh no! Why are you telling me this?" It really, really hurts. It is sad that miscarriage comes with no predetermined cultural rituals that declare our pain. Instead, it is up to those of us who've been through it to support and sorrow with our friends when they suffer. I wish I hadn't had to go through this to understand it, but let us comfort others; let our pain be blessed by the Lord to transform us; to make us instruments of His grace!

A Historical Twins Miscarriage

I stumbled upon the Google Books excerpt of A.E. MacRobert's book, Mary Queen of Scots and the Casket Letters which mentions the twin miscarriage that Mary (not my favorite historical figure) had while held in the castle of Lochleven. When I read his assessment of the historical evidence that this was a miscarriage of twins, I am reminded of a story told in one of the wonderful books by James Herriot. I believe it was in All Creatures Great and Small.

James Herriot was in veterinary school in Edinburgh and he had just attended his first great lecture - on the anatomy of the horse. He walked out of the lecture hall feeling a veritable expert, an insider, one with knowledge. He saw a carthorse standing on the street and came up to examine this creature as one with special knowledge. The horse grabbed him by the back of his collar and suspended him from his mouth until the driver appeared. The coalman reacted in fury, shouting that he shouldn't mess with things he knew nothing about.

Mr. MacRobert describes the scene on 24 July 1567, as related by Nau: Lindsay and Ruthven enter the queen's chamber, where she is lying prostrate from her troubles and a "great flux caused by the miscarriage of twins." MacRobert describes an envoy's letter dated a week before describing her as 7 weeks pregnant. He speculates on the date of conception as being before or after her marriage to Bothwell on May 15 - all historically debateable matters. What gets me is this paragraph on page 62:

A miscarriage of twins resulting from a pregnancy following her marriage on 15 May could not have been apparent to her attendants. Even if she had conceived as early as her abduction on 24 April it is highly unlikely that a twin miscarriage could have been recognised in the "great flux" reported by Nau. Perhaps an attendant made a mistake over the twins or Mary had been pregnant before her abduction.

By all evidence, she was at least 8 weeks pregnant and could have been as much as 12 weeks pregnant legitimately. Having just lost twins who died at 6 weeks and 10 weeks, to say that twins were "highly unlikely" to be recognized is ridiculous. In my opinion, especially if they were fraternal, it is highly unlikely they would not be recognized. With all due respect for your scholarship in a convoluted period peopled by unsavory characters, Mr. MacRobert, "Dinna meddle wi' things ye ken nuthin' aboot!"

A Happy Providence

Several weeks ago I spent some time searching for a memory box to keep my few memories of the twins in. I remembered that Hal's cousin had shown me the memory box someone had given her when her little girl died shortly after birth. When my sister-in-law lost her eldest son to stillbirth, I remembered how precious that box was to Caren (Did I spell your name right?) and went looking for a memory box for Hal's sister. I found a Tuesday Morning and some lovely hat boxes. There was a pretty, small yellow one and a bigger one that had Victorian cherubs, decorations, and a ribbon banner that said, "How bright things are here!" on a lovely blue box. I originally bought the smaller one because I was afraid her things would seem lost in the big one, but when I went out to the car, the saying written on the blue box kept ringing in my heart. I realized that particular box pointed to heaven. I had to go back in and get it! I'm so glad I did because that memory box has been precious to our sister.

When I lost the twins, I wanted a beautiful box, too, but I couldn't find one anywhere. I searched on memory boxes and found a lovely charity, Memory Box Artist Program. They are a group of artists that make handmade memory boxes to send to hospitals for parents suffering the loss of an infant. I paged through the site, and saw so many lovely boxes. I thought about how much I'd love to have a simple blue one with lovely flowers - no angels, no teddies, just memories. I wrote one of the volunteers, asking is she knew of anyone who sold or gave boxes to parents who suffered an earlier loss at home. The sweet lady who I emailed said that though it wasn't strictly in their mission, that they'd be glad to make me a box. I didn't tell her what I wanted because I felt like they were doing me a special favor and I didn't want to be presumptive. A couple of weeks later, I received the most gorgeous pastel blue box with a garland of painted flowers on the top that says, "Precious Memories," and it was even lined with lovely padded cloth. It was made by Mary Bobrowski - a wonderful artist. It was the very box I had dreamed of! Isn't God good? I don't know why He choose to give me this when so many of my dear sisters haven't had anyone do something like this for them. I do know I was at a very low ebb in my life and not just the loss of the babies - I believe our Father was showing me that I was safe in His arms, not abandoned, not forsaken.

If you have the opportunity to help this charity or others like it (I just found Joshua's Boxes in the UK) please do - they are doing a worthy thing! If this is something you would like to have, or to give to someone, a lovely box can be made out of a hatbox as well, and I trust the Lord will lead you to just the right one, too. :-)

Immediate Tips for When There's No Heartbeat

If this is your first ultrasound, your dates may be off. Everything may be fine, but you need to do another one later to make sure. If you see a heartbeat then, rejoice! If the news is bad again:

If you have already seen a heartbeat and now there is not one, or if your second ultrasound confirmed an early loss, I am so sorry!!! I wish I could put my arms around you and pray for the Lord to comfort you. Thinking carefully about what to do next can really make a difference in how you recover.

Don't feel like you have to be in a rush to make a decision. Many women are rushed into D&C and have second thoughts afterward. There is no hurry at all unless you are hemorrhaging. Many women have waited weeks with no consequences.

If seeing the baby and burying it is important to you (and many, many women don't realize how important it is to them until it's too late because they were too numb to make decisions and were rushed), then you may want to opt for waiting for a natural miscarriage. At the very least, you should make it very clear to your doctor and the hospital that you want the remains if you have a D&C. Some are helpful with this, many are not. Contrary to what some hospitals say, you need no special permission to take the remains of a baby that died before 20 weeks (in most states, this may vary a week or two) or to bury it. Please don't miss this just because you think it will be gross - it really isn't and helps many women.

If you opt for a natural miscarriage at home, you may benefit from talking to and consulting a midwife. The midwife in my area was far, far more helpful, informative and resourceful than my very good OB. Also, if you've consulted a midwife you'll have someone to call if you have questions or difficulties whose automatic answer is not going to be "go to the hospital."

If you don't want to wait at home, or to have a D&C, there are meds the doctor can give you or herbs the midwife can, to induce your body to go ahead and labor, either at home or at the hospital.

If you are a friend or a relative of someone in this position, particularly if they are waiting for an ultrasound to confirm a loss, it is hard to support her, because I'm certain she doesn't want to talk about miscarriage right now. However, if she goes into the doctor without thinking over her options, she may get railroaded and have a harder time emotionally recovering. Pray you'll have the wisdom to know how to talk to her. Maybe even to just say, "I really recommend you don't make any decisions there at the doctor's office. Many women regret the decisions they make in a hurry like that."

I hope that helps some :-(

HCG and HPT - When a Big Fat Negative is a Good Thing

We are a family that welcomes whatever children the Lord gives us, so for us, getting a BFP on an HPT was always a great thing. (Wondering what that is? It's a Big Fat Positive on an Home Pregnancy Test) I just yesterday had the weird experience of being very excited to get a BFN (Big Fat Negative). What's up?

HCG or human chorionic gonadotropin is the hormone that it released into your body when you first get pregnant. That's the hormone that HPT tests respond to in your urine. When you have a miscarriage, it can take up to 7 weeks or more for the HCG to be completely out of your system. Until it is, your regular fertility cycle won't work. Lingering HCG can be a sign of a molar pregnancy, retained fragments from the pregnancy, another baby in there, or just your body taking a long time to break the hormone down. It was the retained fragments part that concerned me.

I had a miscarriage of twins a few weeks ago with a hemorrhage. A week later I visited my OB's office for a check up and she found some tissue in my cervix. She and I were both extremely concerned that I could have retained tissue and could have another bleed when it let go. That would have been extremely dangerous since my hemoglobin was very low from the hemorrhage. I didn't want to go back for HCG testing because money is extremely tight right now. I did have a stock of very sensitive HPTs, though, so I decided to check every week until I got a negative. [Update after checking the test later that day.] This week the test had only a very, very faint positive line. Maybe we're almost to the end of the physical part. That'll warrant a Happy Dance!

Lessons Learned - Things I'd Do Differently

Writing the story of my miscarriage made me think of a whole host of things I'd do differently, or lessons I'd learned. I thought it might help someone else avoid some mistakes:

Don't go out of town or let your dear husband go out of town if you are waiting on a miscarriage!

If you start the active part of a miscarriage and you are alone or just with your children, call another woman to come stay with you until your husband or midwife can get there. You don't need privacy as much as you need safety.

Make sure someone stays in the room with you - if they have to leave the room, they shouldn't leave earshot.

If you have a feeling you need help, get it. If you think you might need the midwife to come, ask her to - don't wait for her to volunteer.

Don't sit or lay on a towel - especially a dark colored one! - if you can help it. It is easy to underestimate how much you are bleeding if you can't see it. Chux pads are a better choice.

Don't despair, thinking this is going to take forever, or mar your life, or take away your joy. If you have Christ, you can know for sure, that he has come:

3 To console those who mourn in Zion,
To give them beauty for ashes,
The oil of joy for mourning,
The garment of praise for the spirit of
heaviness; That they may be called trees of
righteousness, The planting of the LORD,
that He may be glorified.” Isaiah 61:3

Recovery from Blood Loss

I hemorrhaged during the miscarriage of our twins, though I didn't go to the hospital because a dear midwife friend was able to stop the bleeding. If I'd gone to the hospital, I'd have probably received a transfusion, though I'm glad I didn't because then I'd be worried about exposure to disease. Anyway, I've had a tough time finding out how to best recover from blood loss, because everything assumes if you had significant blood loss, you had a transfusion. So, there's my mandate again: I had a tough time finding out about it, so I'll record it here!

I remember reading in the novels of G.A. Henty of heroes who would be sorely wounded in battles and lose a lot of blood. It would take them months to recover! I thought, "What Victorian baloney!" but now I know better! True, now we have antibiotics to prevent infection, but the reason we don't hear about recoveries like that any more is that nearly everyone who loses a lot of blood these days, gets transfused. Those who don't get transfusions, though tell about weeks and weeks of weakness and recovery time. I read on a Red Cross website that it takes 3-4 weeks for your body to replace the red blood cells in a pint of blood.

What can you do to get up to speed more quickly? My OB's office recommended taking twice the normal dose of iron supplements and vitamin C to increase uptake. My midwife friend recommended liquid iron like Floradix and liquid chlorophyll. The chlorophyll molecule is very similar to the heme molecule which hold iron in our body. The theory is that the body can use chlorophyll as a shortcut - remove the magnesium and add an iron. Everyone recommended eating lots of red meat (especially liver - if you don't like it you haven't had it cooked right!) and dark leafy greens (collards are my thing!).

Well, I've been mostly in the bed for almost two weeks and am still pretty weak. I don't want my experience to frighten you out of a natural miscarriage at home. Hemorrhaging is very rare and seems to be often connected to something unusual - like an already anemic mom who's losing twins - me! I'm still glad I did it at home because I don't have to worry that they made a mistake with the ultrasound, I got to be with people I love and didn't have to hear the smart mouths at the hospital, and I got to say goodbye in my own way to our beloved babies.

Miscarriage of Twins

I could not find any information about miscarriage of twins when I found out we had lost our second twin as well. The only story I heard was an email recieved from another MOMYS. She had miscarried twins and had passed tissue, thought that was it, then kept up some bleeding, and passed more tissue about a month later. She said she'd have done a D&C if she'd known it would be so prolonged.

A D&C was not an option for me - I have an incompentent cervix and I was afraid that forced dilation could make my cervix even worse, so I was determined to wait it out. If I'd known then what I know now, though, I'd have called my midwife friend to come to me as soon as I started bleeding heavily.

A few days after my miscarriage, in which I passed both babies about 30-40 minutes apart and bled extremely heavily needing medication to stop it, I had a talk with a different midwife. She said that she'd had a twin miscarriage as well. Her story was like my MOMYS friend - two episodes of tissue passage a few weeks apart. However, she said she'd had three cases of twin miscarriage in her practice. Coincidentally (?) those three mothers were the only cases of hemorraging in miscarriage she'd had in her practice as well.

This is all just observational, but if you are expecting multiples and miscarry, then you may want to call for help to stay with you immediately as soon as the heavier bleeding starts and make sure they have herbs or medicines to stop the bleeding if necessary.

BTW, I had no bleeding after the death of our first twin at 6 weeks. I had cramping the day before the ultrasound showing only one sac instead of the two we'd seen the week before. The cramping was not severe at all and stopped after a few hours. It did not affect my cervix. I understand from my midwife friends that you can have no bleeding/no cramping, bleeding/no cramping, cramping/no bleeding, passage of tissue or no passage of tissue if you miscarry one twin of a twin pregnancy.

When we miscarried finally, one of the babies (who died at 9-10 weeks) was in a complete sac and placenta, the other (who died at 5-6 weeks) had a broken sac and placenta. I am very glad we stayed at home and were able to see what our little ones had left behind when they went to heaven. It was so important to me to see clearly that there had been two of the precious little ones. We are planning to bury them at our family's lake house and I'm going to plant two trees there.

Miscarriage Supplies

One of the frustrating things I had to deal with when I recently miscarried my twins was that I couldn't find out what I should have available to make things easy when I miscarried at home naturally. Here's my suggested list:

A safe place to stay - A bathtub is a good one if you are concerned about saving the remains, also if you faint, you aren't going to fall and hit your head. Clean out your bathtub with disinfectant before you need it. You could also stay in your bed, but you will need to line it with plastic, towels or probably, best... chux pads.

Sanitary pads - Get big regular ones. This is how most health care providers will measure your blood loss.

Chux pads - or any other bed pad - look in the incontinence section of the drugstore (near the Depends :-). They are absorbent on one side and plastic on the other and are flat. These are great to keep down the mess and to sit or lay on. Don't use a towel to sit or lay on, because it can absorb a lot of blood making you not realize how much you are losing. Ask me how I know :-P It's more obvious on the Chux pad.

Wipes - These are good for a quick clean up of your hands or legs.

Paper towels - Two rolls, to help clean up with.

A small bowl - to save the remains of your precious one. I think you'll be glad you did. I did not find this at all disturbing, but rather it gave me comfort to know I wasn't grieving over nothing and to be able to say goodbye.

A cup to drink from and it might be a good idea to have some gatorade or other electrolyte drink to keep you hydrated.

HemHalt - or other remedy to help stop excessive bleeding

A measuring spoon for medication

A camera - I know that doesn't sound appealing right now, but there may come a time when you can't remember and wish you could. (Hat tip to Erin)

A phone to call for help

*Someone who will come stay with you! This is critical. Everything should go smoothly, but if you were to faint, you can't very well get help yourself.

*Someone who you can call to help in an emergency - your doctor or 911 or best of all, a local midwife who can come and give you objective assessment and help.

**If you have had excessive bleeding in the past, or if you are expecting multiples, you probably ought to ask a midwife to come stay with you the whole time, as you may bleed heavier than others.

Hope that helps,
Melanie