When the doctor says, “It looks like this pregnancy has failed,” your first thought isn’t about what happens next.You might feel your partner’s hand squeezing yours—crushing your fingers with sudden grief. Maybe you’ll look for reasons to blame yourself or your partner, refusing to accept that nature does its own dirty work. You will likely doubt the doctor’s prognosis: because duh, you’re looking at the screen and seeing clearly the shape of a head and a tiny bum. On top of that, you might realize in some corner of your mind that the baby rattle your grandmother just shipped across the ocean will remain unused.
But doctors follow a certain protocol. When they see a too-small fetus without a heartbeat, they don’t hesitate to shift gears.
The first doctor knows to ask a second doctor for confirmation. Then they both explain in soft voices that miscarriage happens to 1 in 5 pregnancies, that it was nothing you could control, that a chromosomal abnormality is the likeliest culprit. (Why is this new information? Why is such a common occurrence only mentioned in hushed tones?)
And when that’s done they shepherd you and your partner to another room “to discuss your options.” You might think, what options?As it turns out, even after you’ve lost the baby, there’s still the matter of actually losing the baby.
For some women, miscarriage happens quickly and at home. They bleed and they know. But when Alec and I lost our baby, the only indication was an ominous lack of morning sickness (which everyone told me to appreciate) and a serious bout of cramps (which professionals said were nothing to worry about). Maybe these were symptoms, and maybe they weren’t.
I was ten weeks pregnant. Turns out, from the size of the fetus, the pregnancy failed around nine weeks. But we didn’t know that until it came time for the first check-up and ultrasound. The beginnings of our child were still inside me, perfectly intact except without a heartbeat. And we had to do something about that.
I was given three options:
1. Go au naturale.
Wait a week or two for the body to expel the fetus on its own. They do suggest a follow-up to ensure that all the pregnancy tissue is gone, but you could potentially avoid any artificial means to removing the tissue. Also, this route may take a while, or it may never happen on its own, so patients often default to Option #3 after all.
Take some special medication that, for all intents and purposes, puts your body into early labor. You can do this at home, but the process might last hours. According to my doctors, this option is often painful and messy.
3. Let the doctors do it for you.
Dilation and curettage (D&C) happens in a hospital setting, with general anesthesia to put you to sleep. Manual vacuum aspiration (MVA) is essentially the same process, but in a clinic setting, without general anesthesia. Instead of putting you to sleep, the clinic might give you local anesthesia to numb the cervix area, as well as some other medications to make you drowsy.
Because I hadn’t bled yet, I was skeptical that anything would happen on its own, even if we tried to let the body do its thing. On top of that, I wanted to avoid the constant dread and uncertainty of waiting.
From there, I knew I’d prefer the clean security of a professional medical environment over our tiny bedroom and bathroom. So it was between a D&C and an MVA.
Honestly, I had no idea which one to choose. In the end, the D&C sounded like more of an ordeal. I’ve never been checked into a hospital, let alone put under general anesthesia. I figured I’d stick with the MVA because it sounded like a shorter recovery time, and less hassle dealing with a hospital stay.
Yet in all my Internet research before the procedure, I found very little useful information. Although the web is rife with technical explanations of MVAs and D&Cs, it seems that hardly anyone has bothered to describe the experience of an MVA from the patient’s perspective.
My experience with manual vacuum aspiration
So here’s a short description of my own experience. I will try to include the necessary information while leaving out gratuitous details. However, this is my warning: I am about to describe a medical procedure, albeit from a limited perspective.
On the day of, we spoke with multiple doctors and nurses. Among other things, they explained the risks and benefits of an MVA. (The risks are mostly minimal. Ask your doctor for more information.) After these brief discussions, I was handed a cup full of pills. Basically, it was a special cocktail to make me drowsy. There were also some painkillers in the mix. They asked me to empty my bladder, too. By the time they moved us to the procedure room, I still felt rather aware—though they tell me I wasn’t.
It was similar to any normal OB/GYN exam room, except a bit larger and with more intimidating silver instruments. Someone had dimmed the lights and closed the blinds. The nurse turned the radio on to a somewhat soothing volume. Presumably, they were setting the tone for me to relax and let my meds take effect. Alec encouraged me to try and close my eyes. I insisted that I was still pretty alert, so at one point he stepped into the hall to ask if that was normal. I overheard the response—“They all say that. They’re less lucid than they think.”
I was worried that I would be the one patient that couldn’t relax, even with that special mix of meds. But when the doctors walked into the room, they asked me to sit up and adjust my position; I felt my vision slide as I tried to sit up, and I realized that the pills were indeed working.
At this point, things get a little blurry. They began the procedure, of course. Alec held my hand and sat beside me through the whole thing, while one sweet nurse stood on my other side and gently rubbed my stomach. Two doctors worked down on the other end. They kept me informed about the whole process, and they told me when to expect pain.
I did feel pain. Not unbearable, curl-up-in-a-ball pain—but strong discomfort. It’s hard to describe the exact sensations, but I do remember sharp pinches and jabs, as well as intense cramping. A few times my eyes welled up with tears, both from pain and from just the shock and emotion of things. It helped that Alec was there to keep me company. He and the nurse provided welcome distractions from the situation at hand.
Then it was over. Suddenly the doctors were leaving the room—and I remember very little after that. My adrenaline had worn off, allowing the pills to take full effect, so ironically I have less memory of the rest of the afternoon than I do of the procedure itself.
Recovery & conclusion
I was lethargic afterward. The antibiotics made me sick—I never threw up during the pregnancy, but I did after the MVA. Two days post-procedure, and the cramps have been completely manageable with over-the-counter pain meds. Bleeding has also been minimal. I feel mostly normal, if a little overtired and emotional.
Alec asked me yesterday whether I would make the same choice next time around—if, God forbid, we experienced another miscarriage. My answer?
Probably not. I think if I had to choose again, I would opt for the D&C. I might have to deal with general anesthesia and a hospital stay, and I don’t imagine my recovery would be much different from an MVA, but at least I would not be conscious during the procedure. Yes, I was disoriented from the drugs, and yes, they provided me with local anesthesia. However, I still felt a fair amount of discomfort in that moment—enough that I would advise other women to avoid the same situation.
Of course, each individual will experience varying amounts of pain and varying side effects during medical procedures. If you ever have to make this difficult choice, consider your personal needs before settling on a specific route. I am just putting this information out there for the benefit of patients who want to make an informed decision.