What should I actually be doing after my first miscarriage?

chloe97 · December 2015

I had a D&C on 12/4 after a MMC at 10 weeks (baby passed away at 8 weeks, 5 days). Physically I'm back to normal, but emotionally I still have my days. Last week, I made a plan so that I feel like I have some sort of control. I made an appt with a new/old OB to start fresh with a new Dr who I used to go and loved, but moved 30 minutes away. I see her the day after my D&C followup appt. I reached out to an RE and made an appt to learn about genetic testing and have my hormone levels checked for PCOS, I made an appt with a therapist who helped me with some previous grief issues I experienced 4 years ago, and I made an appt with an acupuncturist who specializes in fertility issues.

I'm starting to wonder if I'm jumping the gun on acupuncture and RE at this point. RE could be covered by my insurance, but we aren't sure because it's my first MC and I read that they require you to have 2 or 3 mcs before they cover you for meeting with an RE. Even if they agree to cover the costs, they could decide later on not to cover the full costs. Acupuncture is set to cost $100 a sessions and I hear you need a lot of sessions. H is ready to spend any amount of money to get our baby, but we aren't rich. I worry about depleting our savings when we may not have any issues next time. But at the same time, I'm so emotionally depleted from this experience and I just need to feel like I'm doing everything I can to not go through it again. Am I being crazy?

Any thoughts or experiences to share??

penelope4612 · December 2015

I'm so sorry for your loss.

It looks like you got your BFP right away after you started TTC. I understand not wanting to go through a miscarriage again, but at the same time it seems like you and your husband are fertile. Is there some reason that you think you might have PCOS? Are there genetic disorders that run in either of your families? It looks like you're over 35, so of course there is increased risk of trisomies, etc, but that is not something that a genetic counselor would necessarily be able to preemptively diagnose unless you did IVF.

With that said, you should be able to call your insurance and ask if they would cover a RE. They should be able to tell you what the criteria is to cover that appointment, and you should try to figure out if you meet it. As someone who recently had medical costs that a doctor assured us our insurance would cover, only to find out that they didn't, I can tell you that it can be astoundingly expensive. It might be worth finding out from your new OB if there are labs that they can order (genetic testing, labs to diagnose PCOS) before pursuing an RE. My OB could do both of these things, although we ended up getting the referral to a genetic counsellor from DH's PCP because he is Ashkenazi Jewish and so he was really the one that insurance would cover to be tested for genetic diseases that are common in that population. In the event that your initial labs are off, your insurance may be more likely to cover the referral to the RE.

If you want to go down the acupuncture road, it is possibly worth finding out if there is a place near you that treats multiple people at the same time in the same room, because I believe that that is significantly cheaper (like, $25 per session). I haven't done this personally, but that is what I have seen when I was researching it in the past. You can also find out if your insurance covers this at all, or has some way that they might reimburse for it, or if there are places that give you a discount based on your insurance.

queenklau · December 2015

Hi @chloe97, sounds like you have a plan, it is all about what fits your situation.

To answer your question, and in my opinion, you should be focusing on healing. Doctors don't worry about roots/causes/prevention of future mc until you have had 2-3 in a row. I wouldn't rush to go and do everything at once and spend a lot of money. The one thing I recommend is doing the genetic testing on the tissue, that may give you a definitive answer to what caused your mc and then all the additional tests will become unnecessary.

It is very unlikely that you will go through it again. I was part of the statistic with 2 mmc in a row, but have high hopes for the next time around.

strickland8052 · December 2015

If all of those things make you feel better emotionally, go for it. However, I don't think the RE and acupuncture are medically necessary at this point, and you may not get the clear answer that you are hoping for. You also should probably brace yourself for the possibility that the doctors might not take you seriously. They could likely brush you off since it is your first one. I do second PP on the genetic testing on the tissue and a discussion with your doctor about any specific issues that may be of concern (family history, symptoms of PCOS, etc).

Right after my chemical a couple of weeks ago, I had a lot of those same feelings. I considered special diets, supplements, RE, etc. As a runner, I feel like if I just work hard enough and do the right things then I'll accomplish my goals (as if getting and staying pg is the same as training for a race. *eye roll at my own self). Unfortunately it isn't so simple. At this point, there isn't much we can do: live a healthy lifestyle, take prenatals, follow doctors orders, find a way to heal emotionally, and then give it another try...I think that is about it.

Don't wear yourself out trying to do everything at once. Figure out what will help you emotionally and do that.

For me, sitting in a waiting room of happy pg women and adorable baby photos, only to be told that I'm overreacting because it is *only* my first MC- it just is not something that I think will help. Instead, I decided to use that money on a weekend getaway with DH (to have something non-baby related to look forward to) and some improv classes (to help me stop being an over planner and live more in the present).

Best wishes. Hope you find healing!

chloe97 · December 2015

@penelope4612 MY H is Ashkenazi Jew too, so I am hoping that we can get genetic testing done at the first appt with the new OB. We probably will end up cancelling with the RE if the OB tells us that there is no reason to follow up with her.

@klauerinaking - I hate that physicians don't focus on the causes until you have had 2-3 in a row. I am 36.5 and we want 2 kids. By the time that I can possibly get a BFP again, it will have been 6 months between when we started TTC, so it's possible that another MC will result in a year wasted on my fertility. Even though, I have even had a chance to conceive a healthy child yet, I am already thinking about how I will not have a chance to breastfeed my first for a year because we will have to start trying for the second around his or her first birthday. And then start the whole cycle again. It's insane what older women have to put their bodies through just to have 2 kids. And I am a lucky one- we got pregnant on the first try!

@strickland8052 I have heard that doctors don't take women who have had a MC seriously and it upsets me so much. I'm also a Type A achiever. I am used to being able to research and figure out a solution to any problem that I put my mind to. It drives me crazy that doctors wouldn't even bother testing my fetal tissue to see if there was a problem. Outside of miscarrying at home and finding some independent lab that would have tested the fetal tissue for me, there is like nothing that I can do. That drives me crazy. I hate this feeling of having no power.
Anyway, thanks to everyone for their insight. I figured that I was probably going overboard, but I was hoping that someone would reply that they got all the testing after the first MC and the answers that they needed to ensure a healthy next pregnancy.

queenklau · December 2015

just to add, I got genetic testing first time around and it came back inconclusive...so even if you try to get it done you still may not get an answer. When I was told that they had NO results, I was even more pissed than before!

silentP · December 2015

I think this is so tricky. You likely will go on to have a healthy pregnancy, but I also think it's good to simply ask questions, do your own research, maybe read a book on the topic. I liked "Coming to Term."

But at the same time, it's so out of our hands. I felt completely blindsided that I had a second miscarriage a few months after my first. I thought the odds were in my favor. So, I think it would have been helpful if I did more research or read up on it and prepared myself better for that being a possibility.

Good luck to you! I understand having a certain timeline and I hope your doctor listens to your concerns and that you get some info that makes you feel better about jumping in again.

I hope 2016 is a good year for everyone! I personally am looking forward to 2015 being over!

penelope4612 · December 2015

chloe97 said:

@penelope4612 MY H is Ashkenazi Jew too, so I am hoping that we can get genetic testing done at the first appt with the new OB. We probably will end up cancelling with the RE if the OB tells us that there is no reason to follow up with her.

Definitely find out from your/his insurance WHAT genetic testing they will cover before you get any. Our insurance said it would cover the testing for diseases common in the Ashkenazi Jewish population, but our genetic counsellor recommended a few other "common" tests (Fragile X, Spinal Muscular Atrophy, something else I can't remember) and recommended DH get some kind of chromosomal analysis because his cousin had a child with Down's and it turns out our insurance didn't cover several of those tests and now we are potentially looking at a bill for like $700.

lilyaster · December 2015

@chloe97 I just wanted to say many women are able to get pregnant while nursing and many choose to keep breastfeeding during part or all of the pregnancy. Many with kids close in age enjoy tandem nursing. I didn't want you to think you must quit bfing to have a second kid.

PeggyOlsonFTW · December 2015

lilyaster said:

@chloe97 I just wanted to say many women are able to get pregnant while nursing and many choose to keep breastfeeding during part or all of the pregnancy. Many with kids close in age enjoy tandem nursing. I didn't want you to think you must quit bfing to have a second kid.

This.

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