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Saturday, 26 November 2016

Miscarriages - How to cope in Thailand

This post was the main reason for me starting this blog but its taken me a while to build up the courage to write this.

We suffered 3 miscarriages in quite quick succession, each time was different and each experience has made me a more grateful person, a more understanding person and a more open person.

The first thing to understand when TTC in Thailand is that Thai people look at most things from a different cultural perspective. Karma plays a very large part of the psyche and this can lead to some blunt, less empathetic approaches.

General things to remember about Miscarriage before I go on:

  • It is not your fault
  • There are many reasons why you might miscarry
  • Focus on the now - deal with what is happening right now and worry about the future later
  • It is scary, but you will be ok, and you will get through this (both physically and emotionally)
  • Your partner will be scared too
  • This is not the end of your journey

Practical things to know, I won't sugar coat this bit:
  • If you find out about your miscarriage in hospital they probably won't have anywhere quiet to go (I was crying my eyes out for ages in the corner of the Ob/Gyn waiting room)
  • A natural miscarriage bloody well hurts - it hurts like nothing I have experienced before
  • Paracetamol does help with the pain
  • If you start miscarrying at home and think that you would prefer doctors intervention to ensure complete removal try to avoid eating before going to the hospital (my doctor wouldn't do a D&C if I had eaten anything)
  • If you have been on baby aspirin they will need to check your blood before carrying out a D&C (this can delay the procedure)
  • If you use tablets to induce, or complete, a miscarriage it may take up to 4 doses to complete, you may need some large pads or adult diapers for a few days
  • If you want to check for chromosomal reasons for the miscarriage you will need to retain the foetal material, for me this is when a D&C is a preferred option
  • I was knocked out for both of my D&C's, but it was not a full general anaesthetic, it was a new modern version of something similar, that is apparently safer
  • If you have a D&C you may wake up in the same recovery room as mothers and babies of c-sections (be prepared for the emotions this can raise)
  • It will take a few days for your hormone levels to return to normal. Expect a particularly bad emotional time approx 48-72 hours after the miscarriage, this is when the hormones really start to dip
  • You will not be offered any counselling by your health care provider in Thailand
  • There is a lot of help and information online (some are on my website page)

Our first miscarriage started at home when I was 11 weeks pregnant. I passed a lot of blood and the foetus into the toilet, whilst profusely sweating (why is there no air con in bathrooms?), crying in agony; my husband looked petrified and tried to support me as best he could. I had started spotting brown blood and having cramps just before bedtime, the cramps got worse and in the middle of the night I realised it was the real deal. I focused on what I had to do at the time, pant and sweat my way through it, and we went straight to the Samitivej hospital first thing in the morning, once I could stand up straight and move.

My doctor was running late that morning but rushed to get in as soon as she could. She performed a trans vaginal ultrasound (not nice when you're still bleeding) and confirmed that the foetus had gone but that the placenta had not passed yet. I was due to fly to England the next day so taking a tablet to finish the job wasn't an option for me, she agreed to carry out a D&C that morning to complete the removal. Because this was unplanned I obviously had some waiting around, most of this was done in the waiting room, with drip lines being prepared at random times in random rooms, before I was taken off for the procedure. When I woke up I was drowsy but free from pain. They called my husband on his mobile and we left an hour or so later. An hour after that I was drinking my first caffeinated coffee in Starbucks for nearly 3 months and calling my mum and dad to explain that they had just missed out on being grandparents and that I might be emotionally fragile when they picked me up at the airport 24 hours later.

My mum was the only person that warned me about my hormones dipping in 48-72 hours and like clockwork I broke down on my mum and dad 2 days later. But after that I returned to Bangkok, and life pretty much went on. You will need a check up to confirm everything is ok, but they will not offer any emotional support or counselling in Thailand.

Our second miscarriage was discovered at my next 11 week scan. The baby had no heart beat, it measured approx 9 weeks. Anticipating a heart beat and a wiggle on screen I cannot explain what goes through your mind when you instinctively realise that you are not hearing or seeing what your mind is so desperately searching for. My doctor (this time in Bumrungrad) was a bit flustered and called for help from her colleague, who also couldn't "wake" our baby up. I was made to cough and move around to try to "wake" it but nothing worked. They eventually left the room and we waited for further instructions, but they left the picture of our still baby on the screen. This I couldn't cope with and had to call for someone to switch it off, to this day that image will haunt me.

Again I was offered a tablet to induce the miscarriage at home, but I had an important business meeting the next day, so I asked for a D&C, which they scheduled for later the same day. We were asked if we wanted to test the foetus for chromosomal defects and we agreed to pay for the tests, this had been our second miscarriage in only a few months and we wanted some answers. Again I waited in the waiting room, trying to hold back my sobs. Eventually they came with more facts, figures and explanations of cost, all of which was in broken English and we tried desperately hard to contain our emotions whilst signing consent forms and invoices for procedures costing over THB85,000, with little explanation as to why and what it was all for.

At Bumrungrad I was given my own room for the afternoon, the rooms are exceptional with all mod cons like a hotel. I had been on baby aspirin so it took a while for them to check my blood but at least I was comfortable and out of the way of everyone else with their bumps and babies. When the time came I was wheeled to a waiting area and I will never forget the anaesthetist that came to introduce herself to me, she spoke the nicest, softest, kindest words at such a difficult time and really did give me my hope back. I was then wheeled into the surgery room and strapped down like a crucifix. The Thai nurses gleefully carried out their preparations and it took the entrance of my doctor (a formidable lady) to sternly remind them to keep quiet at such a difficult time for the patient, and she turned to apologise to me for their behaviour.

The next thing I remember was waking up in the recovery centre, in more pain this time, and hearing a baby crying (the mum was sedated after a c-section). I called for the nurse and asked for pain relief. I think they gave me paracetamol via a drip, it was very cold in the back of my hand, I much preferred taking a tablet like I had been given in Samitivej, but I wasn't about to complain.

I dozed in recovery for longer this time before being taken back to my room, where I could text my husband and was so pleased to see him, it had felt like a very very long day. I was kept in for a few more hours to make sure I could pass urine without problems, but I was desperate to get home and we checked out as soon as they would let us.

I suffered with a few more side effects this time. I had been sent home with some antibiotics and stupidly started taking them without questioning. I didn't finish the complete set and as a result I got thrush, I also ended up with a bit of cystitis and also some constipation and haemorrhoid's, so all in all my whole nether regions were not a nice place for a while. But nothing was too difficult to cope with or get over.

It was the follow up appointment and receiving the chromosomal test results that was the next slap in the face. My doctor tried to explain to me what the foetus was like when she removed it, and the only word she could come up with at the time was "mushy". To this day I have no idea why anyone would think that is an appropriate word to use in this regard. A few weeks later and going through the tests results in more detail (our baby had Trisomy 21) she also inadvertently blurted out that the baby had been a girl, this was probably my lowest point - it made it so real.

Our third miscarriage was more of a missed pregnancy. I was very early, only 5 weeks. I had confirmed by blood test at 4 weeks that I was definitely pregnant but I lost it a week later as a heavy period. I curled up at home with a hot water bottle and cried a little bit, but as with the others life had to go on.

Everyone will feel differently about miscarriage and I don't mean to make light of anything in this post. I was able to cope with things in quite a pragmatic way but some other people will need more guidance, help and support to get through this. My biggest concern in Thailand is that emotional and psychological support from Thai health professionals does not exist, you will need to be brave and reach out further to get support either online or via contacts back home or expats in Thailand. I will try to update this site with suggestions as I come across them, but please please do not go through this alone - if you need support reach out.

For now please read the article below for resources I am currently aware of Miscarriage Support - A Guide to Getting Help in Thailand

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