chances of m/c

On Sat, 29 May 2004 06:40:18 +0000, Jenrose wrote:

When I was lying there, bleeding, not knowing if my baby was alive or dead,
it felt like I was carrying "Schroedinger's Baby". Because bleeding in
pregnancy means a 50/50 chance of the pregnancy ending, and we knew there
was still a baby there, but until the box was opened, so to speak, it was an
uncollapsed wave form of possibility.

This describes very well how I felt when I heard the last time my
progesterone was low and hCG wasn't rising fast enough...

--
-- I
mommy to DS (July '02)
mommy to three tiny angels (28 Oct'03, 17 Feb'04 & 20 May'04)
guardian of DH (33)

Ilse,
I completely agree with you on this. I guess I was talking about a
completely normal healthy pg -- no bleeding or spotting or miscarriages. I
do believe that medical professionals could be more compassionate,
especially when dealing with women who have lost a pregnancy and are
pregnant again. We have a special set of worries and fears, and need more
hand holding than the average first time pregnant woman.
--

Jamie & Taylor
Earth Angel, 1/3/03

Check out Taylor Marlys -- www.MyFamily.com, User ID: Clarkguest1,
Password: Guest
Become a member for free - go to Add Member to set up your own User ID and
Password

Check out our Adoption Page at http://home.earthlink.net/~jamielee6


"Ilse Witch" wrote in message
news
On Sat, 29 May 2004 17:26:27 +0000, Jamie Clark wrote:

While I understand what you are saying, there isn't anything that really
can
be done, medically speaking, any sooner. You can't stop an unviable
pregnancy from ending, just as without medical intervention, you can't
cause
a viable pregnancy to end.

I know that, but as Hilary pointed out, it would certainly help a lot if
the medical world would realize the stress this puts on you and the
emotional hell. First pregnancy I phone midwife with bloodloss at 5.5w,
and get nothing but "we'll have to wait". Eventually my GP had to send me
off for an u/s at 7.5w as she refused to do anything before 10w. She
simply didn't even KNOW she could do something.

They cannot keep an unviable pregnancy from m/c, but they can measure your
progesterone, hCG and do u/s from ~5w and such. And most importantly, they
can support you and offer follow-up care after your loss. Saying after m/c
"bad luck, try again" is not what you want to hear. There are a gazillion
questions, but to get answers you have to go sit in a waiting room with
other pregnant women, between flyers about nursing your baby and storing
their cord blood, magazines full of maternity wear.

There is no or little research on the impact that m/c can have
physically
and mentally, and the general assumption is that you'll be "better"
after
a week or two.

I don't think there is any way to research this. It's subjective, and
it's
different for every woman, and every miscarrage.

I don't know, but I have seen quite a lot of studies on grief after the
loss of a loved one. This is no different from my POV. I suffered from
depression after my first m/c, and if I hadn't phoned the midwife myself,
I would still be there. Knowing how many women feel like that after m/c or
pregnancy loss could help in providing better follow-up care and prevent a
lot of grief to their families and loved ones. Such simple things, yet
nobody seems to know...

I will say there are quite a few good books on pregnancy loss, or
conceiving after pregnancy loss. Many of them have helped me
tremendously.

I am aware of that. But to me it feels like saying to a patient with
a bad cough "Well, you could have lungcancer, I don't know. Here's a good
book, read up. If you're still coughing next year, we could maybe do some
tests"...

No offense Jamie, I know you've been through a lot. But I see so many
women suffer from the insensitivity and sometimes even lack of knowledge
that plays a role with m/c and bleeding in early pregnancy, I think a few
basic things could change their experience a lot for the better.

--
-- I
mommy to DS (July '02)
mommy to three tiny angels (28 Oct'03, 17 Feb'04 & 20 May'04)
guardian of DH (33)

My cousin unfortunately had a still birth about 5 years back. Her
follow-up care was really good. The doctors and nurses did everything
they could to help answer her questions.

When she got pregnant again she was so afraid through the whole
pregnancy. Her doctor was amazing though. He was completely there for
her. He talked to her whenever she had a question, she didn't even
need an appointment. He used to just tell her to stop by the office so
she could hear the heatbeat whenever she wanted. The second baby was
born completely healthy and everything was fine.

She got pregnant again but this time her doctor had to move to the
other side of the country. He recommended another OB to her. This
woman was just as great as he was. My cousin just gave birth about 2
weeks ago. This doctor was supposed to be off that day but stayed with
my cousin for 12 hours keeping her company while she was in labour.
The new doctor even called her old doctor and they turned up the
monitor so loud that he could hear the heartbeat through the phone.
She said "now you have heard all three heartbeats". Apparently he got
all weepy on the phone.

I wish all doctors could be like that. She is very fortunate. The
problem is that there is such a doctor shortage where I live. They
just don't have the time. Very sad.

On 2004-06-01 12:21:27 -0400, "Jamie Clark" said:

Ilse,
I completely agree with you on this. I guess I was talking about a
completely normal healthy pg -- no bleeding or spotting or miscarriages. I
do believe that medical professionals could be more compassionate,
especially when dealing with women who have lost a pregnancy and are
pregnant again. We have a special set of worries and fears, and need more
hand holding than the average first time pregnant woman.
--

Jamie & Taylor
Earth Angel, 1/3/03

Check out Taylor Marlys -- www.MyFamily.com, User ID: Clarkguest1,
Password: Guest
Become a member for free - go to Add Member to set up your own User ID and
Password

Check out our Adoption Page at http://home.earthlink.net/~jamielee6


"Ilse Witch" wrote in message
news
On Sat, 29 May 2004 17:26:27 +0000, Jamie Clark wrote:

While I understand what you are saying, there isn't anything that really
can
be done, medically speaking, any sooner. You can't stop an unviable
pregnancy from ending, just as without medical intervention, you can't
cause
a viable pregnancy to end.

I know that, but as Hilary pointed out, it would certainly help a lot if
the medical world would realize the stress this puts on you and the
emotional hell. First pregnancy I phone midwife with bloodloss at 5.5w,
and get nothing but "we'll have to wait". Eventually my GP had to send me
off for an u/s at 7.5w as she refused to do anything before 10w. She
simply didn't even KNOW she could do something.

They cannot keep an unviable pregnancy from m/c, but they can measure your
progesterone, hCG and do u/s from ~5w and such. And most importantly, they
can support you and offer follow-up care after your loss. Saying after m/c
"bad luck, try again" is not what you want to hear. There are a gazillion
questions, but to get answers you have to go sit in a waiting room with
other pregnant women, between flyers about nursing your baby and storing
their cord blood, magazines full of maternity wear.

There is no or little research on the impact that m/c can have
physically
and mentally, and the general assumption is that you'll be "better"
after
a week or two.

I don't think there is any way to research this. It's subjective, and
it's
different for every woman, and every miscarrage.

I don't know, but I have seen quite a lot of studies on grief after the
loss of a loved one. This is no different from my POV. I suffered from
depression after my first m/c, and if I hadn't phoned the midwife myself,
I would still be there. Knowing how many women feel like that after m/c or
pregnancy loss could help in providing better follow-up care and prevent a
lot of grief to their families and loved ones. Such simple things, yet
nobody seems to know...

I will say there are quite a few good books on pregnancy loss, or
conceiving after pregnancy loss. Many of them have helped me
tremendously.

I am aware of that. But to me it feels like saying to a patient with
a bad cough "Well, you could have lungcancer, I don't know. Here's a good
book, read up. If you're still coughing next year, we could maybe do some
tests"...

No offense Jamie, I know you've been through a lot. But I see so many
women suffer from the insensitivity and sometimes even lack of knowledge
that plays a role with m/c and bleeding in early pregnancy, I think a few
basic things could change their experience a lot for the better.


--
Shannon

Please remove -NO SPAM from email address to email me personally.

In .net,
Jamie Clark wrote:

*Ilse,
*I completely agree with you on this. I guess I was talking about a
*completely normal healthy pg -- no bleeding or spotting or miscarriages. I
*do believe that medical professionals could be more compassionate,
*especially when dealing with women who have lost a pregnancy and are
*pregnant again. We have a special set of worries and fears, and need more
*hand holding than the average first time pregnant woman.

absolutely. I got pregnant the first cycle after my m/c and was a wreck. I
called my doctor in the middle of the night because I had some weird pain
at 5 w 6 d and he brought me in the very next day for an exam and a
viability scan. It was comforting, and I know he did it just to ease my
mind, because honestly if I hadn't just had the m/c I would never have
called him about that.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large

On Tue, 01 Jun 2004 16:21:27 +0000, Jamie Clark wrote:

I completely agree with you on this. I guess I was talking about a
completely normal healthy pg -- no bleeding or spotting or miscarriages. I
do believe that medical professionals could be more compassionate,
especially when dealing with women who have lost a pregnancy and are
pregnant again. We have a special set of worries and fears, and need more
hand holding than the average first time pregnant woman.

So right!

Interestingly, a similar discussion is going on on a Dutch forum on m/c's.
Somebody posted results from a study on the care received after the m/c.
Turns out that 90% of the women received no care whatsoever and had to
deal with everything on their own. Of the ones that did receive care, 85%
thought it was inadequate. I was stunned by such high numbers, but not
entirely surprised, remembering my own experience there.

Keep in mind that in the Netherlands there is a lot of easily accessible
mental and emotional care available. So even without money you can get
counselling or therapy. All the more stunning that hardly any midwife or
OB/GYN refers women to such institutes for counselling.

--
-- I
mommy to DS (July '02)
mommy to three tiny angels (28 Oct'03, 17 Feb'04 & 20 May'04)
guardian of DH (33)

"Donna Metler" wrote in message ...

no one ever suggested that I do
even the minor things which can slow the progression of pregnancy-induced
hypertension into pre-eclampsia, like sit down a lot, put my feet up, sleep
on my left side, etc, or that I even check my BP outside the doctors office.

If it cheers you up at all, severe cases of pre-eclampsia and HELLP
syndrome generally don't respond much to that sort of management. Our
best guess at the moment is that a severe case means that your body
didn't let the placenta implant properly right at the very beginning
of your pregnancy. When the baby starts to put on weight, and starts
demanding more blood, the spiral arteries of the placenta are unable
to ferry a sufficient amount. So the placenta gets hypoxic and starts
dumping a protein that destroys blood vessels, which gives you all the
lovely sequelae you and I are so familiar with.

There's not much anyone can do after the fact to fix an improperly
implanted placenta or to fix the way your body is going to respond to
the problem. Some people end up with IUGR diagnoses. Some get PE,
mild or severe. Some get HELLP.

When I got admitted for just severe PE (my platelets were just a bit
too stable to class me as HELLP) they put me on bedrest on my left
side with a lovely bolus of labetelol and a mag sulfate drip. The
bolus brought my pressures down to 150/90 but over the next few days
they spiked back up to 220+/110+ while I was on a maintenance dose.
If it slowed my progression to be on bedrest, it didn't slow it by
much. I was just damn lucky to go haywire at 33 weeks 5 days.

--
C, mama to nineteen month old nursling

"Dagny" wrote in message ...

PE is almost unheard of though, in obstetric or midwife
practices where women are encouraged to eat lots and lots and LOTS of
high-quality protein, fresh vegetables, and salt their food as much as they
want.

snip

Of course, then there's me.

--
C, mama to nineteen month old nursling

In ,
wrote:

*If it cheers you up at all, severe cases of pre-eclampsia and HELLP
*syndrome generally don't respond much to that sort of management. Our
*best guess at the moment is that a severe case means that your body
*didn't let the placenta implant properly right at the very beginning
*of your pregnancy. When the baby starts to put on weight, and starts
*demanding more blood, the spiral arteries of the placenta are unable
*to ferry a sufficient amount. So the placenta gets hypoxic and starts
*dumping a protein that destroys blood vessels, which gives you all the
*lovely sequelae you and I are so familiar with.

Whose best guess?

It doesn't really make sense to me that pre-eclampsia could be related to
a failure of proper placental implantation early on, when there is no
ultrasonographic evidence of such failure prior to the diagnosis, and when
populations of patients under the care of certain practicioners have such
an aberrantly low level of PE (Brewster, Gaskin, etc).

The list of currently theorized causes at preeclampsia.org includes:

genetic tendency
insufficient mag oxide and B6
high body fat
nutritional problems, poor diet
immunological activation
preexisting maternal disease (hypertension, hyperthyroidism, et al)
hemodynamic vascular injury
calcium deficiency
endothelial activation and dysfunction
prostacycline/thromboxane imbalance
uterine ischemia or underperfusion

But it does not include "improper placental implantation at the beginning
of pregnancy." I'd be interested in knowing your sources for that
information so I can read their theories.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large

In ,
wrote:

*"Dagny" wrote in message ...
*
* PE is almost unheard of though, in obstetric or midwife
* practices where women are encouraged to eat lots and lots and LOTS of
* high-quality protein, fresh vegetables, and salt their food as much as they
* want.
*
*snip
*
*Of course, then there's me.

"almost" being the operative word.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large

(Hillary Israeli) wrote in message ...
In ,
wrote:

(typing quickly because DS is sick)

*If it cheers you up at all, severe cases of pre-eclampsia and HELLP
*syndrome generally don't respond much to that sort of management. Our
*best guess at the moment is that a severe case means that your body
*didn't let the placenta implant properly right at the very beginning
*of your pregnancy. When the baby starts to put on weight, and starts
*demanding more blood, the spiral arteries of the placenta are unable
*to ferry a sufficient amount. So the placenta gets hypoxic and starts
*dumping a protein that destroys blood vessels, which gives you all the
*lovely sequelae you and I are so familiar with.

Whose best guess?

For the research on the hypoxic placenta and the protein it dumps in
response, see: http://www.jci.org/cgi/content/full/111/5/649

For the research (often Susan Fisher's work) on why the
cytotrophoblasts don't convert to an endothelial type, see:
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14990702

and several others.

It doesn't really make sense to me that pre-eclampsia could be related to
a failure of proper placental implantation early on,

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11988332

"Preeclampsia is characterized by shallow trophoblast invasion and
unconverted narrow spiral arteries. This leads to fetal hypoxia that
causes endothelial injury that eventually manifest as maternal
hypertension, edema, and proteinuria."

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10831118

"We found that the ontogeny of HIF-1alpha subunit expression during
the first trimester of gestation parallels that of transforming growth
factor-beta3 (TGFbeta3), an inhibitor of early trophoblast
differentiation. Expression of both molecules is high in early
pregnancy and falls at around 10 weeks of gestation when placental PO2
levels are believed to increase. Antisense-induced inhibition of
HIF-1alpha inhibited the expression of TGFbeta3, and stimulated
extravillous trophoblast (EVT) outgrowth and invasion. Of clinical
significance we found that TGFbeta3 expression was increased in
pre-eclamptic placentae when compared to age-matched controls.
Significantly, inhibition of TGFbeta3 by antisense oligonucleotides or
antibodies restored the invasive capability to the trophoblast cells
in pre-eclamptic explants. We speculate that if oxygen tension fails
to increase, or trophoblasts do not detect this increase, HIF-1alpha
and TGFbeta3 expression remain high, resulting in shallow trophoblast
invasion and predisposing the pregnancy to pre-eclampsia."

when there is no
ultrasonographic evidence of such failure prior to the diagnosis,

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14998177

"The association between pre-eclampsia, intrauterine growth
retardation and increased uterine artery resistance measured by
Doppler ultrasound has been described and subsequently color Doppler
waveform analysis of the uterine arteries has been used as a screening
test for adverse pregnancy outcome."

and when
populations of patients under the care of certain practicioners have such
an aberrantly low level of PE (Brewster, Gaskin, etc).

There's a lot of dispute over diet. Here, for example:

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14583907

"In five trials involving 1134 women, nutritional advice to increase
energy and protein intakes was successful in achieving those goals,
but no consistent benefit was observed on pregnancy outcomes.In 13
trials involving 4665 women, balanced energy/protein supplementation
was associated with modest increases in maternal weight gain and in
mean birth weight, and a substantial reduction in risk of
small-for-gestational-age (SGA) birth. These effects did not appear
greater in undernourished women. No significant effects were detected
on preterm birth, but significantly reduced risks were observed for
stillbirth and neonatal death.In two trials involving 1076 women,
high-protein supplementation was associated with a small,
nonsignificant increase in maternal weight gain but a nonsignificant
reduction in mean birthweight, a significantly increased risk of SGA
birth, and a nonsignificantly increased risk of neonatal death. In 3
trials involving 966 women, isocaloric protein supplementation was
also associated with an increased risk of SGA birth.In three trials
involving 384 women, energy/protein restriction of pregnant women who
were overweight or exhibited high weight gain significantly reduced
weekly maternal weight gain and mean birth weight but had no effect on
pregnancy-induced hypertension or pre-eclampsia."

But it does not include "improper placental implantation at the beginning
of pregnancy." I'd be interested in knowing your sources for that
information so I can read their theories.

I'm sorry these are mostly to abstracts...

--
C, mama to nineteen month old nursling