Ep. 27: What to expect before & during miscarriage, with Arden Cartrette
Caitlin Estes:
Welcome to the woven well podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you on your fertility while honoring the deep connection your fertility has with your faith. Let's get started. Welcome back to the woven well podcast today. We're continuing our conversation about miscarriage by talking with Arden Cartrette, who is the founder of the miscarriage doula and company, a group of women with personal experience in or passion for women walking through miscarriage. So Arden, thank you so much for joining us.
Arden Cartrette:
Yes, of course. Thank you for having me.
Caitlin Estes:
So the miscarriage doula serves a very unique role in the lives of those experiencing or processing a miscarriage. Why don't you start by sharing with us what the miscarriage doula is?
Arden Cartrette:
I saw that people were doulas and helped women through birth. And so I was like, well, miscarriage is birth and we really need support there. So I created the miscarriage doula, which is an online resource and service for women in any stage of their miscarriage journey. I consider a miscarriage journey to even be after miscarriage because it changes us forever. It changes the way that we carry on in our fertility journey in our life, if we have living children after loss, all of those things. But it's emotional support. And then I also provide like group support and digital stuff and all of that.
Caitlin Estes:
So last week in our podcast, we talked about what a miscarriage is and what the most common causes of miscarriage are, but that information isn't what really helps you the most as you're actively walking through a miscarriage or you suspect that you're having a miscarriage. There are so many aspects to it that can come at you really fast and furious when that's happening, and it can make it difficult to make those informed decisions if you don't know what to expect or what your options are. So let's kind of start off by talking about what tips you have for advocating for yourself when you suspect or anticipate a miscarriage.
Arden Cartrette:
Usually when a woman anticipates a miscarriage, it's because of a couple of reasons, one her pregnancy tests that she's taking every day, because we all do that, they're getting lighter and she's a little confused, or maybe she has spotting and she's concerned whether she has spotting and cramping or just spotting without cramping. So with either of those, I would recommend calling your doctor and saying, I want an HCG draw. I would like you to check my progesterone. With both of those scenarios, both HCG and progesterone should be checked. If you're over six weeks, I would recommend pushing for an ultrasound. Some doctors will say, well, we'll see you around 9 or 10 weeks for a first ultrasound. And that's a little too long if you're anxious or if you're bleeding, especially.
Caitlin Estes:
Those are both great options. And I love that you said also get your progesterone checked because anyone listening to this podcast knows, we talk about the importance of progesterone a lot and especially in early pregnancy. So, that is great. I'm definitely a fan of that.
Arden Cartrette:
I just wanted to add one other thing to that. So whenever advocating for yourself, if somebody were to fight you a little bit on it, like let's say, they're like, well, it's probably nothing just come in at 10 weeks. You know, everything will be fine or go to the hospital if you're concerned, which is something that people doctors will say. And it doesn't make any sense because I don't wanna go to the hospital. <laugh> I want my care to be taken care of. I always tell my clients to use the words "I'm uncomfortable with waiting. I'm uncomfortable with not being seen." And by saying that you're uncomfortable, it kind of puts them in the position to not really be able to write that off. And I've never had somebody get turned down for being seen from using that language. A last ditch effort, if your doctor will not see you, there are services like anylabsnow.com where you can put in your own order for things like HCG and progesterone, and it's really inexpensive and it's a great service. They're not in every area. And so that's kind of the tricky part, but if you're ever in a scenario like that, I would check out anylabsnow.com.
Caitlin Estes:
So what are a couple's options once they've maybe had a diagnosed miscarriage, like a missed miscarriage, let's give that scenario, and they are anticipating the physical passing? What can you tell us about the options that this couple would have so that they can make an informed choice in that situation?
Arden Cartrette:
The three main options that are usually given to a patient are one to wait it out, which is essentially if you're not bleeding, waiting until you, until you start bleeding, and if you are bleeding, waiting and see where the bleeding takes you, which is kind of an agonizing thought. The second is to take a medication called cytotec or the generic name is mesoprotal. And that essentially induces labor it's actually used in full term live birth to ripen a cervix to get labor going, except for in a live birth they give, I believe it's 25 micrograms. In a miscarriage, it's 200 micrograms. Both of those would be done at home essentially. The third option is procedures. And so usually it's a D and C that is offered to you. And if you're over 12 weeks, sometimes a doctor will offer a D&E which is just a little bit different in the way that they do it. I feel like it's really important to know that you have these three options because sometimes doctors will only give you the first two, if it works differently for their or schedule. I, I find that a lot where sometimes doctors won't recommend a D&C for somebody who's eight weeks along because maybe that doctor thinks that that person can handle it at home. And so they don't give that option. And so it's really important to know that you have the right to ask and say, I want a D&C, and I want it scheduled as quickly as possible. If you're bleeding vaginally and you want to have a D&C, definitely push for it to be done as soon as possible, or you could risk miscarrying at home. There's different layers of pros and cons with each of them, right? Like some people kind of like the thought and I'm putting like in air quotes because they obviously don't wanna be in the position, but out of these three options, they want to give birth at home because they want to be able to say goodbye to their baby. They want to be able to have a more controlled environment. They might want to feel a little bit more connected to their body. So they will like opt to have it at home. And sometimes if that bleeding doesn't start in a certain timeframe, that's when the medication is used. But there's also, there's unfortunately a chance that they miscarry at home and then still have to have a procedure. And I don't think a lot of people are aware of that. They think that they can just pick one option and that's just the way it goes, but no, knowing those three options can kind of help where if you have to do two out of the three options, you kind of know what to expect. I like to tell people that with the first two options of miscarrying at home, that they can change their mind at any moment. They could take the Cytotec, be bleeding and think this is too much for me. This is a lot of blood. This is a lot of pain and they can go to the ER and they can ask for a D & C. That is a possibility. And I think that we're not really told of what to do if the bleeding feels like too much, because we're just kind of told that it's a heavy period <laugh> and that it will be over and then it'll be fine. That's not the case for everybody. So knowing these three options, it's not just making one decision. It, it can be in multiple decisions. If that makes sense.
Caitlin Estes:
It does. And I also appreciate you explaining how it could be a different preference for each couple, and it's not like there's one right way to walk through it. There are going to be couples who prefer, like you said, to miscarry at home, for many reasons, there are going to be couples who prefer to go through a D&C or a D& E and that's okay. All of those options are perfectly fine. And knowing what the options are first is a good place to be so that you can make that informed decision. So in any of those scenarios, once a pregnancy has physically left the body, many couples wonder what they should do with it, you know, is there a right or wrong way to process remains? What are the options that couples have? So what do you find that most couples consider to be their options there?
Arden Cartrette:
Most couples don't know that there are options and it's usually in the moment, especially if they miscarry at home, they are kind of frantic and if they're miscarrying in the bathroom, they will retrieve their baby from the toilet and not know what to do. So I have many clients who have put their baby in things like Tupperware, and they're like, I don't know what to do from here. And then they will think about a burial or they'll Google it and find little to no information and then feel a little bit more lost. But I also, in my own journey, wish that somebody would've told me I had options because I felt kind of weird, even thinking, should I bury my baby? You know, should I retrieve these remains? Should I do this? Or I felt very uncomfortable with the thought of how other people would view that. And so I didn't do anything. And it's to this day, a very big regret of mine. Legally there is no law saying that you can't bury a baby under, I believe it's 20 to 22 weeks, depending on the state, after 20 weeks in a lot of states, your baby is issued a death certificate. And so, usually you would call a funeral home. You can actually call and they would issue things like that. Or at the hospital. I say usually because some doctors are, are not so great with this, but even at the hospital, after a D&C, you should be asked what you would like to do with your child's remains. If you are under 20 weeks pregnant, you still have that same right. You don't receive a death certificate, but you have the same right to the remains of your baby. So whether you miscarry at home and you retrieve them, or if you have a D and C, you can say, I would like my baby returned to me. I would like my baby sent to this funeral home. You have that right to do that and they don't have any right to tell you, no. You know, that is your baby. And so I think it's really important to empower couples, to know that they can have burials or they can have cremation done. A lot of funeral homes will do it for no cost. If that is something that you wish to do and something that will help you with your grief and help you with processing what's happened to you. It's very much worth going through it.
Caitlin Estes:
Yes. I completely agree. Just again, having the options, because everyone's going to want to address those remains in a different way, and there is not a right or wrong way to do that. But knowing, like you're saying, you're thinking about what other people are gonna think, and you look online and there are no resources. So just knowing that whatever feels right to you for how to process that is probably the right way for you to go. And if you have a scenario where you are encountering a doctor who is unwilling to give you remains back after a D&C, would you recommend just going to another doc, like trying to find another doctor at that point? Or do you have kind of a scenario where you can keep saying, no, I can do this.
Arden Cartrette:
Yeah. I mean, I feel like I'm more pushy <laugh> now because of my own personal experience with having to advocate for myself in the medical field, to where I would tell somebody to keep saying, well, I'm not gonna accept no for an answer. Like, this is what I want to do. Okay. It's gonna be billed to me. I'm gonna pay for, it's gonna be under my insurance. This is my DNA. You can't tell me no. Like I would for sure argue that until I'm blue in the face. However, if they are just so dismissive, if it is really triggering or you don't trust putting the remains in that person's possession, definitely find another doctor. Don't be afraid to call. I would call different OBS. I would call hospitals. See what you could find out if you know anybody else in your life who has had a miscarriage.
Caitlin Estes:
mm-hmm <affirmative>. So I would imagine there are many listening today who have not experienced a miscarriage, but want to be prepared in case they do. We know that miscarriages are very common, up to one in four pregnancies could end in miscarriage. And then there are also gonna be many who have experienced one. And maybe it was, I mean, it's already traumatic, but maybe it was even more traumatic than it could have been otherwise because they felt uninformed. So I really hope that this information has been helpful because I feel like it is very practical, really good information. So is there anything else that you'd like to share?
Arden Cartrette:
I guess, well, you know, just going off of what you said, because I am the person who's probably more traumatized than I needed to be, because I didn't know this stuff. And so if anybody is listening to this that has had a miscarriage, and they're just feeling like I should have known this, I should have done this. I should have done that. I regret not keeping my baby's remains or knowing that I could, you know, we can't know something until we know it. And unfortunately for me, I'm in the same boat as that person listening that I didn't know it until somebody shared it with me after the fact. So I guess that's just one thing that I wanna make sure to put out there, because I know that I've had moments where I'm like, I should have known this. I should have done this, you know, I'm that baby's mother and I didn't know that I had options for them. And that's, that's a hard thought to have whenever you're grieving.
Caitlin Estes:
Mm. That is such a good word. I really appreciate you saying that. And one of the things that you mentioned earlier was, you know, if you are extreme bleeding or if you are having extreme pain, you always have the option to go in and get a D&C and that sort of thing. Would you kind of share with us what that level is? Because I imagine a lot of women who are very strong would say to themselves, well, this is probably okay. You know, like whatever they're dealing with, you know, the pain or the blood loss, I'll just wait another hour, I'll just wait another whatever, you know. So what is that level where women should start considering going in and getting some support?
Arden Cartrette:
That's a great question, because again, I was that woman. I was like, no, this is fine. And then I, I had a moment where I was like, this is not fine. I have got to go to the hospital and it was escalated very quickly. So what I say is during a miscarriage, having bleeding that does not slow down, I would say after an hour of excessive bleeding. And I say that because usually whenever you are physically miscarrying, there's been an hour time span where it's at it's heaviest. It's at it's peak. And you're, you're really g birth. It's a lot of contractions, a lot of pain, a lot of bleeding, if that does not slow down after you, you know, pass very large tissue, that is a sign that something more is happening that your body is just losing a lot of blood and you need to go to the hospital. There's like a lot of doctors will say that if you fill a pad in under an hour and you do that three hours in a row. I say, if you are drenching a pad in one hour, you go to the hospital. You do not wait for three hours. Even if you think what if I get there and they tell me it's not that much blood that I've lost. It does not matter. You go to the hospital, if you feel like you are in need of medical care, because you know, with full term live birth women who birth at home have midwives. They have medical professionals with them. So you're not trained to know what is happening to you. And it's okay to seek medical care. And going to the hospital, my tips, because again, I'm telling you this from experience, is as soon as you get their request pain medication, ask them for IV medication. And the reason I say that is because if you do have to have a D and C, you already have an IV placed, you're not in a lot of pain, which is really helpful while they're taking their hours to do assessments and like looking at, you know, they do like vaginal exams and looking at the level of bleeding and they do blood work. And I mentioned earlier, you could have a D and C or a D &E, which is you would be awake, but that's kind of where if you have an IV, they can do heavy duty pain medications. You don't feel a thing. It is basically like a D&C awake, essentially. And so in my experience with pain medications, it was not painful, not compared to the pain that led me to the hospital. So, I think people don't realize that they can opt not to go into the, or especially because that's also an added cost to have an or staff and all of that.
Caitlin Estes:
Sure. Thank you so much Arden for being on and for sharing so much, very practical information for our listeners
Arden Cartrette:
Anytime.
Caitlin Estes:
So for those of you who are listening, whether you're listening for education or because you may be anticipating miscarriage or you're grieving one, I want to share how honored I am that you would journey along with us, that you would listen, that you would even care what we have to say. And I hope that this has been a helpful episode for you as you move forward. I feel like pregnancy loss is one of the hardest fertility topics, but we don't shy away from it because it's important. And it may be hard, but it's an important one. So we want to provide you with information and a community that's helpful for you in your journey. We would love for you to follow us on Instagram @wovenwellpodcast or @wovenfertility and Arden, where can they find you?
Arden Cartrette:
I am @themiscarriagedoula on Facebook and Instagram.
Caitlin Estes:
Great. So until next time, thank you all for listening as we continue to explore together what it means to be woven well.