Informed Choice in Miscarriage (& Abortion)

Ever since adding miscarriage support to my practice (long overdue – I had know idea HOW to support clients through miscarriages until I took an eye-opening Holistic Abortion workshop with Molly Dutton-Kenny last year), I see people asking for miscarriage advice everywhere. SO MANY PEOPLE are looking for options, support, and alternatives to the commonly recommended surgical procedures in the community but don’t know where to look for support or guidance.

I have said this before, but the more I explore supporting individuals and families through the planned or unexpected release of a pregnancy, the more I realize how similar the modern context for these experiences is to that of full-term childbirth. It has largely moved away from community-based midwife practice and into hospitals that are more comfortable with surgical approaches that favour efficiency and clinical procedures over prioritizing the experience.

Surgical approaches are certainly appropriate and wanted in many cases, but just like in birth, it seems they are often assumed to be best without a full informed choice discussion with the client’s choices, needs, and preferences at the centre.

I find that clinicians often make the assumption that pregnant people in these circumstances will want a “get it over with” approach, and as a result, intentionally or unintentionally, lead people towards D&Cs and way from expectant management or alternative approaches even if those methods are more preferable or suited to them as individuals. Contrary to what is often assumed, many people WANT to feel connected to the experience of releasing a pregnancy, and many want to do this in the least invasive way possible if appropriate for them.Options For Miscarriage or Abortion

People are often scheduled for a surgical procedure before they have a real chance to explore the pros and cons of all options. Some will choose to wait for the pregnancy to pass on its own, monitoring themselves for signs of continued health while they wait, some will use herbs or acupuncture to nourish their bodies or to augment / speed up the release process, and some will opt for a medication called misoprostol to induce the release. All of these, in addition to surgical options, can be very good options depending on the individual’s needs and situation.

In the case of an unplanned pregnancy loss, it can often take several weeks for a pregnancy to pass on it’s own, even upwards of 6-8 weeks at times. Different approaches will have different benefits and risks depending on the gestational age and health factors.

Likewise, in the case of a planned abortion, different options will have different levels of effectiveness and safety depending on the gestational age of the pregnancy.

For example, while herbs are something that have been used throughout history to induce abortion, herbal methods have their best chance of working before 6 weeks of pregnancy, and do not have nearly the same efficacy as medication abortions.  Many people do a combination of herbs and medication abortion for increased efficacy, and some will be choose a herb-only approach as an initial step.

There is also a technique called menstrual extraction that is less common in our modern culture but was at one point a more common (though perhaps underground) community-based approach to releasing uterine contents.

Just like in childbirth, I encourage clients to weigh all of their options and make the choice that is the uniquely best fit for them.

Questions to consider when making your choice would be:

  • Am I healthy right now? Is there any reason to rush into a decision?
  • What is my timeline in terms of the options available to me? Do any of my options have a timeline associated with them?
  • What are the risks and benefits of waiting vs acting now?
  • If I am choosing an expectant management approach to a pregnancy loss, what are the signs of health vs declining health that I should be aware of and watching for?
  • What are ALL of the options available to me, and what are the risks and benefits for me? What does the experience look like for each? Is the experience I have imporant to me?
  • What is important to me about my EXPERIENCE here, and what steps do I need to take to support that kind of experience?
  • What kind of support do I need leading up to, during, and after the release of the pregnancy and where will I get that support?

Full Spectrum Doulas are a service that is growing in popularity to meet a demand for people experiencing the planned or unexpected pregnancy end to a pregnancy.

Please contact me if you are looking for a Full Spectrum Doula in Vancouver, BC.

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