Surgical abortion, pregnancy hormone & depression (need answer fast.)

In My Humble Opinion
1

I am trying to decide between a natural miscarriage and a D&C (the has baby has had no heartbeat for approximately 4 weeks.) I must decide today because I have the procedure scheduled tomorrow morning.

One factor I am considering is the hormonal impact of both. I understand postpartum depression occurs when the pregnancy hormone drops immediately following birth. I’m guessing a similar effect happens following a miscarriage.

I guess my question is if there is any difference in how fast the hormone drops in a D&C vs. natural miscarriage. Is there any evidence that either method puts the mother at a higher risk for depression?

I have a very long history of depression and would rather make the decision that is best for my mental health.

Thanks,

Christy

2

If you have a long history of depression, does this mean that you have a psychiatrist now?

Do you have insurance?

Since you will not be breastfeeding a baby (I’m sorry about this, but FWIW, my mother had a miscarriage at five months, and then a healthy baby about 13 months later), you can take hormones, antidepressants, or both. Have you talked to your OB about checking into the hospital for medical management of your mood to make sure you don’t develop PPD? You might not need to move to the psych ward, but you might get a visit from the on-call psychiatrist.

Do you have a partner you live with, or some who can stay with you (or you can stay with for a few days?

I didn’t have PPD, but I did have a pregnancy-induced mood disorder, which is basically, that with no other context, like age on onset and the fact that I was pregnant, I probably would have gotten a diagnosis of bipolar disorder when I was pregnant-- I didn’t, just a lot of “Don’t be left alone,” and when I teied to stop drinking caffeine entirely and crashed, my OB said it wasn’t necessary to stop entirely, and caffeine is a mild antidepressant that is a lot safer in pregnancy that anything she could give me a prescription for.

My mood stabilized pretty quickly after the birth, even with the lack of sleep, the unplanned c-section, and all the other things that happened, so I’d take this seriously, and be safe, even if it seems a little obsessive.

If you have a mood stabilizer that has worked for you in the past, see if you can start on it again, and ask for a 24 hour stay. Also ask if taking hormones orally so you can taper off might help (it might not, because it might just cause your body to stop making them on its own even more abruptly-- IANAD).

Really, you need an OB to discuss hormone levels with you. If you haven’t told your OB about your depression in the past, I think you should do it.

The only difference I know between natural miscarriage and D&C is that there is a possibility of sepsis if you don’t eventually have a natural miscarriage, and four weeks is a long time.

I don’t think anyone on the board can really give you medical advice, unless we have an OB, but I can say I think you are right to take the possibility of depression seriously. Not to mention some women with no history of depression find having a miscarriage very upsetting all on its own.

Please discuss this with your OB. With this info, your OB can possibly get you admitted overnight, which is something that won’t happen normally, I don’t think, and staying in a safe place where you can be treated for whatever mental health issues come up is a good idea.

3

Medical advice is best suited to IMHO.

Colibri
General Questions Moderator

4

Please call your OB. S/he is best suited to making this kind of decision about this.

AFAIK, you’re going to have a hormonal crash from both, and with your history you should line up psychiatric support now.

I’m sorry you have to go through this.

5

I’m so sorry this happened to you.
Please talk to your OB/GYN and any other Dr you come in contact with.

6

I trust your judgment, but I want to make it clear I’m not looking for medical advice. I’m looking for statistics and/or factual information about hormone levels in D&C vs. a natural miscarriage so that I can make the decision based on factual information. I already have a touchy-feely miscarriage thread in this same forum so I don’t want people to think I’m just gratuitously creating another thread about the same thing.

I have talked to my OBGYN and she said it was up to me. We made the decision to do the D&C, it is scheduled for tomorrow morning which is why I need to decide soon. The only reason I have started second guessing this decision is I started to miscarry - extremely mild symptoms. She is very concerned about the depression. She put me back on Wellbutrin and I have a therapist, so in terms of support and preparation I am in pretty good shape in the event of a major depression relapse. Honestly since we learned about this it has been all about damage control, I am just trying to do everything I can to not relapse. I know the pregnancy hormone is currently buffering me from depression but I am starting to have signs of a miscarriage including a return of depression.

Yes, we technically have insurance but proving it has turned into a giant clusterfuck. So whatever I do has to be submitted for a retroactive claim.

7

Well, my only experience is what I said before-- hormone-induced craziness cleared up pretty quickly after a c-section delivery, but it actually was clearing up from the time I went into labor, so the delivery hormones must have been helping.

I don’t think you will get a yes or no answer to your question here, and the best we can offer is that you should discuss with your doctor the possibility of artificial hormones, so you can taper off. IANAD, so I don’t know if this will work, but it is something to ask. And if I were you, I would try to get an overnight stay, so if I wake up somewhere very dark after the procedure, there are people who can help me within an arm’s reach.

Do you have someone who lives with you who can help you through this? I realize this is a physical problem that happens to manifest emotionally, but it can still help to have someone who can give you a reality check-- or, if you need it, a ride to the ER.

8

Thank you for your input.

My husband will be there 24/7 the day of the procedure and the day after.

I’m not currently in a dangerous place with regard to depression. I just have a high risk of going there if I don’t tread lightly.

9

Based on my experience, you will not have the same hormonal impact as you would following a birth. A lot of changes started happening weeks ago, before you were even aware.

10

FWIW, I was like you in that I have had a history of depression. Suffered fairly severe Post-Partum Depression after both of my babies (poor planning and foresight on my part), but almost nothing of that nature for either of my miscarriages, which occurred at about six and seven weeks.

11

That is actually comforting, thank you.

I have of course had some depression with the miscarriage but I have to believe to a certain extent that is perfectly healthy and natural.

I decided to do the D&C. That is probably going to be best for my health overall.

12

Good luck to you. Please keep reaching out as you need to and as you turn corners!

13

Predicting Depressive Symptoms after Miscarriage: A Path Analysis Based on the Lazarus Paradigm from *The Journal of Women’s Health and Gender-Based Medicine.

I’m still looking for other resources.

14

From PubMed, History of pregnancy loss increases the risk of mental health problems in subsequent pregnancies but not in the post partum. Reading the abstract, they are referring to the post partum period of subsequent pregnancies.

15

Thank you phouka! This is exactly the sort of thing I’m looking for.

16

Adding my voice to the other women who experienced little to none of the hormonal upheaval following a miscarriage, that followed a full-term birth. It’s apples and oranges. You may be depressed, but it’s not postpartum hormone depressed. If that helps you guide your research.

17

Finally. Found it on PubMed:

This is from a government publication, so I believe my copy and paste does not violate copyright.

18

This suggests that the greater depression risk is not immediately after the miscarriage but during the next pregnancy. That’s good to know and explains why my doctor wanted me to stay on Wellbutrin throughout the next pregnancy. Maybe I should start putting some plans in place as to how I will cope with the next pregnancy should that occur. Sr. Weasel and I have already talked about it a little and we know it can never be the same purely joyful experience it was the first time.

From the first article you posted:

I think an argument could be made that, at least in my particular circumstance, the D&C is more active coping. I know because I have been doing a lot of wishful thinking, self-blaming and… if not ignoring the situation, certainly being reluctant to embrace it, and all of that stuff is tied with my ‘‘I should do this the natural way’’ feelings. What I’m really afraid of is the inevitable loss of my baby, and I can’t prevent that from happening either way.

19

Didn’t post the title of the above:

Clinical and psycological impact after surgical, medical or expectant management of first-trimester miscarriage - a randomised controlled trial.

The entire study is posted here: http://onlinelibrary.wiley.com/doi/10.1111/ajo.12064/full

20

From the abstract of the above study:

As traumatic stress can trigger episodes of depression, I would take this into account if you’re planning on the D&C tomorrow. Not, that is, to cancel, but to bring up concerns with your doctor and make sure that your anxiety and pain are addressed. On the plus side, the miscarriage is over and done with (more specifically, you are 98.1% ensured that it will be). You have the benefit of knowing that you are actively coping, and you won’t be surprised by symptoms of miscarriage or have to deal with it lingering for days. On the downside, there is a higher chance of infection.