D&C in E.R.?

[BakersDozen]

If you've had this done at the E.R. would you chime in, please?  If I just had an u/s can I bring my results with me?  Scan showed same 7w2d fetus w/no heartbeat that I saw on July 1.  OB here tested my hcg levels twice and since they were slowly going down he refused more testing.  That was over a month ago (I think).  Found doctor in Phoenix who tested me and found the pregnancy is still in my uterus, hence the reason why hcg is not zeroed out.  Called OB here and was told since I am not a patient he will not do a D&C until I meet with him which could take a week or longer.  I figure I've been carrying around this nonviable pregnancy for over 2 months, I'm not waiting a week for an appointment and another week or even two for a D&C. I'm done.  

[Moxie]

Hugs. That sucks.

 

I can't imagine that they will do a non-emergency D&C in the ER but I could be wrong.

 

I thought you switched to a doctor you liked?? I can't imagine a doctor you've seen not treating you.

[Um_2_4]

Based on what my friend said who is an ER nurse, a D&C would only be done "from the ER" if it was an emergency situation (bleeding out , severe infection from retained product that needs immediate treatment or the like). They would send you to your GP. What about planned parenthood or the like??

[Um_2_4]

dp

 

ETA: if cost is an issue, pretty sure cost in the ER would be LOTS more than $1000.

[BakersDozen]

 

 

I thought you switched to a doctor you liked?? I can't imagine a doctor you've seen not treating you. 

The doctor I switched to after my ordeal at the beginning of the year tested me twice this time; once he saw the hcg levels going down (albeit slowly) he refused to test me further and told me to just wait this out.  After that I kept bleeding so a doctor in Phoenix had me tested and then sent me for an u/s this last week.  I called my OB here to schedule a D&C and was told since I am not a patient (by HIS own choice, not mine) I would have to schedule a consultation (at least a week out) then schedule the procedure (another 1-2 week wait).  The doctor in Phoenix will do the D&C but it would cost me almost $1000 as opposed to $500-600, plus I would have a 2-hour drive both ways.  

 

Isn't this ridiculous?  One thing after another...it just won't end.  

[unsinkable]

Wait, your OB told you that you're not a patient?

 

I think your body needs a break. I am open to life but it really seems like your body is saying enough.

 

(((Hugs)))

[fairfarmhand]

I had one. I was hemorrhaging at the doctor's office and passed out. Went by ambulance to the ER. The doctor whom I was seeing at the time (family doctor) did not do the procedure. The on call ER OBGYN did it.

 

They were very nice and everything went well. I don't really recall the doctor at all..I was put under anesthesia before he arrived, but my dh spoke to him and said he was a very nice, empathetic man. Since this was a small hospital, they had to call him in (it was evening hours by the time I made it to the ER)

 

Since you're not really in an emergency situation, I would think that they would just send you to your dr.

 

Can you go to a GP and see if they will do it?

[Moxie]

Why would your doctor drop you if you just saw him?? Are you sure that isn't a clerical issue?

[BakersDozen]

 

 

Why would your doctor drop you if you just saw him?? Are you sure that isn't a clerical issue? 

When I chose to seek out the Phoenix doctor to continue testing it didn't sit well with my OB, I guess.  I haven't spoken to him, just the Nazi Nurse he has working for him (oh, how I hate that woman).  I can be his patient again but it will take weeks for the consult and then scheduling the D&C.  There is no sense of urgency, I guess, but then he's not the one going through this so what's a few more weeks to him?

[BakersDozen]

 

 

I think your body needs a break. I am open to life but it really seems like your body is saying enough.

(Said very gently) When all I can face is the here and now, comments like this are really not helpful.  I know you mean well, truly I do, but I need to get through this loss before facing a decision like that.  I am open to life and am willing to accept loss as part of this process, difficult and frustrating as it is.  I had numerous losses some years back and am so thankful I didn't give up the possibility of having more dc.  I don't know why this has happened again but I'm going to take this as one dreadful event, heal, then think about what is to come.  I'm not ready to hang up hope yet...not yet.  

 

There was a mama bird outside my living room window who sat on her one egg long after the other birds had hatched theirs and were flying around with their babies. I worried for that one mama as I really thought she would die sitting there.  Eventually she flew off, leaving the dud egg in the nest.  She knew it was time yet she didn't give up until all hope was gone.  I'm still willing to "sit on the nest" in hopes that there will be more than just dud eggs.  :)  When it's time to fly away, I'll do so, but not yet.

[unsinkable]

I meant it gently, too. I would say the same thing in the same situation to a friend IRL.

[Hwin]

I would not want a D&C in the ER, based on my urgent care and emergency room experiences. I'm sorry for your loss.

[Susan C.]

I'm puzzled because of the title of the post.

 

Maybe while you are waiting, you can line up a new doctor. Start getting recommendations from local friends and go from there.

[LMV]

None of the hospitals I have covered as a physician have done D&Cs physically in the ED (and I haven't/don't know of any EM colleagues who have done D&Cs as part of their EM practice---off service rotations during residency training are a different story so yes, technically we've done them but the situation just doesn't play out that way in real life in the ED).  Yes, if someone is having significant hemorrhage from a spontaneous abortion they may need an emergent D&C (or perhaps they really need a laparoscopy)so they will be stabilized by the EM physician in the ED and then they go to the OR for more definitive diagnosis/treatment.  I think if you present to an ED with a missed abortion but are hemodynamically appropriate, afebrile, and have a normal hemoglobin it is likely that you will be referred back to your OB (or another OB if you state you can't see the first one) for follow up.  Now if you are actively bleeding, or if there is concern that there could be infection from the retained products then this is a different situation.

 

If it has been ten plus weeks then it is unlikely that you will pass the products of conception at this point (I presume placenta accreta was excluded on ultrasound) so you will likely need a D&C but getting it done emergently in a non-emergent situation is unlikely.  I seem to vaguely recall when you posted about this before that you have reservations about the D&C and that may have been why you switched OBs.  Forgive me if I'm messing that up.  I don't recall if you discussed the possibility of using misoprostol with your doctor but that may be another option.  I'll be honest and say I don't have any clinical experience using misoprostol so late in the process (we do actually have an incomplete/missed abortion protocol in our ED that was is a joint OB/EM protocol so we do use it just not with women in exactly your situation) and at this point there may be a reason your OB wouldn't want to proceed that way.

 

I hope you get some answers that are helpful and can come up with a solution both you and your doctor are comfortable with.  

[TXMomof4]

Just a thought here - if you go to the eror urgent care and tell them you don't have an OB they may be able to get you an appt with another OB sooner. Completely different situation, but when I had a herniated disc in my neck the neurologists all had a 2-3 month wait. I as losing function in my arm daily, not to mention excruciating pain, they were able to call for me to get an appt.

[TXMomof4]

Sorry for typos - on my phone!

[BakersDozen]

 

I'm home.  Still "pregnant".  I have ER doctor and nurse plus doctor and two nurses from Phoenix calling this horrid doctor up here, telling him this is standard protocol for a D&C to be done locally rather than having me drive 2 hours both ways and pay for out-of-network services.  At the ER I was told to schedule the D&C with the doctor's office upon discharge as the ER doc had spoken to one of the OBs in the practice.  Once outside I called the office and listened as I was told the doctor would not do it.  I lost it. Big time.  Spent the next hour on the phone with various physicians and nurses, all of whom are ready to lynch my now ex-OB.  A partner of his in the practice has said he will do the procedure yet no one can get hold of him at this point.

 

It's been a lovely afternoon.  The good thing (if there is anything good in this) is that from the moment I walked into the ER and told them what was going on I had nothing but support and sympathy.  When asked if I had other children I warned the triage nurse that I would tell her but this is the point the nurse became cold and angry with me on December 31 when I was there for a missed miscarriage.  The nurse looked at me and said, "NO ONE should EVER treat you that way!  It doesn't matter how many babies you've had, you are losing one you love."  â™¥  One nurse gave me a contact for pregnancy loss support, another had a murderous look in her eye when she heard that I've been going through this since July 1.  No one can believe an OB denied me care.

 

Hopefully next week this will all be over.  Thank you for the kind words and love "in action".  Right now I'm dehydrated from crying and exhausted as well.  So I'm going to get a drink of water and find some little ones (or big ones, if they'll let me) to cuddle.

Not sure why that went in quote mode...

[Lanny]

In the E.R.   I don't think that would be a good idea...   That should be a scheduled surgery. My wife had to have one, in 1999, after a miscarraige. It was scheduled and done in a regular surgical suite by an OB/GYN.   And, my stepsons wife had to have one, a month or so ago, because of a non viable pregnancy, and again, it was scheduled and done in a regular surgical suite. Sorry you need to go thru this. GL

[Susan C.]

your quote:

 

The doctor in Phoenix will do the D&C but it would cost me almost $1000 as opposed to $500-600, plus I would have a 2-hour drive both ways.

 

 

If it were me, this is what I would be doing. I finally read everything. No, I would not go to the previous doctor. They obviously don't want you, so I would not let them touch you. A week for consult, then 1-2 wait!! That is ridiculous, they are passing you off. Get the medical care you need. A few hundred extra dollars is worth it to get you good care.

[StephanieZ]

I would definitely go with the doctor in Phoenix.

 

IMHO, knowing a lot of doctors and lawyers, I would guess that the local OB would prefer never to treat you again. I would guess that he, for whatever reason, feels that you are a lawsuit or board complaint waiting to happen, and he would prefer to decline you care. He may not have the power to do that in his particular practice or because of lack of alternative sources of care, but, my guess would be that he will never get easier to deal with, and that you would be best served to imagine he was dead and that you simply have to find alternative sources of care in the future.

 

I am sorry for your pain. I hope you heal well and soon and find some comfort in your family. It must be very hard for you. For me, when i have a loss, it often brings up pain from past losses. I imagine you must really suffer during this time.

 

I encourage you to just do the driving, and get the care you need ASAP.

[Melissa in Australia]

:grouphug:  :grouphug:

[SunnyDays]

I'm so sorry that you are STILL going through this. It's ridiculous... But I don't need to tell you that. :grouphug:

 

Take care of yourself, and make whatever arrangements for care will help you end this and start the healing process.

[kroe1]

I do not know a single ER physician who has the skill to do a D&C. I know probably 100 of them or so including my son. If an ER physician comes across a life threatening active bleed, he will pack it and call an OB/ GYN. Most will hospitalize the patient, give blood transfusions and still wait until morning to do the surgery. And that is only if you are lucky enough to walk into an ER that has an OB on call. If not, the patient will get transferred to a higher level of care via ambulance. So basically, an ER is going to cost around $20,000 or so for the same procedure you could have done safely by your doc for $1000 if you had not waited so long.

 

When figuring that $1000, by the way, note that it probably doesn't cover anesthesia, medications, or the cost of the surgery suite. It probably only covers the surgeon's fee. Make sure you clarify what ALL the costs will be.

 

Big hugs from Florida.

[elfgivas]

it looks as if planned parenthood could help you, for ~$515-

 

here is a page link where you could find one near you, and phone numbers you can call to ask questions.

 

http://www.plannedparenthood.org/ppaz/online-health-center-4983.htm

 

hth,

ann

[Murphy101]

(((Hugs)))

 

I would not want an ER d&c.

 

Have you tried leaving the back story out and just calling another local OB, tell him you are pregnant and miscarrying and can he get you in pronto please? Once in the office and he verifies you are not progressing and you tell him you are ready to be done, hopefully you can schedule right then for a d&c with whatever out patient facility he uses. I'm really not a fan of that, but sometimes the POC system doesn't leave much choice for maternal care. Btdt

 

(((Hugs)))

[Murphy101]

Also have you tried calling the local catholic parish to get a recommendation for a catholic OB?

[PinkyandtheBrains.]

it looks as if planned parenthood could help you, for ~$515-

 

here is a page link where you could find one near you, and phone numbers you can call to ask questions.

 

http://www.plannedparenthood.org/ppaz/online-health-center-4983.htm

 

hth,

ann

 

I second this. They were the only affordable women's services I could find in my younger years.  They are affordable and usually very helpful.

 

I am sorry you are going through this sad time.

[BlueTaelon]

I'm sorry your going though this, I went though a horrible m/c before my last baby and my OB would not do a D&C even after 8 weeks, my body kept trying to expel it so I was literally going through full blown labor every other day towards the end, complete with transition:( My uterus was packed with huge blood clots which was all that I was passing. I don't remember how it happened but I ended up at UCLA medical center and the Dr was appalled I had been allowed to go so long. She did the D&C on her lunch break while I was awake with no pain killers beyond Motrin as I needed to drive myself the 3 hours home. They knock you out more for the Dr's comfort then a real need to I think. It must be hard to work on a patient who is very emotional and possible won't stay still while in distress. It was far less painful then the labors I had had to endure. Honestly if faced with the same situation and I could afford it I would go to the nearest abortion clinic, its the same procedure, just has more stigma attached. I knew my baby was dead but I still had a difficult time emotionally with the procedure because I knew it was no different then an abortion which has all kinds of social stigma, I mean I knew my baby was already gone but the baggage that comes with the procedure is what hit me so hard if that makes sense. I was relieved it was over but the fact it didn't end naturally was what bugged me I guess. That said, 2 cycles later I conceived the 7 yr old who is now bouncing around the kitchen driving me insane right now:) *hugs* hang in there, it will be over soon.

[AimeeM]

I meant it gently, too. I would say the same thing in the same situation to a friend IRL.

During a loss isn't the right time - to a real life friend or an online one.

[AimeeM]

Also have you tried calling the local catholic parish to get a recommendation for a catholic OB?

I second this. While I'm not aware of many catholic OBs in my area, I know that most of the ladies in my group use the same OB I use - he's protestant and evangelical, but very pro-life, very kind, very quick to get you in during an emergency, etc. The Catholic churches in the area may have a list of such doctors.

[Murphy101]

During a loss isn't the right time - to a real life friend or an online one.

I don't think it is the right time ever, IRL or online. If someone wants to know whether you think they should stop having kids or trying to have kids, they'll ask you.

[msrift]

I am so sorry you are going through this. I did have a d&c in the ER as I was hemorrhaging and it was a Saturday night. The miscarriage had already been diagnosed and we were waiting for nature to take its course but things got a little out of control. The ob on call met us at the ER and did the procedure. Even then, they had to get approval from management to do 'an abortion' on site. I can't imagine a regular ER doc agreeing to do a d&c, unless it was a truly emergent situation.

 

I have had other d&c's after miscarriages and they were scheduled at free-standing surgical centers, again, as no hospital around here willingly does the procedure on site.

 

I hope you are able to find a solution.

[momto10blessings]

I don't think it is the right time ever, IRL or online. If someone wants to know whether you think they should stop having kids or trying to have kids, they'll ask you.

Exactly this

[unsinkable]

Wait, your OB told you that you're not a patient?

 

I think your body needs a break. I am open to life but it really seems like your body is saying enough.

 

(((Hugs)))

 

 

During a loss isn't the right time - to a real life friend or an online one.

 

 

I don't think it is the right time ever, IRL or online. If someone wants to know whether you think they should stop having kids or trying to have kids, they'll ask you.

 

I didn't say she should stop having kids or trying to have kids. I was responding to this situation. womanintheshoe has posted that this miscarriage started in June and she had another miscarriage in april and an D&C after natural miscarriage stalled in Feb.

 

IMO, Her body needs a break and is saying enough. I was trying to ask about her OB in the hopes that I could determine why he is responding the way he is so that we could brainstorm with her to get her into him sooner.

[DianeW88]

The ER will not perform a D&C in a non-emergent situation.  I would definitely find a new OB.  You don't want to be the patient of a doctor who doesn't want you to be his patient.

[Murphy101]

I will say that no matter what work was done elsewhere, the new dr and facility will want their own blood work up and ultrasound before doing anything else. I've never ever had them even take me at my word or paperwork for blood type, much less anything more.

[mom2scouts]

I had it done in the ER, but mine was an emergency situation.  I don't think they would have done it otherwise. I'll just say that I would not recommend it.  It was very painful and they didn't give me any painkillers.

[trulycrabby]

I'm very sorry you're having to deal with these complex medical issues in addition to dealing with your loss. :grouphug:

[Lanny]

I don't know where you live. You wrote 2 hours from Phoenix, as I recall, but I don't know in which direction.  There have been suggestions in this thread about going to a Planned Parenhood Clinic. That might be an excellent option for you. In the nearest city to you where they can schedule you quickly. The $1000 you mentioned, for Phoenix, is probably the fee for the doctor. As others have mentioned, the total cost will probably be far more. If you look at the list of Planned Parenthood Clinics (I think a PP posted a link), look at the nearest ones. Probably in Phoenix, Tucson, Las Vegas, Albuquerque, etc.  I hope that you can get this done, ASAP, and that it will not be done in an E.R.  My wife's OB/GYN is in one of the best hospitals in Latin America and I doubt, very much, that when he is "on call", that he would do a D&C in the ER. I assume he would have the patient taken to a Surgical Suite, if one was available, or wait for one to be available, unless it was an immediate life threatening emergency. Gentle hugs from Colombia! GL

[celticmom]

:grouphug:

[Melissa in Australia]

:grouphug:

[SunnyDays]

Shoe, I just wondered if you had any updates... Thinking of you and hoping you are on the way to being done with this mess. :grouphug:

[Ailaena]

it looks as if planned parenthood could help you, for ~$515-

 

here is a page link where you could find one near you, and phone numbers you can call to ask questions.

 

http://www.plannedparenthood.org/ppaz/online-health-center-4983.htm

 

hth,

ann

 

 

 

 

Just for future reference, at least in Colorado, Planned Parenthood will NOT perform a D&C on a nonviable pregnancy.  And they WILL check via ultrasound, and they WILL turn you away. :glare:

 

 

And to Womanintheshoe, I cannot imagine how difficult it has been for you to wait this long.  I found out I was miscarrying around the same time as you and my dr was so paranoid about infection that he wanted me promise I would come in for a D&C if nothing happened after 2 weeks.  I waited 3 before things happened naturally and it was excruciatingly long.  The strength you have is commendable :grouphug: