Nonviable Early Twin Pregnancy

Warning: This may get a little rage-filled and preachy

I was five days in to my miscarriage and going to an OB/Gyn for a completely different problem.  We had actually scheduled a pretty simple office procedure about 6 weeks previously.  I was starting to feel like I was healing a little bit.  I could put words to emotions and even mention to the nurse, that my urine pregnancy test would probably be positive because I was in the middle of a miscarriage, without signing or tearing up too much.

-- So while I love OB/Gyns for procedures and high risk pregnancies, for my prenatal care I stuck (and hopefully will get to stick) with my Family Docs and Midwives. --

I knew that he probably knew about the miscarriage since he is apart of the same hospital system as the ER.  But I was hoping to get at least one of my gyn problems taken care of.  I was also hoping to get a copy of my ultrasound read from the ER.   When I was led to a normal exam room and not the procedure room I suspected something was amiss.   Even more curious was the fact that there were no instruments for any procedure prepared in the room.

"Twins, huh?"  The OB/Gyn greets me.  Confused I say " No, Nothing."   We have some mundane conversation about delaying the procedure until we have a repeat ultrasound proving that the Cytotec worked. 

--Cytotec/Misoprostol is a common medication given for incomplete miscarriage, or in medical terms incomplete & missed abortions.  I was given a prescription for 400mg BID x 3 days.  Which is not the dose recommended by anyone as far as I could tell.  I checked ACOG (American College of Obstetricians and Gynecologist) and gave myself the correct 800mg with 1-2 repeats three hours later, which has a 66-99% chance of working --

He checks my uterus, orders the ultrasound and leaves.  My husband and I disappointedly walk out and I ask for a copy of my ultrasound read, for which I have to sign a release of information (ROI).  It is not until I read the ultrasound impression that I find out that I was pregnant with and miscarrying twins.

HOW DID NONE OF THE 4 DOCTORS I INTERACTED WITH NOT TELL ME I WAS MISCARRYING TWINS!

I talked to 2 ER docs. An OB came down in the ER to talk to me, and I stayed in the ER until the radiologist read the images.  My first US showed only a "Single viable intrauterine pregnancy corresponding to 6 weeks and 1 days." I did not mention having a twin pregnancy, which is generally a pretty key piece of information.  None of them felt it was appropriate to tell me what was happening with my body?! 

Devil's Advocate says: "Would it have made a difference given the fact that there were no fetal heart beats?" "They were probably busy and thought someone else told you.  You know how things go at shift change."  " They probably didn't want to make a bad situation worse."

However the primary care doc in me -- the one who has to give bad news on a daily basis, the one who has to translate the actions of other physicians so that patients understand the treatment they received, the one who believes that I am not just a physician but a doctor, which means to teach -- cuts them no slack. 

Why do people feel they can make decisions about other people's body and the information they should know?   This reminds me of all the injustices and decisions the government is trying to make about women's & fems' bodies (here is summary from BOOM Lawyered).  Is it because I'm Black?  We know that Black Women have worse perinatal health outcomes.   If I had not wanted to see my ultrasound read I would not have known that I had twins, which may have ramifications if I do get pregnant again. (And I had to sign an ROI for my own records?!?) This is the treatment I received when they knew I am a doctor; it was incomplete, with incorrect dosing, and extra hoops to jump.  What would have happened if I wasn't one?

There is now an inquiry in the hospital ED and radiology, and my prenatal folks are checking in with their ultrasound tech since they were missed first time.  I need to tell the OB/Gyn that "Twins" is not an appropriate greeting to someone in the middle of a miscarriage.  That is another reason I will not be seeing him if I am fortunate enough to conceive again. 

I would have rather every single one asked me if I knew I was carrying twins, than be set back to the beginning of my grieving process.  I was without words or expression, trying to figure out what went wrong and what I could have done differently.  Again.