What is a miscarriage?
Miscarriage is the loss of a pregnancy in the first 20 weeks. On average, about 15 percent of known pregnancies end in miscarriage, and more than 80 percent of the time, it happens in the first trimester. (This doesn't include situations where you lose a fertilized egg before you get a positive pregnancy test. Studies have found that 30 to 50 percent of all fertilized eggs are lost before a woman finds out she's pregnant because they happen so early that she goes on to get her period about on time.) If you lose a baby after 20 weeks of pregnancy, it's called a stillbirth.
What causes a miscarriage?
Between 50 and 70 percent of first trimester miscarriages are thought to be random events caused by chromosomal abnormalities in the fertilized egg. Most often, this means that the egg or sperm had the wrong number of chromosomes, and as a result, the fertilized egg is unable to develop normally. In other cases, a miscarriage can be caused by problems that occur during the delicate process of early human development — for example, when an egg doesn't implant properly in the uterus or when an embryo has structural defects that don't allow it to continue developing. Since most practitioners won't do a full-scale work-up after a single miscarriage, it's usually impossible to tell why the pregnancy was lost. (And even when a detailed evaluation is performed — say after you've had two or three consecutive miscarriages — the cause still remains unknown in about half of cases.)
When there are chromosomal problems in the fertilized egg, you may end up with a blighted ovum, where a placenta and gestational sac begin to develop but there's no baby inside, either because the embryo failed to develop or stopped developing very early. In other cases, the embryo does develop for a little while but has abnormalities that make it impossible for it to continue to survive and it stops developing before it has a heartbeat. Once your baby has a heartbeat — it's usually visible on ultrasound at around 6 weeks — the chance of having a miscarriage decreases significantly.
2004.06.09 not the way it was supposed to be
Today I had a lovely time in yoga. I managed to remove my anger at Jonathan for leaving the gas tank on empty, making me a few minutes late, and get into the breathing. I felt loose and strong and balanced. I decided to tell my yoga teacher that I was pregnant, so she could help me alter the poses in the future.
I got my favorite "continental breakfast" from Grand Central Bakery, a grilled croissant with swiss cheese and tomato chutney. I drank my herbal tea. I drove Jonathan to work and picked up Everett. I was so productive.
Today was my first visit with my midwife. I loved her; she was like an older, lesbian version of Dr. Burton (my obstetrician with Everett, who went on extended leave the week before I made my first appointment). She checked me out and praised my "exquisite vaginal tone." She advised on how I could reduce the chances of a ceasarean this time around. Restrict my diet the last few months of the pregnancy to keep the baby lean. Do a lot of squatting in the last month to stretch out those exquisite cervical muscles. Stay relaxed, maybe even getting an epidural a little earlier in my labor to keep calm and loose.
The visit had been a long one and I was tired and a little cranky. Jonathan was antsy but supportive. The receptionist had screwed up and never told the nurse we were here. She marked us as a no-show while we waited, and waited, and waited. Then, she was upset at the mixup, and was sending out negativity all over the place.
The new thing in obstetrics is an early ultrasound to "confirm" pregnancy. We wanted to do one, mostly to ease my fears. Every pregnant woman has fears, from the first positive test to the time the pediatrician pronounces the baby "perfect." OK, from the test to the grave, let's face it, the fear never stops.
Somehow I knew right away something wasn't right. I knew, but I couldn't believe. It took her a really long time to find the "kidney bean" sac that the baby swims in. And once she did she kept saying that she was "looking for a heartbeat." Jonathan kept "seeing" it. But she didn't, and she looked more wrinkled than before.
She finally turned to me and started to say that I had to know that, if there was no heartbeat, it wasn't anything I did or didn't do. It wasn't that exercise, or that glass of wine. It wasn't Everett jumping on me in his acrobatic glee. There wasn't anything wrong with me, I had one healthy pregnancy, it wasn't the end of hope.
I didn't understand, or didn't want to. It didn't sink in then. She was ordering another ultrasound, with the more qualified technician. It would have to be tomorrow, they were now closed. She started talking about options. Let your body figure it out. Do a D&C. Take medicine to cause an abortion.
Something deep inside started to quiver. I asked in a small voice if she was doubtful that we would find a heartbeat, even with the bigger machine in the hospital's diagnostic center. She was, very doubtful. She wanted me to be o.k. She was very sorry.
And I knew that she was sorry, that she was my friend, that she wanted to cry for me, a little. And I knew that the hope was miniscule. The baby was only 1 centimeter long, which indicates about 7 1/2 weeks gestation. I should be 8 1/2 weeks along, and I was certain of my date of conception, absolutely sure. I had been charting, I was aware of my fertility. I was so prepared.
But not for this. Jonathan and I prepared to leave, the nurse was now calmer, and I could tell she wanted to hug me. She would call in the morning with our ultrasound appointment.
Jonathan said that he wasn't sad, because he wasn't sure that the midwife was the most qualified possible ultrasound techician. He was hopeful. I didn't want to face his family with the news. I didn't want to face anyone, really, I wished that I could go hide in a hole until the next day. I told my sisters when we picked Everett up, somehow I made it seem like a normal occurrence. They were sure, they said, that the heartbeat would be found. It was just one of those things.
Jonathan made me a pact on the way home, that if it turned out for the worst, that we wouldn't blame ourselves, that we would know that it wasn't anything we did. He made me shake on it. I knew that I wasn't going to blame myself, somehow, but that didn't make me any less sad.
Jonathan's grandma was with us, and when she asked if we learned anything, I said something noncommittal about having an ultrasound the next day. His brothers came over, and one of them brought his new, chatty girlfriend. I made roast chicken and gravy. I tried to hide behind my computer. But the girlfriend kept talking to me, about everything, even when I tried to hide in the kitchen. Finally I just said I was going to bed. I cuddled Everett close, feeling his healthy warmth.
2004.06.10 end of hope
Work was a blur. I spent most of the day taking care of certain things. I stopped the transmittal of email digests from BabyCenter's pregnancy journal. I Googled miscarriage. I was being practical. That's how I deal with crisis, I want to know what comes next. I have to be informed.
I found things that helped, a little and things that didn't help. I discovered that, since my uterus, cervix and the rest of my reproductive workings were so obviously healthy, it was almost certain any miscarriage would be because of chromosomal abnormalities in the fetus. My chances of future miscarriages wouldn't be any higher. I also discovered that there is no resource for grief at eight weeks. No detail of the symptoms of an unrecognized nonviable fetus.
There were lots of people who wrote about multiple miscarriages with years of trouble conceiving, late-term miscarriages, and still births. They wrote about how difficult it was. There are things to remember with the grief process. Don't forget your husband has lost a baby too. You decide whether to remove the gifts purchased for your child. And never, never blame yourself. But those things didn't help me. That wasn't my struggle. I hadn't bonded with this baby, hadn't sung to it or felt it kick. This baby was the size of a pinto bean or a peanut. This baby had never moved its limbs.
I wanted to be hopeful. I left work and Jonathan, and Everett, picked me up. Everett was happy to see me. I was sad and uncomfortable. We arrived at the diagnostic center early, as we were supposed to. My bladder was full. Everett needed his mommy and required that I stand next to him as he slowly investigated the play area. We kept waiting, and waiting. Everett was getting very restless and cranky, as his nap had been interrupted. He needed to run, and Jonathan was being no help.
I'm sad, and tired, and wanted to pee in the worst way, Everett was intermittently screaming, and they kept me waiting. They finally called my name and we walked down a long, long hall.
They couldn't get a good picture with the external ultrasound, anyway, so I got to empty my bladder. Everett was beyond comfort when I went to the bathroom so Jonathan took him out for a run. As the technician found the kidney bean I could hear Everett's occasional scream for mommy in the hall. She couldn't find the heartbeat. She looked again, but no, she was having trouble. She took some more pictures. She called for official backup.
The doctor quietly, without fanfare, confirmed. There was no heartbeat. He gave me the "it's nothing you did" speech, then went silently back to taking pictures of my ovaries, making measurements, clicking and zooming and clicking and moving the little ultrasound paddle. He was very businesslike, but not unkind. I asked my important question: was it true this was an indication that future pregnancies had the same chance of being carried to term? He said it was and added a perfunctory, "I'm sorry."
They called to send me upstairs to the OB office. The midwife wasn't there and evidently a backup OB had been chosen for me. She was the busy one. We waited. And waited. And waited. I tried to keep Everett occupied with toys, and balloons made out of rubber gloves, and going on walks, and reading books. We weighed him and measured him. He was a whopping 37 1/2 pounds, 34 inches. Huge for his age.
What you don't think about when you haven't been there, is that OB/GYN offices are terrible places for women whose babies have died silently inside their belly. Statistically speaking, you are far more likely to encounter very pregnant women there than anyone else. I did the math in my head. Women in their eighth and ninth months of pregnancy, with their weekly checkups, are 52 times more likely to be there than, say, a woman on her annual visit, or a newly pregnant woman like I ... was.
Once you receive the terrible news you should be whisked away to a special, quiet place without books on spiritual childbirth, calls from labor and delivery, or women with giant bellies. You shouldn't have to endure that, not when the emotional wound is so raw.
The doctor came in and I knew right away I wouldn't like her. This, I thought, is the woman who is going to lead me down the road to miscarriage. She wasn't in any way my soulmate. She was clinical and pressed for time. She answered my questions, sure, but without any sense of loss. She gave me the options. I said I didn't want a surgery, if I could help it. She left me to make an appointment in a week to see what happened.
It wasn't until the nurse practitioner, consulting on the time of my next visit, made a comment about the good results of the abortion pill in the "clinic" where she had worked that I realized the doctor hadn't understood that was what I wanted. One thing I knew was that I couldn't let the kidney bean remain in my belly, still and lifeless. I couldn't have a clinical abortion, if I could help it, that would be too terrible. But I also couldn't go around letting my body believe I was pregnant for a week, or more, just walking around with a dead baby there inside me.
So I spoke up, asked for the medicine, and the nurse practitioner brought me into another room with the pills and the paperwork. I had to read a checklist and initial each one. Since the pill was typically used for elective abortions, I had to agree to things like, "I have asked to end this pregnancy and understand that this is an abortion," or something. I had to agree to come back for a follow-up visit. I had to understand that I might vomit, or have diarrhea. I had to know that this was just like birth, but not nearly so hard, but way, way harder.
The nurse, who had obviously been through this many times, mostly for elective abortions, was knowledgeable and more compassionate. She told me that the baby was too small to be seen by the naked eye, that I wouldn't know what was baby and what was placenta and uterine lining. She walked me through everything. She gave me explicit instructions and patted my hand.
We had been at the hospital over 3 1/2 hours, to learn something I already knew, deep down. I tried to be normal, that night, we took Jonathan's grandma to the farmers' market, we cooked hamburgers with new shallots and Early Girl tomatoes and ate raspberries with cream. I didn't really want to think about it, too deeply. It was over, but it wasn't.
It was too late that night, after Jonathan's grandma went to bed, that I cried. I cried for the pregnancy that I wanted so badly, whose timing was so excellent. I cried for my little girl that we had already described as a fiery redhead. I cried because I didn't want to do this, this pain and discomfort, for something bad. It was ok to have cramps and heartburn and diarrhea and nausea for something good, for a healthy baby. It wasn't ok to have it for the end of a little miracle, the baby who wasn't meant to be, my hopes dashed, a life unlived. I wanted to cry forever, but I couldn't.
2004.06.11 numbness and fear
I let myself sleep in, and thought about emailing my boss and telling him I wasn't coming in, that I had miscarried. But I was ok, Everett needed to be with his nanny, I went to work. I got things done, there was no point thinking about it too much. Besides, I didn't want to have to tell anyone, yet, so it made sense to think about work, not pain.
When I got home, I called my sister and my mom and told them. Hannah seemed to know what to say, and my mom, oddly, didn't. She had five successful pregnancies, though, with no miscarriages, so how should she know? It was easier for her. I let Everett watch Dora over, and over, and over again, 8 or 9 times.
As the pills start with an oral pill that tells the pregnancy hormone to stop working, I had started bleeding a little during the day, but hadn't had much pain. Every trip to the bathroom was a little heartbreak. Every bit of blood was a loss. I waited until Jonathan got home from work to take the mega pills that start the miscarriage. When I put them in my lungs seized up.
I didn't want to do this, I was afraid, I didn't know how it would be, if there would be terrible pain, if the contractions would hurt awfully, if I would be on the floor in tears. I didn't know how to get through this. I was following the instructions mechanically up until now, and I couldn't believe how much the final step terrified me.
I asked Jonathan to come to bed with me, and curled up with my oldest pajamas and a cup of tea. I fell slowly asleep.
2004.06.12 blood and tears
The morning came with a trickle, then a gush. Around 10 a.m., when the Rose Festival Parade started on television, I think I lost the placenta. The toilet water was dark red with blood every time. The cramping was a dull, squeezing pain entirely unlike my labor contractions, much less defined, much more sinister. I hated it, every minute.
This whole time I had been working on a gift for my sister-in-law, whose baby shower was today. I had promised to make a mattress cover for the Gilbert family cradle, which was mine when I was a baby, and Everett slept in two summers ago. I knew the pain was entirely bearable. I had decided to go to the shower, anyway. I didn't want to tell her I couldn't go. Even in my grief I wanted to be happy for Destiny, happy for the little cousin on the way. And I knew I couldn't sour her happiness, not now, not the day of her shower, with only days remaining in her pregnancy.
So I went, with Everett, and it was a truly bad idea. The pile of gifts was several times the size of her very large belly. She is a doula, and several of her clients were there, with their new babies. Her midwife was there. Her pregnant friends were there. Everyone was there, and the joy and anticipation were at a fever pitch.
Not only was I sad for my lost baby in the face of this happy shower, a shower like I so wanted to have six months from now, but the shower was so, so vastly much better than Everett's. My baby shower, held less than a year after I left all my close friends on the East Coast and moved back to Portland, was attended by three family members and three not-so-close friends. People I liked, to be sure, but not the ones with whom I really had hoped to share this day. My gifts were nice but sparse. It was decidedly not feverish.
The worst was Destiny's mom, who I usually love, and who this day was giddy with happiness. Her hilarity would have been infectious, was I capable of catching such a bug. I was not, and wanted to sink into a dark corner. Everett, who always picks up on my moods, was clingy and kept screaming because I wouldn't let him play with the breakables, or take him on a run up and down the street. My mom took him, a couple of times, to play but it wasn't enough.
By the time the last gift was opened, I was exhausted mentally and physically, and had to carry Everett screaming into his car seat. As we drove away, Everett fighting desperately to get out of his shackles, tears started streaming down my face. Somehow the last thing I could face was going home alone with him. But he made me laugh, finally, with his excitement over fire trucks and trees and buses and it was, a little, better.
I was so tired that I changed Everett and got out his toys and napped fitfully on the couch while he played with his cars and his blocks. At 7:30, far before his usual bedtime, he settled down with me and a bottle and fell quickly asleep.
After a little more rest, I gathered up the toys and the nerve to sit down at my computer. I composed, slowly, carefully, an email to the closest of my friends, the ones who had to know. I let it get out, a little bit. But more, much more needed to come.
I had to ask questions, of people who didn't have answers. How do you grieve for such a loss? I didn't even talk to the baby, I couldn't really see anything that distinguished it as a baby on the ultrasound. It was a blob, I blob I never felt kick or read poetry to. A blob that I would never see in life or death. A blob that must already have passed, unmarked, into its watery grave.
But I had come to that place, of pregnancy, of glowing expectation. I had brought out my skirts with the elastic waists and bought some new maternity clothes. I had made an email alias for the baby, and started the pregnancy blog. I had thought deeply about the birth, I had yearned for that urge to push. I had felt the pangs of a growing uterus, the pain, discomfort, the constant presence.
Every little thing was too much. I didn't take my prenatal vitamins, even though my doctor recommended it for the blood loss. I didn't take care to eat fruits and plenty of calcium. I avoided yoga, started for a healthy pregnancy. When I started to make a pot of coffee, wondering why I hadn't made one in so long, I immediately regretted the thought - I haven't felt in the mood for that much coffee in over a month.
When pregnant, I have this feeling of entitled superiority, this happy certainty with every wave of nausea, every twinge of the intestine. I am pregnant, I would think, that's my strong, healthy body growing into itself. I would look at my small, but clearly growing belly with pride. I would hold my belly at night in bed like a separate living thing. I would touch it with a special honor.
And now, the pain, the nausea, are for naught. I don't want this belly, anymore, it doesn't mean hope or life or miracle now. I wonder if it will go away, quickly, I can only hope for that. I wonder how long it will take to get pregnant, again. I wonder if I can endure the return to tampons and pregnancy tests. I wonder if I will know how to be happy in the first eight weeks. I wonder if I will know who to tell.
I don't even know what I need. I can't deal with Everett, all the time, but I need him, his endless hugs and kisses, his very being a reminder that there is life, and hope, and happiness still. I do have a healthy bundle of joy, I have such a sweet little person, he fills me with love and security. But I have more to give, I want more, I want a huge happy family with a baby, a tiny little baby that will grow into a playmate for Everett and a little sister, or brother, for him to watch over with that sweet way of his. I need that baby, I don't understand why it was taken away.
2004.06.13 the end of things
Today, I decided to write about my journey publically. Well, I decided almost immediately, but I did it today. Writing is how I grieve. Maybe it will help me to come to terms with what has happened. Maybe it will be the acknowledgement I need.
When I removed the baby from my BabyCenter "family," they gave me lots of links on miscarriage. It wasn't any consolation.
I think my least favorite thing about this whole experience is that there wasn't any time, any warning or adjustment period. At noon I was pregnant and glowing with 32 weeks of growing belly before me. By 4 p.m. I was not. It was over, with no signs or slow realization or time to prepare. It was over, gone, before I even knew to ask. For some reason I had never thought about this type of miscarriage, the fetus just not continuing, its tiny heart stopping before it could even be seen. I was pregnant, and then I was not. My body didn't even know.
There are lots of things to be thankful for. I can get insurance now (you can't, when you're pregnant, I discovered). I can go running. I can wear my leather pants and my skinny Dolce & Gabbana jeans all summer. I can, let's see, drink myself to oblivion. I can go for days without salad. I can take pain medication and chug gallons of coffee for breakfast. But I don't want to drink and I'd rather feel the pain. I want my pregnancy back, but it's gone, whisked away in the blink of an eye. And it's the waiting I wanted to be over, the months of regaining my uterus lining, the slow days from ovulation until the hormones show themselves, then the entirely new agony of the first 12 weeks, wondering every day if this will be the 80% or the 20%. I can't take the waiting.
I don't know if this has helped or hurt. I've gone from numbness to terror to dull pain in the hours and hours of writing, editing, not getting it right. Perhaps it can be revisited, in a week, a month, when the next baby comes. Maybe I can grieve properly now. Maybe this is my grief, my distress, my loneliness, my song, my poem, my tragedy. Maybe this is the only way.