1,340,666 women just like me
I would like to have a long and potentially unsettling conversation with you about my uterus.
I went off the pill back in December, mostly because it was making me fat and moody enough that it no longer seemed worthwhile. I started tracking my basal body temperature so that I would know when I was ovulating and when to expect my period each month (being scientifically-minded, I like measuring things. Being mildly obsessive-compulsive, I like knowing what to expect). Scott and I returned to the ranks of those who rely on condoms to avoid pregnancy. The thing is (and it's a little embarrassing to admit that I would let something like this slide), we are disease free, married, and do want to have kids eventually. Suffice it to say that there were occasional lapses in birth control, and these lapses were not generally followed by any sincere secondary efforts to avoid pregnancy. We weren't trying to get pregnant, mind you, but I guess it would be equally accurate to say that we weren't trying especially hard to avoid pregnancy.
Although I typically have very regular menstrual cycles (33-35 days long with a long follicular phase and a short luteal phase), my body decided to play a hilarious trick on me back in April. I ovulated 7 days earlier than usual (on April 7th, if the charting software has any say in the matter), and this ovulation managed to occur just on the tail of one of those lapses in birth control. I figured that it was pretty unlikely that I was pregnant, since I'd read somewhere that even without any birth control whatsoever, couples only have a 1 in 5 chance of getting pregnant. So, I waited. Just for background, my luteal phase (that's the time between when you ovulate and when you get your period) usually runs about 10-12 days long. I waited 13 days, but I still hadn't gotten my period. I took a home pregnancy test, I got a single pink line, but, being the suspicious type, thought to myself, "well, it usually takes about 7 to 10 days for a developing blastocyst to make it to the uterus and implant in the uterine lining. This cheap dollar store pregnancy test only guarantees detection of hcg at levels above 50 mIU, so even if I was pregnant, this test might not be sensitive enough to detect it." So I waited. I'm not actually very good at waiting, and only made it another three days (still no period in sight) before I took another home pregnancy test, on April 23rd. This one came back with two pink lines.
I have to say that I was excited. Fifteen minutes before the positive pregnancy test I was worried, anxious, wondering what we would do if I was pregnant, thinking about how the timing was off, wondering if we would decide to keep the baby. I saw those two pink lines, and suddenly I was thrilled, amazed, imagining myself swelling up, imagining what it would be like to have a family. I saw those two lines and knew immediately that I could never give that baby up.
I like to plan ahead, so back when I went off the pill I had thought about how I would tell the people close to me if I got pregnant. I had bought Scott the t-shirt from ThinkGeek with "DAD" spelled out in the binary code for ASCII, and tucked it into the bottom of a dresser drawer under the sweaters that I never wear. I pulled that out and sat on the bed next to him (it was just 7:30AM at this point) and tried hard to read until my fidgetiness finally woke him up. I told him, "I have something for you," handed him the shirt, and watched while he worked through the puzzle, finally coming up with, 'dad,' and saying to me (with a big smile spreading across is face), "You're pregnant?" After that, it was official, and we confirmed with the doctor (estimated due date: December 30th), we went out to eat, we talked about how we'd deal with the bad timing, argued about where we'd put the baby stuff, and were generally very excited about the whole thing. We decided not to tell very many people, because I knew the statistics--one in four pregnancies ends in a miscarriage. I dreaded the idea of "untelling" a bunch of people, so I kept the news to myself.
From my point of view, the pregnancy progressed about as one might expect. My boobs got bigger, and they were sore. I was tired all the time. I started having some food aversions (there were about two weeks when I just couldn't stomach meat, and got most of my protein from peanut butter, beans, and dairy products). I had crazy sex dreams. Typical symptoms, and none of the worrying, potentially bad symptoms--no cramps, no bleeding (except a little spotting after sex, which was pretty obviously coming from the surface of the cervix rather than some internal source). I ate well, I never drank alcohol, I took a multivitamin every day (and had been since weeks before getting pregnant). I kept a journal in which I wrote to the baby about what I was experiencing. Things seemed to be going well.
I wanted some more information about how the pregnancy was going, so I begged my midwife to schedule an early ultrasound. Early ultrasounds are usually only performed when a woman isn't sure of the date of her last period, and not only did I know the date of my last period, I also had a reasonable estimate of the day I ovulated. There was really no reason to do the ultrasound, except to make me feel better. Still, I have a great midwife, and she scheduled the ultrasound anyway. The appointment was for May 27th, when I'd be nine weeks along. She said, "by then you'll be able to see a nice fetus, with arm buds and leg buds, and we should be able to see the heartbeat."
The appointment was set for 10:15AM, and Scott arranged with his supervisor to have a light route in the morning so he could come with me. I figured that it would be nice to have him there, that way he would get to see our baby for the first time, or else I wouldn't have to be alone if we got bad news.
The ultrasound technician was a nice middle-aged woman, thin and healthy-looking in the way that nurses often are. For early ultrasounds like mine, they usual do a transvaginal ultrasound rather than the more familiar over-the-belly ultrasound, so I had to strip from the waist down and prop my knees up just like I was getting a pelvic exam. The technician inserted the ultrasound probe and oriented everything so that she was getting a good view of my uterus. The screen was oriented so that I could see it from where I was resting.
Now, let me say that, being a big geek, I had gone online to look for pictures of ultrasounds other women had from when they were nine weeks along. In general, it was pretty easy to find the developing embryo--even when detection was most difficult, there was at least a lumpy peanut-looking thing in there that you could interpret as an embryo if you were feeling generous.
I had nothing.
Actually, that's not quite true. I had a big empty space (a gestational sac), just like you see in the ultrasound from a normal pregnancy, but no lumpy peanut. Nothing. Empty.
So I knew something was wrong.
And then the technician started asking those leading questions. "Have you had any pain?" "no." "Bleeding?" "No." "Have you had many other symptoms, like nausea?" "Yes." Meanwhile, she was taking measurements, checking my ovaries for abnormalities. I asked about it. She said that everything looked normal, but said in a wishy-washy way that there was no evidence of an embryo.
Here's the thing: even knowing that one in four pregnancies ends in a miscarriage, I still never really believed that I would be in that 25%.
The technician said that she would fax her report over to the midwives, and that I should go over to talk to them right away. Scott said he'd meet me there (he was in the cable van, and I wanted to move my car anyway because I had accidentally parked in the hotel parking lot next to the office building where the ultrasound clinic was located, and I was worried about getting a parking ticket). We arrived at the midwifery clinic, and were hustled relatively quickly into an exam room. Susan Brown, the midwife who was free at the time, said, "So, what did the ultrasound technician tell you." I told her about the part where there was no evidence of an embryo, and the part that the technician hadn't told me, but I knew from my own research: that this was bad news. Susan confirmed that yes, this was bad news. She asked whether I had ever heard of a blighted ovum. This was one point where I had an advantage because I had been a teaching assistant in a human sexuality class. Although "blighted ovum" isn't exactly a commonly used term, I had heard of it.
Blighted ovum is the term used to describe what happened to me--a gestational sac and (sometimes) a placenta develop normally, but, usually because of some major genetic error (like trisomy, which refers to an extra copy of a chromosome, or monosomy, which refers to a missing copy of a chromosome), the embryo fails to develop past a very early stage. Although the term "blighted ovum" sort of rushes to judgment on the egg, the cause of the genetic anomalies isn't really well known (or, at least, my research didn't turn up anything especially convincing). It could be a problem with the sperm, it could be a problem with the egg, it could be that, chromosomally speaking, both the egg and sperm were fine, but as the blastocyst developed, the chromosomes just failed to replicate and divide appropriately. Regardless, it is generally believed that when a blighted ovum occurs, the egg is fertilized, and very early development is normal enough to allow implantation and often development of the placenta. This is why you get a positive result on pregnancy tests. If both the gestational sac and placenta develop relatively normally, then hormone production will be similar to what is observed in a normal pregnancy, which is why you still "feel pregnant," and may not have any signs of miscarriage. But, for whatever reason, the embryo just stops developing after implantation. Blighted ovum is a very common type of miscarriage, with some sources estimating that 50% of first trimester miscarriages are blighted ova--in other words, about one in every eight women who become pregnant will have some variant of the same experience I had.
So we talked to Susan about what was going on, what we needed to do as a next step, and what we could expect. She told me that it wasn't my fault, that miscarriages are very common, and that there was nothing either of us did to cause this, and nothing either of us could have done to prevent it.
For me, it didn't matter how many people told me that it wasn't my fault (and plenty of people have said just that). I still felt (and feel) guilty. Even though I know it is completely irrational, I feel like I ruined the baby.
At this point, I was reeling. I had started the day so excited, planning on asking for a print from the sonogram to use as a visual aid when I told my friends at work the good news later that day. Since I never had any symptoms suggesting that there was anything wrong, I had no reason to expect something other than a fun afternoon of telling everyone that I was knocked up. I walked into that ultrasound clinic pregnant, and walked out with a depressing, empty sac of nothing taking up space in my uterus and making me feel nauseous and tired. I was depressed and shocked, and it was hard to keep focused enough to ask Susan the appropriate set of questions.
I asked if there was something we could do just to make sure that this was a miscarriage, and so we set up a series of appointments to draw blood to test hcg levels, just to make sure that they were actually dropping. Scott called the supervisor on duty and said he was taking me home (we were lucky, his supervisor that day has four children, so he was sympathetic about needing to go home after getting bad news at an ultrasound appointment). I stopped by my office to pick up my laptop, and managed to avoid crying just long enough to make it to the car. It's a good thing that I've driven the route from my office to the house so many times, because I cried the whole way home, and there were a few points when it seriously compromised my vision.
I want to tell you this. I know that, normally, I keep my emotions to myself. That's because I don't like admitting that I am vulnerable. But I want you to understand how heartbreaking it was to lose the future that I had imagined with the baby that never actual was growing in my belly. I feel empty, and that feeling is reinforced every time I return to that moment when I looked at the ultrasound monitor and saw that there was nothing there. I feel like a failure. I worry that there is something wrong with me, and I will never be able to carry a pregnancy to term. I wonder whether this will hurt my relationship with Scott--what if he's mad because I ruined the baby? What if he doesn't want to be with a woman who might not be able to carry his children? I am overwhelmed with feelings of guilt and disappointment, not just because I think that I must have done something wrong, but also because I didn't just take away the near future I had concocted in which I was a parent, I also took away Scott's imminent fatherhood. There are other things I can articulate--what about the mother's day gifts Scott's family gave me just a few weeks before? What about the congratulatory little gifts--what am I going to do with that rattle, should I give it back to Heather? Should I give Scott's first pair of shoes back to his mom?
There's also a part I can't articulate. That was the part that kept me crying the entire way home. Even if my baby never really existed, even though it was never more than an indistinct blob of cells...that baby, the one that I thought would have Scott's chin and my eyes, and would eventually grow those fat dimpled baby elbows, and ask questions about how plants grow and why things fall down instead of up.
That baby is gone.
That baby is gone forever.
And I need to stop thinking about it.
---
You know, as soon as I saw that second pink line, I revised my plans for what I would be doing for the rest of my life.
I don't think that I've been moping since May 27th, but it does seem to be taking an unusually long time to figure out what my new plans should be.
---
Women who find out that they are having a miscarriage before the miscarriage occurs on its own have a few options for what to do next. They can have a surgical procedure called a d&c (dilation and curettage) to have the remains of the pregnancy surgically removed from their uterus, they can take a medication called mispoprostol to chemically induce uterine contractions, to allow a sort of scheduled miscarriage at home, or they can wait until their body spontaneously ejects the remaining tissue (this is often called a "natural miscarriage"). I had a hard time making a decision between these options. Here's why:
Dilation and curettage: pros--It's over right away (this makes it especially popular with women who have seen their developing baby on an ultrasound, but found out that its heart had stopped at some point. Understandably, many women are uncomfortable with the idea of carrying a dead baby around in their uterus for any length of time.). The procedure is performed in a hospital, so if something goes wrong, doctors will be nearby. If you want to get the removed tissue tested for anomalies, there is less time between the point when the tissue is removed from your body and when tests are completed, so the tests are more likely to be successful. Cons--There is a risk of hemorrhage. There is a risk of infection. Some women are uncomfortable with the fact that this is an abortion procedure. Oh, and there is a chance the procedure may damage the uterus or cervix in a way that makes it difficult or impossible to carry a pregnancy to term.
Misoprostol: pros--You don't have to have your miscarriage in a hospital. You have some control over when your miscarriage occurs, so you can get it out of the way quickly, if that's important to you. Cons--There is a risk of hemorrhage. There is a risk of infection. Misoprostol is the second pill administered to someone who uses the "abortion pill," so you may have to fill out paperwork saying things like, "I am voluntarily terminating this pregnancy," (you can probably imagine why this would be difficult for someone who actually wanted their baby). The cramps induced by the drug can be very intense and painful. Because you are at home, any tissue you collect for testing may be too degraded to produce an accurate result. You may not expel all of the tissue, necessitating a d&c. Oh, and sometimes it just doesn't work at all. You take the pill, and nothing happens.
"Natural" miscarriage: pros--You don't have to have your miscarriage in a hospital. Some women say that you return to your normal menstrual cycle more quickly following a natural miscarriage, so you may not have to wait as long before trying to conceive again, if you are actively trying to have children. If it is uncomplicated, it will be cheaper than a d&c or misoprostol. Cons--There is a risk of hemorrhage. There is a risk of infection. The cramps can be very painful. Because you are at home, any tissue you collect for testing may be too degraded to produce an accurate result. You may not expel all of the tissue, necessitating a d&c. Oh, and there is no way to control when your miscarriage occurs--you just have to wait until your body gets going on its own.
Great.
Since I wanted to wait for the results of the hcg draws, I didn't have to make a decision anytime soon. They did the first blood draw on the Friday before Memorial Day, and those results wouldn't come back from the lab until the following Tuesday. My next blood draw would be on Tuesday, and those results wouldn't be back until Wednesday. So I had at least five days before I needed to make a decision about what to do.
Going into the midwifery clinic on Tuesday for my second blood draw was an experience.
See, the thing with midwifery clinics and OB/GYN offices is that they are filled with pregnant women. And, more than that, because of the typical schedule used for prenatal care, you are more likely to see hugely pregnant women who are close to their due dates than women who only recently found out that they were pregnant. Understandably, the waiting rooms are usually filled with things that will appeal to women who are about to be parents...magazines about parenting, books about breastfeeding, bad artwork featuring images of women with newborns.
I saw a couple come in, and it was obvious they were there for their first appointment--you know, they had just found out they were pregnant? They looked so cheerful, and he put his hand on her knee so protectively. (and how do you stop yourself from shouting, "You just found out you were pregnant? Your period is maybe a week late? Yeah, there's still a one in four chance that you'll never see that baby. There are, what, six pregnant women in this room right now? What makes you so sure you won't be like me in a few weeks, alone with your arms crossed over your pathetic empty uterus, trying to become invisible behind a copy of Newsweek? Congratulations on your 75% chance of carrying a baby to term.")
They called me to the space in the hallway where they do all their blood draws, and I dutifully squeezed the pill-shaped squeeze toy while the nurse executed yet another painless needle stick to get the blood she needed for the next hcg beta test, just a few millimeters from the site of the last blood draw. Then I was sent to chat with Jeanette, who told me that my hcg level from Friday's draw came back at 29,000. Great. I have an empty sac of no baby in my uterus, and my hcg levels are still on the low side of normal. I ask her a question--Scott and I are supposed to go on a trip the following week, which was going to be our last hurrah before the baby, but now will serve as a distraction from the fact that we have no reason for a last hurrah. Is it safe to travel? Will I miscarry while I'm away? We decide that we'll wait until we have the results from today's blood draw, and we'll take another blood sample two days from now just to make sure we know how things are going. But, in the very least, we'll make sure to print out copies of my medical records that I can take with me if I do end up traveling.
I stop by on Wednesday morning to check whether they have the new levels back. They do. 31,000. Great. At nine weeks along in a healthy pregnancy, hcg levels are supposed to be doubling about every 48 hours. With a miscarriage, hcg levels should be dropping from draw to draw. Mine aren't doing either of those things. Apparently, my body still wasn't quite sold on the whole empty gestational sac idea, and thought it would make an effort to continue supporting the sucker at least a little longer.
They put stat on the blood draw from Thursday so that the results would get back from the lab the same day. 25,000. Okay, good. So my body is at least bright enough to notice, eventually, that there is no point in continuing to act pregnant in the absence of a baby. There isn't enough time between the time when we get this number and the time when I'm scheduled to go on vacation, so I get to put off my decision about how to manage my miscarriage for another week. They print out my medical records, schedule an appointment and another blood draw for the morning after my return, encourage me to try to have a good time on my vacation, and send me on my way.
So I was waiting. Still no signs of miscarriage, no cramps, not a speck of blood, nothing. I packed my medical records, a supply of over the counter pain killers, and two sizes of maxi pads just in case. Scott and I boarded a plane and headed to a random island near the Bahamas where Scott's parents have a timeshare.
For the first few days, I swam and snorkled and wore two-piece bathing suits and tried very hard to pretend that nothing was wrong. Then on June 8th I started to bleed, just a little bit. So I cried a little in our room, and figured that this was the beginning of the end. But the bleeding never got any worse. In fact, it got lighter, and although I kept spotting, it was barely even enough to warrant a pad. So I swam and snorkled and wore two-piece bathing suits and tried very hard to pretend that nothing was wrong. And I waited for something to happen. And then we went home.
At my midwife appointment the next day I told Margaret about the spotting, and asked if we should think about scheduling a d&c. I don't like hospitals. I don't like the idea of voluntarily choosing a procedure that may make it impossible for me to ever have kids. But I'd been waiting two and a half weeks already, and I was tired. The problem was that none of my three options sounded good, and I didn't want to pick because I didn't want any of it. What I really wanted was to no longer be in a position where that choice was necessary, because it was hard enough dealing with my failure to have a good pregnancy, and the fact that I couldn't talk to anyone about what was going on because most people never even knew I was pregnant, and even if they did, miscarriage is not something that people feel comfortable talking about. In fact, the closest I usually came to talking about the miscarriage with someone other than Scott or my midwives usually went something like this:
Person in the know pulls a concerned face, and, in a low voice and wearing that facial expression that is supposed to communicate to the viewer that the speaker is prepared to receive bad news, says, "How are you doing?"
I respond with, "Well, it's hard. But I'm still just waiting for everything to happen."
And that's the end of the conversation.
Now this is kind of interesting. No one talks about miscarriage.
This is probably a cultural thing. I read that in Japan there are temples where you can present an offering to honor your aborted or miscarried fetus. Not so much, here.
It's strange, really. We're supposed to immediately shift to a baby-centered lifestyle upon finding out that we are pregnant, taking prenatal vitamins, doing abdominal exercises, setting up prenatal care, taking weekly pictures of your belly so that you'll be able to track the progression of your pregnancy, eating and not eating the appropriate set of foods, talking to your belly. Clearly there is some recognition that this is a potential human being. But, as soon as there is a problem, there is a huge pressure to act as though that would-be human never existed. Really, the only way to comfortably talk about your miscarriage is to find a group of women who have had miscarriages and talk to them. Of course, this task is made more difficult by the fact that even if some of your friends have had miscarriages, you probably don't know about it, because people are discouraged from discussing their miscarriages.
So, it may not be a surprise to learn that one of the easiest ways to find a group of women who are willing to discuss their miscarriages is to go online. I guess the taboo doesn't seem so serious when you can choose to remain anonymous.
From one perspective, I can understand this. It's hard to know what to say--you never knew the child, never bonded with it. You're really just mourning the loss of an imagined future in which that child existed, and that imagined future is probably something pretty personal and difficult for anyone other than you to understand.
On the other hand, with one in four pregnancies ending in a miscarriage, and considering how devastating the experience can be, it seems completely stupid that women are denied the simple reprieve of being able to talk openly about their experience just because no one really knows what to say. Moreover, if we could just get started talking about it, it would get easier and easier, because miscarriage is so common that, before long, even people who had never been through a miscarriage would have a friend or a family member whose experience might provide some shred of insight, hope, or, in the very least, make people a little more sympathetic. Maybe you've never had a miscarriage, but when someone you knew found out that her pregnancy was over, you could say, "My mom had a miscarriage the first time she got pregnant. There was a song that reminded her of the time when she was pregnant, and she always looked a little sad when she heard it. This must be really hard for you, I'm so sorry."
---
I want to talk a little bit more about these statistics. Bear with me.
I've already said this a couple of times now: by most estimates, one in four pregnancies end in a miscarriage. Let me put that another way: for every three obviously pregnant women you see, there is one woman who doesn't look pregnant at all, because she had a miscarriage.
Okay, maybe you don't go around looking for pregnant women, and it's rare to see three pregnant women at once outside of an OB/GYN office.
I bet you know women who have children, though. You know, like your mom, your grandmother, aunts, cousins, sisters, friends. Do you know four women who have children? Because, if you do, there is a good chance that you know a woman who has lost a pregnancy.
How about this: I looked up the most recent statistics I could find for the number of babies that are born in the United States in a year. In 2002, the Census Bureau reported that 4,022,000 babies were born in the United States. If we stick with that one-in-four statistic, there were probably about 1,340,667 women who had miscarriages in the year 2002, and that's just in the United States.
One million, three hundred and forty thousand, six hundred and sixty-seven women.
This is the part where this implicit taboo against discussing miscarriage really bothers me.
I had a miscarriage. There may be one million, three hundred and forty thousand, six hundred and sixty-six women this year who go through the same thing. Despite this, two emotions that have played a prominent role in my own experience of losing my baby are loneliness and isolation.
---
On June 15th, they called me with the results of the blood draw from the previous day--down to 9,000. By now it was Wednesday, and I had to head to Vermont for my cousin's wedding over the weekend. I figured I'd just wait another week, and if nothing had happened by then, I'd get the d&c done, just so I wouldn't have to wait anymore.
I also calculated the average rate at which my hcg level was dropping. I'd read that the role of hcg in early pregnancy is to prevent the uterine lining from breaking down while the fetus is establishing itself, so I guessed that the hcg level would have to get pretty low before I finally miscarried. Although I had no reason to expect that the rate at which hcg levels dropped would be consistent, I figured that a rough estimate was better than none, and determined that if the levels did fall at the same average rate, I would probably miscarry on the 20th or the 21st.
I'd been spotting continuously since June 8th. On the 16th, I started losing some stuff that looked like little gray bits of membrane.
The 16th was also the day that my sister-in-law found out that her baby (due just about a month before mine would have been born) was a girl.
The 16th was a rough day.
By the next day I was back to my regularly scheduled program of barely noticeable spotting.
For the wedding, I packed two outfits. One was the nice outfit I would wear if there were no major changes in the miscarriage department, the other included a long black skirt that would disguise any minor leakage, just in case I happened to start bleeding in the hours leading up to the wedding. I packed the same stash of medical records, pain medications, and feminine hygiene products that got me through my last trip.
I guess I got lucky--the black skirt stayed in the suitcase. I saw family members who I hadn't seen in years, and Scott impressed my grandma and my cousin. We ate at an IHOP that wasn't marginalized by the ubiquity of Waffle House. I talked to a random stranger (actually a close friend of my aunt) about miscarriages during the wedding reception. It turns out that she had one, too. It was a pretty good trip.
On Monday afternoon, I finally started bleeding for real.
Honestly, after three and a half weeks of waiting, it was kind of a relief to have something happen. Intellectually, it helped that this was about when I expected things to start happening based on my rough estimate.
The bleeding was actually pretty light, and the rest of the day was relatively uneventful. Tuesday was when everything went a little nuts.
I suppose I should have guessed--waiting until the next full moon to have a miscarriage is just the sort of unnecessarily coincidental thing that I would do.
I wasn't feeling great in the morning on Tuesday, I was still bleeding and a little crampy, but I went into work anyway. I actually was fairly productive through the first half of the day, but the cramps just kept getting worse, and by the afternoon I was e-mailing my work buddies to let them know that I wasn't going to make it to trivia night that evening. I picked up Scott from work at 4:30PM, and took some pain medication as soon as I got home. I asked him to be in charge of dinner, because the pain was intense enough that standing up wasn't always easy, and it was difficult to maintain coherent thoughts through the periodic spikes in intensity. I only made it to 7:30PM before the pain was strong enough that I took more pain medication. I guess the pain must have been rapidly increasing in intensity, because those pills could have been made of sawdust for all the relief they provided.
I want to say for the record that I am usually pretty stoic about pain. Even my tattoo artist commented on the fact that I seemed to be totally unreactive to the pain of getting a tattoo, even when he was working in a sensitive area.
By 8:15PM I was alternately rolling around on the bed whimpering and moaning, rolling around on the bathroom floor whimpering and moaning, curling up in fetal position in a tub full of hot water whimpering and moaning, and rocking back and forth on the toilet with my face buried in a towel while whimpering and moaning. I felt really embarrassed about the fact that I was unable to control my vocalizations, and I hated the fact that I was so vulnerable, and also that I seemed to be making Scott so anxious. After a while, I got scared that there might be something seriously wrong. The bleeding had slowed down considerably, but the pain just kept getting worse. Rocking back and forth on the toilet seemed to be working out the best for me, so I stayed there. Scott called the midwife on duty and asked whether the stuff I was experiencing was normal, and asked for recommendations about what to do. The midwife called in prescriptions for a massive horse pill of ibuprofen to help ease the muscle cramps, and a smaller dose of hydrocodone for pain control. At some point while Scott was on the phone I decided to check on the state of my vagina and cervix. I wish I had been coherent enough to do that a few minutes earlier, because the combination of intense pain and minimal bleeding made a lot more sense knowing that there was a large lump of tissue that was only half done squeezing its way through my cervix.
A few minutes later, my chunk of tissue, which probably had been my placenta, finally fell out. By feel, it was about four inches long and two inches wide. After it fell out, all I wanted to do was get into the tub, so I did. Scott flushed the toilet while I climbed into the tub, so I never got a good look at what it was that I had just squeezed out of my uterus (my midwife said that it was probably my placenta). The pain was reduced to a manageable level almost immediately, but, of course, with nothing blocking the opening of my cervix (which dilated to about a centimeter just for the occasion), there was no longer anything preventing me from bleeding profusely into the tub. Pretty soon I was comfortable enough to be embarrassed about the whole laying-in-a-tub-full-of-blood thing, and I stood up, drained the tub, showered, and finished dressing just in time for Scott to return with the pain medications the midwife had prescribed.
And that was it.
I've been bleeding some ever since, and I'll occasionally cramp up and squeeze out a nickel or quarter sized blood clot, but it seems like the big chunk of tissue was the main event.
I went in for a checkup with the midwives on Thursday. Got a pelvic exam, and Susan said my cervix was closed, and that she didn't see any extra tissue hanging around, so I should be okay. Hcg levels from the blood draw came back at 625. We'll draw blood every two weeks or so until the level drops below 5 (if it doesn't, it may mean that I didn't lose all of the tissue, in which case I'll need a d&c after all).
I'm glad that my miscarriage is pretty much over. I'm sad. I want to be a mom, but I guess that won't be happening any time soon. I'm scared of getting pregnant again, because I don’t want to lose another pregnancy (and hey, there's still a one in four chance that it'll happen on the next one, so it's certainly possible that I could lose another pregnancy. It sort of makes me wish that I believed in God, because you can't really get mad at statistics.). I'm tired. Plus, the loss of all those pregnancy hormones means that I'm no longer producing high levels of progesterone. Progesterone has a leveling effect on mood, and without it I'm moody and fat, just like when I was on the pill.
I'm sorry if this sounded preachy, or if I disgusted you with the gory details of the miscarriage. The effort of keeping all of the information to myself has exhausted me, and while I'm not looking for a pity party, and I certainly don't want anyone to feel sorry for me, nor do I want anyone to think that I believe that my situation is any harder than anyone else's. But I'm lonely and scared. And I just wanted to talk to my friends.
If you made it through this whole mess you have my sincere thanks. I hope that you are well. I owe you one, so if you ever need to talk, let me know. I think I've got all of my talking out of my system for a while, so I'd probably be pretty good at listening.
I went off the pill back in December, mostly because it was making me fat and moody enough that it no longer seemed worthwhile. I started tracking my basal body temperature so that I would know when I was ovulating and when to expect my period each month (being scientifically-minded, I like measuring things. Being mildly obsessive-compulsive, I like knowing what to expect). Scott and I returned to the ranks of those who rely on condoms to avoid pregnancy. The thing is (and it's a little embarrassing to admit that I would let something like this slide), we are disease free, married, and do want to have kids eventually. Suffice it to say that there were occasional lapses in birth control, and these lapses were not generally followed by any sincere secondary efforts to avoid pregnancy. We weren't trying to get pregnant, mind you, but I guess it would be equally accurate to say that we weren't trying especially hard to avoid pregnancy.
Although I typically have very regular menstrual cycles (33-35 days long with a long follicular phase and a short luteal phase), my body decided to play a hilarious trick on me back in April. I ovulated 7 days earlier than usual (on April 7th, if the charting software has any say in the matter), and this ovulation managed to occur just on the tail of one of those lapses in birth control. I figured that it was pretty unlikely that I was pregnant, since I'd read somewhere that even without any birth control whatsoever, couples only have a 1 in 5 chance of getting pregnant. So, I waited. Just for background, my luteal phase (that's the time between when you ovulate and when you get your period) usually runs about 10-12 days long. I waited 13 days, but I still hadn't gotten my period. I took a home pregnancy test, I got a single pink line, but, being the suspicious type, thought to myself, "well, it usually takes about 7 to 10 days for a developing blastocyst to make it to the uterus and implant in the uterine lining. This cheap dollar store pregnancy test only guarantees detection of hcg at levels above 50 mIU, so even if I was pregnant, this test might not be sensitive enough to detect it." So I waited. I'm not actually very good at waiting, and only made it another three days (still no period in sight) before I took another home pregnancy test, on April 23rd. This one came back with two pink lines.
I have to say that I was excited. Fifteen minutes before the positive pregnancy test I was worried, anxious, wondering what we would do if I was pregnant, thinking about how the timing was off, wondering if we would decide to keep the baby. I saw those two pink lines, and suddenly I was thrilled, amazed, imagining myself swelling up, imagining what it would be like to have a family. I saw those two lines and knew immediately that I could never give that baby up.
I like to plan ahead, so back when I went off the pill I had thought about how I would tell the people close to me if I got pregnant. I had bought Scott the t-shirt from ThinkGeek with "DAD" spelled out in the binary code for ASCII, and tucked it into the bottom of a dresser drawer under the sweaters that I never wear. I pulled that out and sat on the bed next to him (it was just 7:30AM at this point) and tried hard to read until my fidgetiness finally woke him up. I told him, "I have something for you," handed him the shirt, and watched while he worked through the puzzle, finally coming up with, 'dad,' and saying to me (with a big smile spreading across is face), "You're pregnant?" After that, it was official, and we confirmed with the doctor (estimated due date: December 30th), we went out to eat, we talked about how we'd deal with the bad timing, argued about where we'd put the baby stuff, and were generally very excited about the whole thing. We decided not to tell very many people, because I knew the statistics--one in four pregnancies ends in a miscarriage. I dreaded the idea of "untelling" a bunch of people, so I kept the news to myself.
From my point of view, the pregnancy progressed about as one might expect. My boobs got bigger, and they were sore. I was tired all the time. I started having some food aversions (there were about two weeks when I just couldn't stomach meat, and got most of my protein from peanut butter, beans, and dairy products). I had crazy sex dreams. Typical symptoms, and none of the worrying, potentially bad symptoms--no cramps, no bleeding (except a little spotting after sex, which was pretty obviously coming from the surface of the cervix rather than some internal source). I ate well, I never drank alcohol, I took a multivitamin every day (and had been since weeks before getting pregnant). I kept a journal in which I wrote to the baby about what I was experiencing. Things seemed to be going well.
I wanted some more information about how the pregnancy was going, so I begged my midwife to schedule an early ultrasound. Early ultrasounds are usually only performed when a woman isn't sure of the date of her last period, and not only did I know the date of my last period, I also had a reasonable estimate of the day I ovulated. There was really no reason to do the ultrasound, except to make me feel better. Still, I have a great midwife, and she scheduled the ultrasound anyway. The appointment was for May 27th, when I'd be nine weeks along. She said, "by then you'll be able to see a nice fetus, with arm buds and leg buds, and we should be able to see the heartbeat."
The appointment was set for 10:15AM, and Scott arranged with his supervisor to have a light route in the morning so he could come with me. I figured that it would be nice to have him there, that way he would get to see our baby for the first time, or else I wouldn't have to be alone if we got bad news.
The ultrasound technician was a nice middle-aged woman, thin and healthy-looking in the way that nurses often are. For early ultrasounds like mine, they usual do a transvaginal ultrasound rather than the more familiar over-the-belly ultrasound, so I had to strip from the waist down and prop my knees up just like I was getting a pelvic exam. The technician inserted the ultrasound probe and oriented everything so that she was getting a good view of my uterus. The screen was oriented so that I could see it from where I was resting.
Now, let me say that, being a big geek, I had gone online to look for pictures of ultrasounds other women had from when they were nine weeks along. In general, it was pretty easy to find the developing embryo--even when detection was most difficult, there was at least a lumpy peanut-looking thing in there that you could interpret as an embryo if you were feeling generous.
I had nothing.
Actually, that's not quite true. I had a big empty space (a gestational sac), just like you see in the ultrasound from a normal pregnancy, but no lumpy peanut. Nothing. Empty.
So I knew something was wrong.
And then the technician started asking those leading questions. "Have you had any pain?" "no." "Bleeding?" "No." "Have you had many other symptoms, like nausea?" "Yes." Meanwhile, she was taking measurements, checking my ovaries for abnormalities. I asked about it. She said that everything looked normal, but said in a wishy-washy way that there was no evidence of an embryo.
Here's the thing: even knowing that one in four pregnancies ends in a miscarriage, I still never really believed that I would be in that 25%.
The technician said that she would fax her report over to the midwives, and that I should go over to talk to them right away. Scott said he'd meet me there (he was in the cable van, and I wanted to move my car anyway because I had accidentally parked in the hotel parking lot next to the office building where the ultrasound clinic was located, and I was worried about getting a parking ticket). We arrived at the midwifery clinic, and were hustled relatively quickly into an exam room. Susan Brown, the midwife who was free at the time, said, "So, what did the ultrasound technician tell you." I told her about the part where there was no evidence of an embryo, and the part that the technician hadn't told me, but I knew from my own research: that this was bad news. Susan confirmed that yes, this was bad news. She asked whether I had ever heard of a blighted ovum. This was one point where I had an advantage because I had been a teaching assistant in a human sexuality class. Although "blighted ovum" isn't exactly a commonly used term, I had heard of it.
Blighted ovum is the term used to describe what happened to me--a gestational sac and (sometimes) a placenta develop normally, but, usually because of some major genetic error (like trisomy, which refers to an extra copy of a chromosome, or monosomy, which refers to a missing copy of a chromosome), the embryo fails to develop past a very early stage. Although the term "blighted ovum" sort of rushes to judgment on the egg, the cause of the genetic anomalies isn't really well known (or, at least, my research didn't turn up anything especially convincing). It could be a problem with the sperm, it could be a problem with the egg, it could be that, chromosomally speaking, both the egg and sperm were fine, but as the blastocyst developed, the chromosomes just failed to replicate and divide appropriately. Regardless, it is generally believed that when a blighted ovum occurs, the egg is fertilized, and very early development is normal enough to allow implantation and often development of the placenta. This is why you get a positive result on pregnancy tests. If both the gestational sac and placenta develop relatively normally, then hormone production will be similar to what is observed in a normal pregnancy, which is why you still "feel pregnant," and may not have any signs of miscarriage. But, for whatever reason, the embryo just stops developing after implantation. Blighted ovum is a very common type of miscarriage, with some sources estimating that 50% of first trimester miscarriages are blighted ova--in other words, about one in every eight women who become pregnant will have some variant of the same experience I had.
So we talked to Susan about what was going on, what we needed to do as a next step, and what we could expect. She told me that it wasn't my fault, that miscarriages are very common, and that there was nothing either of us did to cause this, and nothing either of us could have done to prevent it.
For me, it didn't matter how many people told me that it wasn't my fault (and plenty of people have said just that). I still felt (and feel) guilty. Even though I know it is completely irrational, I feel like I ruined the baby.
At this point, I was reeling. I had started the day so excited, planning on asking for a print from the sonogram to use as a visual aid when I told my friends at work the good news later that day. Since I never had any symptoms suggesting that there was anything wrong, I had no reason to expect something other than a fun afternoon of telling everyone that I was knocked up. I walked into that ultrasound clinic pregnant, and walked out with a depressing, empty sac of nothing taking up space in my uterus and making me feel nauseous and tired. I was depressed and shocked, and it was hard to keep focused enough to ask Susan the appropriate set of questions.
I asked if there was something we could do just to make sure that this was a miscarriage, and so we set up a series of appointments to draw blood to test hcg levels, just to make sure that they were actually dropping. Scott called the supervisor on duty and said he was taking me home (we were lucky, his supervisor that day has four children, so he was sympathetic about needing to go home after getting bad news at an ultrasound appointment). I stopped by my office to pick up my laptop, and managed to avoid crying just long enough to make it to the car. It's a good thing that I've driven the route from my office to the house so many times, because I cried the whole way home, and there were a few points when it seriously compromised my vision.
I want to tell you this. I know that, normally, I keep my emotions to myself. That's because I don't like admitting that I am vulnerable. But I want you to understand how heartbreaking it was to lose the future that I had imagined with the baby that never actual was growing in my belly. I feel empty, and that feeling is reinforced every time I return to that moment when I looked at the ultrasound monitor and saw that there was nothing there. I feel like a failure. I worry that there is something wrong with me, and I will never be able to carry a pregnancy to term. I wonder whether this will hurt my relationship with Scott--what if he's mad because I ruined the baby? What if he doesn't want to be with a woman who might not be able to carry his children? I am overwhelmed with feelings of guilt and disappointment, not just because I think that I must have done something wrong, but also because I didn't just take away the near future I had concocted in which I was a parent, I also took away Scott's imminent fatherhood. There are other things I can articulate--what about the mother's day gifts Scott's family gave me just a few weeks before? What about the congratulatory little gifts--what am I going to do with that rattle, should I give it back to Heather? Should I give Scott's first pair of shoes back to his mom?
There's also a part I can't articulate. That was the part that kept me crying the entire way home. Even if my baby never really existed, even though it was never more than an indistinct blob of cells...that baby, the one that I thought would have Scott's chin and my eyes, and would eventually grow those fat dimpled baby elbows, and ask questions about how plants grow and why things fall down instead of up.
That baby is gone.
That baby is gone forever.
And I need to stop thinking about it.
---
You know, as soon as I saw that second pink line, I revised my plans for what I would be doing for the rest of my life.
I don't think that I've been moping since May 27th, but it does seem to be taking an unusually long time to figure out what my new plans should be.
---
Women who find out that they are having a miscarriage before the miscarriage occurs on its own have a few options for what to do next. They can have a surgical procedure called a d&c (dilation and curettage) to have the remains of the pregnancy surgically removed from their uterus, they can take a medication called mispoprostol to chemically induce uterine contractions, to allow a sort of scheduled miscarriage at home, or they can wait until their body spontaneously ejects the remaining tissue (this is often called a "natural miscarriage"). I had a hard time making a decision between these options. Here's why:
Dilation and curettage: pros--It's over right away (this makes it especially popular with women who have seen their developing baby on an ultrasound, but found out that its heart had stopped at some point. Understandably, many women are uncomfortable with the idea of carrying a dead baby around in their uterus for any length of time.). The procedure is performed in a hospital, so if something goes wrong, doctors will be nearby. If you want to get the removed tissue tested for anomalies, there is less time between the point when the tissue is removed from your body and when tests are completed, so the tests are more likely to be successful. Cons--There is a risk of hemorrhage. There is a risk of infection. Some women are uncomfortable with the fact that this is an abortion procedure. Oh, and there is a chance the procedure may damage the uterus or cervix in a way that makes it difficult or impossible to carry a pregnancy to term.
Misoprostol: pros--You don't have to have your miscarriage in a hospital. You have some control over when your miscarriage occurs, so you can get it out of the way quickly, if that's important to you. Cons--There is a risk of hemorrhage. There is a risk of infection. Misoprostol is the second pill administered to someone who uses the "abortion pill," so you may have to fill out paperwork saying things like, "I am voluntarily terminating this pregnancy," (you can probably imagine why this would be difficult for someone who actually wanted their baby). The cramps induced by the drug can be very intense and painful. Because you are at home, any tissue you collect for testing may be too degraded to produce an accurate result. You may not expel all of the tissue, necessitating a d&c. Oh, and sometimes it just doesn't work at all. You take the pill, and nothing happens.
"Natural" miscarriage: pros--You don't have to have your miscarriage in a hospital. Some women say that you return to your normal menstrual cycle more quickly following a natural miscarriage, so you may not have to wait as long before trying to conceive again, if you are actively trying to have children. If it is uncomplicated, it will be cheaper than a d&c or misoprostol. Cons--There is a risk of hemorrhage. There is a risk of infection. The cramps can be very painful. Because you are at home, any tissue you collect for testing may be too degraded to produce an accurate result. You may not expel all of the tissue, necessitating a d&c. Oh, and there is no way to control when your miscarriage occurs--you just have to wait until your body gets going on its own.
Great.
Since I wanted to wait for the results of the hcg draws, I didn't have to make a decision anytime soon. They did the first blood draw on the Friday before Memorial Day, and those results wouldn't come back from the lab until the following Tuesday. My next blood draw would be on Tuesday, and those results wouldn't be back until Wednesday. So I had at least five days before I needed to make a decision about what to do.
Going into the midwifery clinic on Tuesday for my second blood draw was an experience.
See, the thing with midwifery clinics and OB/GYN offices is that they are filled with pregnant women. And, more than that, because of the typical schedule used for prenatal care, you are more likely to see hugely pregnant women who are close to their due dates than women who only recently found out that they were pregnant. Understandably, the waiting rooms are usually filled with things that will appeal to women who are about to be parents...magazines about parenting, books about breastfeeding, bad artwork featuring images of women with newborns.
I saw a couple come in, and it was obvious they were there for their first appointment--you know, they had just found out they were pregnant? They looked so cheerful, and he put his hand on her knee so protectively. (and how do you stop yourself from shouting, "You just found out you were pregnant? Your period is maybe a week late? Yeah, there's still a one in four chance that you'll never see that baby. There are, what, six pregnant women in this room right now? What makes you so sure you won't be like me in a few weeks, alone with your arms crossed over your pathetic empty uterus, trying to become invisible behind a copy of Newsweek? Congratulations on your 75% chance of carrying a baby to term.")
They called me to the space in the hallway where they do all their blood draws, and I dutifully squeezed the pill-shaped squeeze toy while the nurse executed yet another painless needle stick to get the blood she needed for the next hcg beta test, just a few millimeters from the site of the last blood draw. Then I was sent to chat with Jeanette, who told me that my hcg level from Friday's draw came back at 29,000. Great. I have an empty sac of no baby in my uterus, and my hcg levels are still on the low side of normal. I ask her a question--Scott and I are supposed to go on a trip the following week, which was going to be our last hurrah before the baby, but now will serve as a distraction from the fact that we have no reason for a last hurrah. Is it safe to travel? Will I miscarry while I'm away? We decide that we'll wait until we have the results from today's blood draw, and we'll take another blood sample two days from now just to make sure we know how things are going. But, in the very least, we'll make sure to print out copies of my medical records that I can take with me if I do end up traveling.
I stop by on Wednesday morning to check whether they have the new levels back. They do. 31,000. Great. At nine weeks along in a healthy pregnancy, hcg levels are supposed to be doubling about every 48 hours. With a miscarriage, hcg levels should be dropping from draw to draw. Mine aren't doing either of those things. Apparently, my body still wasn't quite sold on the whole empty gestational sac idea, and thought it would make an effort to continue supporting the sucker at least a little longer.
They put stat on the blood draw from Thursday so that the results would get back from the lab the same day. 25,000. Okay, good. So my body is at least bright enough to notice, eventually, that there is no point in continuing to act pregnant in the absence of a baby. There isn't enough time between the time when we get this number and the time when I'm scheduled to go on vacation, so I get to put off my decision about how to manage my miscarriage for another week. They print out my medical records, schedule an appointment and another blood draw for the morning after my return, encourage me to try to have a good time on my vacation, and send me on my way.
So I was waiting. Still no signs of miscarriage, no cramps, not a speck of blood, nothing. I packed my medical records, a supply of over the counter pain killers, and two sizes of maxi pads just in case. Scott and I boarded a plane and headed to a random island near the Bahamas where Scott's parents have a timeshare.
For the first few days, I swam and snorkled and wore two-piece bathing suits and tried very hard to pretend that nothing was wrong. Then on June 8th I started to bleed, just a little bit. So I cried a little in our room, and figured that this was the beginning of the end. But the bleeding never got any worse. In fact, it got lighter, and although I kept spotting, it was barely even enough to warrant a pad. So I swam and snorkled and wore two-piece bathing suits and tried very hard to pretend that nothing was wrong. And I waited for something to happen. And then we went home.
At my midwife appointment the next day I told Margaret about the spotting, and asked if we should think about scheduling a d&c. I don't like hospitals. I don't like the idea of voluntarily choosing a procedure that may make it impossible for me to ever have kids. But I'd been waiting two and a half weeks already, and I was tired. The problem was that none of my three options sounded good, and I didn't want to pick because I didn't want any of it. What I really wanted was to no longer be in a position where that choice was necessary, because it was hard enough dealing with my failure to have a good pregnancy, and the fact that I couldn't talk to anyone about what was going on because most people never even knew I was pregnant, and even if they did, miscarriage is not something that people feel comfortable talking about. In fact, the closest I usually came to talking about the miscarriage with someone other than Scott or my midwives usually went something like this:
Person in the know pulls a concerned face, and, in a low voice and wearing that facial expression that is supposed to communicate to the viewer that the speaker is prepared to receive bad news, says, "How are you doing?"
I respond with, "Well, it's hard. But I'm still just waiting for everything to happen."
And that's the end of the conversation.
Now this is kind of interesting. No one talks about miscarriage.
This is probably a cultural thing. I read that in Japan there are temples where you can present an offering to honor your aborted or miscarried fetus. Not so much, here.
It's strange, really. We're supposed to immediately shift to a baby-centered lifestyle upon finding out that we are pregnant, taking prenatal vitamins, doing abdominal exercises, setting up prenatal care, taking weekly pictures of your belly so that you'll be able to track the progression of your pregnancy, eating and not eating the appropriate set of foods, talking to your belly. Clearly there is some recognition that this is a potential human being. But, as soon as there is a problem, there is a huge pressure to act as though that would-be human never existed. Really, the only way to comfortably talk about your miscarriage is to find a group of women who have had miscarriages and talk to them. Of course, this task is made more difficult by the fact that even if some of your friends have had miscarriages, you probably don't know about it, because people are discouraged from discussing their miscarriages.
So, it may not be a surprise to learn that one of the easiest ways to find a group of women who are willing to discuss their miscarriages is to go online. I guess the taboo doesn't seem so serious when you can choose to remain anonymous.
From one perspective, I can understand this. It's hard to know what to say--you never knew the child, never bonded with it. You're really just mourning the loss of an imagined future in which that child existed, and that imagined future is probably something pretty personal and difficult for anyone other than you to understand.
On the other hand, with one in four pregnancies ending in a miscarriage, and considering how devastating the experience can be, it seems completely stupid that women are denied the simple reprieve of being able to talk openly about their experience just because no one really knows what to say. Moreover, if we could just get started talking about it, it would get easier and easier, because miscarriage is so common that, before long, even people who had never been through a miscarriage would have a friend or a family member whose experience might provide some shred of insight, hope, or, in the very least, make people a little more sympathetic. Maybe you've never had a miscarriage, but when someone you knew found out that her pregnancy was over, you could say, "My mom had a miscarriage the first time she got pregnant. There was a song that reminded her of the time when she was pregnant, and she always looked a little sad when she heard it. This must be really hard for you, I'm so sorry."
---
I want to talk a little bit more about these statistics. Bear with me.
I've already said this a couple of times now: by most estimates, one in four pregnancies end in a miscarriage. Let me put that another way: for every three obviously pregnant women you see, there is one woman who doesn't look pregnant at all, because she had a miscarriage.
Okay, maybe you don't go around looking for pregnant women, and it's rare to see three pregnant women at once outside of an OB/GYN office.
I bet you know women who have children, though. You know, like your mom, your grandmother, aunts, cousins, sisters, friends. Do you know four women who have children? Because, if you do, there is a good chance that you know a woman who has lost a pregnancy.
How about this: I looked up the most recent statistics I could find for the number of babies that are born in the United States in a year. In 2002, the Census Bureau reported that 4,022,000 babies were born in the United States. If we stick with that one-in-four statistic, there were probably about 1,340,667 women who had miscarriages in the year 2002, and that's just in the United States.
One million, three hundred and forty thousand, six hundred and sixty-seven women.
This is the part where this implicit taboo against discussing miscarriage really bothers me.
I had a miscarriage. There may be one million, three hundred and forty thousand, six hundred and sixty-six women this year who go through the same thing. Despite this, two emotions that have played a prominent role in my own experience of losing my baby are loneliness and isolation.
---
On June 15th, they called me with the results of the blood draw from the previous day--down to 9,000. By now it was Wednesday, and I had to head to Vermont for my cousin's wedding over the weekend. I figured I'd just wait another week, and if nothing had happened by then, I'd get the d&c done, just so I wouldn't have to wait anymore.
I also calculated the average rate at which my hcg level was dropping. I'd read that the role of hcg in early pregnancy is to prevent the uterine lining from breaking down while the fetus is establishing itself, so I guessed that the hcg level would have to get pretty low before I finally miscarried. Although I had no reason to expect that the rate at which hcg levels dropped would be consistent, I figured that a rough estimate was better than none, and determined that if the levels did fall at the same average rate, I would probably miscarry on the 20th or the 21st.
I'd been spotting continuously since June 8th. On the 16th, I started losing some stuff that looked like little gray bits of membrane.
The 16th was also the day that my sister-in-law found out that her baby (due just about a month before mine would have been born) was a girl.
The 16th was a rough day.
By the next day I was back to my regularly scheduled program of barely noticeable spotting.
For the wedding, I packed two outfits. One was the nice outfit I would wear if there were no major changes in the miscarriage department, the other included a long black skirt that would disguise any minor leakage, just in case I happened to start bleeding in the hours leading up to the wedding. I packed the same stash of medical records, pain medications, and feminine hygiene products that got me through my last trip.
I guess I got lucky--the black skirt stayed in the suitcase. I saw family members who I hadn't seen in years, and Scott impressed my grandma and my cousin. We ate at an IHOP that wasn't marginalized by the ubiquity of Waffle House. I talked to a random stranger (actually a close friend of my aunt) about miscarriages during the wedding reception. It turns out that she had one, too. It was a pretty good trip.
On Monday afternoon, I finally started bleeding for real.
Honestly, after three and a half weeks of waiting, it was kind of a relief to have something happen. Intellectually, it helped that this was about when I expected things to start happening based on my rough estimate.
The bleeding was actually pretty light, and the rest of the day was relatively uneventful. Tuesday was when everything went a little nuts.
I suppose I should have guessed--waiting until the next full moon to have a miscarriage is just the sort of unnecessarily coincidental thing that I would do.
I wasn't feeling great in the morning on Tuesday, I was still bleeding and a little crampy, but I went into work anyway. I actually was fairly productive through the first half of the day, but the cramps just kept getting worse, and by the afternoon I was e-mailing my work buddies to let them know that I wasn't going to make it to trivia night that evening. I picked up Scott from work at 4:30PM, and took some pain medication as soon as I got home. I asked him to be in charge of dinner, because the pain was intense enough that standing up wasn't always easy, and it was difficult to maintain coherent thoughts through the periodic spikes in intensity. I only made it to 7:30PM before the pain was strong enough that I took more pain medication. I guess the pain must have been rapidly increasing in intensity, because those pills could have been made of sawdust for all the relief they provided.
I want to say for the record that I am usually pretty stoic about pain. Even my tattoo artist commented on the fact that I seemed to be totally unreactive to the pain of getting a tattoo, even when he was working in a sensitive area.
By 8:15PM I was alternately rolling around on the bed whimpering and moaning, rolling around on the bathroom floor whimpering and moaning, curling up in fetal position in a tub full of hot water whimpering and moaning, and rocking back and forth on the toilet with my face buried in a towel while whimpering and moaning. I felt really embarrassed about the fact that I was unable to control my vocalizations, and I hated the fact that I was so vulnerable, and also that I seemed to be making Scott so anxious. After a while, I got scared that there might be something seriously wrong. The bleeding had slowed down considerably, but the pain just kept getting worse. Rocking back and forth on the toilet seemed to be working out the best for me, so I stayed there. Scott called the midwife on duty and asked whether the stuff I was experiencing was normal, and asked for recommendations about what to do. The midwife called in prescriptions for a massive horse pill of ibuprofen to help ease the muscle cramps, and a smaller dose of hydrocodone for pain control. At some point while Scott was on the phone I decided to check on the state of my vagina and cervix. I wish I had been coherent enough to do that a few minutes earlier, because the combination of intense pain and minimal bleeding made a lot more sense knowing that there was a large lump of tissue that was only half done squeezing its way through my cervix.
A few minutes later, my chunk of tissue, which probably had been my placenta, finally fell out. By feel, it was about four inches long and two inches wide. After it fell out, all I wanted to do was get into the tub, so I did. Scott flushed the toilet while I climbed into the tub, so I never got a good look at what it was that I had just squeezed out of my uterus (my midwife said that it was probably my placenta). The pain was reduced to a manageable level almost immediately, but, of course, with nothing blocking the opening of my cervix (which dilated to about a centimeter just for the occasion), there was no longer anything preventing me from bleeding profusely into the tub. Pretty soon I was comfortable enough to be embarrassed about the whole laying-in-a-tub-full-of-blood thing, and I stood up, drained the tub, showered, and finished dressing just in time for Scott to return with the pain medications the midwife had prescribed.
And that was it.
I've been bleeding some ever since, and I'll occasionally cramp up and squeeze out a nickel or quarter sized blood clot, but it seems like the big chunk of tissue was the main event.
I went in for a checkup with the midwives on Thursday. Got a pelvic exam, and Susan said my cervix was closed, and that she didn't see any extra tissue hanging around, so I should be okay. Hcg levels from the blood draw came back at 625. We'll draw blood every two weeks or so until the level drops below 5 (if it doesn't, it may mean that I didn't lose all of the tissue, in which case I'll need a d&c after all).
I'm glad that my miscarriage is pretty much over. I'm sad. I want to be a mom, but I guess that won't be happening any time soon. I'm scared of getting pregnant again, because I don’t want to lose another pregnancy (and hey, there's still a one in four chance that it'll happen on the next one, so it's certainly possible that I could lose another pregnancy. It sort of makes me wish that I believed in God, because you can't really get mad at statistics.). I'm tired. Plus, the loss of all those pregnancy hormones means that I'm no longer producing high levels of progesterone. Progesterone has a leveling effect on mood, and without it I'm moody and fat, just like when I was on the pill.
I'm sorry if this sounded preachy, or if I disgusted you with the gory details of the miscarriage. The effort of keeping all of the information to myself has exhausted me, and while I'm not looking for a pity party, and I certainly don't want anyone to feel sorry for me, nor do I want anyone to think that I believe that my situation is any harder than anyone else's. But I'm lonely and scared. And I just wanted to talk to my friends.
If you made it through this whole mess you have my sincere thanks. I hope that you are well. I owe you one, so if you ever need to talk, let me know. I think I've got all of my talking out of my system for a while, so I'd probably be pretty good at listening.