Monday, July 2, 2012

A Little Loss

I recently miscarried at 11 weeks into my first pregnancy. I would like to share my experience here, not because I am seeking condolence, and not because I feel like I want the world to know this about me, but because I have been disappointed by the amount of information and discussion on this topic. I know women who have miscarried, but I have not spoken to any of them about the details. Our doctors and our books seemed intentionally vague. The fact is that this is not something people talk about, and I think that is extremely unfortunate. It is especially interesting because this is a surprisingly common occurrence. If you think you do not know anyone who has miscarried, you are probably wrong. I am writing this post to encourage discussion in the chance that it might help one woman, man, or couple.

Disclaimer: I want to share our decisions with you, but want to be clear that I am not advocating that the decisions we made would be right for all women. Every woman is different. Every couple is different. Every situation is different. I would simply like to share our decisions and the associated outcomes. I would also like to ask that if you are in your first trimester of pregnancy, that you not read this. There is no sense in worrying about every possibility. While positive intention may not guarantee the outcome you are hoping for, it is certainly the healthiest way to proceed. 

I took a pregnancy test one day before I expected to start my period after suspecting (and hoping) I might be pregnant. I woke up early that morning and tried to tell myself to wait but simply could not. I took the test, saw two little pink lines, and woke my husband up (much earlier than he prefers to be awake) to share the wonderful news. We lied in bed together for a couple of hours in pure joy.

At this time, I began thinking about the idea of waiting two more months before telling the world we were expecting. The little baby growing in my belly was the only thing I could think about, and it was extremely difficult to prevent it from coming up in conversation with my friends and co-workers. In addition, my body began changing immediately. I was more tired than I could ever describe to you. My breasts hurt so much that I found myself holding them when moving around. (This was especially difficult to try NOT to do at work.) My digestive system came to a screeching halt which affected my eating habits and my waistline. I knew it was bloat, not baby, but either way, I could not wear any of my pants. (After only a couple of weeks I had to purchase bigger bras, and sew a couple of skirts with wide jersey knit waistbands that I could wear to work.) It was very strange to be experiencing all of this, to be so excited about something, and to answer questions like “How are you?” and “What’s new?” with “Good.” and “Not much.” Why do we wait to share this news? Is it because we do not want to have to deliver bad news if things do not work out? Is it because, if we were to lose the pregnancy, we would be embarrassed or ashamed? If we were to miscarry, would we not want the support of our closest family and friends?

After a couple of weeks, I thought, “I know everything is going to be okay” and we decided to share the news with our immediate family members, and a couple of our closest friends. Their excitement fueled our excitement. Their hopes and expectations grew along with ours.

Our routines changed immediately. The baby was the first thing I thought of every morning when I awoke. We began talking about plans relating to our careers... our finances... our home... potential baby names... We began reading pregnancy and birthing books... talking about our ideas and preferences... We chose a group of midwives to work with... I fell asleep every night with my hand on my belly... and if not my hand, my husband’s.

At 11 weeks into the pregnancy, my husband and I arrived at our appointment at which we were supposed to hear that little heartbeat for the first time. After a physical exam, the midwife glided the doppler stethoscope across my belly... for a long time. My husband held my hand. The midwife could not find a heartbeat. She left the room to schedule us for an immediate ultrasound. As I got dressed, I told my husband that I still knew that everything was going to be okay.

We arrived at a strange building and navigated a dark elevator and odd hallways to arrive at the imaging office. It did not feel like a very happy place, and nearly instantly my hopes took a major hit. An older, stocky man performed the first ultrasound. He did not see anything. He asked his female counterpart to come in to do a trans-vaginal ultrasound. She confirmed that it appeared the baby stopped growing at 7 or 8 weeks, and that there was no heartbeat. She left the room. My husband and I cried. I remember him saying “We’re both still alive.”

We went back to the office of the midwives and were met with overwhelming compassion. We were given time to cry and time to ask questions. The midwife explained that nearly 1 in 4 reported pregnancies end in miscarriage. It is very, very common. It was not a result of anything we did or did not do. Imagining all of the things that need to line up for a baby to develop successfully, it is easy to see why it does not always work. It also brings to light that, when it does, it is truly a miracle.

The midwife explained our options. Those options were as follows.

 Expectant Management - Simply waiting for the woman’s body to recognize that the pregnancy has ended and to pass the “products of conception.”

Medical Management - Using medication to speed up the process.

Surgical Management - Scheduling a D and C (dilation and curettage). In this case, the patient is put under general anesthesia, the cervix is dilated, and the uterus is either scraped or a vacuum is used to empty the contents.

We did not make the decision right away. I (we) needed time to process the news. We were told under which circumstances to call the midwives (or go to the emergency room) no matter what time of day (or night). We went home.

Suddenly, I understood why people choose to keep this secret for months. People knew we had this appointment scheduled... people were waiting to hear the good news... and I did not want to talk to anyone. Making those phone calls was incredibly difficult. I desperately wanted the “telling people” part to be over, immediately.

My husband and I cried. We embraced. We poured a couple of drinks. We packed up all of the pregnancy and birthing books, prenatal yoga DVDs, and the baby journal we had started. We talked. And while we were really, really sad, we were also feeling exceptionally grateful to have each other. We love each other. We love our life together. And while we remain completely optimistic about having a baby one day, we knew that even if it were always just the two of us, we would live a very happy and full life together.

After a little while, I decided to lie down. I slept for three hours. I awoke with my hand on my belly. I think this was the hardest moment for me. It was like I had forgotten, and received the news all over again.

I could not sleep that first night. Instead, I lied on the couch and watched sitcoms in an attempt to distract my mind. One of our cats climbed up and stretched out over my hips and lower abdomen and stayed there all night. Cats are amazing. I dozed off here and there. I dreamed many therapeutic dreams. I dreamed that I held a tiny baby in my hand and said goodbye (when I awoke, I felt like I was saying goodbye to this round of hopes and expectations, not an actual baby)... I dreamed about a lot of people, places, and things that I have previously had a hard time letting go of, but was now able to let go of so easily...

The next morning I was still unsure of how I wanted to proceed. As soon as I found out I was pregnant, I began focusing on the knowledge that a woman’s body knows how to handle pregnancy and birth. I knew that if I were to have any success in natural childbirth, having faith in my body and myself was crucial. I desperately wanted to let my body process the miscarriage naturally, as only it knew how. However, I was worried about how long it would take. I work full time and could not imagine sitting in the office wondering if and when it might happen. Fortunately, I have a job which can be performed at home, and so I decided to get ready for work, go into the office, and discuss my situation with my boss.

I recognize how fortunate I am to have a great relationship with my boss, and to feel comfortable enough sharing my situation with him. I, again, was met with great compassion and the flexibility to work from home during the process. I returned home feeling like waiting to let my body handle the situation was the right thing to do. Being home with my husband was especially beneficial in that we could continue talking and healing together.

When the midwife described the natural process to us, she explained that I might feel a little more crampy than a normal period, and that at some point I would start bleeding. She said that given how far into the pregnancy I was, she expected that I would see a large clot, about the size of a golf ball, when the miscarriage was complete. This seemed very manageable. That day I began feeling very crampy, and so I worked from home on the couch and waited.

That night, I had intense anxiety dreams. I woke up in a panic feeling like I wanted to go to the hospital immediately and have the D and C. In that moment, I did not feel like I could wait. Fortunately, I was able to calm myself and go back to sleep.

The next day (two days after hearing the news), I was significantly more crampy than my worst period. Again, I worked from home and waited.

The following day (three days after hearing the news), I woke up feeling even more crampy than the previous day. My husband had meetings to attend, so he left with me knowing he was only a phone call away. By 10:30 AM, the cramping and pressure were so severe that I could no longer sit or lie down. I paced back and forth in the house. I walked around the yard (it was a beautiful day). I squatted in front of my laptop at the coffee table and worked. By noon, I had to focus on my breathing in order to not focus on the cramping and pressure. By 1PM, I felt like I could not be alone any longer. I called my husband, who was thankfully on his way home. By the time he got home, I was vomiting, and the pain and pressure were so strong that I could barely complete sentences. Since this was not how it was described to us, he called the midwives to see if what I was experiencing was “normal.” Now, I know that there is no “normal” when it comes to pregnancy and birth, but we were just looking to see if the amount of pain, pressure, and intensity warranted concern. I also wanted to know how much longer it might take, because I was at my pain threshold, was vomiting (and concerned about dehydration), and knew I was about 30 minutes away from the hospital. I feel the need to add here that I have experienced serious pain in my lifetime, and am not afraid of it. I underwent heart surgery when I was 12 and my body rejected every pain management option offered. I know what pain is, and this was extreme. The midwife did not seem concerned (but was also not terribly reassuring), but explained that, if I wanted to, I could go to the emergency room for pain medication. A little more time went by, and I could no longer stand. I told my husband I wanted to go to the emergency room. 

We got into the car, and began driving. I was kneeling in the front seat, squirming around and breathing heavily. About half way there, I felt a huge gush of fluid... and instantly, the pain, pressure, cramping, and intensity were gone. Gone! I was in disbelief that such intensity could vanish immediately. My husband and I decided to turn around and go home.

When we got home, I sat on the toilet, and my husband and I looked at what had come out. It was gooey-clotty looking material... all added up, about the size of a golf ball, so we assumed that the products of conception had passed. We were told to watch the bleeding closely for the first two hours. I did a little math and realized that I could still make it to my hair appointment (which I always enjoy, and which is extremely hard to reschedule), and I did.

Over the course of the next two days, the bleeding slowed down. The cramping was minimal, and I was grateful to have been able to process the miscarriage naturally. I planned to return to the office on Monday morning.

However, when I awoke on Monday morning, I felt a little crampy, and a little bit of pressure. It was nothing like what I felt three days prior. I paced around the house for about an hour. When the pressure intensified, I sat on the toilet, and mass of tissue came out that was about the size of a lime. I called my husband in to take a look, and we determined that we were now seeing the products of conception that we were expecting. Three days later? With much less pain? I was so confused!

I never advocate looking for medical advice online, but after getting so little guidance from our midwives and our books, my husband and I resorted to it. We found many stories of women whose experiences were much more intense and extended than what they expected based on what they were told by their doctors. I was led to the following conclusions...

When giving birth, contractions act to dilate the cervix. When miscarrying, the cervix needs to dilate in order to expel the products of conception. Obviously, the cervix does not need to dilate as much as when giving birth, but when the cervix is dilating to give birth, it has already been softened (due to hormones) and dilates more easily. When miscarrying, the cervix has yet to be softened... and dilating an unsoftened cervix can be extremely painful. Many women said their miscarriages (within the same timeframe as mine) were more painful than giving birth for these reasons, and also because there is no break between contractions when miscarrying... they are constant. Of course, this was not every woman’s experience. Many women miscarried exactly as the midwife described... just a little cramping. I was grateful to learn I was not alone. I was also grateful to learn that if I reached that pain threshold in miscarrying, that did not mean I would not be able to handle natural childbirth.

Over the course of the next couple of days, the bleeding slowed to next to nothing. I embarked on a previously planned business trip (with air travel), desperately hoping that we were correct in believing the miscarriage was complete.

Two weeks later, we returned to see the midwives. The midwife felt that the size of my uterus indicated that everything was expelled, and that my cervix closed on its own. What a relief! I felt so grateful to have made the decision to let the process happen naturally. The process was healing, on its own. I did not need medical intervention. I did not need to become a patient in a hospital. I did not have anyone else take anything from me. My body knew what to do, and did it. For this, I am extremely grateful.

I have additional thoughts that I would like to share, that I am having a hard time fitting into this story, or forming into their own paragraphs, so here they are...

  • I do not feel like we had a baby who died. I very much believe that the little spirit who will join our family is still hovering around us, waiting for everything to be lined up perfectly before joining us in the material world. 
  • I am glad we shared the news with the people we shared it with. The love and support of our closest family and friends were overwhelming and so very helpful. 
  • I am glad we did not share the news further. Breaking the news was hard. 
  • I am so very grateful for my job and my boss and the flexibility they afforded me. In another situation, I may have been forced to seek intervention. 
  • I am so very grateful that my body knew what to do, however intense and uncomfortable it was. The natural process was healing, and gave me faith and confidence in myself and my body. 
  • I am so very grateful that my husband supported the decision to wait and let things happen naturally... to be willing to examine things scientifically with me and help me determine what was what. 
  • I am so very optimistic about our future family. 
  • I am so very disappointed by the lack of information and discussion about this topic. 
  • I am so very amazed by the wisdom of women’s bodies. 
  • I am so very grateful for my husband and the love and life we share. 
  • My intuition that “everything is going to be okay” was spot on. Not in the way I thought, but spot on. 
This experience was and is one of the most difficult times in my life. At the same time, I have felt far less lost and helpless than I have in previous hard times. I know that this is because of my relationship with my husband, my happiness with our life together, my confidence in myself, in us, and in knowing that the universe is conspiring for us. While the most significant grief occurred in that first week, I still have difficult moments. Again, I am so very grateful for my husband, my family, and my amazing friends for their support. At such an unlucky time, I have never felt more lucky or more grateful.

If you know me (or if you do not), I am happy to talk about this with you. At the same time, please do not feel the need to say something or comment if you do not want to. I am fine. Actually, I am great. And as my intuition told me from the very beginning, everything will be okay.

12 comments:

  1. You my dear are a remarkable woman and a beautiful daughter
    Love Dad

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  2. I've been reading your blog for a while now, but I don't think I've yet left a comment. I feel your pain because I experienced something similar, and I'd like to share. I am at work now, so I'll comment again later. *hugs to you and your husband*

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  3. (I typed a response on my phone, but it did not send for some reason.  Sorry if you get that first comment after this one.)

    I've been following your blog for a while, but I don't believe I've commented before; I'm sorry that it has to be under circumstances like this, but we both went through this motherhood experience, so I would like to share. 

    I miscarried my first baby at 11 weeks, after trying for what seemed like forever (but was really less than one year).  As a biologist, and being in my mid 30s, I knew that there was a good possiblity of losing the pregnancy, so I thought I would be prepared.  I was not.  Without going into the vagaries of the public health care system in Quebec, I had not yet had any prenatal care when the miscarriage began (since we don't always get an OB/GYN visit until the 2nd trimestre), so I did not have anyone to call for advice.  When the contractions started, I knew what was going on but didn't know what to do.  As you said, they are contractions, not "uncomfortable cramps" as you so often hear.  I've delivered two children now and I can safely say they are like early labour!.   

    After three days I was vomiting and couldn't sleep, so we went to ER.  I got to see a doctor at the end of the first day and was sent home with an analgesic so I could sleep.  At the end of the second day, I got an ultrasound and was told the baby was dead, and to go back to the ER and wait for admission.  The next morning, we were back again and waited all day before I finally received a D&C (to add insult to injury, I had to wait in the prenatal admission area with all the happy couples going to get their first ultrasound at 18 weeks.  Nothing like sitting in the midst of that while vomiting and wearing a blood-stained gown).  No follow up, no councilling, no literature.  I ended up with a persistent infection that required 3 follow-up visits to a walk-in clinic, the ER and finally an OB/GYN before it was treated properly.  Then the hospital had the gall to send me a letter soliciting for a donation based on the "professional care I had received during my recent stay".  In a fit of rage that is very unlike me, I wrote something across the front of the letter that I won't repeat here and mailed it back to them. 

    Most people were quite understanding and considerate when we explained to them (we hadn't yet told anyone I was pregnant, but missing a week of work and then all the follow-up trips to the doctors meant we had to talk about it).  Unfortunately, some people said horrible things and they still resonate with me 7 years later.  I was told to consider myself lucky because "I wouldn't have wanted that baby anyway", meaning there must have been a dreadful genetic disorder.  People don't understand that it isn't necessarily the loss of that fetus, but the loss of the hope you held out, and the loss of the potential child you planned for in your head and your heart. 

    I talk about it willingly now whenever the subject comes up for exactly the reasons you express:  there is a silence surrounding pregnancy loss that leaves us alone and unprepared.  I share my story with friends who miscarry, and I talk about my 3 pregnancies whenever new friends ask about my family.  That first baby will always be part of our family history and makes up appreciate our two kids even more (even on the days when they drive us crazy we wonder why we had them!  ;)

    *hugs to you and your husband*  and thank you for sharing your story.  It will get better, but you'll never forget. 

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  4. I too am glad you shared your story, even if it were only on the grounds that it is so hard to find resolution to these losses in the medical setting. I've lost four to five pregnancies to date, each one I've been able to accept but that doesn't mean the experiences were easy. I know that nothing is guaranteed and that life without children isn't a horrible thing to run away from. However, the losses are still hard and being vulnerable to the world in sharing these losses is difficult (I spent my big 30th birthday party in the ER).
    I am now 30 weeks along in my first "viable" pregnancy, and even now I cannot assume all will work out. But I do know that now is a much better time for this child to join us, rather than 7 years ago when I lost my first. *I* am much better for this family.
    Good thoughts sent you way. And thanks again for sharing. <3

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  5. Dori, thanks for sharing.  I'm so sorry you guys had to go through this, but so happy that you have each other to lean on.  We love you guys.

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  6. Thank you so much for the hugs. I am so sorry for your loss and that the health care system failed you in so many ways.  I appreciate you sharing your story more than I can say. I especially love hearing that you now have two beautiful children!  Thank you for your encouragement, your willingness to talk about your experience, and for helping me and others who read this to feel less alone.

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  7. Thank you, Christine. We love you guys, too.

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  8. Somehow, this comment circumvented my comment system (Disqus) and went straight to blogger. I wanted to share the content here:

    "seeks has left a new comment on your post "A Little Loss": 

    I too am glad you shared your story, even if it were only on the grounds that it is so hard to find resolution to these losses in the medical setting. I've lost four to five pregnancies to date, each one I've been able to accept but that doesn't mean the experiences were easy. I know that nothing is guaranteed and that life without children isn't a horrible thing to run away from. However, the losses are still hard and being vulnerable to the world in sharing these losses is difficult (I spent my big 30th birthday party in the ER).
    I am now 30 weeks along in my first "viable" pregnancy, and even now I cannot assume all will work out. But I do know that now is a much better time for this child to join us, rather than 7 years ago when I lost my first. *I* am much better for this family. 
    Good thoughts sent you way. And thanks again for sharing. <3"

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  9. I am so sorry to hear of your losses...  but thrilled to hear of your current pregnancy! I hope that knowing that you are more ready now that you would have been then gives you faith and confidence that this time it is meant to be. Please share the happy news when your little one is born!

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  10. Eh, the internet is a strange place. I was looking for more sewing blogs to follow. I <3 sewing blogs. Yours said a journal of dancing, knitting and sewing. Oooh dancing! Sewing! uh ... I usually crochet rather than knit though.
    Reading your blog, find this post.
    Thankyou for writing it and putting it here for this stranger to read. I've been through the miscarrying thing too many times. Just too many times. And I too have found people just ... it isn't talked about much. Apart from the medical people saying it is Normal, and all that.
    I was quite amazed at how similar your experience of the pain and the pattern of the miscarriage was to some of my times.


    I understand too, that deeply intuitive feeling of everything being alright. I have a little daughter now, another women bore her but didn't want to be her mother. And I'm in an unusual position for an Australian woman that if I want to adopt a child officially I can, due to various reasons. But me and my partner so want our own.
    After the last miscarriage, I just woke up one day with a sense of peace inside. A feeling that maybe I'm just meant to be the mummy of another little child who needs a mummy, like my first daughter did. And that it is all alright.
    Nice to meet you. Thankyou for sharing.

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  11. I stumbled on your blog while browsing around knitting subjects. I lost two babies before having two successful pregnancies. I still think about my two elder children, even though life is busy dealing with the younger ones. There is a huge lack of support and information and a deep unwillingness to talk about miscarriage and mourning. Good luck to you and your husband in the future.

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