Well, we’re heading back to square one. I’ve experienced my second pregnancy loss. It’s been a bit of a roller coaster of emotions but I hope that writing out my experience will help me to deal with all the emotions that I’ve been keeping mostly contained. I’ll warn you now that I’m going to recount the entire experience in all its graphic nature so if you don’t want to read about it, you may want to stop now. I’m doing so for two reasons. First, I feel like writing it out can help me close this chapter in my life and move past it. Second, I hope that anyone reading who is going through the same thing (or deciding which route to take) can gain a better understanding about the whole process and make decisions based on real experiences, not just what the doctors will tell you.
So I guess I’ll start at the beginning. Last Thursday, January 3rd, I woke up to a small amount of spotting. I was a few days away from completing my 11th week of pregnancy at this point. I was a little anxious about it but not terribly concerned. I knew that spotting happened in a lot of pregnancies and most of the time there was nothing to worry about. The blood was a murky reddish brown color which furthered my resolve that there was nothing really wrong. To be on the safe side, I called my OB that morning on my way to work to let her know about it. When I spoke to the nurse, she echoed my thoughts that there’s likely nothing wrong. She said to monitor it throughout the day and if there was another incident of bleeding, to call her back.
I went about my day not thinking too much about it but I still read up on the causes of bleeding in pregnancy and felt relief that there were many things that were completely benign and tried not to think about it too much. Well, the next time I had to go to the bathroom, I noticed that I was spotting a bit more. There was no bright red blood which is the big warning sign that I read about, but there was more of the brownish stuff than there was in the morning so I started to get a little more worried. I called the nurse back and she said that I could either wait it out until Monday when I had my appointment with my OB (my first OB apt for the pregnancy) and they would do an ultrasound then, or I could have her schedule one that day with the radiology department with the hospital. I know that stress negatively impacts my blood sugar levels so I opted for the latter. I just figured that I would get a quick look at the baby and we would be on our way and everything would be fine and dandy. Going into the hospital, I had every confidence that everything was just fine.
When we went back to start the ultrasound, the tech started with the regular abdominal wand. The last ultrasound that we had was at just over 8 weeks and they could see everything that they needed using the external wand. The baby had a heart rate of 187 beats per minute and looked healthy as can be. Using the external wand this time, she started by looking at my ovaries and measuring those and measuring my uterus size and all that regular stuff. I was getting a little impatient waiting for her to start looking at the baby but just laid there patiently. When she started measuring the baby and the gestational sac, I noticed that on the screen the measurements were all in the 9 week range. I was a little worried but I know that sometimes measurements can be off or there can be times of slower and then faster growth so I wasn’t too upset. Then she said that she was going to need to switch to an internal wand. I thought it was a little weird but didn’t think much of it because I’ve had to have them multiple times and figured she just needed a better picture.
After a change of clothes and a trip to the bathroom, we resumed with the internal wand. The measurements were all looking the same on the screen from what I could see. I started to worry a little. Then she put up the colorful map that showed the blood flow inside the uterus. I could see the blood in my ovaries and all around the gestational sac, but I noticed that there was nothing lighting up inside the sac at all. Then she turned on the sound and I could tell that she was trying to get a heartbeat reading. I could see on the screen the white line that previously had lots of little spikes and divots indicating the heartbeat of my little baby but this time it was completely flat. That was it. There was no heartbeat. I had played off the fact that I didn’t see the bright lights of the blood flow and the fact that there wasn’t a lot of movement inside the sac as strange but not indicating anything as being wrong, but that flat white line told it all. My baby was not alive anymore.
The tech finished up and asked me to change back into my clothes. She asked me if I had any questions and I said that I assumed it was bad news since we didn’t see anything. She said that she wasn’t allowed to comment on the results of the ultrasound but that I would be getting the report from my doctor soon and I should follow up with her. Jon knew right away what this meant but I was just in a state of shock and denial. I didn’t really allow myself to understand what the results meant. I waited until the ultrasound report was available to view online later that night. When I read it is when it finally sunk in. The radiologists finding was that the results were consistent with a failed intrauterine pregnancy. That line just stuck with me. I had had a failed pregnancy. Failed. I broke down into tears as I was putting Zoey to bed. I cried quite a bit that night which is good. It took me a lot longer to actually get the emotions out after the ectopic pregnancy. I told Jon that I was emailing in sick the next morning and he took Zoey to daycare and went to work himself, leaving me home alone to process what had happened.
After sleeping in until almost 11, I spent the day scouring the web for information. First, I wanted to find out if there was a possibility that the tech was wrong – if there was some way that the baby could still be okay afterwards and I just needed a second opinion. Phase 1 – Denial. After spending a few hours reading other people’s experiences and realizing that this sort of thing happens a lot more often that I was led to believe, I came to accept that there was no going back, there was no second opinion needed, I just needed to accept the cards as they were dealt to me and move forward.
After I accepted the loss, I started researching my options. I learned that what I had was called a missed miscarriage. My baby had stopped growing but my body didn’t recognize the pregnancy loss and kept on thinking I was still pregnant. I had three options in front of me – wait for my body to miscarry naturally, have a D&C to surgically remove all the tissue or medically induce the miscarriage. My first instinct was to let my body miscarry naturally. I had already started to spot a bit and letting my body do what it was designed to do seemed like the safest option to me. I started looking up people’s experiences with the process and how long it took. For some people, it happened quickly, but for most, it took weeks for the actually miscarriage to happen. That really shook me. I thought about it a lot and I knew that the small amount of spotting and the lack of any red or pink bleeding meant that there was a long ways to go before I miscarried on my own. I also checked my cervix and felt that it was still firm and closed. That confirmed to me that this would be a slow process. I wasn’t sure if I could handle weeks of knowing that my baby was no longer alive but my body was still acting pregnant. I knew that I couldn’t wait it out.
I started looking at the process of a D&C. I know several people who have had them and they all described a quick and relatively painless process. I watched a video of what happens on the internet and read several people’s experiences as well. Most people were very favorable of the process but there were some that were not. Then I started reading about the complications. I saw that there is a risk of fertility issues with later pregnancies and that really scared me. If I was in the unlucky 2% of people who miscarry past the 8th week and hearing a heartbeat plus I was also in the 1% of people who get ectopic pregnancies and the 4% of people with gestational diabetes and the 1% of people who get PUPPPS, who’s to say that I’m not going to be in that small percent of people with fertility issues after a D&C?! The thing that really sealed the deal for me though was the fact that you have to be under general anesthesia for the procedure. I have stopped breathing under anesthesia before (gallbladder/appendix surgery) which the anesthesiologist attributed to my asthma and I also had a horrible upper respiratory infection to boot. I had a hard enough time breathing at the time without pumping my lungs full of chemicals. I was just too scared to go through with the surgery after all that.
There was only one option left after that – a medically induced miscarriage. I thought that I knew what to expect with this because of the ectopic pregnancy and the methotrexate shots that I had to get to end that pregnancy. Boy was I wrong. I read a LOT of information on the web about the process. There were many different ways to administer the misoprostol (cytotec is the brand name) but they all had relatively the same outcome. I knew that it would be painful and intense but it seemed to have a relatively good success rate. I read several stories of people who still had to have a D&C afterwards because of retained tissue so that was a little worrisome, but I resolved to cross that bridge when I got to it.
When I went to the doctor on Monday morning, she laid the three options in front of me and I told her about the research I had done (she was pretty impressed) and that the misoprostol was the best option for me. She was on board 100% with my choice and gave me a rundown of what I was going to have to do. She seemed very concerned with the amount of pain that I would be in. She wanted to prescribe pain killers for me but I’m allergic to opiates so there’s really nothing that I could take. I told her that I would be fine with ibuprofen. She seemed to think that it wouldn’t be enough and pressed me for anything else that I could take. I told her that I had taken tramadol previously and had been okay (opiates depress my respiratory system – morphine makes me stop breathing!) and she wrote me an rx for that and told me to take both because I would need them. I left for the pharmacy and Jon went off to work. I told him that the drugs usually took several hours to start working so he was okay to go so long as he checked in with me often to make sure I was still alive.
I headed off to the pharmacy and then home to start the misoprostol regimen. I started at about noon after eating some lunch. I had read that most people don’t have an appetite after taking the meds so I wanted a full belly first to keep my strength up for the process. I started by inserting 4 pills into my vagina, near the cervix. They were chalky tablets so I knew that they would dissolve over time. I didn’t really feel too much happening for a while – just a few cramps and a little spotting. About 4 hours later, I took 2 more pills buccally (inserted between the cheek and gums). This was a little weird. The pills didn’t feel like they were dissolving very well. I held them in my cheeks for about 45 minutes (which was a long time because I couldn’t talk with them in) and when they still weren’t completely dissolved, I ended up swallowing the remainder. Some of it felt like it was stuck in my gums or my teeth so I swished some juice around and ate a cookie to try to get it all into my system. Shortly after that I felt like things were moving along. I went to the bathroom and had some significant bleeding. I also noticed that two of the half-dissolved pills came out with the blood. I was slightly concerned that they hadn’t fully dissolved, but I figured that since the second dose got things moving, I should be fine.
I continued taking two pills buccally every 3 hours. The bleeding increased over time and several quarter sized pieces of tissue also came out. It kind of resembled pieces of liver. I still had a horrible cough and I noticed that each time I coughed, a bigger piece of tissue would come out. This is one time that I actually was a little thankful to be sick. The cough seemed to be taking some of the work out of it for me. I could usually feel when there was going to be a piece of tissue or a large amount of blood coming down. Each time, I would run up to the bathroom so that it could come out right into the toilet instead of soaking through a pad each time. This worked out pretty well as I’m sure I would be soaking through a pad every 15-30 minutes otherwise. The doctor had said to call if I was soaking through a pad an hour every hour for four or more hours but from all the experiences that I read online, this was completely normal. I knew that I was just getting all the blood and tissue out and that I hadn’t passed the sac yet so I let everything continue and didn’t bother calling.
About seven or eight hours into the process, I started getting much more severe cramps. These weren’t like menstrual cramps at all – these were just like contractions. It started at the top of my uterus and rolled its way down just like when I was in labor with Zoey. I could tell that this was the start of the real miscarriage at this point. I managed the contractions the same way that I did in labor. I tried to relax all the other muscles and not tense up so that I could just let the contraction roll through me. This worked out very well for a few hours. I decided to take a tramadol at this point because I could feel the intensity increasing. By about 9:30 the contractions had gotten to a point that I was no longer able to relax around them to manage the pain. There was no oxytocin to help me mentally through this labor. I had no baby to look forward to to help me through the pain. This wasn’t the same pain with a purpose that labor with Zoey was like. The mental defeat was crippling to my coping .
I decided that since I spent late labor in the tub with Zoey, water was the way to help me through this labor as well. I was going to take a bath but a quick google search said that it probably wasn’t a good idea and advised against by moth doctors because of the risk of infection. I wasn’t in the state of mind to do my usual evidence based research so I accepted that and opted to hop in the shower. At first, just the water running over my abdomen was enough to ease me through each contraction. It was very comforting and I stayed standing in the shower for about half an hour. I soon became exhausted though and found that I couldn’t really stand in the shower any longer but I felt like the water was still helping quite a bit. I switched the shower from the main shower head to the extendable one and sat in the tub with the water running over my stomach. This was a bit of a relief from the effort of standing plus it allowed me to go back into my relaxed mode and let all of my muscles relax around the contractions and just let my body do its thing. I passed quite a bit of blood and tissue while I was in there. I sat there for quite a while just letting each contraction go by but realized that I couldn’t sit in the tub all night waiting for the sac to pass. I was also getting a little cold as the rest of me was all wet and only my belly was getting the warm water. I decided to get out and dry off and find a heat pack. It was about 10:30 PM and I was ready to lay down even though I knew I wouldn’t be able to sleep.
I got out and dressed and still felt the contractions going full force. I started looking for my microwavable hot pack so that I could place that on my stomach and hopefully have the same effect as the warm water. Jon and I searched for several minutes before I found it and I popped it in the microwave for a few minutes. As I was standing in the kitchen waiting for the hot pack to get warm, I felt a big contraction – bigger than they had been up until that time. I started to sway my hips back and forth to get through it. It passed and a minute later came again. I hunched over the counter and swayed my hips again. Then as I curled my back around my stomach, I felt instant relief from the contraction. I felt a large gush coming so I stopped the microwave and ran upstairs to the bathroom. As I sat on the toilet and pulled my pants down, I saw the sac along with tissue and blood on my pad. I picked it up and put it in the sink. I sat on the toilet for several minutes as I felt a large amount of blood come out. I was happy at that moment that we were potty training Zoey because we had flushable wipes on the toilet and I needed quite a few to clean myself up after that. After wiping up all the blood, I washed the sac off in the sink so that I could look at it. It may sound really morbid, but it was kind of neat, for lack a better word, to look at. I could see the fetus floating around in the sac. It was white and almost kind of see-through and the face was a little pointed. It looked like it still had a little bit of a tail. I could tell that this was not an 11 week fetus – it looked more like 7-8 weeks. I didn’t know what to do with it so I just left it on a wipe on the bathroom counter.
I went into the bedroom to tell Jon that I had passed the sac. I told him that I wasn’t sure what to do with the fetus. He asked what I did with it and I told him that it was on the counter. He decided that he wanted to look at it too. I guess that’s what happens when two scientists have a miscarriage – they want to examine it. He thought it was really interesting too. I kind of wanted to look at it some more – maybe open the sac to get a better look, but I realized that I was just trying to use the science to divorce myself from the emotion of the situation and decided that it was a bad idea. Jon said that we should probably just flush it down the toilet. I didn’t really have any better idea but it still seemed so weird to me that I was going to flush my baby down the toilet. I was kind of glad to have Jon do it for me because I don’t know that I would have been able to do it. Jon asked if I had any last words and when I just gave him a bit of a sad smirk, he pulled the lever. I was too exhausted to really have any more emotion after than but we just held onto each other for several minutes before going to bed.
The next morning, Jon told me that he was really worried about me in the middle of the night, unbeknownst to me. Apparently I breathe pretty loudly when I’m asleep and when Zoey woke Jon up in the middle of the night, he looked over at me because he didn’t hear me breathing. He watched to see my chest rise and fall but couldn’t see that either. He reached out and grabbed my arm and I moved around a little. He stopped panicking at that point and went back to sleep. It seems that even Tramadol is enough of a respiratory suppressant for me so I decided not to take any more. I didn’t really need more anyways. After the last contraction that pushed the sac out, I wasn’t in any more pain. Over the next few days, I had some menstrual like cramps but nothing that I felt like I had to take anything for.
I took the next week off of work. Partly to heal physically but mostly because I couldn’t bear the thought of all the people at work that would be pitying me. I also needed a little time to be emotional at all the comments that people left for me on Facebook and the flowers and gift baskets that were sent to me. I had to put away the things that reminded me of what was lost. I put away the maternity clothes that I had been wearing the past few weeks. I didn’t fit well into my regular jeans yet, but somehow wearing my maternity jeans felt fraudulent. I know that it’s irrational, but I would rather wear regular jeans that are too tight. I don’t want to risk looking pregnant and having someone make a comment – I’d rather wear the jeans that try to flatten my stomach.
I’m now exactly one week post-miscarriage and I’m still bleeding a bit. I would say that it’s about equivalent to a light day on a regular period. I will be so happy when I don’t have to wear pads anymore though. I seriously hate pads but I’m not supposed to wear tampons for two weeks because I don’t want to introduce any sort of bacteria into my body while my cervix is open. I’m back at work today and while I’ve had one person tell me that they are really sorry for me and give me a hug, everyone else just seems to be avoiding talking to me. I think that people are just afraid of saying the wrong thing. I am kind of happy to be getting back to a normal routine but at the same time, I was enjoying not working for a while.
One thing that I do have to say is that my work has been incredibly wonderful through the whole thing. I emailed my boss on Monday morning to tell her about the news that I had received and that I would be out of work for a while but didn’t know how long. She was very supportive and told me to take as long as I needed and even gave me three days of paid bereavement leave. She also let me work from home a bit and spread the news around my office (on my request) so that I wouldn’t be mistakenly thought to be pregnant when I returned. My HR department sent me flowers and a nice note saying that they were sorry for my loss and on Friday, my team sent Jon home with a card filled with nice notes from each of my teammates and a $120 gift card so that I could do something nice for myself. I am so luck to work someplace with such wonderful supportive people. It has really helped me to get through all of this just that much easier.
So, looking forward, my doctor told me that it would be best to wait two full cycles before trying again so that the uterus is a pristine environment for the new baby but I also read that just waiting through this cycle wouldn’t pose any undue risk on the next pregnancy. I figure that I’ll just wait it out and see how I feel going forward but we’re not planning on using any sort of prevention method. I am anxious to be pregnant again to regain what I lost but at the same time, I know that the second I am pregnant I will be a nervous wreck. I don’t know that I’ve ever felt so ambivalent in my entire life. I do know that the next time around I’m going to request more labs and earlier appointments and still know that it likely won’t change anything.
Hopefully the next post is good news. Until then, I wish luck and good health to anyone who has read this.
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