This year I celebrated my third Mother's Day being a mother myself, and it was a good day. My honey made me waffles and we took our son to the aquarium, somewhere he had never been before. We saw jellyfish and played in the water and ate veggie fajitas for lunch. We smiled and laughed and enjoyed being together as a family. And yet, during the quiet moments in between fun and laughter and sunshine, I found myself battling melancholy. I've been successfully keeping sadness at bay for weeks now, but on this oh-so-commercialized holiday celebrating moms everywhere my mind kept returning to one simple fact:
I would be 21 weeks pregnant now, had I not had a miscarriage.
I should have had a nice, well-rounded baby bump, a glowing complexion, the sensation of movement deep in my womb. Instead, my tummy is flat and empty, both physically and figuratively.
"Bonding between mothers and their unborn babies takes place long before others can see that they are pregnant, long before ultrasound can prove that life exists, long before the father and other loved ones can feel the stirrings of young life as the baby kicks and moves within its mother." (from Miscarriage: Women Sharing From the Heart)My second pregnancy had been planned, although I can admit now with only a little trepidation that I felt a bit ambivalent about having another baby. As with my first baby, I conceived within a week or two of trying, and the pregnancy test I took once I was overdue for my menstrual cycle only confirmed what I already knew deep inside. But that doesn't mean I was entirely at peace with my decision. My son, not even two years old yet, still commanded so much of my attention that I had a hard time imagining how another baby could fit into the picture. And while everyone I know with more than one baby has told me, with a knowing and only slightly condescending smile, that of course my heart would expand in order to fit a new little one in its depths, I still had a hard time imagining that I could ever love another baby with every fiber of my being, as much as I love my son.
Still, I embraced my pregnancy and my Bean Sprout (as we lovingly took to calling the baby) with my whole being once it was confirmed. No more trips to Starbucks for Earl Grey Tea Lattes (tall, with soy and just one pump of vanilla, please), no more caffeine at all. I continued taking my prenatal vitamins, which I had been taking inconsistently over the last few years, and I added prenatal DHA supplements. I let myself sleep when first trimester fatigue overwhelmed me, napping with my son during the day and frequently going to bed at night soon after he did. I told my yoga instructors, and by association the other women in the studio where I practiced, and only complained a little about leaving behind inversions, arm balances, and deep abdominal twists. I ate as best as I could manage, considering that I hardly felt like cooking most days, and I worked to add more protein to my diet.
I had a beautiful, empowering home birth with my son, and consequently assumed as soon as we started discussing a second baby that the plan would essentially be the same, just in a new place. (My son was born in Illinois, with a midwife licensed out of Wisconsin, since Illinois doesn't license direct-entry midwives. We now live in California, where the options for a woman interested in natural birth are much, much better.) The local military hospital was never a real option, since I have heard way too many horror stories of women with birth plans completely derailed, and while we briefly discussed the idea of using a birth center, my husband quickly acquiesced to the idea of another home birth without any real opposition. After my first birth, I had a hard time envisioning birthing anywhere else other than in the comfort of my own home. Well, not without true medical need, anyway.
There are only a few midwives in San Diego who accept my insurance for even part of the cost of their services. Fortunately, I already knew the midwives in one of those practices; they attended the birth of the second baby of one of my closest friends, and I had been there as support. Without hesitation, I contacted them, first for a consultation, then to start receiving regular care.
My first prenatal appointment was just before I reached the twelve-week mark. It was a pretty uneventful visit. I had already done the whole pregnancy thing once before, and my ideas about birth matched their philosophies pretty closely. We measured various parts of me, did a pap smear, and took some blood. And we tried to listen to Bean Sprout's heartbeat, but the midwife couldn't find it. She wasn't alarmed, and I tried not to be either. After all, a baby at twelve weeks gestation is pretty darn small, and dopplers are not the most powerful tools in the world.
The midwife offered me a referral to get an ultrasound done, if I wanted one. I had hoped to avoid ultrasounds with this pregnancy; after all, I had not had a single one during my first pregnancy. (Note that I am not against ultrasound, I just did not want one without medical need.) After much discussion with my husband, I decided to schedule an appointment for one, just for the sake of peace of mind.
We came to that decision on Friday afternoon; I resolved to call first thing Monday morning.
On Saturday night, I went to use the bathroom and discovered that I was bleeding. Not a lot, but it was bright, bright red blood, and it frightened me. I noticed then something that I had been willfully ignoring all day. I was feeling crampy, like I do when my period comes.
I knew then and there what was happening, but when the bleeding subsided as quickly as it had begun and the cramping got no worse I tried to reason myself out of it.
I called my midwife the next morning, and she did her best to reassure me. She said bleeding was not uncommon, that it might be nothing. She urged me to get an ultrasound as soon as possible, but didn't think it was worth worrying myself over.
That, of course, is easier said than done. I did worry. I worried all day, as I continued to spot blood off and on. I worried as the cramps persisted. I worried while trying to act normal for my son's sake. I worried as I cried on my husband's shoulder, fearing the worst.
I woke up early Monday, with no doubt left in my mind what was happening. The bleeding was getting worse. The cramps had started coming in waves, eerily reminiscent of being in labor, and I could no longer sleep through them. I had to get up and move. By the time my family was all up, a few hours later, I had abandoned my plans of making an ultrasound appointment at the place my midwife recommended, abandoned even the idea of just showing up at the OB/GYN department of the military hospital. I had to go do something NOW, so I left my son home with his daddy and drove myself to the emergency room.
On some level, I believe I was finally allowing to happen what was inevitable at this point. The mind is a powerful thing, and I think that by going to the hospital I was giving my body permission to start letting go. As I walked from my car to the ER, I felt something... bigger... come out. The ER was, thankfully, pretty empty, and by the time I got back from the bathroom they were ready for me in triage. I was moved into a room and a heplock was inserted into my arm, blood was taken, and the doctors began trying to arrange to get me in for an ultrasound.
Unfortunately, the wait was a long one. A lot of the time that I spent in the ER was pretty fuzzy, but I know I spent a long time in that room, reading the book I had (thankfully) remembered to bring, bleeding onto the bed, and making regular trips to the bathroom, where I bled more and continued to pass clots and pieces of tissue. By the time they finally got me in for an ultrasound, I was starving, having not eaten anything since a very early breakfast, now hours ago. But the doctors wouldn't let me eat and I had not brought any food of my own. The vaginal ultrasound was very in depth, and took what seemed like forever to me. I was bleeding and in pain, and it seemed like such a violation, but I did my best to relax and let them take as many images as they needed to. The technician said barely a word to me the whole time, informing me only that the pictures would be looked at by someone else and someone would come down and talk to me in my room in the ER.
More time passed. I got hungrier. I bled more. I was given water, but nothing else.
At one point, I got up to use the bathroom again. It had been a few hours since my last bathroom trip, and the amount of blood I had lost finally caught up to me. I barely made it to the bathroom, where I bled more into the toilet and passed more tissue. I felt like I was going to pass out. By the time I staggered back to my room, someone had come to change the sheets, so I couldn't just climb into bed. My vision was going black around the edges, and I sank to the ground and put my head between my knees, doing my best to stay conscious. I heard the orderly stop what he was doing, and a few seconds later he hesitantly asked me if I was alright. I told him I felt faint. After a few more seconds, he asked if I needed help. I would have laughed if I could have, at the stupidity of a question whose answer should have been obvious, but instead I just responded yes. I think I even said please. He called in the doctors, then quietly pointed out that, well, my hospital gown had fallen open in the back. I told him I didn't care. I was just fighting to stay conscious at that point.
Moments later, the room was rushed by several doctors and nurses, who had me up and onto the freshly-made bed in short order, tilted with my head below the rest of the body. After hours of slow-but-steady blood loss with no food to replenish myself and no IV fluids, it was really no wonder that I had nearly passed out. They gave me saline, straight from the fridge, which helped with the dizziness but soon had me shivering uncontrollably. And they were out of blankets, so instead I was piled with lots and lots of sheets to help warm me up.
Turns out, nearly passing out is what finally got someone down from OB/GYN to talk to me about the ultrasound. The status: I was, in fact, miscarrying. By the time the ultrasound had been done, my uterus was already pretty much empty; only the empty embryonic sac remained. A quick vaginal exam showed that one more trip to the bathroom would have done away with that, too; the doctor was able to easily pull it out with her fingers. A portable ultrasound machine was brought in, and my womb was shown to be completely and totally empty; no evidence of my pregnancy remained.
And once the sac was gone, the bleeding slowed down substantially. They kept me for a few more hours, for observation and to make sure I was handling the blood loss okay. (I did not need a transfusion, thankfully.) I did not require a D&C or any further kind of surgery to remove anything from my uterus. I was given permission to eat, and a nice corpsman found me graham crackers and juice, which I devoured fiercely. I was given a shot of RhoGAM, even though my bloodwork revealed that I was already isoimmunized and there probably wasn't much point in doing so.
(I have no way of knowing when I became sensitized. I received RhoGAM after my son's birth; was I part of the small percentage for whom the medication did not work? Had I been bleeding for awhile internally before I started spotting? All I know for certain is that any future pregnancy I have will now be classified as high risk. And, consequently, chances are good that I will never have a home birth again.)
And that is my story. A few short days, a lot of blood, and most of a day spent in the ER, and I was suddenly no longer pregnant. Most of my friends had no idea I had been pregnant in the first place, and I've only since told a bare handful about what happened. We had just told our immediate family a few days before, after my midwife appointment, and now had the unpleasant task of informing everyone that Baby #2, our little Bean Sprout, would no longer be gracing our lives in September. I bled for a week, and cried frequently for many more. I don't cry over it very often anymore, but sadness creeps up on me every now and then.
"She was not a bunch of cells to me. She was my child. Though I never met her, not literally, I carried her, and that is an experience unlike any other. The bond grows fiercer the longer the pregnancy, but it is strong from the beginning." (from Three Minus One)Coping with miscarriage has been a whole new experience for me. I understand now how our society has a tendency to minimize it, to expect women to just get on with their lives in short order. I understand that different women are affected by miscarriage in different ways. I know that some women do "bounce back," ready to try for another baby soon after they are physically healed. And I know it's not uncommon at all for women to continue to grieve for their babies for weeks, months, even years afterwards.
I know now that most people have no idea what to say in response to a miscarriage. I know that not too long ago, I had no idea what to say either. When I was in the ER, right after I almost passed out, I remember that one of the doctors spent what must have been at least ten minutes by my bedside, telling me over and over again that it was okay, I would heal, I could have another baby, I could start trying again as soon as I wanted to. I just cried and nodded and acknowledged what he was saying, but deep down I wanted to punch him. Of course I could probably have another baby someday. But I wanted this baby. Even people who I would have thought should have known better reacted by telling me that someday I would have another baby. People who say things like that surely mean well, but it feels like a slap in the face.
What has helped has been talking to people. I have a few friends (that I know of) who have suffered miscarriage in the past, and talking to them has brought me great comfort. Hearing the stories of others helps me feel less alone. Having a sympathetic shoulder to cry on, someone willing to listen while I try to sort through my emotions, helps more than words can express. Having friends who think about me, pray for me, send me messages to check in and find out how I'm coping makes me feel so loved, so understood. I know that I am not the only one who feels this way. I know that it is not unusual for me to still be grieving.
Books have been helpful too, although reading through them has been slow and difficult. Miscarriage: Women Sharing From the Heart helped me to understand that what I was and still am feeling is normal. Three Minus One, which technically focuses more on stillbirth than on miscarriage, helped me to feel less alone. I reread The Big Lie, a book that I reviewed for San Francisco Book Review some time ago, and the grueling statistics within have taken on a whole new meaning. Still on my list is Coming to Term: Uncovering the Truth About Miscarriage, which promises to help me better understand how and why miscarriage happens.
"In the United States alone, over 26,000 couples a year deliver a stillborn child--that is 1 in every 160 births and more than 6 times the number of children who die of SIDS every year.
If one includes neonatal death, which is the death of the child within the first 28 days after their birth, the numbers nearly double to 1 in every 85 births or over 50,000 per year. This is greater than the amount of people who die in traffic accidents across the country each year.
If one goes a step further and includes miscarriages, than 1 in every 4 women and couples have been touched by a loss which still remains silent, misunderstood and ignored by society." (from Three Minus One)At almost ten weeks postpartum, as it were, I still struggle with many different emotions.
I am shocked at how common miscarriage is, shocked that I did not know, shocked that most people are so willfully oblivious to the possibility until it happens to them. Depending on who you ask, anywhere from 10-30+% of pregnancies end in miscarriage. (For the record, miscarriage is the loss of a pregnancy anytime before 20 weeks gestation. And, actually, the technical medical term for miscarriage is "spontaneous abortion.")
I feel an odd, morbid sort of curiosity about whether anybody else I know has suffered a miscarriage. If miscarriages are as common as the statistics say, how many of my friends have had one without me knowing about it? How many of my friends will have them in the coming years?
I feel shame at my body's inadequacy. What happened to the woman who, just a few short years earlier, gave birth fearlessly and powerfully and beautifully in the bathroom of her own apartment? What happened between now and then to leave me so broken, unable to even grow a baby properly, much less give birth to it?
Sometimes, I feel envy. I am jealous of my friends who seem to carry their babies so effortlessly, so securely, so naively in their ignorance of how easily things can go wrong. At times, I am a little resentful towards people I know who had no problems conceiving and birthing a second baby. But really, I do not resent my friends so much as I resent my body for failing at doing the same thing.
But most of all, aside from sadness of course, I feel guilt. I feel guilt that I am somehow to blame for losing my baby. (Was it because I got the stomach flu early in my pregnancy? Was it the raw milk I drank? Too much caffeine in the days before I knew?) I feel guilty because I had misgivings about being pregnant in the first place. I feel guilty that almost all of my baby's remains ended up in the toilet. (I know that this is very common, but still I feel guilty about it. Surely my baby deserved better.) I feel guilty that I have no idea what caused my miscarriage. I feel guilty for feeling as much grief as I do, because surely mothers who deal with stillbirth or multiple miscarriages or persistent infertility have much more of a right to grief than I do. I feel guilty for feeling as much grief as I do, because I already have one healthy son, and I am young and surely I will be able to have another baby someday if I decide to try.
And another effect of my miscarriage? I am certified instructor for Birth Boot Camp, something I pursued after my son's birth because I was so passionate about helping to educate others about their options when it comes to birth. After my miscarriage, I cancelled my upcoming class series, which would have been my first one, because I couldn't bear the thought of being around that many pregnant women. I was struggling with my grief, and I didn't think it would be fair to students to teach when I couldn't give it my all.
I haven't rescheduled. I don't know when I will be ready to think about teaching again. I don't know if I will ever be ready.
"I wanted to disappear and be as silent as my miscarriage had been, for in the end, all that remains is the sound of an aching silence for which there are no words." (from Three Minus One)Miscarriage was awful, is awful. That day was one of the worst days of my life. And yet, in all honesty, I am glad it happened the way it did. Not that I lost my baby, never about that, but that it happened how it did. I miscarried in the same way that I would have (hopefully) eventually given birth: naturally, without medication, with minimal intervention, when my body was ready. I don't know how much time passed between my baby's death and the miscarriage, and I really don't care. I will never know if my baby was just hiding from the doppler during my prenatal appointment or if she was already dead. I like to think I would have been strong enough to hold onto my ideals, to let the philosophies that guided me through birth guide me through loss, but I'm glad I did not have to make that decision. I certainly don't fault women who choose D&C, women who cannot and will not continue to carry death within their wombs, and instead choose medical intervention to end things now, but I am glad I did not have to make that decision.
I had a miscarriage. I am still grieving. I am slowly moving past it, slowly healing, but I will probably always grieve on some level.