Missed Miscarriage

Trigger warning: Discussion of miscarriage, including emotional grief and graphic descriptions of the physical process

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Today, October 15, is Pregnancy and Infant Loss Remembrance Day.

I wanted to make a happy social media announcement this week - the week that would have marked the beginning of my second trimester of pregnancy. Instead, I'm making a different sort of post.

At my eight-week ultrasound at the beginning of September, I learned that I was having a missed miscarriage. Though my body had yet to get the memo, the ultrasound showed that everything was measuring only six weeks and five days along, with no detectable heartbeat. I had no symptoms of miscarriage, and over the next few days, while I researched what might happen next and talked to my doctors, I would still never have any symptoms.

And so I was faced with a series of awful options:

1. Anxiously wait several more days (or weeks) for my body to start naturally expelling what the medical field calls "the products of conception"

2. Take medication to induce uterine contractions to speed along the process

3. Get a D&C - a surgical dilation of the cervix and removal of the uterine contents by suction

I read several accounts online of women who had chosen options 1 or 2 (or been forced to endure them by nature, their doctors, or financial limitations), and knew from their stories that the experience was often physically and emotionally traumatic. For one thing, it would almost certainly include some degree of labor-like pains as I “birthed” into the toilet the blood clots and tissue of what could’ve, in an alternate universe, become an April baby and its placenta. Furthermore, there was a chance I could end up in the ER if I started hemorrhaging or fainting due to blood loss - or that I wouldn’t be able to pass everything naturally anyway, and still end up requiring a D&C to prevent infection. It all sounded horrific, from both a physical and emotional standpoint, and more than anything, I didn’t want to do it.

Option 3 carried its own risks - as any surgical procedure does - but on the whole it seemed the “least awful” to me. At least a D&C would get the physical process over with faster, less painfully, and on my own terms - something I longed for in a situation where I felt like I had so little control about what was happening. (It is worth noting that my husband has health insurance through his work which covered the majority of my D&C, and we have the means to cover what’s likely to be our $1000-1400 out-of-pocket expense. I didn’t have to factor in the financial cost when making my decision - a privilege that I wish every person had when weighing important options about their health.)

I told my doctors I wanted a D&C, and they quickly scheduled the procedure for me, on the day that would’ve-could’ve-should’ve been one day shy of a nine-week pregnancy. My first pregnancy was thus completed in the span of exactly two months, from July 13 to September 13.

Left: At my 6-week ultrasound on August 24 we were told that everything was measuring slightly behind, at maybe 5 weeks 5 days - but that it was common for dating to be off by a day or two that early in the pregnancy, especially if there was a chance it implanted later than expected. The ultrasound tech insisted that she could see a fluttering signaling the beginnings of a heartbeat, and while it was "still too weak" to officially measure the heart rate, she remained optimistic that it was just because it was so early that a day or two can make a huge difference in the embryo's development. We had no reason to believe I would have a miscarriage, and the ultrasound tech spent time showing us which parts were the gestation sac, yolk sac, and fetal pole.

Right: In the two weeks between my early ultrasounds, I watched some of my early pregnancy symptoms lessen or disappear - while other pregnancy symptoms ramped up. Part of me worried that I might be having a missed miscarriage, but as this was my first pregnancy and I had nothing to compare it to, I had no REAL reason to believe that these changes meant anything. Still, I was much more nervous going in to my 8-week appointment on September 7 - and not just because I'd told more people about the pregnancy in the interim and was getting rather attached to the idea of being pregnant and becoming a mom. The ultrasound tech at my 8-week appointment was much quieter, making her measurements quickly and silently. Before she said the words, I already knew. She handed me tissues while I cried. After a moment, she said: "This may seem weird, but would you like a picture?" I didn't think it was weird. I was grateful. And even though I already had one from my 6-week ultrasound, I said yes, I wanted another one.

Pregnancy loss is a grief that is hard to reconcile, with very few answers to explain why, and very few memories or pictures to draw on for comfort. And all of these feelings are compounded by changes in hormones, which come crashing back to pre-pregnancy levels after weeks of steadily rising. I am not often a crier about Big Things - I tend to grieve more silently - but there were days before and after my D&C when I was surprised at how emotional I felt.

There is so much to process - not just the loss of someone you'd never met but somehow started to bond with anyway, or even the loss of potential: what that baby could've been, what our family could have been. There's the fear of what will happen physically: the potential pain and loss of blood if the miscarriage should start to happen naturally, the possible complications of a surgical procedure, and anxieties about how long physical recovery will take. There's the feeling of being cheated out of a joyful pregnancy and birth and sharing that happiness and excitement with the world - and the awkwardness and grief of telling family, friends, and coworkers that you miscarried, many of whom never even knew you were pregnant. There's the loss of the sense of pride and accomplishment in carrying a child to term, giving birth, and becoming a mother. There's envy towards women to whom pregnancy seems to come easily, and anger that I was not one of them.

There's even difficulty readjusting back to a state of non-pregnancy: planning meals for the week that suddenly aren’t restricted by pregnancy diet requirements, re-adopting my pre-pregnancy blood glucose targets, unsubscribing from weekly pregnancy update emails (and trying to ignore all the targeted pregnancy-related ads on my Facebook feed that I couldn’t unsubscribe to), and packing up maternity clothes I purchased prematurely and never got to wear. These mundane tasks might seem like nothing - but they’re not unlike the tying up of loose ends that many mourners go through when a loved one dies: sorting through their belongings, stopping mail, contacting other people or businesses to let them know of the loss, and paying off medical bills.

There's also resentment stemming from never knowing the cause of my pregnancy loss. I never truly blamed myself, but many women do. I’d read so many articles and statistics even before I’d been through my own that I knew miscarriages were caused by unpredictable chromosomal abnormalities; furthermore, I was fortunate enough to hear from many people (including my very kind doctors) that it was nothing I did or didn't do, nothing I ate or drank, and not even anything related to my diabetes, which is generally very well controlled (and a discussion for another time). But that didn’t stop me from WANTING to find a way to hold myself culpable - because then at least there would be a reason it happened, and something I could do differently to prevent a recurrence. Without that, I'm left with the unsatisfactory truth that life and death are unknowable and uncontrollable; I'm left with a loss of innocence for potential future pregnancies and the fear that this could all happen again.

In my particular case, preparing for my D&C, there was also a longing for my pregnancy to "not be taken away" from me, or (to put in other words) for me to somehow find a way to both get the physical process over with as quickly and painlessly as possible while also not being "complicit" in having my pregnancy terminated. Of course, it was already ended, whether I was "complicit" in it or not - my hCG hormone levels were dropping, the “products of conception” were starting to break apart, and my pregnancy symptoms had been disappearing or gone for days if not weeks. But despite all the evidence from blood draws and ultrasound screens, it was still hard to believe that it was over - and hard not to ask the doctors to triple and quadruple check for signs of potential viability.

I'm sure that initial disbelief affects all women who go through a pregnancy loss - denial is one of the stages of grief, after all, and there are undoubtedly women who pass golf-ball sized clots or survive unimaginable hemorrhaging and pain and still hold out hope for the continuation of their pregnancy - but I also felt like it was a hurdle somewhat harder to cross when I wasn't experiencing any of the telltale bleeding or cramping symptoms. Not only was I upset that my body was unable to maintain the pregnancy, I was also angry that it couldn't seem to "miscarry properly" either, leaving me stuck in a horrible limbo.

Getting a D&C was not a decision I settled on lightly, but one I ultimately chose for my mental and physical health. I hoped to at least avoid the worst of the pain and bleeding - and I'm sure that I did, compared to what it could've been - but in doing so, I forgot that getting a D&C was hardly nothing. My post-op paperwork told me that bleeding for up to six weeks after the D&C was not uncommon (mine lasted on and off for about two weeks), and recommended that I take 600 mg of Motrin every six hours as needed for pain. To be sure, there were days when I had very little cramping or bleeding, and no need for Motrin. But there were a few days, more than I had anticipated, where the opposite was the case and I needed that pain medication to get through the day. A D&C is still a miscarriage.

It took three and a half weeks (and seven pokes for blood draws at the doctor's office) for my hCG hormone to get completely back to non-pregnant levels after my D&C, but thankfully only about one week to start to feel like my body was my own again - that I could count on it to look the way I expected it to look, feel the way I expected it to feel, and behave the way I expected it to behave. Even though I'd been early in my pregnancy, my body had still gone through several changes: by 8 weeks, for instance, the uterus has already grown to twice its typical size - which isn't really visible from the outside, but feels and looks very different to the person it's happening to, as things get more crowded in their abdomen. It was such a relief, then, when I started to feel like "myself" again; after weeks of emotional and physical turmoil, it was a comfort to be back in familiar territory. But that relief was also colored with guilt, shame, and anxiety that were hard to dispel. What if my relief meant I hadn't wanted to be pregnant enough, or that I wasn't ready to be pregnant again?

I tried to tell myself that if I had carried this pregnancy to term, no one would fault me for my happiness at seeing my body return back to normalcy - and indeed, that no one would likely fault me for feeling this way after this ordeal, either, and that I was once again being my own harshest critic. I also reminded myself that pregnancy can be difficult to endure even when it’s at its easiest and least complicated - and that I would never accuse another person who hated or feared the physical changes of pregnancy of not loving their child or looking forward to parenthood enough. But it’s hard to rationalize your emotions away, and what ultimately helped me feel better (about this and so many other aspects of the healing process) was confirmation from others going through similar situations that they felt the same way I did - that it was normal to feel conflicting emotions even over things as seemingly innocuous as the speed/ease of digestion, the frequency of urination, or the shape of my stomach in my favorite shirts.

When I was pregnant, I thought about being pregnant nearly constantly - from worries about when nausea might strike and how that might affect how much insulin I should take, to the excitement of planning the paint colors for the nursery. When I learned of my missed miscarriage and all those pregnancy thoughts vanished, I filled the vacuum they left behind with other anxieties: Was that twinge a symptom of impending miscarriage? Will I “make it” to the date of my scheduled D&C? Is it typical to have these cramps and on-and-off bleeding after the procedure? When will I feel normal again? As more weeks passed and my body healed, it was hard to stop obsessing. I wasn’t sure if I should toss aside all my memories of what I’d been through or if I should continue to dwell on them, to mourn, to read online articles about grief.

And if I do let all the thoughts about my pregnancy loss fall away - what should I think about instead, to fill that new vacuum? Is it too soon to start checking my temperature and peeing on sticks in an effort to chart what would likely be an irregular first couple of menstrual and ovulation cycles? Is it unhealthy to keep switching out one obsession for the next - pregnancy for miscarriage, miscarriage for trying to conceive again?

Once enough time has passed, it all starts to feel like it never really happened. It feels weird to say “when I was pregnant” when I have nothing to show for it but a couple grainy sonograms and weeks-old, already-fading memories of early pregnancy symptoms. It feels like something that happened to someone else. That, too, is painful. This was my first and (so far) only pregnancy; this was the closest I ever came to having a child and becoming a mother. Until I get pregnant again, these memories are all I have. And I don’t want to forget them.

Statistically speaking, at least 1 in 4 pregnancies end in loss - and yet, we hardly ever talk about it. It is remarkable, when you start talking aloud about your miscarriage, how many people come back with “me too” - people who you would never know had a miscarriage until you mention yours. To quote Angela Garbes in her amazing book Like a Mother: A Feminist Journey through the Science and Culture of Pregnancy: "Many people are uncomfortable talking about pregnancy loss, so they don't. And it's no wonder - any meaningful discussion of it requires acknowledging death, blood, tears, and items being expelled from the vagina." But just because it's difficult doesn't mean it should continue to be taboo.

I'm choosing to share my story publicly because I want other women who have experienced pregnancy loss to know that they are not alone. Pregnancy loss can feel very isolating - but it doesn't have to be. I am so grateful to everyone who showed me support in the days before and after my miscarriage, including family, friends, coworkers and strangers on internet forums.

I’m also choosing to share my story for my own sake. There is a lot of societal pressure to bury this topic, presumably to save other people a few minutes of feeling uncomfortable or sad, and I often feared that no one wanted to hear any of this - let alone hear me “still” talking about it, weeks later. What can I do, then, when talking or writing helps me, but I feel like I’m not allowed to talk/write about it? Share my thoughts anyway, I suppose, without waiting for other people to give me permission to do so. I still want that outpouring of love and support that I would’ve gotten if I’d had happier news to share today; I don’t deserve it less just because my pregnancy is over too early.

To again quote Angela Garbes: "When it comes to pregnancy loss, there is no script to follow. To help a woman navigate it, you don't need to offer advice or perspective. It is enough to show up, however awkwardly, and be there, to listen." Writing has always been a form of therapy for me. Thank you for listening.