TW/spoiler alert (though the title was a giveaway): post contains details around miscarriage, child loss, etc. If you’re pregnant, feeling trauma from your own loss, or have loved and lost in a way that would make you feel uncomfortable reading this, please stop. Your heart doesn’t need this. Take care of yourself. You have all of my love, just the same.
Also: never meant for this blog to morph into an anxiety journal - like some sort of captain's log on the good ship adulting - but here we arrrrreeee.
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The below encompasses several very long weeks. Having added to this post at various points of this process, it's obnoxiously long, and I straight-up didn't feel like editing myself down this time - so please be generous in your reading. And, um, I’ve been going through a thing so… don’t be a dick.
This is laced with some flippant remarks and bits of levity. It's a coping mechanism. I am not trying to minimize or make light of anyone else’s trauma or loss, I promise. As every birth story is unique, so is every pregnancy journey. Your story is your own, and it matters. And you don't owe anyone your trauma. In a world of oversharing, you decide what you are comfortable telling others, periodt. I'm sharing our story, knowing it's one of many, and that many will never be shared. Sending love to all.
I want to say off the bat: I’m okay. Really. I’ll explain, but, just know I’m alright, friends. We are alright.
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The Odds May Not Ever Be in Your Favor
One in four. It’s the kind of stat that you’d hear and think “that’s really high!” If you were told you had a one in four chance of getting struck by lightning, you’d probably be a lot more afraid of storms. And while it’s not actual lightning, it can strike in a way that’s just as shocking… a miscarriage.
One in four pregnancies end in miscarriage.
A miscarriage is defined as a spontaneous loss of a pregnancy before the 20th week. You’ve probably had many people you know wait to tell people about their pregnancy until after they were “in the clear” – given that the risk of a miscarriage drops drastically after week 12. People are afraid to share the news, knowing there’s such a risk of loss. I used to not understand, but in my first pregnancy, it became a bit clear as to why... What happened if you did face such loss, and suddenly you got a “hey how’s pregnancy?” ping from a friend. Or a knitted hat from an aunt. Or some other slap-to-the-face reminder that you had a shared joy with so many that was taken away?
The chance of miscarriage does increase with certain risk factors (advanced age, certain health conditions, if you smoke/drink/drug while pregnant, etc.). BUT it’s important to know, really know, that most miscarriages cannot be prevented. There’s nothing the mother or birthing person could have done differently. It is not their fault. Most miscarriages simply occur because the fetus is not developing as expected (about half of miscarriages are due to an extra or missing chromosome). The body knows that the pregnancy is no longer viable, and it aborts the pregnancy.*
Odds are that you know at least one person (more likely many) who has gone through a miscarriage. Many miscarry so early on that they may not even fully realize what has happened. Some suffer a miscarriage further on in their journey and go through a very different event. Either way, there is often a lot of trauma, sadness, and pain that accompanies this thing. It blows my mind how just now the subject is finally becoming slightly less taboo but, in the attempts to make it less taboo it’s also being somehow…minimized? Like, oh, one in four, it’s very common. Sorry you went through that very common thing, I’m sure it was bad, but you can try again right?? >> An oversimplification of some of what I’ve seen, NOT directed at me, but at others.
Again: each person will have a different experience, a different kind of feels. The below are mine.
Our Story
Week 4
A missed period. Tale as old as time. A mental review of the calendar, and a quiet wondering if maybe this is it, we’ve signed up for another journey into a very new chapter of parenthood. Ready or not.
I didn’t take a test. I wasn’t ready. It was too soon. I’d been certain that things might take longer to work out, due my darling aging uterus. There was no way we were pregnant already. I didn’t say anything to my husband, and just carried on.
Week 5
Mentally certain. While my period had changed post-partum, it had continued to be as consistent as a damn colonial’s watch (...despite comments made to others about it being inconsistent PP – a narrative that I'd started building as a means of protecting my heart later if we found ourselves struggling with fertility: blame the wonky period, easy, an easy lie, and who could contradict it?) I knew it was time to take a test and make things real. So, Friday morning when my husband had left for work, I did the standard pee in a cup, popped in a pregnancy test, and played with our toddler while the timer ticked on.
Before I’d even set the test down, there was already the faint two lines. My daughter and I checked the test together as the timer rang, and there it was: pregnant. Ready or not. A few days later, we shared our surprise with my husband (in the form of a "big sister" t-shirt on a very drooly little girl).
Week 6
A few days after my positive at home test, at my OB’s office, peeing in yet another cup. She “checked my homework” to the same conclusion: there was a baby brewing. We put the 8 week ultrasound on the books and back to life went. Work, prep for our daughter’s first flight and a trip to see family, and the usual doings. My body started to hold weight, my boobs were like “let’s go girrrrls,” my hormones came out to play, I was once again perpetually thirsty and waking up to pee in the middle of the night. The quiet exhaustion set in. First trimester was underway, in a familiar rhythm.
I mentally held the same shield I did during my first pregnancy. “It’s very early,” I disclaimed when telling my husband, “there’s more risk than the last time, I’m not getting any younger.” Labels like "advanced maternal age" were slapped on my paperwork and I jokingly said of my uterus, "Let's hope the old girl can pull this off!" Even our language to each other was laced with caution, things like: "hopefully this is the last time we tell our moms that we’re having a baby" and "if we're lucky, this is the last time we get to do this: how should we share the news?" or "no bad morning sickness, knock on wood, seems like I got off easy for all my pregnancies!"
I didn’t project personhood onto the tiny cell cluster forming yet: it remained abstract. Logistical things started to play out in my mind, like alerting daycare to put us on the waitlist for March of 2024 (because yes, there's a waitlist that far out, ugh). And really specific things spun about: like our toddler’s transition to a big-girl bed vs the baby needing the crib and me not wanting our toddler to think the baby stole her crib so wondering when to do that and how to reconfigure our rooms to best help her sleep when a newborn was up screaming at night. I cried, thinking about my late December due date and how I’d miss being at family Christmas for a fourth year in a row. I shushed selfish thoughts about how I’d be stone cold sober for a dear friend’s bachelorette AND wedding. In my mind, I organized newborn things we had kept and could reuse vs things we’d want to update/replace. But, I didn’t think about names, or the new person who would be joining us because they weren’t allowed to be real yet in my mind, for my own protection.
Because I knew the odds.
I felt a bit bad about this mental wall, and tried to do little things to start pulling this abstract idea out of the ether and into view. In the morning, when buckling our baby girl into her carseat to go to daycare, I always give her three kisses and say, “One for you, one for me, one for dad” – I started to add “one for the baby” to which she happily would say, “BABY!” (because she likes the word ‘baby’). I found myself doing the default “hand on tummy” position when sitting, giving a little hand of comfort, with a “we got this” whisper when I started feeling overwhelmed at the idea of starting things over again. And of course, the adjustments in my diet and routine, to keep my body safe for bebe. There were little moments like this, but we mostly carried on as if not pregnant.
Week 7
We were visiting family in California and decided to share the news. Because what else would explain my not wanting sushi the second I approached the coast? We warned how it was still so earlier. Too soon to even be saying anything. So risky. One in four. We hadn't even told other close family yet.
In shops, I gently touched tiny newborn clothing, without purchasing.
Week 8
In my 8-week ultrasound, all was not well. No heartbeat. Our wee little one had stopped growing at six weeks. A “silent miscarriage.”
How that played out in real time:
When I arrived for my appointment, there was a mix-up with the fax and order for my ultrasound or something silly. After much back and forth, they agreed to squeeze me in twenty minutes after my original time. If you’ve ever had an ultrasound, you know it involves drinking an epic ton of water in advance of the appointment and holding that liquid. Sitting in the waiting area, the usual stream of HGTV schlock flashing on the nearby TV. I texted my husband: this felt like a bad omen, and I might pee my pants. (Literally, I almost peed my pants.)
Finally in with the ultrasound tech, answering a pretty standard series of questions: Was this my first pregnancy? No. How many children did I have? One. How many pregnancies had I had? …One. That question had seemed odd to me initially. Like, I just told you I had one child, so duh I had one pregnancy. My brain took a full moment to think about all the loved ones I knew who’d had far more pregnancies than living children, and I gave an open look of sadness. A brow furrow. And then that tiny moment of recognition passed and I was laying down with a wand on my belly.
The thing about an ultrasound tech: they’re not supposed to tell you definitive information. They do the scans, and your OB/doc tells you explicit medical answers after the fact. A good tech has a poker face. A more realistic tech doesn’t. In an 8-week ultrasound, there’s a big three that you need to get from your tech, and anything beyond that comes from your doc later after they’ve seen what the tech has sent over. The big three: Is there a good heartbeat? Is it only one heartbeat? Are things developing on track with the due date predicted, or is there a different due date estimation?
After a few minutes of silent wanding, I knew something was off. “So, how is it looking?” I asked, as casually as possible. A tiny attempt at a reassuring smile flashed my way, with a lined brow prominent above concerned eyes. She wasn’t quite seeing what she needed to, she likewise tried to say casually that it was likely just due to my tilted uterus (something my OB had warned might happen in my ultrasound – a known thing to cause visibility issues with an external look). When I asked what she wasn't quite seeing so gave a pause and an um. She wasn’t seeing a baby…. Would it be okay to do an internal ultrasound? I agreed after confirming what that entailed, if there was an alternative, how it’d feel, etc.** They insist you go to the bathroom before that, mercifully. I quietly shed some tears in the bathroom, taking a few deep breaths. I texted my husband saying something might be wrong. This felt ominous. This didn’t feel like it was going well.
She started the internal ultrasound. A minute later, she still was quiet. I let a few quiet tears drip sideways off my face.
I left the office soon thereafter, informed that I'd need to talk to my OB - with a side comment that maybe I should prepare for not good news. Yeah. Yeah I'd gathered that already, thanks. I blindly walked to the parking ramp and sat in my car, waiting on a phone call from my OB. After a few minutes, I started driving back towards home, deciding I'd get a shake from Arby's en route. I pulled over as soon as my OB called. "I'm sorry, but we both know what this is..." she began. And there I was, parked outside some random person's house in the suburbs, while my logic brain calmly asked my doctor about next steps, and my emotional brain wept.
A "missed miscarriage" or "missed abortion" was the technical term. But. It couldn’t legally be classified as a conclusive ultrasound because of certain rules in my state,*** meaning I had to schedule a second ultrasound a few weeks out (assuming my body didn’t resolve things in the interim) to get another ultrasound to prove that I had miscarried, before I could receive any medications to help my body process. I also had the option to do blood work to show if my hormone levels were decreasing in order to help prove that the pregnancy was no longer viable - but since that isn't always conclusive (i.e. your hormone levels can stay pretty high until the actual departure of pregnancy tissue from your body occurs), I opted to not put myself through that as well.
The phone call with my OB was fairly long: a thorough explanation of all the possible aftermath/outcomes. Necessarily graphic and detailed, I tried my best to absorb the information so I'd be prepared for what was to come. [I'm forever grateful for the partnership I have with her in all stages of my pregnancy journey(s).] After the call, I got that Arby's shake and drove home to lead a retro call for work - I'd only taken the morning off. My afternoon was packed with meetings.
Week 8-10
A waiting game. Carrying tissue in my womb that was no longer a baby. Waiting to see if I'd start bleeding. It felt very much like the final days of pregnancy with my first: you know that any time of day, no matter where you are, you could suddenly have a bunch of fluid leave your body in a very violent way. Only in this case, the end result was not a baby, it was a lack thereof. A very long two weeks indeed.
After the ultrasound, I was mentally and emotionally fairly okay. I had known the statistics/risks. I knew there’s nothing I did wrong or could have done differently. I understood the science. We knew that it was still very early and there had been a very real possibility that something may go wrong. My logic brain understood it all. But for two weeks I carried around the persistent thought of the wee bebe that didn't get a chance to grow, but that wouldn't leave its mom. My body wouldn't let it go, and so my emotions escalated quietly over the course of several weeks - caught in a limbo, me and the baby that wouldn't be. Neither one of us physically able to move on.
During this, the real kicker was that my body continued to think it was pregnant. My hormones continued to rage, my boobs continued growing as if preparing to feed a small army, my exhaustion was all encompassing, and overall my body carried on with the first tri like nothing was amiss. Just as I carried on with my day-to-day (through the hormonal brain fog). It's hard to explain that you're going through a miscarriage but haven't yet fully miscarried - most people don't think about miscarriage as a state of purgatory, but instead as an event that happens fairly suddenly. That's how I'd always thought of it as well.
While about 25% of pregnancies end in miscarriage, less than 5% are silent miscarriages.
Week 10
Exactly two weeks after my first week ultrasound, I found myself in that same waiting room, with the same HGTV schlock echoing about the room. The ultrasound tech physically braced herself as she opened the door and called my name. I told her it was okay, I knew what we were expecting to see and I was ready for it this time. These things happen. One in four. It was okay.
I had asked my OB what the odds were that I might march into the second ultra and suddenly they'd find a growing, living baby. "I'm not trying to cling to optimism, just wondering how prepared to be for another drastic emotional swing," I had told her on the phone. She said she hesitated to even say there was less than a one percent chance. Trusting her, and knowing what we knew, it was no surprise to me when the tech one again found no heartbeat, and only tissue pacing at six weeks.
Conclusive. It was finally conclusive in the eyes of the State.
Once again on the phone to my OB, she already had the news as I rang. She had called in a prescription to the pharmacy before I had dialed. Called instead of faxed, because she needed to explain the situation and confirm that the medication I was getting was for "miscarriage management" and not an abortion, (because pharmacies are skittish these days). We talked through all the steps, what I could expect, etc.
If you're not interested in that process, or details around this kind of "woman problem" or the idea of abortion methods stresses you out - feel free to skip ahead to the "It's Gonna Be Okay" section. Else, knowledge is power, so the following is fairly detailed, based on my knowledge for my specific experience. I'm not a doctor, or medical expert, so this is paraphrased based on explanations from my OB.
When you hear people talk about "early stage abortions" there are two main methods:
- A Medical Abortion: typically done at home - i.e. the 'abortion pill'
- A Surgical Abortion: done in-clinic - i.e. a D&C (Dilation and Curretage)
Both are also options for "miscarriage management." D&C being the less ideal option, but both being very safe approaches to helping your body miscarry the no-longer-viable pregnancy tissue. In my case, we opted for the pill, with a D&C being a last resort if my body wasn't able to expel the tissue fully with medicinal support. The 'abortion pill' is actually a series of pills typically:
- Mifepristone : this pill blocks progesterone - the hormone your body needs to support pregnancy (it basically helps your uterus lining implant and support your egg / baby in the first tri) - stopping the pregnancy from growing
- Misoprostol : this pill causes cramping and bleeding to empty your uterus
Based on my situation, I was prescribed just two doses of misoprostol (since my wee bebe had already stopped growing). The effectiveness is around 85-95% so the second dose was to be on hand in case it didn't fully work with the first round. When to take it was up to me. I could wait, and hope my body figured it out itself. But that could lead to complications if it took too long, and also would stall out our fertility journey in general (because getting pregnant again when your womb is already occupado is a tricky matter). In my case: waiting had already been taking a toll on me emotionally/mentally, and the continued physical toll on my body was not something I wanted to just let drag on.
I decided to take it the next day. My OB advised that the heaviest bleeding/cramping typically started about 6-12 hours after taking the pills, and could last several hours. It was one of those things you should kind of clear your schedule for. With the lead time, I was also worried about taking it too late in the day and being up all night dealing with the trauma in the wee small hours. So I decided to take the first dose after daycare dropoff. It was a Wednesday. I didn't have any afternoon meetings and I'm WFH. (I had also heard rumor of major changes coming at work so figured it would be a day where people would be distracted - it turned out to be a day of massive layoffs, restructures, and pay cuts - so - the day was very dramatic on EVERY front for me.)
Additional disclaimer: this is where the TMI comes in - if it's not something you want to read about, please skip ahead. I had NO idea what this process was like prior to going through it myself so - TMYK.
So Misoprostol. You don't take it in your mouth.... :|
I felt like I was trying to sneak drugs across the border or something bizarre. Because the whole thing was bizarre. Like a sitcom freeze frame on me awkwardly popping pills up my snatch with a voiceover quirkily saying, "so how did we get here? well it all started two weeks and a day ago..."
Hours later, cramping and light spotting. And then things hit their stride. If you imagine how the flow of your regular period exits over the course of several days, instead it was like… it exiting all within 12 hours. In much larger clots. Terrifyingly large blood clots. Like, when you see a clot the size of a golf ball and think "Oh, it's getting smaller" you know you've been going through a thing. Throughout this, I texted my husband a running tally of how things were going.**** Fun fact: there's isn't a great "period" emoji - and a few days prior we had been discussing a lecture he had watched about emoji development and the conversation around a period emoji (because a bloody undie emoji was not kosh). What a lot of people use instead is either the blood drop, or the Japanese flag (white with a red dot). So... our text history now has a two day stint with an alarming number of Japanese flags.
Within 24 hours, things should be pretty well done. You may have some period-like bleeding for a few days but you're mostly in the clear. But, sometimes you aren't. In my case, the bleeding continued at a higher than normal, but not alarming flow (there are rare cases of excessive bleeding, which will pop you into urgent care - I was not at that point). Something wasn't quite right. I kept in close contact with my OB and a week later, she suggested it might be prudent for me to take the second dose. Help my body finish the process. Or I could wait it out. It was up to me.
Week 11
A week and a day after the first dose, with continued bleeding and uncertainty around whether the first dose was fully effective, I caved and took the second dose. With the second dose, you can't just snatch-pop the pills, because your bod would bleed them out. So instead you hold them in your cheek/gums until they dissolve. Also like a drug addict. (I don't know much about The Drugs, but this should all be a pretty good indication that I'd be bad at them.) And then you wait, again. In my case, there was not another mass exodus. It seemed like things might be over.
Week 12
A positive pregnancy test. Still.
My OB had warned me that this might happen for a few weeks following my miscarriage. And with my prolonged bleeding, I knew it was too early to take one, but I tried anyways. Because the longer this dragged out, the more my state of mind deteriorated. While I had been very sound and certain upfront, each day that I couldn't move forward dragged me down further. Random cries, exhaustion, a feeling of constant overwhelm... all the fun and then some.
So what next? As I roll into Week 13...
I plan to take another test tomorrow. If I'm still getting a positive test, then I need to call my OB to figure out what we do next, because something could still be lingering. It may be a third round of pills or a D&C, or something else. After I get a negative pregnancy test, my OB recommended we wait until my next normal period barrels through before 'trying' again. If we're emotionally ready, my bod should be physically ready. It could be another week before we get a negative test, or several weeks if I need to take additional next steps, and then maybe a couple more weeks before my period, and then a couple weeks before we hit a 'fertile' window.... all told, it could be 17 weeks out from when my last pregnancy began before we can start trying for the next one. Almost five months of "lost" time. For my aging uterus, that somehow feels like a massive tick tock of the clock.
But...
It's Gonna Be Okay
Again, PLEASE do not take any of this as minimizing your experience or that of a loved one, if you’ve been close to a miscarriage…
We're okay. Truly.
- If this had been my first pregnancy, I think a miscarriage would've broken me. But we have our daughter. She is the literal light of our lives. She is truly enough. Anything more is a beautiful bonus. So if a second child isn't in the cards, it'll be alright. We won't just be content, we'll be happy. Sure, we'll try again, but if it's a "one and done" situation, then that'll be perfectly fine for our wee family unit. Our girl has so many people who love her, it's enough.
- I take a lot of solace in knowing: this ain't my body’s first rodeo. I’ve got a proven track record of both getting knocked up and having a full-tern pregnancy / big old baby delivery. I know my body is capable, and that this whole experience was it being capable in knowing something was wrong and that the pregnancy couldn’t continue. It did what it had to do, and there is no different way things could have gone this time around. There's no blame here, just a sidestep in the journey. (Everything so far also indicates that nothing is awry with my body - this all is not a sign of any overall infertility issues, knock on wood.)
- We have such a strong village of friends, family, and loved ones. The small handful who we told about this early on literally encased us in a bubble of kindness to protect us from the baddies. And so many others gave support without fully knowing the situation, just based on vibes. We are massively hashtag fucking blessed by the people in our lives, and know that they'll be here for us no matter what turn this road takes. It makes everything in general feel more okay, honestly.
- There are a bunch of other life things that we had felt rushed on / worried about with a December due date on the horizon, so this unfortunate change does give us time to iron those things out. It gives me time to get stronger, to get into a better groove eating, to support loved ones going through their own big changes right now, etc. There's not a "silver lining" to something sad like this, but there is just knowledge of how the steps forward can dance about a bit in the interim.
There's no point where this all fades from my memory. I'll be grateful to physically move forward, so my logic brain can kick back in and acknowledge this whole situation fully for what it is: an unfortunate thing, that just happens (and happens to SO many). Somehow typing this all out helped put some of the weight of it off my mind, and out into the ether. I hope it gives you some perspective on what some go through and that you never have to experience it yourself. Honestly, silence is just not golden in this case.
* Yes, a “spontaneous abortion” is one of the other terms for a “miscarriage” - you'll hear doctors say "ab" instead of "abortion" in some cases - probably due to the stigma around the word "abortion."
** "Not as invasive as a pap” she said she’d been told – pretty accurate in my opinion. It’s a big wand up your snatch, but not the duck bill.
*** Because it was measuring at six weeks, and I could just be a silly girl who got my dates wrong and maybe I wasn't certain when my last period was or certain when I'd gotten a positive pregnancy test at home and in my doctors office. So, not to be trusted, it could be I hadn't given it enough time. (Because a six week fetus is indeed very tiny and hard to capture on an ultrasound - which is why you go in at 8 weeks plus typically - and which is why I did go in at 8 weeks.)
**** I have a deeply rooted fear of ending up in the hospital, unable to communicate, and the staff asking my husband what kind of symptoms I've been having or if there's been anything amiss and him not knowing or being able to help because "she hasn't said anything." My father-in-law passed away very unexpectedly of sepsis, and had the people closest to him heard some of his symptoms as they were happening, he may have gotten to the hospital sooner, may have had precious time on his side, may have been able to give clues to tip off and get him the help he'd have needed. Since then, I sound like a complete hypochondriac, but I insist that my husband know every time I'm feeling out of sorts. I want it said out loud, and in his mind, should something happen and doctors need to know.
