WHAT IT'S LIKE TO LOSE SOMEONE YOU NEVER MET

It’s been a while between articles and this article is going to explain part of the reason why.

Nourish that is a website and resource for you, and not my personal blog, but I thought sharing my experience in this could be helpful to someone.

This article is going to discuss my pregnancy loss, so if that is a topic that is triggering or upsetting for you in any way, please read no further. It does get quite specific and real, so if you are a sensitive person, please read no further.

We were ready to build a family. I was pregnant. I was in the first trimester with the “morning” sickness (all day!) and tiredness, and all the body changes that are typical. We were excited.

At 9.5 weeks there was a little blood. I knew it could be normal, but something felt off. I called the doctor and they requested a hCG test. Human chorionic gonadotrophin (hCG) is a hormone produced by the ovaries and the placenta which tells the body, hey this little being is welcome, supporting the pregnancy. My hCG was high, which is good, and they were optimistic but the doctor still requested a sonogram. It was my first one. My partner came with me in the waiting room but couldn’t come in for the scan. The sonographer was a Polish guy, very chatty, and I got a glimpse of the grey blip surrounded by the black stuff (the baby in the fluid). He got a bit quieter, and said he wanted to rush out to get the radiologist to look at the images before the radiologist finished for the day in 15 minutes. Ah.

10-15 mins later the sonographer came in and told me he wasn’t meant to be the one to tell me but there was no heartbeat. He said he’d seen more miscarriages in the last few months than he ever had and he didn’t know what was going on. He paged a few ob-gyns until one called, and the ob-gyn told me on the phone I had a miscarriage. The baby stopped developing at about 7 weeks and I never knew. He gave me options as to what to do: wait to let the body pass it, take progesterone (misoprostol) to induce the release, or have a dilation and curettage (D+C) surgery. I decided to wait and see. Later I found out this is what’s known as expectant management. I went out to the waiting room, said nothing to my partner except a sad shake of my head, and we left. I waited until I had a moment alone to cry.

Still having symptoms of pregnancy and no baby is really cruel. Morning sickness while bleeding seems unfair. But miscarriages are common. I knew that there was a 20% risk of miscarriage at my age. But since I was drawing near the 12 week mark, the end of the first trimester, and pregnancy loss is a lot less common in the second trimester, I was getting more optimistic. We had told only our immediate family.

Most miscarriages in the first trimester are due to genetic errors so that’s why the baby’s development can go no further. That’s just the nature of that many cell divisions, and there are more errors with older eggs. People with ovaries are born with all the eggs they will ever have. Only sperm have the fountain of youth (I am not taking that metaphor any further, you’re welcome). If you don’t meet a partner who you would love to build a family with until you are older, or are not ready until you are older, that’s just the reality. It’s not “biologically ideal”, but we are a long way from the cave, baby.

Less commonly, miscarriages can be due to prescription drugs, illicit drugs, toxins, radiation, and diseases. Obviously the risk of these causes is dependent on the situation of the pregnant person and their partner.

The ob-gyn had told me that they don’t usually do any testing of the miscarried embryo/fetus in the first miscarriage, and would only investigate if there are recurrent miscarriages. He said our chances of falling pregnant again and carrying a healthy baby to term are excellent and to try not to be discouraged.

So days went by, then weeks. On/off bleeding or clots like the middle of my period, crampy feelings like in a period but not too bad, feeling very exhausted, and a gradual waning of morning sickness and the other pregnancy signs. I tried to buy myself my favourite foods to cheer me up.

By now I had been on the web to learn a bit more about what was going on. Turns out I had a “missed miscarriage” where the baby stops developing but your body doesn’t realise for a while. In the weeks after my scan I had only had stabbing pains with bleeding on one morning, and didn’t pass anything more than small clots the whole time. The ob-gyn had told me I would likely not pass anything that “looked like a baby” and likely just some pieces of tissues. This is different to a complete miscarriage in which all of the conception materials are passed and there could be something that looks like a baby. I was reading highly medicalised accounts of what was expected when passing the conception materials and it didn’t sound like that had happened to me. Yet?

I also read that the risk of a consecutive miscarriage is much lower, only about 5%. The ob-gyn had said a subsequent miscarriage could possibly be due to a platelet disorder and there’s a medicine to take to prevent it if it was to happen again. And there is a higher rate of conception in subsequent ovulations for several months. These are the so-called “rainbow babies”. The theory is that the body is still primed for pregnancy. So yes, a little good news. But of course it means that delightful all day sickness all over again. And the emotional rollercoaster.

While waiting, I decided to get the coronavirus vaccine since I didn’t want to take it during pregnancy for obvious reasons (Zero testing in pregnant people! New vaccine! New technology! Many unknowns!). It had been 2.5 weeks after my “diagnosis”, so I decided to call the doctor again.

Now I have very very strong feelings about the US medical industrial complex as you would know if you read a previous article. Since I was spoilt for 30 years living in Australia where healthcare is COMPLETELY FREE i.e., paid by our taxes (prescriptions are not free, but they are usually heavily discounted!), I do not like paying for my medical care, and also don’t like how the US system is set up to manage you like a chunk of data, not a person. My first prenatal appointment, by the way, was a phone appointment with a nurse who basically just dumped all the information on me she had to (for insurance and legal purposes), sent me a bunch of videos on the online portal, and didn’t even ask me how I was feeling. Truly.

Anyway, I called the damned system and they advised I come in for an appointment. I was not overjoyed for another doctor visit during coronavirus time but of course it made sense. So in I go with my 2 masks and glasses on, avoiding touching surfaces like always. Sigh. The nurse and ob-gyn were very nice, but sitting in spaces surrounded by pictures of babies and pregnant people is extremely upsetting. The ob-gyn was good though, he asked me actual questions, and scanned me, and the pregnancy was still in there. All that discomfort for now 2.5 weeks and nada. But there wasn’t much left of the embryo, which actually felt comforting to know that process was proceeding naturally. What to do? In theory, I could keep waiting maybe weeks more, but with the on/off bleeding and fatigue, I haven’t been able to be doing anything except work and rest. OK so I can’t do much more than that anyway in raging coronavirus country, but I hadn’t felt well enough to exercise most days, and didn’t want to go surfing and risk anything (ruining my bathers and wetsuit, being shark bait). Quality of life, And I didn’t want to wind up getting an infection and needing surgery or antibiotics. We discussed options and he advised not to keep waiting, and offered the progesterone or the D+C. He also told me quietly about his wife’s miscarriage and healthy subsequent pregnancies in her mid to late 30s. I decided to take the pills. I was to come back in 2 weeks for a hCG blood test to make sure those levels are falling appropriately and that the medicine worked, and another scan to make sure I am all clear.

These pills are the drug misoprostol (a synthetic prostaglandin), also used for stomach ulcers. I was given 2 doses- in case the first dose didn’t “work”. Happily with my “co-pay” the medicine only cost me $15 (and the doctor’s visit was $90 upfront but I’ll probably get another bill for another chunk of money). I asked about when to take them and he recommended when I had the next day off. There would be cramping and bleeding, which usually starts within 4 hours and over within 12-24 hours. I work a lot, so decided to get it over and done with and take it as soon as I got home. She’ll be right.

The pills are best taken for this purpose as pessaries- yep, up the hoo-hah (vagina). By placing the medicine near the cervix, it induces contractions quite powerfully. So I put the medicine in and about 2 hours later, started feeling a bit crampy. I was resting, and asked my partner to come over to walk my dog and he was going to stay over. Then it got real.

I was not prepared for the pain. I am generally pretty stoic, have a pretty good pain threshold, but for the next 5 hours the pain escalated to the point of me curled up, shivering, with heavy bleeding, fresh blood and clots. And vomiting. When I thought the vomiting was done, I took an acetaminophen + codeine tablet. In hindsight I should have taken it at the first signs of cramping but I had no idea it was going to be like this. I waited for the pain relief. Why wasn’t it helping? This was the worst pain I had ever felt. It got to the point that I asked my partner to call the nurse advice line. I could barely speak but she told me to go to the ER if the pain was intolerable. I was imaging all the horrors of the ER. So I thought I would wait another half an hour or so. Half an hour passed, one hour passed. Then around 8 hours after I took the medicine, there was an easing of the tense stabbing pains to a more dull feeling that let me rest, then the shivering stopped, and I could eventually sleep.

The bleeding continued the next day but I felt OK. I went to work with my menstrual cup in and period underwear, with vigilance of still passing a lot of blood. It occurred to me that taking the medicine the day after I got my first coronavirus vaccine may have made the pain and bleeding worse. The bleeding had slowed by the evening and I went to sleep right away. I even slept through the washing machine finishing it’s load despite it’s little shrill song it sings.

I woke up the next morning and there hadn’t been much bleeding overnight. I was wondering if there was a giant blood clot in my uterus and I got a bit scared. Maybe the clot is holding a deluge of blood like a plug? I read that if you passed a clot bigger than an orange that you had to go to the ER. When I replaced my menstrual cup I felt something a little odd but said to myself, leave it alone, go to work, deal with it later. There was not much bleeding throughout the day, so I removed my menstrual cup in the evening with just my period underwear going on (Thinx are awesome, by the way).

The next day I had the day off so was like ok, let’s take care of everything I need to this morning, then see what’s going on with the “situation”. I was worried I had that giant clot sitting there and if I squeezed it out, I would start bleeding everywhere and have to go to the ER and have to have surgery (this is the way my brain works). It did occur to me that if the bleeding was really heavy it would either come out, or put pressure on my uterus and cause pain so my theory about the blood clot plug was likely baloney. I gathered my nerves and decided I was ready. I went to the bathroom, Kegel-ed, and something splashed into the toilet bowl and I could see some clots. Oh here it goes. Then checking. Only a small amount more of blood and clots. Hm.

I am a scientist so of course I fished in the toilet bowl and realised it was the gestational sac, complete and intact. I had passed my miscarriage. The medicine, as awful as it was, had worked. I had something to bury and I could grieve properly now. Such a small thing. Very sad. I can say goodbye to someone I never met.

Now I expect the bleeding to slow and stop over the next 2 weeks. I have the ultrasound in 2 weeks and the hCG test. Hopefully there are no remnants left in my uterus otherwise I will need the D+C surgery. I am trying not to get surgery because it can cause damage to the uterus lining and could impact future chances of getting pregnant. But the alternative is that remnants may get infected and I could get sick, so if surgery is what has to happen, then that’s what has to happen.

I share all this not to receive sympathy. I don’t want to upset people. I am not brave. This is not gross. This is life.

But I want to break the taboo of discussing miscarriage since it is so common and not talked about. It’s sad, it’s sensitive, it could be traumatising. Some people may think I am lucky to even have been pregnant for a short while. I just wanted to share my experience to say, hey it happened to us. I don’t know if we will have a healthy baby in the future. This isn’t a happy ending, or any kind of ending. This is just an example of a real thing that happens to real people, and the future is unclear in terms of building our family. I am lucky to have a supportive partner who is not shying away from this.

If you know someone who has had a miscarriage, please read this article “What not to say after someone has a miscarriage” by Dr Jessica Zucker who is a psychologist specialising in reproductive health. She also offers psychotherapy services.

For support, check out these Support Organizations.

This process is different for everyone, so please be sensitive to that. As with any grief, acknowledgement without inserting your story or opinion unwelcomed is the best way to proceed.