October 2009

It’s been a week since my miscarriage and I’m feeling like I’m pretty much over it.  I did a lot less grieving than I thought I would.  The procedure on Friday went smoothly and I felt fine by Friday night.  I just moped around the house over the weekend and, although it was probably good to have some time to reflect, I was very happy to get back to my normal routine on Monday.

I guess I was right when I said that there wasn’t much of a context to disintegrate with this loss.  Usually, that disintegration is the work of grief.  (I got that from Leonard Peikoff, but the specific source eludes me.) When you love someone, you integrate him or her into your life.  You share values.  In my case, I hadn’t integrated a person into my life, but a pregnancy.  I had to do things like unsubscribe from a pregnancy newsletter, cancel ob-gyn appointments, cancel my prenatal yoga class, rethink next summer’s travel plans, set aside the plans for preparing the baby’s room, and even cancel a prenatal massage.  Those things were a disappointment.  I had valued all of it as part of the pregnancy experience.  But I had no connection with the life growing inside me yet.  I do indeed feel like this is just a setback.  We’re still going to have a second child and all the values that come from that – we’re just not going to have them as soon.

I don’t mean to diminish this experience.  It really is a horrible thing to go through.  I think when it happens in a first pregnancy it is much more difficult.  But it’s been a week and I’m over it.  Sure, there is a little residual sadness, but it is in the background.  There is a little bit of new doubt about whether we will be able to have a second child, but I’m fighting that by focusing on the fact that it is metaphysically given whether or not we will succeed.  We will take all the action we can to make it happen, but worrying about it will not change anything.

We did decide to get the chromosomal analysis of the fetus.  We should have the results in a few weeks.  If there is anything to learn from this that can help our future efforts, we’ll learn it.  Most likely, though, we won’t learn anything at all.  I’m ok with that too.

There are other things I’ve learned from this experience.  I’m working on a bad premise I have about accepting help and support from other people.  And I’ve been vindicated in my practice of being totally honest with my daughter about sensitive issues like this.  We told her everything from the day I took the pregnancy test to the miscarriage, and she’s handled it just fine.  I’ll write more about both of these subjects in the days to come.

So tomorrow I go to the hospital for a procedure called “dilation and curettage,” which is a type of abortion.  This is my second unwanted abortion, and I’m not happy about that.  Since it makes me feel better to write about all of this, I’ll tell you what I know about this process.  (And thank you all for your kind comments.)

In a case like this, where it is discovered that the fetus is not developing before there are any symptoms of miscarriage, there are two choices:  have the D&C, or let things happen naturally.  Eventually, my pregnancy hormones would adjust and my body would naturally expel the contents of my uterus.  The problem with that option is that you don’t know exactly when it will happen, it can be very painful, and it is very bloody.  The doctor emphasized, “a lot of blood.”  The risks of a D&C these days are minimal, the most common major problem being infection, which could lead to perforation of the uterus and infertility.  But I trust the doctor who advised me yesterday that this risk is very small.  I will be on prophylactic antibiotics anyway, and I’ve never been prone to infection.  Many times, even if you let things happen naturally, you need the D&C anyway to be sure all the tissue has been expelled.  The other benefit of the D&C is that a genetic analysis can be performed to possibly find out what went wrong.  I’m not sure if my insurance will cover this, so I’m not sure we’ll have it done, but it would be nice to know if possible, especially given my history.

The biggest cause of miscarriage is genetic defect.  If the problem is bad enough, the fetus can’t get beyond a certain state of growth.  When we are amazed at how well DNA builds such perfect human beings even with all the problems we see in living people, we shouldn’t forget that there are a lot of errors – these are the miscarriages.  I read last night that up to 75% of a 40 year old woman’s eggs may contain genetic defects.  Unfortunately, the book I have does not include footnotes and this figure sounds ridiculously high.  (The book is also one of those types where pregnant women are encouraged to take no risks whatsoever so I don’t completely trust it.  Another source put the percentage of defective eggs at 50, with the caveat that this figure was arrived at by studying only infertile women, so it is probably still high.)  But one hard fact is that the miscarriage rate for 40 year old women is about 1 in 3 and it goes up dramatically as you move towards 45. 

These figures can be depressing, and it is certainly possible that we’ll never have another child.  (Here is an interesting personal anecdote from a woman who tried to have a second child in her mid-forties – she eventually did fail.)  But I look at these figures as a way to understand and cope with this miscarriage.  As I said before, it can be seen as “normal” at my age of 39.  And I have to be prepared for it to happen again.  But for now, this is no deterrent.

Tomorrow is going to be a terrible day, and from what I gather, I’m going to be in pain through the weekend at a minimum.  But I want to get it over with.  I’ve spent the past 24 hours worried sick that things would start happening on their own.  I hope I make it through the next 24.

I had an ultrasound today.  There is no heartbeat.  The fetus stopped developing a couple of weeks ago.  I had a miscarriage.  On Friday I’ll have a D&C.  I’ll write more about that later.

It’s ok.  I mean, it’s horrible, but I’ll be ok.  This is nothing like losing a 24 week pregnancy.  When that happened, I really resented people who equated my experience with a miscarriage, but I wasn’t sure if my feelings were just, because I had never experienced a miscarriage.  Well, I was right.  This is hard, but I don’t feel like I’ve lost a baby.  We didn’t know the sex yet, we had never heard the heartbeat or seen the baby on ultrasound, and we hadn’t bought anything for the baby.  My belly hadn’t grown.  I hadn’t felt the baby move.  We hadn’t bonded with it.  We don’t have a huge context to disintegrate.  We just have to start over.

I do have one similar feeling:  the feeling that I have lost time.  When our first child was stillborn, I felt like I had lost a year of my life.  We had spent 4 months getting pregnant, 5+ months being pregnant, and then we had to wait 3 more months before we could try again.  I’m sure I’ll be told that we should wait 3 months again, but I might not heed that advice.  I started planning and thinking about it within 10 minutes of finding out, and Adam agrees: We’re getting right back on that horse!

I’m also thinking about the things that will be easier.  We have some travel plans that will be much easier now.  Next time, I’ll be better prepared with the right drugs for my psoriasis, which has gotten totally out of control since I had to suddenly stop my medication.  Well, that’s about all the positive stuff I can think of right now.  As for the negative, I think the thing that bothers me the most is that when we do have SS, there will be that much more of a gap between our children’s ages.  That, and the fact that, the older I get, the less likely we are to successfully have a child at all.  But, at least right now, I’m not feeling as stressed out about that as I was when we first decided to try for another child.  For some reason, I was really afraid that we wouldn’t be able to conceive at all.  A miscarriage is almost par for the course at my age, so I don’t feel like this doesn’t bode well for the future.  We might have another miscarriage, but we’re still fertile, and we’ve had one healthy child, so there is no reason to leap to worries about ultimate failure.

And that is one of the reasons I decided to announce my pregnancy to the whole world immediately.  I knew this could happen, and if it did, I wanted people to know.  I can’t tell you how shocked I was after our first, failed pregnancy, to find out how common miscarriages, infertility, stillbirths, and other problems really are.  Once you are a part of “the club,” the stories come out of the woodwork.  Miscarriage is common enough that I would call it normal.  If you don’t know how common it is and you have one, you will not have the right perspective, and you might become afraid.  It might seem like there is something wrong with you, or that you did something wrong like eating the wrong food or exercising too much.  Many women even feel ashamed, since it is just never, ever talked about (except in those internet chat rooms, and you should not go there–trust me).  I don’t want women to have to go through that.  I mean, I hate thinking about all the pity people will feel for me, and even the sympathy.  I hate to cause other people those negative feelings and I hate to be the object of them.  I could have spared all of us that by just keeping my mouth shut.  But now that this has happened, I can confirm what my gut told me in the first place:  We need to stop hiding early pregnancy and miscarriages.  It’s one thing to learn the miscarriage rate as an abstraction.  It’s another to know that 5 out of your 6 best friends have had miscarriages, fertility problems, or a stillbirth. 

I’ve only known that I miscarried for about 8 hours now, and I’ve had to tell 5 people.  Telling people is difficult and painful (although writing this blog post is cathartic).  I understand the desire not to have to go through that.  But I think that telling people is an important part of facing up to what happened.  I can’t imagine having been pregnant this whole time, losing the baby, and having the whole thing be invisible to all of my friends and family.  I think it would prolong the pain.  I don’t mean that I want to ”share” the pain, like spreading it out would lessen it or something.  I just don’t like keeping secrets from people who are close to me.  (And once you tell those people, the cat is out of the bag and you might as well tell everyone.)  It’s important to note that I absolutely do not think that it is dishonest to keep an early pregnancy a secret–it is nobody’s business but the parents’ and there are plenty of situations where it is rational to keep it hidden.  What I’m saying is that this default practice of waiting 3 months to announce a pregnancy does not do anybody any good.  Ignorance is not bliss.

I’ll write more about this in the days to come, but now I have to go have a good cry.