Memoir of a Miscarriage
by Amy M. Miller
Twenty to twenty-five percent of known pregnancies end in miscarriage. Even more women miscarry without knowing they were pregnant. One third of all first pregnancies miscarry. These statistics seemed high to me, at least they did before I miscarried and began talking to other women. When I told people that I had miscarried, women flew to me through email, phone, by mail and in person, to tell me their own stories of loss and disappointment. With such a tremendous response, I realized that twenty to twenty-five percent only seems like a high number because nobody discusses miscarriage in polite society. One doctor told me that OBs just don't give out the stats to pregnant women because pregnancy is only supposed to be a happy occasion. Previously, I only knew of three friends who had miscarried. Now I understand what a common occurrence this actually is. How long have women suffered silently and why is this still a taboo topic, only whispered about around the office coffee pot or worried over in therapist offices?
It's December 23rd. Tomorrow is Christmas Eve and although I'm Jewish and my husband is agnostic, this is an important day for his parents. Every year we spend Christmas Eve with his family, indulging in a big dinner and exchanging gifts. It has become an even bigger holiday now that we have a child. Fiona is almost two and really understands the concept of gifts. She is an adored child, youngest of the grandchildren by eleven years. News of another grandchild will send Rick's parents into Christmas ecstasy. We decided to be cute and bought a doll to wrap for them, on which we'll attach a note: "Fiona's baby brother or sister." At the moment, however, I'm a nervous wreck, waiting at my OB-GYN's office for my first prenatal visit.
I had this sinking feeling all day that something could be wrong. I had this feeling with my first pregnancy too, despite how uneventful and healthy a pregnancy it was. I tend to be neurotic and apologize repeatedly to the doctor. Basically, I can't relax nor believe that I'm really pregnant until I hear a heartbeat. The doctor, not my regular OB, asks why I'm so nervous – she's the same age as me (late 30s), and she just had her second baby. I'm also in the high-risk category due to a chronic condition, I explain. She reassures me that I did fine with the first pregnancy and leans me back for the pelvic exam while my husband averts his eyes and holds my hand. She wants to alleviate my worries and asks a technician to wheel in a rickety ultrasound machine. Apparently, I'm not far enough along to warrant a heart monitor.
The ultrasound is blurry and snowy like a t.v. with bad reception. I see what looks like an amniotic sack. Rick says that he sees a "critter" inside of it. My doctor is wonderful. She believes I'm not as far along as originally I thought, so she writes an order for a vaginal ultrasound to measure the fetus and get a better idea of my due date. She thinks we can get the test done today.
I told a ton of people that we're pregnant. Probably more than I should have, but I figured, I'm close to ten weeks along and will push through the first trimester – the riskiest stretch of the pregnancy – in a matter of weeks. I began telling people one at a time, waiting to tell my family and Rick's family when we were all gathered over the holidays. I thought my best friends would be in town for Christmas, so I held off telling them too. Then the announcements started. My family gathered for an early Chanucka party at my sister's house. SURPRISE! Then, my high school friends had a holiday dinner party. I'M DUE IN JULY! I approach my last day at work before the holiday break and tell my peers, my bosses. FIONA WILL BE SUCH A GOOD BIG SISTER! Fiona's playgroup had a shower for one of the pregnant moms and two of us announced we were pregnant. I didn't mean to, but when Stacey made her announcement, and her due date was so close to mine, I chipped in without censoring myself. Rick and I were starting to feel guilty that the only people who didn't know we were pregnant were his parents and my best friends. After this December 23rd appointment, we could relax and tell anyone we pleased with confidence.
Rick and I go to pay our bill at the doctor's checkout window and the receptionist starts to schedule our next appointment when she notices the order for the ultrasound. Cheerily, she hands us back the orders and directs us to the Imaging department. We walk back down the corridor, settle into some overstuffed chairs, and begin reading articles on how to survive on one income and how mothers of small children have left their careers to work from home. Within five minutes we are called into an imaging room by a technician, an older woman in a holiday, medical smock, festooned with angels and wreaths. Her name is Pat and she instructs me to undress from the waist down, but to leave on my socks. Sweatered and socked, but bare-assed, I joke around with Rick about how sexy a look that is for me. Beneath the paper sheet I tremble while we wait for Pat to return.
In the past, when I thought of miscarriages, I imagined a woman waking up in a pool of her own blood, sobbing hysterically. This is precisely what happened to Salma Hayek who portrayed Mexican artist Frida Kahlo in the 2004 bio-pic, Frida. Alone, she gasps in bed, discovering the hand she reached down below her waist is coated in blood. Kahlo proceeds to paint through the trauma of her loss with graphic, bloody self-portraits. Perhaps I've seen one too many movies, but I'm sure this has happened to many women and not that long ago. Most likely women in less technologically advanced societies than the United States endure this type of trauma on a regular basis.
A friend of mine just recently miscarried and described a completely different scenario. She and her husband went to the OB for the first check up of their pregnancy and were told that the baby wasn't viable. The doctor recommended that she wait a week to see if she passed the fetus naturally. Her mourning evolved into anxiety as nothing changed and she remained pregnant. When she went in for a follow-up appointment with the OB, she scheduled a D and C, and within the week, she was able to move on and reflect without profuse bleeding. The whole experience seemed very clinical and mysterious to me and my friend seemed calm, disappointed certainly, but not hysterical. Only one woman I spoke with passed the fetal tissue naturally. Her doctor did not offer her the option of a D and C. She told me that weeks after bearing the terrible news of her miscarriage did she pass the fetus, and that was accompanied by cramping, excruciating pain, and so much blood that she thought she was hemorrhaging.
Pat enters the room and pulls a curtain around the exam chair on which I am reclined. She lubes up a thick wand and asks if I had ever had a vaginal ultrasound before, as my husband's jaw drops, looking at the instrument. He holds my hand again, this time a little tighter. Pat inserts the wand and rotates the ultrasound screen so that we can see what the monitor detects. She points out the "yolk sack" and before I can joke about feeling like a chicken, she says she is not seeing the flutter of a heartbeat. She uses the word "ominous." We hold our breath and in slow motion I watch her measure the amniotic sack and the white blob that is my fetus. "The sack is measuring around eight weeks," (two weeks behind where I thought I was), "and the fetus looks like it stopped developing around six weeks." Rick wants to know if she is sure, but Pat is certain and apologizes several times for having to bear bad news. I continue to watch the screen and feel Rick's head collapse on my shoulder. A quiet voice in my head whispers, "This was your greatest fear. It's happening." I feel numb, but stroke Rick's hair and listen to Pat tell us that the doctor will see us again to discuss our options. Rick raises his head. His eyes are wet.
Why do so many women miscarry? Immediately, I wondered, "Should I not have lifted that box of books?" "Did the sushi I ate before I knew I was pregnant cause this?" My doctor reassured me that I didn't do anything to cause the fetus to stop developing. The doctor who performed my D and C explained that there were no abnormalities found in the pathology. "It's just chromosomal," she explained. The fetus may have had an abnormal amount of chromosomes, or the chromosomes could have been structurally defective. The genes within the chromosomes might have been abnormal in some way. In other words: it was a fluke. That is not to say that women can do whatever they want while they're pregnant, disregarding medical advice and plain common sense while singing Que Sera Sera. But it should be reassuring to those of us who tend to blame ourselves on a regular basis.
My doctor sees us again in the examination room and is empathetic and supportive. She shares her own miscarriage story and tells us of her two successful pregnancies. She tells us to stay in the exam room as long as we need. When we are ready, we see the cheery receptionist again and showing her the new orders, I inform her that we will be scheduling a different kind of appointment than originally we thought. Am I making her uncomfortable? I don't care. I want to make someone cry. We spend a long forever in the surgery nurse's office, just making decisions (the surgery day, time, doctor) and reading and signing forms: release forms, insurance forms, hospital admittance forms, and all of the informational brochures on D and Cs and "Early Pregnancy Loss."
I remember my mom and my sister having D and Cs. A couple of my friends had had bleeding or endometrial problems and had undergone the procedure. No one told me what it entailed. Dilation and Curettage: the doctor dilates your cervix and uses a surgical instrument to gently scrape off the uterine lining, including embryonic tissue. As news of my miscarriage filtered around my community of friends, I received a supportive email from a woman I barely know. In addition to offering me her phone number and telling me of her two miscarriages, she told me that the D and C sounded worse than it really is. She promised "you'll be on your feet in no time." The procedure is usually performed outpatient, and my doctor suggested partial anesthesia, called a MAC. Friends tell me the pre-op is more time consuming than the actual procedure. I just want it to have already happened.
The hardest part of miscarrying for me was waiting for the D and C. My pregnancy symptoms continued during the course of the week before the surgery—the nausea, weird appetite and cravings, the exhaustion, all of which were mixed with the heaviness of sorrow. I was experiencing the discomfort but none of the joy of pregnancy. During this period of waiting, I also had the unpleasant task of informing friends and family of my miscarriage. When we returned home from the OB's office, I climbed into bed with the phone and called my sister and a friend at work. I asked both of them to pass along my news so I didn't have to repeat the words miscarriage, unviable, and D and C over and over. Later that night after an afternoon in bed, I called my best friends in Richmond, Virginia. It wasn't the joyous news I had hoped to break over the holidays. Meanwhile, Rick drove to his parents to pick up Fiona and shared our sad news with them. (We still have the doll in the basement, the one we were going to wrap as a surprise for them to open at Christmas. I'm not sure I can look at it.) The last part of my announcement plan was to send out a massive email to every family member and friend I remembered telling about my pregnancy. It read like a bad holiday form letter ("Hi to All of My Friends and Happy Holiday, Sorry to send bad news on Christmas weekend," but tough shit!) I just wanted to get the news out into the ether and return to bed for a month to forget everything.
But I didn't forget about it. The week that I waited for my D and C, the week between Christmas and New Years Eve, I checked my email compulsively, two, three, twenty times daily. The responses that I received both as reply email messages and phone calls, and a few note cards mailed to my home, were supportive and kind, but also surprising and illuminating. Although I received virtual hugs from many dear friends who had flawless pregnancies or who had never had children of their own, I mostly heard from women who had experienced miscarriages of their own. The twenty to twenty-five percent number started seeming like a low-ball figure once my friends, family, and health care providers shared their stories. I know one woman who endured at least two miscarriages and one therapeutic abortion between her first and second children. Another woman had five (five, shit!) miscarriages and two stillbirths before bearing two healthy children. Many women at work and playgroup shared stories similar to mine: they discovered the fetus had stopped developing between six and eight weeks. According to The American College of Obstetricians and Gynecologists most miscarriages occur within the first trimester or first thirteen weeks of pregnancy. All of these women told me that they became pregnant again within three months of their loss. Two women miscarried before learning that they couldn't bear children—one adopted two girls, the other has five dogs.
The numbness I felt after receiving the news that I was miscarrying still washes over me in varying interludes. Sometimes I feel sad, sometimes hopelessly sad, sometimes numb again, but I also feel hopeful and grateful. Go figure! After hearing from so many women that they were able to get pregnant again after miscarriage, I am hopeful that we will get pregnant again, and that it will be an uneventful pregnancy like my first. I am also grateful to already be a mom to a hilarious little stinker of a toddler. I am grateful to have the kind of husband who let me sleep late every day during this ordeal while he let out the dogs and changed Fiona's diapers. Moreover, I am weirdly grateful that I told as many people as I did that we were pregnant. If I hadn't broken the news early, I would not have had the long-reaching web of support that I did.
The women I have spoken to, who have shared their own miscarriage stories with me, have been open and honest. In discussing my own miscarriage within the context of a greater community of women who have experienced the trauma of losing a baby, I feel less alone. I am one of many. I am one of the twenty-to-twenty five percent. I am one fourth of all pregnant women. And while this was a private loss, I didn't want to mourn privately. Discussing my miscarriage allowed me to understand that I had not done something terribly wrong to provoke the loss. Perhaps if more women shared their stories of loss, we could help one another cope, recover, and foster a collective of shared experiences. Miscarriage is not necessarily the end of the story. And it does not have to be a secret that you bury beneath a façade of quiet strength.
Amy Miller is a writer who has written professionally for non-profit and educational organizations. She is also a burgeoning essayist and poet. Amy holds an MA in English from the University of Louisville and lives in Louisville, Kentucky with her husband, her toddler, Fiona, and their two, drooly dogs.
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