The Miscarriage – From Naivety to Reality: Part 2

After finding out about the miscarriage I sat in the doctor’s office crying, overwhelmed and at a complete loss of what to do.  My initial instinct was to get as far away from any medical technology as possible.  I could not even fathom any type of abortion procedure at that time; it made me sick.  After we had adjusted to our new normal, I realized that I couldn’t wait for the miscarriage to happen naturally.  Being as far along as I was, with my hCG levels as high as they were, it could take weeks for my body to miscarry naturally.  The extra cruelty of a missed miscarriage (as if it could be any more cruel), is that my body thought it was still pregnant.  The pregnancy symptoms I had been experiencing were still in full force.  Morning sickness and exhaustion would be well worth it, if it was for the benefit of my little one growing inside me.  To experience those symptoms knowing that I would never hold my baby was just pure torture.  I had to do something.

After doing some research online and speaking with the nurses at the fertility clinic, we scheduled another ultrasound to be done one week after we had received the terrible news.  If there was no heartbeat and no development at the second ultrasound, we could be sure that the pregnancy was not viable.  As a secondary confirmation, I would also have my hCG levels measured again.  If my hCG had dropped from previous testing then we could be sure of the miscarriage.  There was no way I was ending my pregnancy without full confirmation that it was no longer viable.  I couldn’t live with myself without knowing for sure.

Every time the fertility clinic called to check in, I told them I still felt as pregnant as ever.  I felt so betrayed by my body.  I never had any spotting or bleeding or cramping.  No signs whatsoever of the death that took place.  My baby just slipped quietly away, without me even knowing.

The fertility clinic was such an amazing source of support for me during this time.  Suddenly, the hundreds of dollars of clinic fees seemed totally worth it.  A few days after we found out about the miscarriage I called the nurses to get some more guidance.  I was sitting in my car during my lunch break, as our office walls don’t provide much privacy, and started asking about my options.  I soon broke down into tears.  The nurse was so sweet and understanding.  She listened to me cry and said that it was a terrible thing that was happening to me.  It was the first time someone had said that to me and it felt so validating.  She didn’t try to tell me that everything was okay or that I’d have better luch next time.  It was a terrible thing.

A couple days before the second confirmation ultrasound, I knew I had to figure out what I was going to do if we found out for sure that the pregnancy was not progressing.  We had three options: (1) expectant management (wait and see); (2) medical management with misoprostol to induce abortion; or (3) surgical management with dilation and curettage (D&C).

Each option sounded worst that the last.  I never dreamed that after working so hard to get pregnant, I would have to work even harder to end my pregnancy.

Before I go into how we made our decision, let me say that there is no one-size-fits-all choice for everyone.  Unless there is a medical emergency, there is no “right” answer.  Each option comes with it’s own consequences and each person needs to make a choice that suits them in their circumstances, in conjunction with their health care provider.  I spent hours reading stories about all three options, all with extremely different outcomes.  Reading through the stories of people who have had to deal with miscarriages helped me determine what was important to me, which led me to make the decisions that I did.  My experiences that follow are in no way a substitute for medical advice, nor are they a guide for how every woman should handle a missed miscarriage.  This was just how my story unfolded for me.

Expectant management simply was not an option for me.  I could not imagine weeks of waiting for bleeding to start.  Many women opt for this choice, as they feel it is more natural and doesn’t involve any intervention.  I completely agree and that was my initial reaction to finding out about the miscarriage.  Perhaps if I wasn’t as far along I would have waited.  Based on my hCG levels, it would be weeks before my body figured out that I was no longer pregnant.  The other downside is that there was a risk of infection, as the remaining tissues from the pregnancy would be in my uterus until my body could expel them.  I guess didn’t have the courage to wait it out, and maybe that makes me weak.  I just couldn’t bear it.

The second option of medical management seemed to be the middle ground between an invasive D&C procedure and waiting for the pregnancy to pass naturally.  Using the misoprostol pill, I could have the miscarriage in the comfort of my home (not that there was going to be anything comfortable about it), in my own time and with the support of my wife.  There would have been a day or two of downtime following taking the pill and then we could move on.  The nurses at the fertility clinic said that when the pill works, it works very well for most women.  There is bleeding for 1-2 weeks and then it’s done.  The risks of this option included excessive bleeding, uterine rupture and not fully passing the products of the pregnancy.  If the pill didn’t work, then a D&C would be the next step.

The D&C would have been the fastest way to deal with the miscarriage, but the procedure sounded so awful.  I kept imagining myself, legs wide open on the operating table, vulnerable to the world on the operating table with a doctor digging around in my uterus, scraping out the remains of my pregnancy.  I had horrible visions of only being under conscious sedation (instead of being put totally under) and feeling the pressure and pain of the instrument inside me.  It filled me with such anxiety that it made me cry just to think about it.  I already felt so traumatized by the whole experience, that I wanted to handle the miscarriage quietly, on my own terms.  The risks of a D&C included the usual risks of any surgery (bleeding, infection, anesthetic etc), as well as scarring from the procedure, potentially leading to infertility.  This is known as Asherman’s syndrome, and it is extremely rare, but I didn’t want anything ruining my chances of getting pregnant in the future.

Medical management seemed to be the “best” option for me.

I called the fertility clinic on Friday to request a prescription for misoprostol and a pain killer, to ensure that it was ready for me on Monday after the ultrasound.  If we got the confirmation we were expecting, I couldn’t wait another day for the miscarriage.  I just wanted to move on.  The nurse I spoke to agreed with my decision with gentle encouragement.  The nurses never once told me what to do, but said that whatever I chose would be a good option.  She said that the pill works within a few hours and it was very effective for most women.  I hoped that I fell into that category.

On Monday, our nightmare was confirmed.  My wife and I handled the news in a matter-of-fact way, though our hearts were heavy with sadness.  We were much more prepared for the disappointment.  I don’t think it made anything easier, we just didn’t feel the shock that we had at the last appointment.  We knew the miscarriage had happened, but we wanted confirmation in order to move on.  In addition to the ultrasound showing no progress or heartbeat, my hCG levels had also dropped slightly.  Now we knew for sure.

We went straight to the pharmacy to pick up my prescription.  To make matters worse, the pharmacist could barely look me in the eye when he handed me the misoprostol.  He obviously knew that the medication was for an abortion.  He mumbled something about inserting the pill vaginally and that there would be no side effects because it was a local application.  He didn’t say anything else and awkwardly handed me the bag.  I felt so embarrassed and angry.  I wanted to tell him how much I wanted my baby.  I wanted to scream at him that I never wanted this to happen and that he should act like a professional and give me the information that I needed without judgement.  No side effects?!  How about bleeding excessively or uterine rupture?  How about intense nausea and diarrhea?!  He also told me only to take the T3s if I had pain, as if I was planning on going home and getting high on codeine. I was so upset.  After such a painstaking and devastating decision, to be treated with such disrespect was a slap in the face.

I tried to brush off the negative encounter and hoped that I was maybe just particularly sensitive given my present circumstances.  My wife and I picked up grapefruit juice, a McCain’s chocolate cake and some ice cream.  I knew emotionally eating is really counter-productive.  Given what I was about to go through, I really didn’t care.

At home, I nervously unpackaged the misoprostol and, like a good nurse, carefully read all of the instructions and side effects.  Contrary to what the incompetent pharmacist had said, there were side effects even when the pill was inserted vaginally.  I inserted the 800 mcg dose, which was 4 tablets total.  The tablets were uncoated and awkward to insert.  The medication is actually for stomach ulcers, with an off-label use for inducing abortion early in pregnancy and inducing labour.  The nurse at the fertility clinic told me sometimes it only takes an hour for the pills to work.  I put on a pad and anxiously awaited the effects.  My wife and I got into bed, and started watching Voyager (I may be a bit of a Trekkie) and had some cake.  I was so glad to have her there with me.  I couldn’t imagine going through it alone.

Five hours later I began cramping.  It was worse than any menstrual cramps I have had.  I read that the sensation is very similar to contractions, so I tried to breathe through them, imagining that they were practice for labour later on down the road.  I was glad I had taken a T3 and an ibuprofen earlier.  The cramps were so bad I was just moaning and breathing, lying on my side, hoping they would be over soon.  Then the cramps subsided a bit and I was slammed with a huge wave of nausea.  I jumped out of bed and almost missed the toilet.  I vomited violently five or six times while my wife rubbed my back and held my hair.  No side effects, my ass.

The nausea retreated as quickly as it had come on and I was back in bed dealing with the tail end of my cramps.  The cramps only lasted an hour, thank goodness, but I had not actually bled yet.  It was very late at night, since I was not expecting the misoprostol to take so long to work, and I ended up drifting off to sleep.  In retrospect, this was probably a little bit dangerous as I could have bleed excessively in my sleep.  I woke up in the middle of the night and went to the bathroom.  As soon as I stood up, blood was running down my legs.  I had completely soaked the pad I was wearing and could feel clots and blood passing as I sat on the toilet.

I was both relieved and totally heartbroken.  As I was getting back into bed, I remembered that some women had kept the tissues they passed to bury them.  I felt like I was a terrible mother for not showing more respect for the life inside me.  But I didn’t know what else to do.  I didn’t know what I was supposed to do.

I was so emotionally drained.  I hoped everything would seem better in the morning, but I knew it was probably going to be worse.

I rested for the next two days at home, which I felt guilty about because I needed to save my sick time for the next round of IUI.  But I was exhausted and depressed and still having frequent outbursts of tears.  I was also still bleeding quite a bit and I really didn’t feel like I could deal with that at work.  I watched Netflix and my wife brought me cake when I asked for it and we cuddled.  We did the best we could to grieve and comfort each other.

During those two days, we also received a lot of support from our close friends and family who knew about the pregnancy.  Every text, Facebook message and phone call was so very appreciated.  One of my amazing friends back home sent us a wonderful care package with a vegan cookbook and a kilogram of gummy bears.  You can bet I ate every single one of them in less than a week.  I understand why people want to keep pregnancy and miscarriage private.  At the same time, having all of the support of our friends and family made everything so much more bearable.  Every time someone asked me how I was doing, it allowed me to process and express my grief.  Don’t get me wrong, it hurt like hell.  But I think it was better than hiding all of that hurt in my heart.

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As I said in my last post, the misoprostol did not work for me and I ended up bleeding so much that I soaked through my clothes at work two weeks after taking it.  This resulted in a trip to emergency and a D&C procedure, the details of which will be in my next post.

Despite my initial pangs of regret for telling everyone that we were pregnant, I now am so thankful that we don’t have to hide the pain we are experiencing.  Countless friends and family members have reached out to us, offering condolences, compassion and care packages, for which we are so incredibly grateful.  Knowing that we are not alone has made this dark time in our lives a little bit brighter.  Thank you for reading and for being a part of our journey.

-K

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The Miscarriage – From Naivety to Reality: Part 1

Well, there’s no easy way to say this, so I’ll just say it.  We had a miscarriage.

I was diagnosed with a missed miscarriage at 8 weeks 5 days, and after confirming the diagnosis I had a medical abortion with misoprostol (brand name Cytotec) at 9 weeks 5 days.  After two weeks of bleeding from the medication, I started bleeding extremely heavily and was advised to go into emergency.  After some tests and an ultrasound it was determined that I had retained some products of the pregnancy and had to undergo a dilation and curettage procedure (D&C).

Needless to say, these last two weeks have been hell for me and my wife.  It’s hard to remember back to the days following that positive pregnancy test.  All of the joy and excitement we had when we found out we were pregnant is such a stark contrast to the devastation we feel now.  It feels like I was living a different life.

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I found out I was pregnant on my birthday and it was the best gift I could have received.  I could hardly believe that it had worked the first time!  It was a dream come true.  Sounds like the beginning of a picture perfect movie, right?  That’s what I thought too.

Truth be told, I actually had an inkling that I was pregnant the day before my birthday.  The two week wait was killing me and I really wanted to be prepared for the news from the fertility clinic.  At exactly two weeks, I was to go have blood work done to check my hCG levels (the pregnancy hormone) and then the fertility clinic would call me the same day with the results.  I decided to take a Clear Blue pregnancy test the night before the blood work, just to see what would happen.

I peed into a cup (much easier than trying to aim for the stick!), dipped the stick, sat on my bathroom floor, and started my timer.

The indicator window was blank for the first couple of minutes.  Of course.  It’s exactly what I thought.  It didn’t work, I’m broken, we’re gonna have to shell out another $2000 next month to do this all over again.  Ugh.  Nonetheless, I continued to stare and stare and stare at the stupid window right until my timer went off.  All of a sudden, the faintest, palest, shadow of a second blue line started to appear.  I stared at that silly pregnancy test from every angle, in every light, straining my eyes to make sure what I was seeing was correct.  I could hardly believe what was happening.

I was pregnant.

My cute Pinterest-y plans of telling my wife the good news quickly went out the window as I yelled her name from the bathroom and started freaking out.  When she came in, I was still sitting on the bathroom floor, next to my pee, waving the pregnancy test in the air like a crazy person and I kept asking her, “Is this real?!  What if this is REAL?!”.  It was all very romantic.

As an aside…who are these amazing women who set up adorable photo shoots and blindfolded taste tests to surprise their partners with their big news?!  I couldn’t imagine holding on to such exciting information long enough to plan something so delightfully elaborate.  My original plan was to give my wife a set of baby Converse shoes (so cute!) when I told her that we were pregnant (which I had wrapped and stored in my underwear drawer for the last couple months, because I’m a planner like that).  She loves Converse, it’s the only shoe she wears other than combat boots.  She even wore them at our wedding!  How cute would that have been?  I had imagined it all perfectly, and after I told her the precious news we would embrace and smile and be filled with joy.  Rainbows would shoot from the ceiling and doves would fly gracefully down from the heavens to mark our celebratory moment.

Yeah, that didn’t happen.  Like, at all.

The next day, after the blood test, I watched my phone obsessively waiting for the actual confirmation from the fertility clinic that the pregnancy test was positive.  I was secretly very excited, but I also wanted to make sure that it wasn’t a false positive.  I watched and waited, and watched and waited some more.  Unfortunately, despite leaving a voicemail for the clinic, no one got back to me with the results that day.  It was pretty frustrating, but I decided I would just take another pregnancy test (or two!) and get confirmation myself that evening.  I picked up a First Response dual pack (way better than Clear Blue, in my opinion) with a digital test and a line test.

The second I got home, my pants were off and I went straight to the bathroom with a cup.  I waited anxiously, but it didn’t take long for a very clear “Yes +” to show up on the digital strip and the brightest, clearest pink vertical lines to show up on the other strip.

Okay, I really am pregnant!!!

I could hardly contain my excitement and we immediately contacted our parents with the great news.  This was really happening.

I was just glowing for the next few days.  My heart was full and I felt incredibly blessed to have had our IUI work the first time around.  I think I was also equally shocked that it had actually worked the first time around.  I’m sure a lot of other couples weren’t so lucky.  I received a call from the clinic, that my hCG levels were excellent.  I had to go for a second set of blood work 2 days after, just to ensure that the levels were rising appropriately, as hCG should double every second day at the beginning of a pregnancy.

My second set of hCG levels were sky high and I was starting to feel all of the lovely first trimester symptoms.  My boobs were gigantic and I could smell EVERYTHING.  I felt like a superhero.  For anyone who knows me, I definitely do not need help in the bosom department, but it was nice to feel the changes in my body.  It made everything feel so real.

Around 5 weeks is when things really started to get fun.  I started having the worst morning sickness, that quickly upgraded to all day sickness.  I was exhausted and I hated all food.  Seriously.  I tried all the standard remedies for morning sickness like soda crackers and ginger ale, but nothing really helped.  I couldn’t imagine eating anything, but at the same time I was starving and having food in my stomach really settled the nausea.  As you can imagine, I was pretty miserable, but also knew that all of the symptoms were a constant reminder of the life growing inside me.

At 7 weeks and 1 day, we had our first ultrasound scheduled.  We had the familiar drive up to Saskatoon, but I was over the moon that we were about to see our little (very little) baby.  My wife and I chatted about the future and continued our plans that had been brewing for our little family since we received the news.  I was so excited to see our baby and maybe even hear a heartbeat!

In the clinic, I laid down on the table for a transvaginal ultrasound.  That early in the pregnancy, a transvaginal ultrasound is much more accurate than an abdominal ultrasound.  Within a few seconds our doctor found our little tiny baby.  He or she was really in there!  My heart just about burst with love for this tiny being that was only the size of a strawberry.  I asked if we could hear a heartbeat too, but the doctor said that she was having some difficulty finding it, but that it was probably nothing to worry about.

After the ultrasound, we had a brief consultation in her office.  Our doctor said all of the measurements looked excellent and right on track for how far along I was, but that the lack of a measurable heartbeat was “mildly concerning”.

My heart dropped.

Those were the last words we wanted to hear and though I was trying to focus on the positives, I was devastated.  What happened to our picture perfect movie?  I was supposed to see our little baby, hear their precious little heartbeat, smile loving into my wife’s eyes, glistening with tears and feel a deep sense of joy at the life being created inside me.

Instead, I felt scared and disappointed and cheated.

All of the wind was taken from my sails and we had a pretty quiet drive back home.  We had another ultrasound booked in a week, to confirm that everything was okay.  It was slightly early to hear a heartbeat, so I clung on to the fact that the measurements were good and we saw little flutters of movement on the ultrasound screen.  Maybe everything will be okay after all.

With the Easter weekend quickly approaching, we decided that we would go ahead with our plans to tell our family.  We don’t see everyone back home very often and we really wanted the chance to tell our loved ones in person.  Even though I knew miscarriage was a possibility, I just couldn’t believe that it would ever happen to me.

Miscarriage is one of those things that happens to other women.  Friends of friends.  The fertility nurse who did my IUI just had to look at me and I got pregnant.  Clearly, my body was ready to make a baby.  I wasn’t in a high risk group.  I was only 29 years old.  I had taken my pre-natal vitamin for three months before trying.  I slept well, exercised, went to yoga regularly.  We had minimal processed foods, tons of fruits and veggies.  I had cut out caffeine and alcohol long before our first IUI.  I had switched all of my cleaning and personal products to brands that did not contain phthalates and all of those other nasty chemicals that aren’t recommended during pregnancy.  I made my own deodorant, for god’s sake.

I had done everything right.  But I guess it wasn’t enough.

On Easter Monday, we drove back from Edmonton and stopped in Saskatoon for our follow-up ultrasound.  We were cautiously optimistic.

I laid down on the table for the trans-vaginal ultrasound and immediately my eyes were glued to the ultrasound screen for any sign of our little baby.  I still felt so very pregnant.  The doctor scanned and scanned and kept doing sweeps of my uterus.  The doctor was very quiet.  Deep down I knew that something was wrong. I felt my wife’s hand on my shoulder.

“I’m sorry.  I don’t see anything.”

“What do you mean?” I said, knowing what she meant, but refusing to believe it.

“I just don’t see anything.  Last time there was a fetal pole and now I can’t see anything.  I’m so sorry.”

She removed the ultrasound wand and I sat up.  She said she would meet us in her office down the hall.  I turned to my wife and said, “I guess this is why people don’t tell early” and burst into tears.

I felt ill. I could hear the blood pumping through my ears.  My throat hurt so much from holding back a flood of tears.  I just wanted to break down, but there were other patients around in the office, so I tried to keep my composure.

As we sat down in the doctor’s office, the first thing she said was that it wasn’t my fault.  That should have made me feel better, but it didn’t.  I was devastated.  I felt like everything was my fault.  How could it not be?

She presented our options.  I felt bad for her.  I’m sure this was one of the worst parts of her job.  I was only half listening, trying to process how our lives and future plans had just shattered all around us.  In that moment, I couldn’t imagine any sort of abortion procedure.  I said we would just wait for the miscarriage to happen naturally.  She said it may take a week or two.  I couldn’t think.

My wife drove home and I cried.  I couldn’t think of what to do except to start telling my close friends and family that we had miscarried.  I couldn’t speak.  I didn’t want to call anyone or answer the phone.  I just texted through my tears.

I miscarried.

I found out I had a miscarriage.

I just found out I miscarried.

Every time I typed that word, it looked more strange, as words do when you stare at them too long.  I think it helped me accept what was happening, in some small way.  With every person I delivered the news to, I felt another piece of my heart break.

I felt a deep shame and embarrassment.  Like I had let everyone down.  Everyone was so excited for us.  We had a trunk full of baby gifts already.  A bassinet, blankets, little toys, a diaper bag.  I felt stupid for having those things.  How foolish to start planning so early, when I knew full well this was a possibility.  I still haven’t taken those things out of my trunk.  I can’t.

I immediately understood why people choose not to tell anyone they are pregnant until the first trimester is over.  In that moment, I wished we had done the same.

When we finally got home, my wife and I collapsed onto our bed a cried together for a while.  I was upset that she hadn’t shown much emotion, as she was trying to hold it together for us, but as soon as she started crying I wished she would stop.  Her tears made this nightmare real.  Her sadness broke my heart almost as much as losing our baby did.  We held each other for a while and eventually the tears stopped.

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The following week was a confusing mess of hope and devastation.  As I regained my critical thinking and started to adjust to our new circumstances, I explored the options for handling the miscarriage.  My initial idea of allowing the miscarriage to happen naturally, was seeming more traumatic by the day.  With my hCG levels as high as they were and the pregnancy as far along as it was, it could take weeks to miscarry naturally.  I’m pretty tough, but I’m not that tough.  I couldn’t imagine dealing with all the pregnancy symptoms (which were still in full force at this time) and just waiting day after day for bleeding to start.

My other options were to take a pill to induce the miscarriage or to elect for a surgical dilation and curettage procedure where they remove the pregnancy products and lining of the uterus.  Both options sounded awful, but not as awful as waiting for endless weeks for the miscarriage to happen naturally.

In my next post, I will write about the next steps we took with our miscarriage.  There are no easy decisions and no “one size fits all” approach when it comes to a miscarriage.  I will go into detail about how we came to our decision and the resulting events, but I don’t think I can handle much more crying today.

My hope is that my writing here may provide some comfort for women and couples who are dealing with the same experience.  I personally found a lot of comfort in reading the various miscarriage discussion pages and threads out there, so I hope to return the favour.  I have found that it helps knowing that you are not alone.

I also hope that reading my experiences here will be a reminder that although pregnancy can be a very joyous time, it can also be very traumatic.  I think it’s important to remember that everyone has a story.

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This was our first ultrasound.  The little blip between the green crosses was our baby at 7 weeks 1 day.  At the appointment, I remember making the ultrasound joke from that Friend’s episode, when Rachel couldn’t see her baby on the ultrasound screen.  But I definitely saw her.  And I loved her.  And I was already imagining a life with her.  I know she was very small and brand new, but for a few weeks I was her mom.

-K