Sanguine

A Detailed Account of Miscarriage After Loss

My Intentions

I’m writing this for women. I’m writing this because people don’t talk openly about loss. I’m writing this because it is considered socially unacceptable to share, let alone take, images of loss. I’m writing this because it is somehow still taboo to document the processes of bodies. Due to these formalities, women find themselves with more questions than answers regarding the normalcy of their bodies, and at the worst of times, this pervasive lack of information and points of comparison adds another layer of fear and shame to already painful experiences. I’m writing this for women who are suffering, and for myself in an attempt to alleviate some of my own.

This is the story of my miscarriage and it contains graphic images which I have chosen to include for referential purposes. Consider this a trigger warning, but I do implore you to look and read. Information is necessary even if it may be painful.

Pre-Conception

I never wanted children. I wanted a life where I could be an authentic self (piece 1), and to my mind, having dependents would limit my freedom (piece 2), and therefore, my selfhood. However, something was changing in me as I was processing the death of my brother, and more importantly, my best friend. He killed himself on January 27th — a date which would become the anniversary of two tragic deaths — in 2017. My brother left a note in an online drop box, its address written on a piece of paper found in his pocket by the train tracks just a couple of miles from the place I live now, and in that note entitled “sorry.doc,” he addressed each member of our immediate family. To me he wrote:

XXX— Sorry man [redacted] We grew apart and part of that is my fault. I’ve always felt like you got the

short end of the stick. The world is overwhelming to me and I deal with that by withdrawing. I think something similar happens with you but you hate that feeling of powerlessness so you lash out. Your way of coping burns bridges and tht [sp] must suck. [redacted]

He was right. His last words to me will live forever in some deep corner of the internet and they are burned into my mind. He was my other half. He knew me best. And, his final act was to impeach my character. I don’t know how I’ll ever make my peace with that, but I do know that what he said was true, and it was of the utmost necessity for my growth as a human being that he said it.

The winter continued on in his absence. I spent months in bed. My body grew so weak that I could hardly walk for longer than fifteen minutes without shaking. Spring came and I put my mind to recovering. I decided to live. I took a Cartesian approach to rebuilding myself; I started at the most basic tenants of who I was and worked my way back up through decades of beliefs and assertions looking for contradictions. I found many. I reconsidered everything I had believed. In the summer, we moved, and I used the change as an opportunity to be someone better, to put into practice my reconstructed ethics, to become someone my brother would have loved more, perhaps. I found meaning in kindness and became skeptical of the concept of authenticity. My enjoyment of life was revitalized and I felt happy.

The idea of having a child crept into my mind. The desire shook me. But I began to enjoy contemplating the particulars. I liked the idea of sharing my life with a child and of being a mother. However, the idea also stirred in me memories of how I had rejected motherhood once before, nearly two decades ago. It was something I had to come to terms with in a new way and as a vastly different person.

When I was eighteen, after an accident, I found myself desperately trying to get my hands on the morning after pill. In 2002 it wasn’t yet available over the counter, and therefore, it took me over 48 hours to get the prescription. I was, however, within the window where it should have worked. I took the pills and felt a great deal of relief.

I wasn’t good at keeping track of my periods when I was young, but at some point I realized that it was very, very late. Two pregnancy tests later, I began the process of trying to acquire an abortion. At this point, I was already eight weeks along. Managing to get an appointment to have the procedure done was no small feat. There was no surgical center offering abortions in the city where I lived. I had to travel back and forth, two hours with traffic each way, to the many appointments necessary to even schedule the procedure. There were some appointments that I was turned away from because I arrived late due to incredibly bad traffic and I’d drive home in tears knowing that more weeks would pass before I could terminate.

Practical matters aside, I was also terribly ill with morning sickness which for me was all-day sickness. I vomited day and night. I lost weight. I was miserable. I tried not to think about how far along I would be at the time of my abortion, but when the time came, that was an impossible task. On the day of my D&C I was nearly twenty weeks and that is a fact I have been unable to say aloud to this day. I am embarrassed and ashamed of it, and I say that as someone who also affirms their decision to have had an abortion, and as someone who remains pro-choice.

This is a very particular ethical conundrum, for I believe that causing any harm is unethical. I go as far as asserting that plants can be harmed. Most people who argue in favor of abortion argue that no harm is actually committed. I don’t believe that to be true. Robbing a potential person of their future life is most certainly a harm. However, sometimes one ought to do that which is wrong. At the time, having the child would have also caused harm. I had a difficult choice to make, and I will never know if I made the right one. That is just another uncertainty that I’ll have to live with.

Pregnancy

My next pregnancy was purposive. I know the date on which I conceived and upon finding out that it was a successful attempt, I was overjoyed. I took a pregnancy test in Italy the day before Christmas Eve while looking out over Lake Como and the Swiss Alps. Seeing that second pink line develop into a deep fuchsia was one of the happiest moments of my life. I took another test on Christmas and was just as happy.

I became nauseated on that trip for about a week and then it subsided. I was prepared for a nine-month bout of vomiting, and despite being relieved when it abated rather than intensifying, a part of me became concerned. Soon after, I began having what felt like menstrual cramps on the right side of my abdomen near my ovary. Actually, they became so bad that my partner’s mother called a mid-wife friend who reassured me that cramping during early pregnancy is normal. There was speculation that this was implantation cramping, but in hindsight it’s clear that I was too far along to have been experiencing that. However, within a few days, the cramping had entirely stopped and I was relieved. The rest of the trip went smoothly in terms of my pregnancy symptoms. I was quite tired, but I knew that was something to expect.

In my utter joy and excitement, I decided to tell everyone that I was expecting. I didn’t realize how uncommon first trimester pregnancy announcements were because I also didn’t know how common first trimester miscarriages are.

I’ve come to find out that in my age range (I am 34), 40% of pregnancies end in first trimester miscarriage, and most women chose not to say that they are pregnant prematurely in an attempt to spare themselves the humiliation of having to then announce a miscarriage, and also to spare their friends and family the disappointment if the worst were to happen. If I knew then what I know now about how likely it was that I would miscarry, I would have chose to announce it anyway. I want my friends and family to celebrate with me the joyful experiences, and mourn with me the losses.

If there is something that people talk about less than miscarriage, it must be underwhelming familial reactions to an announcement of pregnancy. Most of those who were tagged in my post reacted with excitement and overwhelming happiness. Unfortunately, there were two close family members who reacted poorly. It hurt me very deeply and despite the death of my baby, it has damaged my relationships with these people perhaps beyond repair. Only time will tell if that is to be the case. I mention this because it becomes relevant later on. You can probably already imagine in which ways.

About a week after getting home from Italy, I had my first prenatal appointment with an obstetrician who, when discussing my current medications (100 mg Zoloft), told me that I no longer needed antidepressants, for I would no longer be depressed! He told me:

There’s no need for you to be depressed now. You’re pregnant. That will make you happy.

He spent a total of ten minutes with me during which time he merely did a vaginal ultrasound and commented on my mental health in an aggressive yet disinterested manner. I imagine that cultivating such an approach took many years of fine-tuning. He did, however, ask me about my pregnancy symptoms. I told him that I had a week of nausea and that it had abated quickly. He responded by telling me that “we want pregnant women to feel more sickness than that.” I asked him if I should be worried to which he replied, “I’m just joking.” I left feeling dismissed and offended, but made an appointment with another OB as soon as possible. I did get to see my baby, though. I got to see his little heart beating away. I teared up. I was so relieved to hear that the baby was healthy and growing.

It would be two weeks before my appointment with the new OB. During that time, I began having some dull pain where the cramping had been early on. Terrified, I began doing research and found that as long as the pain isn’t accompanied by spotting, it is usually just caused by uterine stretching. On January 18th, the spotting began. It was quite light and brown in color. I was panicked. I called the OB who I had already seen and was told that as long as the blood is brown, it is probably nothing to worry about. I was told that spotting like what I had described was normal during early pregnancy.

On January 19th, the brown blood became red. I was terrified beyond belief and called the OB again. He told me not to worry and that even red spotting was normal during early pregnancy. He told me that I should be seen immediately, however, if I began passing clots. I tried to relax after the phone call, but the next day, the 20th, the red spotting had turned to deep red coagulated blood.

Upon seeing that amount of blood on the toilet paper, I threw up. I thought for sure I was having a miscarriage and rushed to the emergency room. Oddly enough, I wasn’t having any pain at that time — neither right before, nor immediately after. I tried to take some comfort in that.

I waited at the city hospital ER for about three hours without being seen before leaving to go to a private emergency room where I was seen immediately. They did a vaginal ultrasound and, amazingly, the baby was alive and well. He had actually grown and they were able to see more of his features. I was so proud of him. I thought, my strong little one, persevering. The bleeding was medically unexplained. The pain was chalked up to a hemorrhagic corpus luteal cyst on my right ovary.

I went home happy and relieved. At the same time, I started to suspect that something was wrong despite all the evidence to the contrary. I became suspicious of my body. I began to speculate that the baby was fighting against something.

The night of the 22nd, I began experiencing the pain again, and with it came even more bleeding. A pattern began to emerge: the pain would begin around 5 PM in the lower part of the right side of my abdomen, where the cyst was. The bleeding would start around 10 PM, right around the time that the pain would subside. During the days I was asymptomatic.

This particular night, however, the pain was substantial and the bleeding was heavy. I knew I had an appointment with the OB in 24 hours, but decided to go back to the ER to have it checked out anyway. …They said everything was fine and that the heavy bleeding was probably due to a subchorionic hemorrhage. The baby was alive. I watched its heart beat. I saw that it had grown.

That night I prayed, not to a god, for I’m not a believer, but to my brother. I asked him that if he had any say in the matter, to please protect my baby and keep him alive. I also told him that if it was too much trouble or too, I don’t know, cosmically draining, not to worry about it.

The next day I went to the second OB who was absolutely wonderful. She took her time, did proper exams, was kind and understanding. She did another vaginal ultrasound and said that the baby was completely healthy. She confirmed that the bleeding was most likely due to a subchorionic hemorrhage and told me that this is really just the way it goes for some women, that some pregnancies are just…bloody. She put me on progesterone suppositories to assist in embryonic development, put me on pelvic rest, and suggested that I “take it very easy.”. At this point, I figured that I was just being overly concerned. I had seen so many different doctors who had all told me the same things. I started to believe that everything would be okay.

As the week went on, the bleeding strayed from its original pattern and became constant. The doctors all had told me not to worry unless I was bleeding through three pads per hour and I wasn’t. My bleeding was nothing like that. In fact, I really only saw the blood and the clots when I wiped myself after using the bathroom. But then again, I could say the same thing of my normal periods. The bleeding I was experiencing as a pregnant woman was significantly heavier than my periods. Despite all the reassurance, despite seeing my healthy baby so many times, it just didn’t seem normal or healthy to be bleeding like I was. In fact, I began to look ill. My face looked drained of color and my lips took on a pale appearance. So, mid-week, around the 25th, I called the new OB who told me again not to worry and that sometimes these hemorrhages cause bleeding like I was experiencing throughout pregnancy. She also suggested that I insert the progesterone in the morning as well as nightly due to the fact that I may have been bleeding it out before absorption. I tried to relax. At the same time, we were approaching the one-year anniversary of my brother’s death, and from the beginning, from the moment I learned that I was pregnant, I was terrified of losing the baby on that day — on the 27th.

That Saturday, the 27th, was a hard day. I spent it building an incredibly long railroad in Minecraft to pass the time. I went to bed thinking of my brother, and woke up at 4 AM in terrible pain. The pain was different. It was located low and deep in my pelvis. I felt it in my cervix. The pain felt like contractions — deep, aching, strong. The bleeding didn’t change in amount or consistency. The pain lasted until about 10 AM. Only then was I able to fall asleep. I knew something was wrong. I told my partner that I was sure I lost the baby. However, I wasn’t bleeding any more than usual, and that gave us some comfort. I had an OB appointment on the 29th, so we just crossed our fingers.

During the intervening time, the bleeding never increased. It remained as it was before the episode on the night of the 27th. However, on the 29th when the doctor did the ultrasound, there was no heartbeat. There were no discernible features. It was just a little sack surrounded by hemorrhages. The baby was dead.

Even sadder was the fact that the baby had grown since the previous ultrasound taken less than a week beforehand. When I saw the ultrasound image, even before the doctor said anything, I knew the baby was dead. It was unrecognizable to me. All of the minute details that I had come to associate with my baby had disappeared. All that was left was blood. I cried. We all cried. The doctor said she really thought we were going to make it.

I was sent home with a fetus collection kit, with a prescription for Tylenol 3, and a prescription for misoprostol — a drug that was offered to me when I was eighteen as an abortion option, and one which I turned down in favor of a D&C because I was so terrified of the side-effects and of the experience itself — to help the miscarriage pass. I declined having a D&C this time around because my OB was worried about uterine scarring especially given my history and age. I didn’t want to do anything which could thwart my future attempts to conceive and give birth. So, I went home and inserted 600 mg of the drug vaginally and waited.

It took about three hours for the misoprostol to begin working, but when it did, I experienced the worst pain of my life to date. I was hunched over in agony. I could hardly breathe. My partner called the OB to ask if this kind of pain was normal. She said no, and admitted me to the ER. The pain was so intense that I could hardly walk. The ER doctor began to do a pelvic exam, but very shortly after she inserted the speculum, the fetus still in its sack fell out of my body. Frankly, this was such a relief, for I was terrified of the prospect of having to scoop my dead baby out of the toilet myself. The doctor got a specimen jar and collected it for me. I’m incredibly thankful for that. Within minutes of passing the baby, the pain subsided and I was sent home.