This is the most difficult thing I’ve ever written.

It’s painful, sad, unpleasant, lonely, scary, relieving, necessary, and something no one should have to suffer through quietly or alone — but we do, all the time.

About half of all pregnancies end in a miscarriage. For about 75% of these miscarriages, the women don’t even know they’re pregnant, yet. I’ve now been on both sides of this number. It’s been a very eye-opening experience from several different perspectives — emotionally, medically, socially — and since it’s an event that most of the women I know either have or will experience, I think it’s worth talking about. I was three years post-miscarriage before I knew what had happened the first time. This time, I was fully aware of what was going on and it was a completely different experience. None of this is in the women’s owner’s manual and no one talks about it. It’s time to change this.

Not everything that’s painful should be forgotten.

Health & My Body

Physically speaking, my body cannot carry a healthy baby full term. Never could. I dislocate bones and joints just by sleeping funny or getting out of bed. My skeletal structure cannot manage the weight and pressure that a growing fetus would introduce. Have you ever had a dislocated rib? How difficult was it to breathe? To eat? To sit, stand, lay down, get dressed, shower, drive,…anything? What about 3 or 4 ribs at a time? Normally, when I dislocate a rib, my doctor helps me put it back. With a growing baby, though, that wouldn’t be possible. Even if we managed to get it back where it goes, it’ll come right back out. So, we’re immobile, suffocating, starving, and hormonally imbalanced because my body is trying to manage a great deal of pain. For brevity’s sake, I’m only covering the rib-cage and am skipping over the plethora of other bones/joints that would be an issue, as well as my immune system, thyroid, adrenals, etc. Some of us simply cannot create and carry a healthy child, and it has nothing to do with wanting or not wanting to.

I personally believe that it is far more important to raise amazing people than it is to birth them. That being said, I’m so very glad that there are plenty of other people out there who can do both.

Not all of us who are meant to teach, love, nurture, show compassion, and improve the human race are also designed to birth those humans.

Knowing my physical limitations, I also opted to sacrifice my health just a little more to ensure that I wouldn’t accidentally get pregnant and end up torturing myself and my unborn child until the inevitable, tragic conclusion. The official recommendation is that you shouldn’t be on Depo Provera for more than about 2 years. I was on it for 15. I’d still be on it, too, but after 15 years, my body decided it’d had enough and started rejecting it.

Now firmly in the “over 35” category, miscarriages are even more common. As are significant birth defects. Compounded on top of previous concerns about whether or not a child would survive the experience, we also have to consider whether or not I would.

This, unfortunately, is our starting point.

Discovering Life

I should have been more cautious. There’s always something more that could have been done. Hindsight has a way of pointing these things out, but that doesn’t mean it’s obvious at the time. I hadn’t ovulated in 16 years and my doctor was pretty sure I never would again, so the odds that it would happen that one week were slim.

It was almost a month before I suspected anything was off, but that’s when I realized how long I’d been in pain. No period, just cramping, and expecting it any day… but it didn’t show up. I kept thinking, “there’s no way… so, let’s confirm it’s not that.” A quick test confirmed the wrong thing.

First, there was shock. Then there was denial. Followed by more shock. “There’s no way.” And finally, acceptance. << This took almost a week.

Then came the doctor appointments.

What I Learned #1: Unplanned Pregnancies

This would be a good time to mention the many ways that someone can accidentally get pregnant while on birth control. Yes, guys, this happens even when we’re being super-responsible. One of the stigmas I noticed was the automatic assumption that “if you got pregnant, you were obviously being irresponsible.” I’d like to help clear up this misconception a bit (without getting into the many messed up things hormonal birth controls do to the female body — that’s another post for another time).

Out of 100 women who use the pill each year, about nine get pregnant. Hormonal birth control by itself greatly reduces the odds that a pregnancy will happen, but it’s not a guarantee. On top of that, these are things that can cause hormonal birth control methods to be less effective (i.e., not work):

Medications:

Antidepressants such as Prozac and Zoloft, and the SSRI (selective serotonin reuptake inhibitor) Serzone (nefazodone)

Diabetic medications such as Actos (pioglitazone) and Avandia (rosiglitazone)

Antibiotics used to treat Tuberculosis or Meningitis such as rifampin (Rifadin), Rimactane, Rifater, Rifamate, IsonaRif, Priftin (rifapentine)

Antibiotics used to treat bacterial infections, like pneumonia and other respiratory tract infections, acne, infections of skin, urinary tract infections, and certain sexually transmitted infections, like Sumycin, Achromycin V, Panmycin, Diabecline, Acnecycline, Dyabetex, Tetra-abc (tetracycline), Bactrim (sulfamethoxazole/trimethoprim), Solodyn, Minocin, Dynacin, Arestin (minocycline), Flagyl (metronidazole), Macrobid, Macrodantin (nitrofurantoin)

Some types of penicillin; Moxatag, DisperMox (amoxicillin); Polycillin, Principen (ampicillin), Kelfin (cephalosporin), penicillin V

Anticonvulsants/anti-seizure medications and medications that treat epilepsy, bipolar or anxiety disorders, nerve-related pain, migraines, or producing sleep such as Barbituates, Carbamazepine, Oxycarbazepine, Phenytoin, Primidone, Topiramate, Felbamate, Lamotrigine, Tegretol, Dilantin, Mysoline, phenobarbital, Luminal, Solfoton (phenobarbital), Mysoline (primidone), Topamax (topiramate), Trileptal (oxcarbazepine), Tegretol, Carbatrol, Equetro, Epitol (carbamazepine), Dilantin, Phenytek (phenytoin), Valium, Diastat (diazepam) or Restoril (temazepam)

Anti-fungal medication used to treat fungus infections of the skin, hair, scalp, and nails as well as ringworm, jock itch, athlete’s foot, and yeast infections, such as griseofulvin (Fulvicin, Gris-PEG, Grifulvin V, Grisactin (griseofulvin), and Gristatin), Mycostatin, Nilstat, and Nystex (nystatin)

HIV medications (antiretroviral drugs), including Nevirapine and Nelfinavir- and Ritonavir-boosted protease inhibitors (Darunavir, Fosamprenavir, Lopinavir, Tipranavir). There are antiretroviral drugs that do not mess with the pill, including Tenofovir.

Mycobacterium avium complex medication, Mycobutin (rifabutin)

Pulmonary arterial hypertension (PAH) medication Tracleer (bosentan), a dual endothelin receptor antagonist that also causes serious birth defects if taken during pregnancy

Nausea medication Emend (aprepitant)

Supplements/Foods:

Soy Isoflavones – natural substances obtained from the soybean plant which claim to reduce the intensity of menopause-related hot flashes, help maintain strong bones, and reduce breast cancer risk.

St. John’s Wort – an herb or dietary supplement promoted for its anti-inflammatory properties and ability to improve mild depression.

Grapefruit and grapefruit juice: grapefruit causes a decrease in CYP3A levels in the intestine and your body needs this enzyme to metabolize certain medications, including some birth-control pills. Women who consume grapefruit are therefore encouraged to take progestin only pills.

Conditions/Circumstances:

Vomiting

Diarrhea

Storage: Extreme heat or cold can help lower the effectiveness of medications including contraceptives. (Keep this in mind while traveling or on vacation.)

Not taking the pill at the same time every day. In order for the pills to be effective, they have to be taken at the same time everyday. This is especially the case for progestin only pills.

Life & The Living

My doctor recently retired, so I found myself in a women’s health facility along with about 30 other women. Some were there for confirmation, some were there for check-ups, some were there to end their pregnancy. Regardless of why you are there, you are not allowed to eat or drink before your visit, you’re advised to bring someone with you, then are promptly separated from them, not allowed to bring any personal effects with you, and deposited into one of the waiting rooms in the back. No one explains what to expect, how many different people you’ll be seeing, what will be happening, and you’re not allowed to interact with the outside world — not even the person who came with you — for the next 4 to 6 hours. For certain exams and procedures, they give you a hand basket for your clothes and have you change into a hospital gown, then you return to the waiting room to sit for a few more hours. It’s cold, quiet, uncomfortable, lonely, scary, and no one knows what’s going on.

I’m still processing so much.

I saw a lot of fear today. A lot of disorganization, questions, getting lost in the shuffle, frustration, low-blood-sugar, caffeine withdrawals, and feeling helpless. Monumental life events should be treated with some reverence, some soulful intention, some peace, and in the absence of fear or abandonment. Today, I sat in a doctor’s office and my heart ached for these women — young women, scared women, alone women, half-naked, stripped of any personal belongings or support system — as I watched a very sacred goodbye take place (and get lost) in a sterile, busy, chaotic, hurried, task-oriented, procedure-driven environment with strangers. The sadness and confusion was palpable. ~ Journal Entry

When I had to let Sushi go three years ago, I opted to do it at home. Just to reiterate: regardless of why or how it’s being carried out, monumental life events should be treated with some reverence, some soulful intention, some peace, and in the absence of fear or abandonment.

I knew Sushi was uncomfortable, irritated, scared, stressed, and angry about being in a hospital, and there was no way those were going to be the last experiences she had. So, I took her home and sat with her in her window all day, scrubbing her chin, listening to her purr, watching it rain, soothing her when a blood clot would cause her to gasp for air. We spent all day in the window together — where she felt loved, safe, peaceful, and warm. When her breathing distress was too much to sooth any longer, I called a technician to come out to the house and administer the medication that would end her suffering.

She was my best friend and longest companion. There was an intimacy and honor to her goodbye. This would have been lost in an environment of chaos, business, stainless steel, noise, strangers, forms, tasks, and procedures. I know the people in that facility were doing their absolute best to make her as comfortable as possible… but, given the realities of this environment, only so much can be done.

This raises a question for me. What is humane?

I witnessed a few dozen women being corralled through a process that I wouldn’t subject my cat to. Can we really claim to revere life while subjecting those who are living to such an inhumane process? I have a hard time believing that any of us actually want to further traumatize women who may be making a medically-necessary decision that they never wanted to make in the first place. I have a hard time believing that a confirmation of pregnancy or a check-up should leave the mother exhausted, with extremely low blood-sugar, and emotionally drained — these things definitely affect the child that’s growing, too. I have a hard time believing that we’d subject any other group of people (save, prisoners of war) to the same type of treatment without feeling some sort of shame or pangs of humanity rapping at our conscience.

We’re so much more likely to feel sympathy for an animal than another person; thus, the best fiction uses animals to define truly humane behavior. ~ Chuck Palahniuk

Then it was my turn for an ultrasound.

What I Learned #2: Ultrasounds

There was something that didn’t make any sense, so I kept asking questions until I understood what was going on. It’s also a pretty important piece of information and can throw several things into question, like paternity.

Based on measurements from the Ultrasound: 9 wks

Estimated conception date: 7 wks

How in the world are these two things different??

When you go in for an ultrasound and they say “you’re at x-weeks and y-days,” it doesn’t mean what you think it means. You are likely NOT that far along in your pregnancy. I know, it doesn’t make sense. Stay with me, though!

If you ask for an estimated conception date, it will generally be different (and I’d recommend asking about this, just to clear up any misunderstandings the ultrasound may cause). For me, I knew that 9 weeks was physically impossible (I’m a woman of many talents, but there are limits to my abilities), so I kept asking questions until I (sorta) understood the explanation.

Why they’re different: the week/day estimate they give you is NOT a time estimate, it’s a size estimate. It’s like measuring your foot and telling you that you’re 12 years old. When you protest, “but… I’m NOT 12 years old…?” They’ll offer, “oh no, that’s not an estimate of how old you are, it’s an estimate of the size of your foot.” << THIS is what’s happening.

Based on additional info — size of the fetus, first day of your last period, etc. — they can actually estimate the date of conception, but this is not what they’re telling you when they say “you’re at x-weeks and y-days.”

This piece of info by itself is misleading — at best. A medical professional should not be allowed to offer this info without also explaining the estimated conception date. I will start by sharing this info with anyone willing to listen, but I will also continue to push until it is no longer acceptable to provide this info by itself.

I witnessed a serious meltdown before I understood what was going on. Because the info was offered without explanation or clarification, the paternity of one woman’s offspring was now in question — she had broken up with someone almost three months prior and was now seeing a very nice man, who she believed was the father of her baby (and she’s probably correct!), but with the ultrasound results, she now has to track down her ex and break the news to everyone. Except that she probably doesn’t, but no one bothered to let her know what’s going on, which is appalling, because everyone wearing scrubs who overheard her frantic phone calls knew that she was operating on bad info.

This needs to change.

Shame & Guilt

I learned a lot of things on a personal level, too.

The amount of pain I was experiencing wasn’t normal.

That at this level of development, the fetus looks kind of like a Peanut.

Peanut wasn’t doing real well.

I knew my body wouldn’t support life, but I’d never been face to face with the reality of it… and I had a choice to make: let it play out until my body rids itself of a fetus that’s no longer growing, or do something more humane… stop the process before Peanut has a nervous system or a brain to interpret the signals, before he’ll have to suffer through any of it.

It doesn’t matter how or why it ends, there is always shame and guilt. You’ve failed and in a big way. It doesn’t matter what your brain knows, your heart is lost.

I need to point out that the people in my life are the most amazing people anyone could ask for. Loving, supportive, understanding, encouraging, kind,… and even with all that, this was still an incredibly difficult thing to go through. I no longer care about why someone might be going through this, whether it’s spontaneous or medically induced, or why they think this is their best or only option, but I wholeheartedly believe that they shouldn’t have to go through it alone, ashamed to tell anyone about it, or worse: surrounded by people who can’t or won’t be supportive. I don’t know how anyone recovers from that. So, I’m putting this out there: if you don’t have amazing people in your life, let me know. I’ll be there.

I’m fortunate that we were still very early in the process, so I didn’t need a procedure of any kind. I could go home and, much like with Sushi, spend some time honoring this life that was ending. Praying, reflecting, checking in with the Universe to ensure we were on the same page… receiving confirmation and comfort.

It took a few days.

My journal notes are fairly detailed, but I’ll spare you most of that.

Once the contractions started, every bodily function you could have came with them — vomit, diarrhea, cramping, bleeding, fever, chills, headache, trembling, sweating… Thankful not to have an audience, the bathroom was my sanctuary, and in about 35 minutes, it was over.

35 minutes.

Life changes so quickly.

I’m oddly glad that I experienced this fully. That I was awake, not numbed, fully present. Awful experiences are just as much a part of who we are as the really pleasant ones… I don’t have to enjoy them, but being present definitely changes my experience of them and the ways in which they affect my life. ~ Journal Entry

While the next part is rather gross, I think it’s worth sharing.

Many women want and pray for something, anything, that they can bury. They need the closure. The child was important and they want to say goodbye with some reverence. I honestly didn’t know what I wanted to do. I knew I didn’t want Peanut to suffer, but I had no plans beyond that. I decided that I would leave it up to the Universe to help take care of my emotional needs since I was in no shape to make those calls.

When it was all over, I was pretty sure Peanut was in the toilet with everything else… but I couldn’t see anything. Unwilling to dig around in there, I flushed the toilet and cleaned myself up a bit. When I returned, it was pristine. Rinsed clean and full of clear water… except for one thing: Peanut. Without muck or debris, Peanut was floating around in the clean bowl, so I pulled him out and put him in a small dish. Super tiny, like the end of my thumb, there he was… completely unaware that anything was going on. There was a strange comfort in that. Seeing him there, at peace, and not the mangled horror show you tend to see online.

It was actually over.

What I Learned #3: Miscarriage Causes

Since it’s talked about so infrequently, I thought it might be helpful to mention some of the things that can cause a miscarriage.

I know I mentioned before that about half of all pregnancies end in miscarriage. I think this is worth repeating. It’s not unusual. And most miscarriages occur between the 7th and 12th weeks of pregnancy. In most cases, miscarriage may be considered a “natural-selection” process, because it marks the ending of a pregnancy that would not have developed into a healthy baby.

Most miscarriages occur when the unborn baby has fatal genetic problems. Usually, these problems are unrelated to the mother.

Other possible causes of miscarriage include:

Infection

Medical conditions in the mother, such as diabetes or thyroid disease

Hormonal factors (like, the mother having a low level of progesterone, which is needed to sustain the pregnancy, or an excess of testosterone, called Polycystic Ovary Syndrome (PCOS), which causes insulin resistance and prevents the endometrial lining from maturing properly)

Immune responses

Physical problems in the mother

Medications

A woman has a higher risk of miscarriage if she:

Is over age 35

Has certain diseases, such as diabetes or thyroid problems

Has a history of three or more previous miscarriages

Has something called “Cervical Insufficiency” where a miscarriage can occur because the cervix does not stay closed and cannot hold the pregnancy. This type of miscarriage usually occurs in the second trimester.

Letting Go

For several days after it was over, I wasn’t real sure what to do — with myself or with Peanut. It was like an ongoing event that had no clear ending, just physical recovery and uncertain emotions.

One thing kept reverberating in my head, though: 35 minutes. I know it doesn’t make sense, but there’s definitely a guilt around how relatively little I suffered. No, it hasn’t been easy, and this is definitely not the grand total of everything I went through as part of this process, but it was so brief. This isn’t a complaint, just acknowledging an emotion — you just sorta feel like you haven’t suffered enough. But you have.

A friend of mine mentioned planting something, as either a marker or simply a memorial, and I thought that sounded like a good idea.

Once it stopped raining, I found a small box for Peanut and dug a hole for the plant in my backyard. It was a very small gathering — just my parents and I.

I’m not much of one for ceremony, but there we were, standing around a little hole in the back yard with a tiny box and a shrub. What do I say? “Glad you had no idea what was happening”? My dad said something brief and I put the box in the bottom of the hole. We added the shrub and filled in the dirt. It was done. ~ Journal Entry

For a while afterward, I was still kind of numb and unsure how I really felt about the whole event.

Do you know that feeling you get when a chapter has officially come to a close?

Leaving an office building for the last time because you’re moving or starting your own company. Signing the last piece of paper finalizing a divorce. Walking across the stage knowing that, come Monday, you won’t be sitting in class. Maybe you’re a little numb, just going through the motions, figuring you’ll sort out the thoughts and emotions later, once you catch your breath. This is how chapters end, I think. With more of a pause or a question mark than a period.

There was no noticeable change in my state of mind after the burial… but the next morning was different. Very different. The air felt lighter, my heart was less heavy, there was no residual pain in a dish in the kitchen, and no more decisions to make. It was over and I was ok. It was the first time in weeks that I felt like myself. I still have bouts of sadness — this is to be expected, but there’s no longer a thick grief in my house. Suffering was minimized, honor was given, closure was received, and healing can begin.

I didn’t realize how important closure would be, but it’s huge.

I am at peace today. ~ Journal Entry

Healing & Compassion

One of the things that touched me throughout this process were the women who kept coming forward and saying “me, too.” Even if it doesn’t change your situation one little bit, it helps to know that you’re not alone.

One of the things that surprised me most throughout this process were the men who kept coming forward and saying “my wife/sister/aunt/mom went through this, too… and I wish we’d been more open about it so she wouldn’t have gone through it in such isolation.”

I think you guys are on to something.

While you may not be able to alleviate any of our physical suffering, companionship and compassion can certainly alleviate some of our emotional suffering… and we could all use a little comfort in that regard.

I’m not sure what I hope to gain from posting this — if anything — but I know that silence rarely helps anyone… so, in some way, for someone, I hope this helps. I’d like to be part of a more compassionate human race. Let’s start with each other.