This article was originally published on January 29th, 2016. We're bringing it to your attention again in honor of National Infertility Awareness Week.
It was a hot Sunday, late last August, when my pregnancy ended. Or when it began to make its ending known.
From the pool deck of a friend’s hillside home, I watched the sun dip into the Pacific Ocean, while the city below me receded into shadow. I remember that I was drinking from a can of lime flavored Perrier, because it was the least offensive alternative to a glass of wine, and the small cans sold in bulk at Costco were the right size to carry in multiple wherever I went. It had been four weeks since the positive pregnancy test, and two since the first midwife appointment. My husband and I had been growing accustomed to the very welcome idea of a baby due in March.
I had been experiencing minor cramping for several hours by that point. Previously that morning, I had discovered what I thought might qualify as “spotting,” though I’d had doubts: the stain more closely resembled rusted metal on a seaside swing set than the color of blood. Blood is a color that women know well. I had gone about the rest of the day feeling concerned but not alarmed, spending a few hours at the beach with my husband and our 2-year-old son, and now helping my friend set the outdoor table for dinner while our families splashed nearby in the pool.
By the time the grilled chicken was plated, my cramps had gone from minor to the dull ache that accompanies a heavy period. By the time we moved inside for ice cream, I felt pain throughout my uterus and across my lower back. I was reminded of early labor and told my husband we should leave. At home I began bleeding in a way that left no room for uncertainty. It wasn’t gushing, but it was a tone of true red that my instincts immediately identified as bad.
This was my second pregnancy, and when I look back at it, I remember that until that evening, I had been almost arrogant about the probability of everything going as planned. At 29, I was not considered high-risk for a miscarriage. And as the mother of a healthy toddler, I knew that I was capable of carrying a pregnancy to full term.
It turns out that my pregnancy did end in miscarriage, in the same way that 10-25% of clinically recognized pregnancies do. That makes me among the one in five pregnant women who miscarries at some point during her childbearing years. But despite how common the experience of a lost pregnancy is, and the fact that, in the majority of cases, it occurs as the result of a chromosomal abnormality for which nobody is to blame, open discussion about the subject has only recently begun to take place.
Throughout the days that followed, I found myself saying the same thing over and over again: "Nobody talks about this part of it." My online searches for information unearthed clinical articles that described in almost comically toned-down terms what symptoms I might be encountering. Searches for commiseration found personal essays that were focused on moving on with life after a miscarriage. I was left feeling isolated and unprepared for the physical, emotional, and logistical side effects of miscarriage that I found myself navigating in real time.
My pregnancy was nine weeks along on the day that I began bleeding, according to the date of my last period. Though it was seven according to the measurements taken by an ultrasound technician two weeks prior, who had pointed to an empty black hole on the screen and told me that I appeared to have mixed up my dates. A yolk sac had formed, but there was no free-floating embryo in sight. “Have you had any bleeding?” he’d asked me, adjusting the always unwelcome transvaginal wand in an attempt to view another angle of my uterus. Despite the implications of his question, I hadn’t been too worried, because the same scenario had played out early on in my first pregnancy. In the case of my son, a second scan soon after had revealed an adorably alien-esque fetus and a strong fetal heartbeat. So, I had scheduled a second ultrasound and cried only when I was alone back in my car.
Because it was a Sunday evening when I began bleeding, I called the after hours phone line for the Ob/Gyn office where my midwife worked, and was told that I should go to the emergency room. I had never visited an ER before, and my first instinct was to wonder if this was a necessary step. But I could not fathom waiting until the morning to find out what was happening inside of me, where as far as I was concerned, there was a life forming — a person whose quirks and eye color I had been imagining for a month.
My husband and I entered the hospital through the same set of doors we’d come two summers earlier during the late stages of labor with our son. I was admitted right away.
The pain eclipsed every other aspect of the event — even, for better or worse, much of my sadness.
Several hours, blood tests, and another probing transvaginal ultrasound later, I was told by the ER doctor that 50% of women who bleed during early pregnancy go on to carry to full term. However, a blood test had revealed that the levels of the hCG pregnancy hormone present in my body were much lower than they should be by this point in gestation. The discharge papers reported my condition as a “threatened abortion”: the medical term for a miscarriage.
The doctor described the day of mild bleeding that would likely follow, as my uterus expelled the remains of the pregnancy. Similar to a short period, he’d said. I was told to visit my Ob or midwife the next day, and to return to the emergency room if I began to bleed through more than one pad per hour. He told me it would probably be over soon.
By 3 a.m., I was back home in bed, exhausted, disoriented, and saddened. For my husband and myself, the sorrow felt less abstract than it might have during my first pregnancy, because now we couldn’t help but see our son as a walking, talking representation of what we’d lost.
The week that followed played out much differently than the emergency room staff had suggested. To begin with, I was surprised to discover that it was a several days-long process. The bleeding also far exceeded what I’d experienced during any period over the past 15 years. But the pain: this was what I was least prepared for. It ended up eclipsing every other aspect of the event — even, for better or worse, much of my sadness.
It began in earnest on Monday evening. The cramping I had been feeling since Sunday intensified to the sensation of labor contractions, approaching the phase they call transition — a phenomenon I had experienced in its purest form two years prior, and which I am sure I will never forget. And, like those contractions that had brought me increasingly closer to meeting my son, these too occurred only minutes apart. I was left with just enough time and energy between them to explain to my husband that nobody had mentioned this part of it, that something must be wrong.
These sets of contractions came for hours, until the waves calmed, and my body was temporarily a sea at rest. They returned on Tuesday morning, and again Tuesday night. After a hurricane swell that dominated much of Wednesday, I discovered in the bathroom that I had passed a few large blood clots, which a phone call with my midwife later led me to understand were the byproducts of the pregnancy. A follow-up ultrasound the next day (the same appointment I had previously scheduled in anticipation of hearing the baby's heartbeat) confirmed that I had expelled all of the tissue naturally, and would not require a D&C procedure.
I bled lightly on Thursday night and felt some cramping on Friday morning, and then it was over. Physically, it was over.
The conventional wisdom is that you should wait until after the first trimester to announce a pregnancy, owing to the fact that the chances of miscarriage decline rapidly after week 13. But this particular pregnancy had been entered into with such a level of confidence that we’d told our immediate families, and a number of close friends, within days of setting eyes on that little plus sign. This alleged oversharing turned out to be one the best decisions of my life.
I could not have endured that week alone. Physically, the childcare provided by both my mother and mother-in-law was invaluable. A friend offered to drop my son at preschool one morning, when I was so doubled over in pain that I barely managed to shuffle to the front door to meet her. I felt that nobody had ever done anything so kind for me. At one point, my mother-in-law left us an enormous batch of pasta salad, which I remember not having quite understood — until mealtimes arrived, and their preparation required no further effort than spooning a serving onto a plate. My front porch became a temporary drop zone for flowers, notes, and all manner of snacks involving Nutella, with my best friends not wanting to disturb any rest I might be getting while still making it clear that they cared deeply about my sadness and my comfort.
When the physical side effects receded, the sadness resurfaced in various forms. No matter how many times I was told that the miscarriage was not my fault, I couldn’t escape a sense of self-blame. A reel of probable causes played through my mind: I had taken to leaning too hard against the edge of the bathroom sink while washing my face, or had spent too much time outdoors during the recent heat wave. My healthy son had been a fluke; I was not actually capable of providing a safe habitat for a growing life. But then I thought about the countless women who had endured one or even many lost pregnancies, having never successfully carried a baby to full term. I felt guilty and selfish for my own sorrow, when here I was lucky enough to already be the mother of a child who made me happier than I often marveled was possible.
This was the strangest part of the sadness: experiencing it in tandem with the baseline joy of an otherwise happy life. As much as I wanted to fold in on myself, to retreat from my responsibilities, and even deny myself life’s pleasures out of some sense of duty to the loss, I had to commit to being the parent I already was. I often felt compelled to cry, but I also laughed easily and eagerly when my son danced in the nude or said something weird about farts. It was simultaneously the high and low point of my life.
No matter how many times I was told that the miscarriage was not my fault, I couldn’t escape a sense of self-blame.
In the month that followed, I had my blood drawn three times in order to track my hCG quantitative back down to zero. The mailman delivered bills from the emergency room, from the ER physicians, from the ultrasounds. I added wine to my grocery list again. I deleted the March due date from my Google Calendar, fully erasing a future for which we no longer needed to plan.
When people who did not know about the pregnancy or the miscarriage asked me when we were going to have a second baby, I responded with a vague “someday” and polite smiles. But I understood then, more than ever, how even well-meaning unsolicited questions about a woman’s reproductive plans are rarely a good idea.
My midwife told me that it was common practice to wait at least one full menstrual cycle to try to conceive again, if we planned to do so. Two or three cycles, she’d suggested, might be better to heal both my body and my heart. But I could not imagine being pregnant again at that time, because I could not imagine enduring another loss. A few months later, I felt ready.
Now I am pregnant again. My first reaction to the positive pregnancy test was absolute fear. “This is a different pregnancy,” my midwife has reminded me. And the statistics are in my favor: 85% of women who have had one miscarriage will have a successful next pregnancy. All signs indicate that the pregnancy is thriving. The hCG levels are high, and as such, I’ve been sick every day for several weeks. At the six week scan, I saw a white blur of baby, like a small shrimp, and heard a strong fetal heartbeat.
So I again find myself experiencing a simultaneous high and low. I am entering the second trimester with, if not confidence, then cautious optimism. But I worry when I feel the slightest cramping, even if it’s only the routine stretching of ligaments. And I feel guilty knowing that I was able to conceive again, when many women are either unable to do so, or else endure multiple losses.
I also know that nothing is guaranteed for me, for this pregnancy, or for my family. There are a lot of sunsets between now and July, when the baby is due, and a lot of opportunities for plans to go awry, in one way or another. Which, as I know from experience already, is the only certainty of parenthood, even after a healthy child arrives.