What to expect when you're no longer expecting...

Don't anyone take this 'stolen' title, as I think I deserve to own this clever take on the "What to Expect When You're Expecting" series! Yes, I think I have some right to the phrase. Why???

Let me back up the proverbial "truck" (which is both what my body feels like and what I feel like I've been hit by in the last year). You may recall from an earlier post almost a year ago (The Day That Changed Everything) that I suffered my first miscarriage in February 2008. This rocked my world. I couldn't believe that something like that would happen to me - me the one with two beautiful, healthy boys. It did. And, yes - I got over it; but not over it like you get over a cold. I can't say that each time I have been struck by "Acute viral nasopharyngitis" or "acute coryza" it has irrevocably changed me. The miscarriage, which for me was the loss of my baby Devyn, did alter who and what I was (not completely). It altered how I saw the world and myself in it, and not in a purely negative way. Finally getting past the "why me" pity party I realized that this experience, which at first crushed me, did not destroy my spirit. Rather, it made it and me stronger. It turned the core and/or character I thought I was/had into elastic. I was stretched in all directions, including toward my own children, my husband, my friends, my work and away from each at times. It was as if someone or something from outside me was manipulating me. My life and my soul (if you will) seemed no longer mine to possess or control. But, as I said, I got over it.

After much soul searching, lots of tears and a few screams DOAD and I were as prepared as we could be to "try again." Trying again after miscarriage is a scary undertaking. I wondered could it happen again? I waited the prescribed two healthy menstrual cycles and we were ready to try for the next pregnancy. It came as quite a surprise last June when we realized we were, in fact, pregnant again. I remember feeling not only excited about it, but also relieved that we wouldn't have to go through the up/down ride of trying to get pregnant (e.g. period, wait 10-14 days, start testing with ovulation sticks etc..... am I? perhaps - no coffee, no wine, no running, no.....). It seemed almost too good to be true. And, it was. July 6th (the day after B1's 5th birthday) I started bleeding, heavy, and I knew what was happening. Somehow (although I remember being sad and upset) it didn't seem to be as bad or as hard to deal with as the first time. It was so early (5 weeks) and we had only known for a week. It was easier to tell myself that I wasn't ready and I hadn't given my body enough time to heal and get healthy from the first miscarriage yet. Off we went the next day to visit family and I tried to just carry on like everything was fine.

Was it? Perhaps. I started getting serious about running again. I went to the gym before work in the mornings and watched more carefully what I put into my body. By the Fall I felt wonderful. I had reached the weight I wanted (I think 1 or 2 pounds less than when I was pregnant with B2 - at time time I felt this mattered!!). I was ready. We were ready.

Ready for what is now the question. After a couple months of trying to conceive my LMP (for those unfamiliar with this speak that's last menstrual period) was October 31st 2008. Forgive my perhaps morbid humour but what first appeared as a treat turned out to be a trick!

Early December I did a pregnancy test and YES, it confirmed it: we were expecting! As I had two miscarriages I had been advised to contact my OBGYN as soon as we were pregnant. I was hyper vigilant now. No running, no caffeine, no alcohol. This time, though, I added more than 'Materna' (pre-natal vitamins) to my daily regiment. My doctor indicated that for some women early pregnancy loss is related to luteal phase defect (low progesterone). I may want to opt for progesterone suppositories. So, there began my mornings with a waxy pill specially made for me that I would pop and days ended the same way. Add a little lose dose aspirin for good measure and the control I had over this pregnancy was complete. Well... I had positive thoughts too?!!? As well, the nurse scheduled me for an early ultrasound, "just to make sure everything was good."

December 29th came, the ultrasound appointment. I should have been at almost 9 weeks, but when the technician did the ultrasound he found a healthy gestational sac measuring at 7 weeks, 5 days and only a small fetal pole. I was sent to the restroom to empty my full bladder so they could do an internal ultrasound to get a better picture. There I looked at myself in the mirror, "This is all going to be alright," I actually said aloud. I felt nothing was wrong (and I was the one who was wrong). I returned for the next step. After the tech had completed the search for my baby's heartbeat and came back empty handed, he left to get the doctor.

This time around the doctor wasn't cold, she merely indicated that "we would have expected and liked to see more at this point. We couldn't get a heartbeat and it would have been there at 6 weeks. Could your dates be off?" I was puzzled and didn't quite know what to make of this. I told her I had a long cycle and hadn't had regular periods. She said to come back in a couple of weeks. I needed something more, so I said, "What are you saying, it is 50/50?" "Yes," she replied.

Somehow I was able to get through the 18 days between this and the next ultrasound. Finally, it was January 15th 2009. Throughout this time I had remained calm, hopeful and otherwise pregnant. My nausea, breast fullness, tummy expansion and hormonal temperament had not subsided. I had no signs the pregnancy was failing. I woke feeling excited that I would hear my baby's heartbeat and know that everything was alright. The experience was not quite was I anticipated.

The technician moved the wand back and forth and I attempted to gain the best glimpse of the screen I could. At that moment, I knew. The fetus was no longer living. This pregnancy was over; only my body wasn't acting like it. The report would indicate no evidence of the fetus, likely already absorbed. The gestational sac this time measured at 8 weeks, 5 days. I don't know what this means. Perhaps things progressed and my baby's heart did beat, or maybe it was already dying at the first ultrasound and the products of conception [which the contents of my uterus would later be referred to as] had simply continued the process of pregnancy without the little being they were supposed to support. All I knew was that this third miscarriage gained me entrance into a new category, "recurrent miscarriage." I had had three miscarriages in a row.... after two healthy pregnancies and babies. But.. I am getting ahead of myself.

I left the clinic. I didn't yet cry. I called my husband and told him our terrible news. He had been so supportive over the past weeks. He kept me upbeat and didn't allow me to lose faith. [Thank-you.] In explaining what happened and how I was making sense of the non-sensical I lost it. I wept in my car alone into my cell phone. Shortly after that, sipping on my REcaffeinated coffee, I drove back to work. I carried on, proceeded as usual. The next day, I started to bleed. I still find this fascinating how the mind and body are both interconnected and at odds. Once my brain knew it was over, I must have let go. Yet, why/how could my mind (all those positive thoughts) keep my body from miscarrying earlier?! These answers I will never have. I do expect other answers, though.

Throughout the weekend the bleeding continued, although not extremely heavily. After I had lost what I thought was most of 'it,' the bleeding started to tapper off. I figured this was a good sign. The early pregnancy loss clinic at the hospital had contacted my Friday (the day after the ultrasound) and urged me to come in 9:00 am Monday morning. In addition to support, they wanted to assess me, get some blood tests done and since I am Rh negative I would need a shot of WinRow/Rhogam.

I left alone for the hospital with DOAD at home with my boys. I got there, pad in place, and spoke to the nurse. I had gone directly to the clinic, so wasn't ever admitted to the hospital. We discussed my options: 1. Let my body finish the miscarriage on its own; 2. Take a drug to make my uterus contract and complete the miscarriage with chemical assistance; 3. Have another ultrasound, get a doctor's opinion on how to proceed; 4. Schedule a D and C. I was planning a trip in two days, so I was concerned about the time frame, however, I had already started bleeding (unlike last February), so I felt comfortable telling the nurse, "I'm just going to let my body do what it's going to do." I didn't know what accurate those words were! Off I went to the lab and here is where things went sideways. I had to wait about 30 minutes for my blood work. During this time I had to dash not once but 6 times to the restroom in order to release the bleeding into the toilet! At this point I became a little concerned.

After they took my blood I returned to the clinic and sat down with the nurse. At first she explained that the shot wouldn't be ready for 1-2 hours and I could go home. Then, she looked at me and I could tell I didn't look good. "Perhaps, we should have you lay down in a room." I needed to go to the toilet (same story as above). This to the room, back to the toilet continued I don't know how many times. The nurse monitored the blood loss. She also checked the contents and told me, "This is not tissue, it is all blood clots." That is not good!

From here on it's a little hazy. From what I recall I was over the toilet hemorrhaging and the nurse was rubbing my back. Next thing more blood, cold sweat/hot needles, and I am out. I come to and feel absolutely like death. A total loss of control (much more so than in birthing my two children), numb and sensation all at the same time. Again, I faint. Now there are several bodies surrounding me and my own is betraying me. First the baby, now all my blood! I was later told that in the span of an hour I lost almost a liter of blood. The nurses and doctors must have put me in a stretcher because next I recall trying to pull my phone from my purse and hearing a voice (my own) say, "I have to call my husband." From not a patient, to outpatient, to emergency, to operating room to recovery, to day surgery - I would certainly have a tour of the hospital that day (although I wasn't conscious for most of it!) I was classified as high risk. As blood poured out of me they rushed me to Emergency. Another woman had been scheduled to have a D and C. She was stable, waiting. I was not. The operating room, the doctor and the team was all ready and prepared, I was to 'bump' her and it would be my body the next procedure would be preformed on that morning.

Everything went well. I escaped having a transfusion. I left a few hours later with a recovering uterus, a bruised hand (from the IV) and a bruised heart. WHAT JUST HAPPENED?

What the "What to expect when you're expecting" books FAIL TO EXPLAIN is what to expect when we are no longer expecting. They fail to equip women with the tools, skills and resolve to withstand the pain and confusion associated with early pregnancy loss. The wider culture also basically ignores miscarriage. This silence hurts not only women, but the men in their lives who suffer silently because they know they are probably their partner's only support system. [Back to the trick/treat metaphor: When all this happened I was at the eve of 3 months. Coincidentally (see previous post) right at the 35th birthday.]

Miscarriage is a mystery. There is a list of potential "causes," but it appears thus far in my experience that no one is willing to point to the reason in individual cases. I was pregnancy THREE TIMES in 2008 and I have no babies!

With Devyn I could make not sense of it, but at least understand the event as something wrong with the baby. I didn't want a sick child; the baby wouldn't have been healthy - nature let it go. The second time around, it was different I felt it was more me, but the general me. I didn't locate the problem with my fertility or reproductive health, but rather general health. I wasn't ready (I convinced myself). With this one, I don't know where to even begin to wrap my head and heart around it. Obviously, the problem wasn't luteal phase defect. So, what was it? Why is this continuing to happen to me?

Now I want some answers. I am pleased so far that my doctor is treating my case differently now. With this third I cross an imaginary threshold whereby I qualify for investigation. After all the hormones are gone I am to begin a battery of blood work. Does it all come back to blood?!

... much more to say, feel and think on this, so the story will continue