Healing After a Miscarriage

I began to heal, it seems, after the news about our baby girl's sad condition. Knowing there was a reason for the miscarriage truly helped, although I know many women never get any answers.

As I awoke from a dream about my baby the next day, my little girl's name came to me very clearly, almost audibly, while in that twilight stage between sleeping and waking: "Her name is Annabelle." I had never considered this name before (I have quite a few names on my list) but it was perfect and lovely and I instantly knew that was indeed her name. I doubted my husband would agree since we hardly ever agree on names. But when I told him, he really liked it, and so I looked up the name's meaning online: "lovable." Well, that was certainly true of our little girl! We deeply loved her and she was entirely lovable even at such an early stage of development (8 weeks in pregnancy terms and 6 weeks gestational age).

My healing since has included creating keepsake albums for our angel babies, Aidan and Annabelle. I included pictures taken when I was pregnant, the beloved "tokens" of the saved postive pregnancy test strips, and of course, the many ultrasound photos we have of Annabelle. My 4 year old daughter helped me put them together with stickers of hearts, flowers, butterflies, angels, "love" quotes and pictures of Jesus with the children.

I also purchased and decorated a wooden box with paint and jewels to place the little bit of fetal tissue I had left of Annabelle (after the D & C I still miscarried some fetal tissue and was told to freeze it just in case it was needed by the OBGYN). We are going to bury the little box at our church and have a private memorial liturgy to thank God for the lives and joy these little ones brought to us in their short existence on earth. They are our children in my eyes, regardless of their gestational age.

I also created a "plan" for healing and good health for a future pregnancy that includes having my husband totally wean off the SSRI's (he has since done this) and take fertility vitamins. For me it includes exercise, healthy eating, prenatal vitamins, increased folic acid, no caffeine or aspartame, and rather religious charting of my own bodily/fertility symptoms. So far so good.

Something else I found really helpful was to purchase a keepsake "baby bean" bracelet with Aidan and Annabelle's due date birth stones from http://myforeverchild.com/ (bracelet pictured above). I couldn't hold my babies, but I wear that bracelet and lovingly kiss and hold my little beans throughout the day alongside their emerald and peridot birth stone beads. I also like it because no one else knows what it means or asks intrusive questions about it.

Additionally, prayer and Scripture reading, which is something I've done daily for years, has taken a new level of priority in my life. This, more than anything, has been getting me through this time and bringing me healing. I record Scriptural promises and pray with more passion while praising God more frequently; this has kept my soul strong and even joyful in the midst of this terrible grief. "The joy of the Lord is my strength." If you have faith and are dealing with a loss: pray, pray, pray. I can't explain it, it's just a God-thing.

Trisomy 13

The OB called back in just a week, and I was surprised to hear from her so soon, but the lab results on the baby were already in after the D & C. She said, "it was an extra chromosome." I immediately wanted to know which chromosome and she explained that it was "number 13"...in other words, Trisomy 13. Trisomy 13 is a very serious chromosomal problem and is considered fatal to the baby she explained. Most babies do not make it to live birth and those that do usually live for only a few hours or days. One of the areas it impacts is the heart, and congenital heart failure is a problem, which explained (to my mind) why the heart beat may have stopped so suddenly. She also said they "weren't worried about it being genetic." Meaning, it was most likely not inherited from us as parents, but simply a random, fluke mistake that happened during conception due to damage in the sperm or egg. Once again...I immediately thought about those SSRI anti-depressants my husband was on and the way they damage sperm DNA. It certainly seems like a very possible cause. Of course, at my age of 37, my eggs aren't in tip top shape either, so between us, our risk is higher. Still....those awful SSRI's! (We resolved to get my husband off of them.)

Finally I asked the OB if they knew whether it was a boy or girl. My OB hesitated and asked, "Do you REALLY want to know?" "Yes" I said. "It was a little girl."

I hung up the phone and immediately called my husband to let him know. While it was sad news, I was also relieved on some level because it meant that we had been spared, in some sense, more heart break later down the road. While I still deeply, deeply wish I could have held my baby if even just once, I know that it would have been beyond heart breaking to go through an entire pregnancy and live birth with Trisomy 13. The pain I was experiencing was awful enough. I also realized, although I had been terribly angry at God, that this was an answer to my earlier prayers: "If something is terribly wrong, please take the little one home to you Lord."

I did a bunch of googling and saw all kinds of images and learned all about Trisomy 13. I also let my parents and best friends know the news. This was of some comfort, just to have answers to give others and not always wonder "why?" like I do with my first miscarriage. More information about Trisomy 13 can be found here: http://ghr.nlm.nih.gov/condition=trisomy13 and I found a very touching site for parents of Trisomy 13 children: http://www.livingwithtrisomy13.org/ .

The OB had me come back for a follow up appointment 2 weeks later and things looked fine. The lab drew 10 viles of blood to start testing me for possible causes of recurrent miscarriage. I was told the doc would put me on progesterone during my next pregnancy, not because she thought it was the cure, but because she would feel like she was doing everything she possibly could to give me and the baby the best chance. Low progesterone levels in women are known to correlate to higher miscarriage rates, but it is unclear and hotly debated whether it actually helps to take progesterone. I suppose many take the approach of, "We don't know but it can't hurt." I left the office feeling that this part chapter of the story was now over and I could begin healing.

The D & C

The morning after learning that my baby's heart had stopped, I knew I needed one more thing before the D & C (Dilation & Curettage): reassurance that my baby was really and truly dead. I called the OBGYN's office and asked, as nicely as I could, that while I knew it was "not logical," I needed "another ultrasound" before they did this irreversible procedure. Otherwise, there would always be the tiniest bit of doubt in my mind that maybe, just maybe, they had made a mistake. At first I was told that the ultrasound schedule was full. So I hung up and immediately made an appointment with a private company that specializes in doing 2D/3D images of (living) babies. I knew my request was odd and that if I hinted at the idea that they were somehow giving me a second opinion, they would probably deny me the scan. So I simply said I wanted some memorial ultrasound pictures of the baby I was miscarrying. They agreed to do it.

I arrived and realized how truly odd this was: it was a room with a large couch and places for a crowd to watch the baby on a big movie screen as the tech performed the ultrasound...obviously a moment of great celebration and fun under normal circumstances. I felt so strange and sad lying there by myself. But the tech did the scan and as the little baby bean's image was projected on to the big screen, it really sunk in that the heart was not beating. I asked her a lot of questions which helped me understand what I was seeing on the screen. I left that place ready to move on, so I don't regret it. (Surprisingly, the one picture I took home from the OB's office was detailed enough that we could see the head, face, body, limbs, and even the eyes and mouth of our little one...even at just 8 weeks.)

I called and scheduled the D & C for later that morning with my OB. My husband went with me and they even did a repeat scan just before the procedure, which was very compassionate of them since they were on a full schedule.

The term "D & C" is most frequently used in reference to the process of emptying the uterus after a miscarriage, but in the first trimester, what is almost always performed is actually a "Vacuum Aspiration." This is a much less risky procedure: often the cervix does not require dilation and no metal curettage is used. The process I experienced was this:

• The OB explained the entire process to me and my husband. He was then excused.
• The OB and nurse gave me a sedative through an IV. (I actually felt like I was very drunk and tired from it immediately.)
• They cleaned/sanitized the exterior of the cervix and inserted local anesthesia into the uterus (this hurt a bit), but the sedative kept me calm. I remember saying, "Ouch!" though.
• They then inserted a small tube into the cervix.
• When they turned on the machine it sounded like a loud vacuum and it aspirates (suctions) out the contents of the uterus in waves, which I found really rather painful. I gripped the table and did not open my eyes; I didn't want to see anything.
• It was over very quickly: just a few minutes of this and the machine was off. They made sure I was okay and then let me recover alone.
• My OB found my husband a little later and brought him back to my room. He had picked up 2 prescriptions: a strong antibiotic to prevent infection and a pill to help my uterus contract in case of heavy bleeding (with pitocin in it).
• The OB gave me some Advil and told me to continue to take it for any pain. I recovered for about half an hour and was told I could go home.

I was grateful that I didn't have general anesthesia because that makes me very nauseated and the sedative left me feeling very sleepy and calm instead. My husband escorted me out of the office once again through the sea of pregnant women and back to the car. We stopped for some noodle soup to go and went home. I spent the rest of the day in bed and my dear cat and dog cuddled up alongside me, as if they knew something was wrong and wanted to comfort me.

The bleeding was light and didn't last long. I had spotting off and on for a few days but over all my physical state was much better than expected. It was easier physically to deal with the D & C than the natural miscarriage which was traumatic because it is so sadly visceral. I cried a lot that week and just tried to be gentle with myself. There was a terrible feeling of emptiness though: I had been "two" and now I was just "one" again. I would reach for my tummy and have to re-remember that no little one was in there. We waited to hear back from the OB about the lab results on the baby. One advantage to a D & C over a natural miscarriage is that they can test the tissue and let you know what happened, if anything. Apparently they discover something about 50% of the time. Most miscarriages are mysteries as to "why" they happened however.

Conceiving Again

In October and November we tried to conceive, this time with the advantage that natural family planning with the sympto-thermal method and charting gave us. I knew the day I ovulated each month and we timed our intercourse just right, even with my husband's DE, I knew we had a shot. I took some early tests at the beginning of December and they were negative, so I took a short break, feeling defeated, then tested again two days after my period was due. Once again, the second line was super faint. What did this mean? I tested again with an early result test, and it was definitely a BFP (big fat positive), but faint. My first reaction was not joy but fear...the line looked too light, reminding me of my last miscarriage and the faint line. I started sobbing and waited for my husband to get home (he was dropping our daughter off at school), so that I could tell him, through my tears, that it was positive...we were pregnant but I was absolutley terrified. I didn't know I would react this way.

I called the OB and they wanted me to get my beta's drawn to check the HCG levels (an early predictor of the amount of hormone an embryo produces) that day. I went to the lab and the results that came back were a tad worrisome: the HCG was 63. I was pregnant but it was a bit too low for this date. I was 16 days post ovulation, and studying up on things, research had shown that late implantation and/or low HCG's levels by day 16 DPO carried higher rates of miscarriage. I would need to retest in 2 days to check the "doubling time." I was learning something new every day! Doubling time is the time it takes for the HCG hormone to double in one's bloodstream: in a healthy pregnancy, it should be somewhere between 24-72 hours, averaging in the 48 hour range. The next beta was drawn under 48 hours later and it was fantastic: HCG was now 440. My doubling time was better than average at 24 hours.

You might think I could relax, but I was far from it. There's sooooo many things to worry about with a new pregnancy, especially after a loss: What if it is an ectoptic? A molar pregnancy? A blighted ovum? A chromosomal defect? What if I miscarry again? I couldn't celebrate, I refused to get "too" happy. I was thrilled on one level, but fear was neck in neck with my joy, keeping my emotions at bay. We would wait to tell anyone, including our parents, until after the first ultrasound that the OB scheduled for 7 weeks. If the little one was growing on track and had a healthy heart beat, our chances of miscarriage would go down to 10%...this was key and I knew it. Christmas came and went: I was totally and completely focused on the pregnancy, nothing else much mattered. I prayed constantly, but also prayed that if anything was terribly wrong, that God would take him/her home to Jesus painlessly.

On December 28th we went in for our first ultrasound, we were holding hands with terrible nervousness. As soon as the tech had a picture of my uterus on the screen, I could see my little one's heart beat just racing away. We were ecstatic! It was going at 130 beats per minute, better than expected, and measuring on track. However, they did see a small "bleed" in my uterus called a subchorionic hematoma. My OB assured me it was nothing to worry about, but to take it easy and no sex for a few weeks. That very day we were scheduled to meet my family at Disneyland and we let them know the great news when we arrived. What a joyful celebration that was.

I could "let" myself start to bond with this little precious one growing inside me...finally, our second child was really and truly on the way! I kept telling my husband that we wouldn't be out of the forest until 12 weeks, but still, the statistics were "on our side" now.

As I started googling to get information on the uterine bleed, the SCH, fear overtook me once again as I realized that rates of miscarriage are much higher with a SCH than not. Our rate of miscarriage jumped from 10% to 25%. The first day I learned this I was paralyzed, but by the second day I was looking at it the other way around: we had a 75% chance of a healthy pregnancy. That was pretty great... and so I started to let myself celebrate. Quickly I was caught up in thinking about baby names and how I was going to tell our daughter and our wider circle of family and friends. I had joined the online "August due date birth clubs" by this time, and we were all bonding in our own way, going through this incredible experience together. Wow: I was due August 16th!

The day of my first regular prenatal exam was January 6th. They weren't even going to do another ultrasound, but I pleaded with the tech. She gave in and as she got a clear picture on the baby, I could clearly see that our little one was measuring right on track. Pure joy! I had been studying and writing down all the normative values and measurements for this date and the face/body, even limbs could be seen: I was in love with this perfect tiny baby! But then it hit me, with a sudden and strange force: I was not seeing a heart beat. I said it aloud, "I don't see a heart beat." I expected the tech to pause and say, "Oh, here it is." But instead she paused and said, "I'm so sorry." *blink* What? "How far along is the baby measuring?" I asked. "Right at 8 weeks" she said, "so the heart must have just stopped beating." I was dizzy, I was in disbelief, this could not be happening again. I reached for my husband's hands and the tears started to come...this was not possible. She quickly turned off the machine and gave us some privacy. I started to lose it. When the OB came in to say "sorry" and talk about a D & C (a procedure where they remove everything in the uterus by dilating and evacuating it), I was simply in shock. She wanted to know if I wanted to do the D & C right then. I couldn't even wrap my brain around this news! And I wasn't about to let them take this little one out of my body already! No...I would wait.

So, for the second time, my husand escorted me out of the OB's office with my red sobby eyes as we walked past all the other pregnant women in the waiting room. Our big day had turned into our big tragedy.

By the time we got outside to the parking lot, I told my husband I thought they were mistaken. They had simply made a mistake. I doubted my own eyes and the tech's analysis....we just hadn't looked hard enough, the baby was just in a bad position....it was a mistake. I knew rationally that wasn't likely, but my heart could not accept that my little one was dead. I was in the first stage of grief: denial.

Prozac, SSRI's, and Fertility

In my research to discover the possible causes of miscarriage, I started studying medication. I was not on my any meds, but my husband was. His meds were for depression and were making conceiving a bit difficult, causing what is called "delayed ejaculation." This meant that more frequently than not, he was unable to ejaculate during sex. We could make love for an hour or more, but he could not climax. I thought this was the extent of the trouble with Prozac and its' impact on fertility. But the more I learned about this class of drugs called "SSRI's" (Selective Serotonin Re-Uptake Inhibitors that includes Prozac, Paxil, Paroxetine, Zoloft, Fluoxetine, Celexa, etc.), the more concerned I became.

Most of us know that meds can impact a woman's fertility and ability to have a healthy pregnancy, but how many studies have been done on men and the impact on sperm? Sadly, not many. But early studies have shown quite convincingly that SSRI's impact a man's sperm in a very negative way. The majority of men on SSRI's in one study showed that their sperms' DNA actually became increasingly fragmented with usage. Men with healthy sperm showed a major increase in damaged sperm in just 4 weeks after taking these meds. Here's one summary of the studies:

http://www.womensmentalhealth.org/posts/paroxetine-paxil-may-affect-sperm-quality/

What is the result of fragmentation in the DNA of sperm? Well, not only does it impact the motility and morphology of the sperm (making it harder to concieve in the first place), but it can also cause more problems once the sperm fertilizes the egg: there is an increase in miscarriages and other problems with the embryo/fetus when an egg is fertilized by damaged sperm. Yikes.

When getting pregnant, you want the best egg and best sperm possible to get together, so anything that reduces their quality can make things more difficult and cause problems. I started to wonder if his SSRI usage might have contributed to our miscarriage. Still, I thought, I'm not getting any younger and it certainly couldn't "hurt" to try again since he had no intentions of getting off of Prozac any time soon. He was in the middle of a major career shift and we couldn't be tinkering with his meds. Wouldn't the best sperm make it to the egg anyway? (Well...maybe, that depends on a lot of things.)

So, we decided to start trying again. But a hint of worry lingered in the back of my mind.

Taking Charge

My response to grief is usually the same: cry and sob, but only for a few days, then dust myself off and do something about it, take action! Do something to start the healing, get stronger, and hopefully, find a way to somehow redeem the situation. But how do you redeem a miscarriage? I had to take 2 months (2 cycles) off from "trying" according to my OB, so I had to -do- something in the mean time.

My approach was to learn all about fertility, reproduction, and my body. I stormed my local library and book store and bought an excellent book called, "Taking Charge of Your Fertility" by Toni Weschler. It was an amazing read: I couldn't get enough. I learned everything I could, reading voraciously, taking notes, creating charts. Why had no one ever taught me this stuff before? The female body is incredible and there are so many things we can do to get to know our bodies and actually understand our fertility signs. God has made us "fearfully and wonderfully."

It was so empowering...and it helped me to feel a little more in control. I started charting my symptoms: basal body temperature upon waking, checking my cervical fluid every day, taking OPK's (ovulation predictors), making note of every bodily symptom I could think of (I even tried checking my cervix but haven't made that a regular thing due to it being so uncomfortable for me!). I did this throughout September and joined the online fertility charting community called "Fertility Friend." My obsession now had a place to go, and I could feed it throughout the day!

I read other women's stories and gained hope and strength. This knowledge would be the redemption. One miscarriage is very common, and it did not put us at risk for another. I would get it "right" this time and conceive again soon. I was "in charge"! Well...sort of. One thing you have to realize about pregnancy is that it requires surrender...to God and to the whole mysterious process.

An Early Miscarriage

Late on a Friday night it occurred to me that I was "late"....like a week late. How had that passed me by? I had been so busy. But then, it was only July and perhaps my body was still regulating itself after being off the Pill and my cycles were just off? But, come to think of it, my breasts were very tender and I was feeling overly tired, and that had been going on awhile. On Saturday I made the trip to the store for a test and took it...it was faint but it was there...2 pink lines. Did a faint line mean it was a positive?!? I didn't know. I called my best friend and she convinced me to go get some early tests and re-test to be sure, but, she assured me, "You're soooo knocked up!" As I drove to the store it hit me: I wanted to be pregnant so badly, and I was going to be completely crushed if the next test was negative. I saw 3, yes THREE pregnant women in the parking lot just parking my car. I smiled and winked up at God: it was a sign! I purchased the much-too-expensive tests while the clerk smiled and wished me "good luck!" I drove home like a maniac, heart pounding.

My body shook as I took 2 more tests: and both were very clearly positive! There was elation and celebration, I was so happy that I told my husband right away and we shared the news with our daughter as soon as she woke up from her nap. "Mommy has a baby in her tummy who is going to be your brother or sister!" We hugged and cried as she cheered. She had been asking for a sibling for months. We gave no thought to the possibility that this wasn't the beginning of a wonderful 9 months that would lead to our second child. We called our parents and the whole family and celebrated that night over dinner. My heart was full of joy and immediately I started making plans: baby names? the nursery? do we need a new car seat? should I see a midwife or an OB? when can I get in for my first prenatal exam? I signed up for all the online "May due date birth clubs" and pregnancy e-newsletters and jumped into pregnancy with both feet. I was 5 weeks pregnant and couldn't be happier.

That week, on Tuesday, I had to drive a long distance for a conference along with another colleague. As we talked, I confided my good news to him only to learn that his wife had the same news! We were absolutely giddy. Suddenly, a huge rock, actually a boulder, bounded down the hillside and headed straight for my car. Thank heavens it missed the windsheild and struck the left bumper. We were okay, surely the angels had protected us and my little baby! What a story we had to tell. The repairs were over $3000...but the boulder had hit in "just the right place." As I walked the dog that night, I was thanking God for his protection and for this wonderful little growing baby inside me. I felt great physically and mentally and I couldn't remember feeling this joyful in such a long time. Elation doesn't even describe it.

The next morning I woke up and hugged my daughter, but as we sat down, I suddenly noticed blood on on my pj's. Sheer panic ensued: what do I do? I had not even established myself with an OB and already I was in trouble! I needed a doctor to see me and to see me right now! I cried and elevated my feet, called the office to take a sick day and tried my best to get an OB to see me. I managed to get in to an office farther north of the city, but I would take whatever I could get because they promised to do an emergency ultrasound right then. The bleeding kept coming...I was seriously tortured and sobbing the whole way: I CANNOT lose this baby, I'm already in love with this little one! I called my husband and best friend..."pray!"

Before my husband could arrive, I was whisked back to the ultrasound room at the OBGYN's. As I looked at the screen I realized something was very wrong: there was no little baby bean with a beating heart...just a collapsed sac and blood everywhere. Could there still be hope? I knew it was unlikely. I met the OB for the first time that morning to get the grim news: I was indeed miscarrying. I was 5 weeks and 4 days along, not even to the 6 week mark. My husband arrived at the office in time to get the news and hold me while I cried and stumbled, blurry eyed, out of the office. We went home and held each other in bed, while I sobbed the rest of the day as the bleeding and cramping increased. This continued for several days and it was hell going back to work: I obsessed over everything happening with and in my body and my soul was truly tortured.

The next few weeks were dark and full of grief and tears for this little one that had been a part of our lives for such a short time. But what a time it was! The joy this little one had brought us was so intense and so blessed. If I had ever doubted wanting another child, those doubts were now gone forever.

We named the little one "Aidan" after a favorite Celtic saint known for his kindness and generosity (choosing a name was the advice of a very helpful miscarriage website to help women deal with their grief: http://pregnancyloss.info/). I had no idea the emotional pain and sense of loss would be so intense after an early miscarriage. I felt so naive, even foolish and wondered if I had done anything wrong to cause it. But since the day I lost my Aidan, it became my sole desire to have another baby. Life is not going to make sense and our family will not be whole until we have another baby. Maybe this is irrational, but it is a drive stronger than I have experienced before. I cannot explain it logically. I have asked God to take away the desire if it's not in God's will for us. Still it remains.

Back in the Beginning

I have a little girl. She's a preschooler now, but when she was conceived nearly 5 years ago, it was by accident while using birth control. Four months into the pregnancy, my husband left me for another woman, saying he did "not want to be a dad." I struggled mightily over that pregnancy, knowing it had cost me my marriage at a time when I was unsure I even wanted children. The labor went horribly and left me traumatized. I didn't think I would "ever do that again."

I was abandoned and the divorce made legal and I did the single mom thing...it was harder than I could have imagined, made more challenging by the fact that I was living thousands of miles away from my family. But, then an answer to my prayers: I met my soul mate, it was sudden and unexpected. We hit it off splendidly...and he hit it off with my daughter who was almost one year old. He proposed and we were married a year later...he even adopted my daughter... now our daughter. And I found that motherhood was a gift beyond measure when the joys and trials were shared with another.

Being a mother has completely changed me. While I find fulfillment in the wonderful work I do as a professional in helping others, motherhood has, over time, become the most meaningful part of my life. My daughter is sincerely the greatest gift from God.

Two years after our wedding, we were ready to grow our family. We wanted to give our daughter a sibling before she got too old and, oh yes, I was already 36, that "advanced maternal age" of post-35 that seems to magically spell difficulty for pregnancy. We were scared and ambivalent but excited. I didn't think it would be too difficult however...we're both in great health, eat well, exercise, do all the "right things" and we even appear younger than we are. I made plans to get off of the Pill and we started trying as we entered June of 2009. I suspected it would take us a few months, but we planned to be pregnant before summer's end, which would be good timing for maternity leave 9 months later during the slow time at work. Only, it didn't quite work out that way.