Miscarriage: The Unspoken Event

Sitting on the exam table, I stared into the cold and sterile space, waiting for the doctor to come in. The nurse practitioner had already examined me. She confirmed what I already knew. I had miscarried…again. My HCG (pregnancy hormone) was falling, confirmed by a blood test that morning.

Any of the few symptoms of pregnancy I had, mainly swollen breasts, fatigue, and increased appetite, were now gone. Seeing the doctor was just a formality. I knew the drill from miscarrying for the first time exactly one year before.

The timing of the miscarriages was the same, ten to twelve weeks of gestation. This time, however, there were three empty sacs when I had the ultrasound. Blighted ovum, they called it. Even though I was a nurse practitioner myself, I had to look it up to understand what that meant. After all, I practiced in pediatrics not obstetrics.

The doctor came in and spoke to me. I don’t recall much of what he said, but I do recall that he was nonchalant and used phrases like, “This happens” and “You’re young, you can try again.” When I expressed what I was really concerned with — a second miscarriage without any successful pregnancies, he brushed it off.

He said something like, “You’ve had two miscarriages; we don’t really get concerned about that. You’ll go on to have children. Let yourself heal and try again.”

There was a problem, though. Now, I didn’t feel like I would be able to have children. I saw a childless future for my husband and me. We purposely waited until we had been married five years before starting to try and have a family. We had both been in graduate school and had limited finances. We wanted to be financially stable before starting a family. By the time the second miscarriage took place, we had been married for six years. I felt the pressure of my most recent birthday — my thirtieth — bearing down on me.

I obsessed over the miscarriages. My thoughts were possessed by why they had happened. Why did we wait to try to have children? Was something wrong with me? Obviously, it wasn’t my husband, I got pregnant; I just couldn’t carry the fetus. My body had rejected them. I felt worthless.

Everywhere I went, I saw pregnant women — at least it seemed this way. The grocery store, the mall, the bagel shop, the gym — everywhere! My perception was that everyone was pregnant except for me. And I very much wanted to be with child. It just wasn’t happening. Again — why? I asked myself this over and over and over.

That December, I had my second D & C. At the follow-up with my gynecologist, I pleaded with him to start some testing to determine why I wasn’t able to sustain a pregnancy. He was the younger partner in the obstetric practice where I was a patient and not the physician who so coolly brushed off my second miscarriage. I liked my OB and knew him as a resident when he rotated through the Level III NICU where I worked as a nurse.

Larry, my OB/GYN, was in reluctant agreement with me. He knew testing would make me feel better and ordered some simple blood tests. Physically, I looked fine — although somewhat underweight for a thirty-year-old at 95 pounds. He encouraged me to try and gain weight and try to relax — he knew I was high-strung from working with me in the NICU.

He reminded me that nature had its way of working out pregnancies that weren’t healthy.

One of the hardest parts of the miscarriages was telling our families. My father said, “Oh, God…not again!” and passed the phone to my mother. No one really knew what to say to us. Neither my mom nor mother-in-law had experienced a miscarriage. My sister wasn’t married and did not have children. The general advice was to heal and try again. Nothing that was said took the sadness away. Laying in my husband’s arms, I cried and cried.

“We’ll get through this,” he said, probably afraid to tell me it would be all right, and we’d have kids — which might be a promise he couldn’t keep, so it wasn’t said.

The tests came back and revealed that I had a luteal phase defect. My obstetrician explained it in simple terms. Basically, it meant that as the pregnancy progressed, I didn’t have enough progesterone to support it — my uterine walls might not have been thick enough or nourishing enough to sustain the pregnancies…so I lost them.

I asked, “What do we do now?” My doctor explained that I would go on progesterone suppositories once I was pregnant again. These are vaginal suppositories from which the medication (hormone) is absorbed through the vaginal walls. They would need to be continued throughout the first trimester. The hope was that the progesterone would support the pregnancy.

At the very end of 1993, I was pregnant, again. This time we had decided to not tell our parents or friends until we were past our first trimester. It was hard not to tell them, but we tried to save them some grief and I didn’t want their pity.

We went, as planned, to Mexico with our friends, who were also expecting at the time. The trip to go at the end of January had been planned for months and my obstetrician felt there was no reason not to go. It was very early in the pregnancy and could take the progesterone suppositories with me.

Even though I was nervous, I wanted to go on the trip. I was hoping that the warm temperatures and tropical breezes would take my mind off of the pregnancy. But that was not to be.

In the air, an hour south of Toronto, I felt the need to go to the bathroom — something was off! Sure enough, when I got to the toilet I saw that I had started spotting. There wasn’t a lot of blood. but enough. It was the same way the previous two miscarriages had started — a little blood and some cramps.

Pale-looking and trying to hold back tears, I returned to my seat on the plane. My husband asked with concern, “Is everything okay?”

“No, I’ve started to spot.”

The rest of the flight was terrifying for me. I prayed that if I was losing another pregnancy it would proceed as the others had — without much ado. I prayed I wouldn’t hemorrhage or get an infection or anything else that would spoil our trip or worse, land me in a hospital in Mexico.

Despite the bleeding, I continued the suppositories on the off chance this was not a miscarriage but just spotting that sometimes occurs normally.

But after a few days of spotting, I noticed tissue and a bubble-type sac in the toilet. I’ve miscarried again, I thought and told my husband. He agreed that the tissue I had passed did not bode well.

During the trip, we both took Pepto Bismol tablets to help ward off travelers’ diarrhea. My OB was aware of us doing this and thought it was safe during the trip but would need to be stopped when I came home. Apparently, it is not something that should be taken in the later trimesters of pregnancy, if at all.

I kept taking it and the suppositories, “just in case.”

Our trip was as enjoyable as it could be. My friend’s pregnancy seemed to be going fine and I didn’t want to worry anyone in our group more than they already were. We both drank non-alcoholic drinks and at an all-inclusive resort, it was hard to make the bartenders understand this until the word bambino was mentioned with our husbands making large tummy motions when ordering drinks.

We went to Tulum and Xcaret enjoyed the resort, but a deep sadness had engulfed me. And I’m sad to say that I felt some jealousy toward our expectant friends, as well.

Luckily, the week passed. The small amount of bleeding subsided, and I didn’t pass any more tissue. I no longer felt pregnant.

We flew home and I called the OB’s office, telling them what had happened and that I thought I had miscarried again while we were on our trip. They asked me to come in for an ultrasound and bloodwork.

During the ultrasound exam, the OB exclaimed, “Well, Carol, you are still pregnant, and I’ll let you listen to the heartbeat!”

I could not believe it! It was the best news I ever had! I was still expecting! We continued the progesterone suppositories, and my OB added a baby aspirin a day — both until the first trimester was over.

The addition of the baby aspirin was empiric, meaning my doctor didn’t have a test result to support doing it but wondered if it would help because he had seen it help others.

Seven months later, I had a healthy baby boy!

We had done it! I was a mom!

Although this is a deeply personal story, I’ve been wanting to share it for some time. I did so with the consent of my husband, for it is his story too. Miscarriage is a devastating loss and when it happens over and over, it can have a profound effect on one’s well-being, both mentally and physically. It is something that needs to be discussed more in society today to let the women and couples experiencing miscarriage know that they are not alone.

Nothing in this article is offered as medical advice, please consult your physician for any advice on pregnancy and/or miscarriage.

This piece was published on April 29th on my personal blog, The Apples in My Orchard, on WordPress, as well as on Medium.com, under the title: "All I Wanted to Be Was a Mom: The Specter of Multiple Miscarriages."