Monday, 18 July 2016

What it's like to have a miscarriage (or three)

Since I embarked on the whole parenthood project, I have had three miscarriages: two before Duckling came along, and one last month. All have been pre-12 weeks, and for that small mercy I am grateful. I know many people who have lost babies after this point and it is a whole different ball game - one I hope I never have to experience. Not that miscarriage before 12 weeks is a picnic by any stretch of the imagination.

Every miscarriage has been different. My first wasn't really a miscarriage at all, in that I did not spontaneously lose the baby. I went for my 12 week scan, and they basically told me the baby had died at about 8.5 weeks - what's known as a 'missed miscarriage'. I had an ERPC* to deal with that one, which wasn't exactly fun, but did mean I wasn't waiting weeks for my body to let go of its tiny cargo. My second was a 'classic' miscarriage at seven weeks, though I don't think the baby had got much beyond five. No surgery needed thankfully - just lots of toilet trips. My latest one was very early, around four weeks. I got a positive pregnancy test the day before we went on holiday, and three days in, my period started. So essentially a 'chemical pregnancy' - had I not taken an early pregnancy test I would probably never have known (apart from the week of ridiculous hunger and total aversion to bananas).

Miscarriage is little discussed in the public domain, or indeed the private. Plenty discussed in Mummy blogs and the odd article entitled "Why does nobody mention miscarriage?" but barely examined beyond, which is perhaps surprising given how incredibly common it is. Too yicky, too female, too depressing I suspect. Nobody likes to make others (or themselves) cry.  So before I had my first miscarriage, I had no real understanding of what it would be like to have one, other than the fact it would involve bleeding and medical examinations and much sorrow. All of these were accurate assumptions (although I didn't bother seeing a doctor this time around) but the whole multiple miscarriage experience has been far more complex than I would ever have imagined. I don't for a second want to suggest that every woman feels the same about miscarriage, but I would imagine most would be able to identify at least one or two of the following emotions:

When you realise the inevitable (be that seeing your tiny silent foetus on a screen or that first, true heavy streak of blood), you go into shock. Ear ringing, heart thumping shock. You may have expected it deep down (and I did with all three of mine) but you're still taken aback by your fear becoming a reality.

This is the emotion most people associate with miscarriage. My first loss was undoubtedly the saddest. I was unprepared and the rapid freefall from excitement to despair was devastating. But it's not just the fact your baby has died and your pregnancy is over. It's a loss of a future that must now be put back on hold indefinitely. A due date that no longer means anything; the pregnancy notes that are now redundant; the mat leave departure date postponed; the tiny impulse buys that must be pushed to the back of the drawer...

Vain hope
You know it's over in your core, but part of you still wants to believe your fears might be unfounded and yours will be the miracle baby that survives when everyone says it has gone. It never is.

At the same time as the vain hope, I find I usually feel some sense of dark relief. The prospect of miscarriage makes the first twelve weeks of pregnancy (and beyond) deeply stressful for anyone; but this is amplified ten fold when you have past evidence that your body cannot be relied upon to take a pregnancy to term. A miscarriage, despite being the thing you fear, puts an end to the uncertainty, the stress, the constant preoccupation and the feeling of impending doom. It's over, and once you've recovered, you know you'll get to start afresh and try again.  Also, being in France for the last one meant I could suddenly eat gooey cheeses and drink rosé again, which was kind of a bonus.


What if I can't get pregnant again? What if I can but my next pregnancy ends this way? What if this means I can't have kids at all? What if my body is broken? I felt the fear particularly acutely after my second loss, where it dawned on me that there could be a problem beyond it being 'just one of those things'. This prompted me to see a private specialist (the NHS won't test you until you've had three miscarriages) who for a small fortune diagnosed Polycystic Ovary Syndrome - which I'd always suspected but never had confirmed - and a possible problem with my immune system. He prescribed aspirin, progesterone and prednisolone, and they worked (or it could have been a coincidence - who knows). Either way, after a very bumpy 9 month emotional rollercoaster, Duckling was born safe and sound in February 2014.

This strikes on two levels. Firstly, when I had my second, "proper" miscarriage, I was kind of grimly intrigued as to what would actually appear. I fully recognise many women would absolutely not feel that way, but for some reason I wanted to see what came out as some kind of validation that I had actually been pregnant. As it happened it was just a lot of blood and a couple of nondescript grey blobs, which was probably for the best given my mental state. TMI I'm sure.

Then there's the question of WHY. Sating my curiosity on this front started with endless Googling (of course), but it also drove me to see the specialist, who ran a bunch of standard tests plus a few additional ones. The PCOS almost certainly plays a role (it increases miscarriage risks for a whole host of reasons) and the immune system theory is also a possibility (I'm not so convinced of that one though) but I think I may also have something called super-receptivity, or an "unfussy uterus" in more layman's terms. This essentially means I get pregnant very easily, but I do so because my uterus does not discriminate between high quality embryos (which will go on to develop into a healthy baby) and low quality embryos (which have cell division issues or genetic defects and are doomed to fail). My womb is basically a totally rubbish nightclub bouncer. It lets anyone in, only to have to chuck out the bad'uns later in the evening, causing much kerfuffle in the process. As much as I am lucky that I have no problem falling pregnant therefore (I'm sure many women with PCOS, and many without, would kill to be this fertile), I kind of wish my uterus was a bit more discerning so I could avoid all the heartache and bleeding that results from its free-for-all policy.

"I'm not pregnant, I'm not pregnant, I'm not pregnant, AHHHH I'm so pregnant! NO, stop it, I'm not pregnant, don't think about it, don't acknowledge it, it's never going to stick, so just pretend it's not happening. I'm not pregnant.... Oh, bugger, I'm really NOT pregnant now."

Oh the guilt. The irrational guilt I may have done something to cause my losses (was it the stupid amount of wine I drank at that restaurant before I knew I was pregnant? Was it those two days I lived off custard creams? Was it that cold I caught?). The guilt that I'm letting everyone down.  The guilt of having to take time off work. Again. The guilt that you can't see your tiny bundle of cells as a baby because attaching that label to it makes it too difficult to process (I am not one of these people who refers to them as rainbow babies / angels I'm afraid). The guilt that I feel and express things other than 'devastation' each time (which is the only acceptable emotion in the face of miscarriage, or people think you're a callous bitch) or that I dwell too much and bring everyone around me down. The guilt that I cried more about Brexit than I did my latest loss... The Guilt.

All of the above combine to create a buzz of stress that bothers you like tinnitus the whole time you're trying for a baby, growing louder in the two weeks leading up to The Test and reaching a crescendo with that first blue line that doesn't really die until your pregnancy does, or you reach some kind of "and relax" point (which for me, if I'm honest, was about 6 weeks after Duckling was born). It's exhausting, but life continues. You make dinner and wipe countertops and fiddle with Excel spreadsheets and sigh about politics as though nothing is happening because what else can you do? I wish I had control. I wish I could know the future. I wish I could have reassured my pre-Duckling self that it would be all right, I would get my baby in the end. I wish a future me could come back and say "keep going, you'll get number two", or " take out a second mortgage and go back to your specialist" or "don't bother, it's just not going to work out." That isn't how life works though. So I shall persevere, and hope that three does not become four, five, six or more... And if we don't get a second child? Well then we'll just love the first all the more.

*Evacuation of Retained Products of Conception.  A charming term I'm sure you'll agree.

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