It’s over

 

Source: gratisography.com

 
After a very long day at the hospital, it’s over. I’m a little relieved for finally managing this miscarriage, but mostly I feel empty. I no longer carry my baby. I’m no longer pregnant. Over. Back to square one.  

I’m not yet ready to start again. I’m not yet ready to give up. I stand here in between, grieving, hoping, feeling defeated, feeling sad, feeling normal. My new normal, that is. Locked in this endless cycle of pregnancy, fear, loss, grief, hope. 

This time, however, is different. I don’t have the anger I used to carry around all the time. Angry at doctors, angry at life, angry at the unfairness of it all, angry at myself. Instead of anger I feel a growing indifference. Is that what acceptance feels like? I had expected it to feel better, to fill my void…

It doesn’t mean I have given up. Far from it. I’m determined to see a specialist willing to treat me and I have 6 blastocysts waiting for their chance to grow.

What I seem to have given up on is my all-consuming fight mode, living on a thread of hope that if I just hang on for a little longer, everything will be ok in a very short while. It won’t. I realise now I have a very long way ahead of me and I need to conserve my energies. As in a difficult long hike, I’ll keep placing on foot in front of the other, for as long as necessary; navigating towards the destination, but remembering to enjoy the way; dealing with unexpected challenges as they come and taking a resting break when needed. 

I’ll keep going, with the support of my amazing husband and the love of the 4 babies I forever carry in my heart. 

***********

In case you’re wondering how it went yesterday, I’ll give a short account. I showed up at the hospital at 8 a.m., had my blood taken and waited for my appointment at 9 a.m.  

The doctor scanned me again and could see my uterine lining was still very thick, with most of it up high and not looking like it would come down. My HCG level rose again yesterday to 3200, from 2800 on Sunday. So, after the third dose of misoprostol, my HCG continued to climb.

I was then admitted at 9.30 a.m., to have the evacuation in the afternoon. A very long, very tiring, very anxious wait followed. I was finally taken to surgery at 6.30 p.m.. The doctor said it all went well and he only used suction (though no scan guidance). He sent the pregnancy tissue to the lab for testing (not chromosomal testing, I understood he wants to confirm the pregnancy is not molar), but he expects everything to be fine. 

I will have no more HCG monitoring and no follow-up scan (definitely disappointed about these things), he only told me to take a HPT in 3 weeks time and if it’s still positive they’ll investigate more. I’m not very happy with this approach, would have liked to see that HCG drop all the way to zero, especially as it was still rising (??!!) after 3 doses of Cytotec.

That’s it, according to doctors all is fine and over with. Time to focus on my emotional recovery. 

Bloody weekend

  
I wanted to wait until the worst was behind me, before sharing my feelings on this miscarriage. My body, on the other hand, had no intentions of playing along. As always, I have no control over any of this, and so much has happened (yet so little has developed), that I just need to write it out. 

After the confirmation scan on Wednesday, my plan was to use the medication Friday morning. My husband would work from home to be there for me if I need it, and in my mind it all seemed straight forward. After all, I’ve been there twice before. 

This being my pregnancy that ended the earliest, the sac measuring less than 6 weeks and without an embryo, I thought it would be over quickly. I imagined inserting the medication around 8 o’clock in the morning, then laying down and watching a movie to distract me. In a couple of hours, the excruciating pain and heavy bleeding would start, and I even thought it might be over whithin 4 to 6 hours. Then, I would take a long, warm shower, eat the lasagna my husband had prepared the day before and rest, finally starting to heal emotionally, since most of the physical pain would be over. 

It began like I envisioned. Got up on Friday at 7 a.m., had breakfast and by 8:30 a.m. I was ready to have the treatment. I took the little bag of pills and looked at the painkiller. Distrusting doctors is my new norm, so I thought to double check that drug on Google, since I never took it before. The problem is, I’m severely allergic to aspirin, which makes me allergic to any NSAIDs (Nonsteroidal anti-inflammatory drugs, which includes several types of painkillers). I’ve had anaphylactic shock twice in my life, and been lucky to survive them. 

On Wednesday, when the RE confirmed the fetal demise and recommended me to manage the miscarriage medically, I specifically reminded her of my allergy and asked that she made sure I got the right painkiller.  So googling the medication on Friday should have been completely unnecessary; only it wasn’t. The medication she gave is a NSAID. 

If I wasn’t overly cautious, this could have ended very badly. My husband was spitting fire with anger at this point, and wanted to make a formal complain about this doctor. These past 3 years, however, have taught me to let go of the smaller things and keep my eye on the important goals. And as much as I’m angry with the RE right now, I need to maintain a good relationship with her so she will refer me to the RPL specialist, which is my primary goal at this point.

The treatment was still waiting for me, so I called my GP instead, to get a different prescription. It took over an hour to get hold of the doctor and go fetch the new medication in the pharmacy, but finally around 10 a.m. I was ready to start. By this time I thought it was all falling into place and it would be over soon. I couldn’t have been more wrong. 

I watched a movie, then read a book, then watched some more TV and the bleeding had hardly started. I felt very mild cramping with the occasional sharp pain, but nothing compared to the pain I had with my other two miscarriages. Something just didn’t seem right, especially the very light bleeding. At 4 p.m. I finally decided to call the hospital and ask if they had any advice.

On weekends (which starts at 3 p.m. on Friday) the gynaecological department is closed down, so I’m always told to call the maternity ward. Calling the midwives and telling them I’m having a medical abortion for a missed miscarriage is always hard. They don’t understand why I’m calling over there and are often rude. They keep transferring my call from one nurse to the other, forcing me to repeat my history of losses again and again. It’s just too painful. At last, a nurse told me to wait until the morning, that maybe the treatment just needs more time and every pregnancy is different. 

I took the nurse’s advice and decided it was time to have that shower and that lasagna, because nothing was going to happen any time soon. At night, I was afraid to go to bed and wake up in the middle of night in excruciating pain, the memory of blood clots the size of oranges and contractions getting stronger and closer together being too fresh still. I finally managed to fall asleep around 3 a.m., without much pain or bleeding. 

In the morning, I called the hospital again and spoke to a doctor. She wanted to scan me, so off I went to the ER. We talked about my history, the fertility treatment and my symptoms, and shortly after I had my legs up in the stirrups, as usual. The sac was not visible anymore, but my lining was still pretty thick, around 27 mm, so she agreed the drugs were not working. I was given 4 more pills and sent home to try again, with the recommendation to call the next morning in case the bleeding didn’t get stronger. 

Another day of mild pain and light bleeding went by, with the hours dragging on and no closure in sight, only anxiety to get this over with. Sunday morning came along and I called the hospital again. Several insensitive nurses later, I spoke with the doctor, who wanted to proceed with a D&C immediately. At this point, having had countless doctors frightening me off about the high risk of developing Asherman’s syndrome from this procedure and how that would negatively impact my already damaged fertility, I asked to try and wait a little longer. After meeting him at the hospital, having another scan and confirming that little had changed in my lining thickness (around 23 mm, after 2 rounds of Cytotec), he agreed to try the medication once more.  

This waiting for the miscarriage to start is hard and I know I can’t let go emotionally until the worse is over. The D&C could have ended it all quickly and with little pain, but I’m too afraid to damage my womb. I don’t need more issues reducing my chances of getting pregnant, my one and only tube and recurrent miscarriages are enough. Moreover, going through the physical miscarriage process, as painful and horrendous as it is, brings me some closure. The physical pain matches well how I feel inside and legitimates my suffering, making the loss more real. No one can say this life was only a few insignificant cells when so much is involved in letting it go. 

Now, I’m still sitting here, waiting for the hours to pass by, waiting for the freeing pain to show up, after the third 0.8 mg dose of misoprostol (Cytotec). Realistically, it’s more likely that I’ll have the operation on Tuesday, on my next appointment at the hospital. Tuesday is the deadline they gave me for the medical treatment, so I can hope for better days from Wednesday on…

No miracles today

  
There will be no miracles today. At least not in this family. 

The scan has shown no signs of development since a week ago and the gestational sac still seemed empty (I guess that’s what is called a blighted ovum? Doctors didn’t use this terminology though). 

I didn’t get to confirm or discard my fear. The doctor wouldn’t even zoom in into the sac to check if a fetal pole had developed. She went straight too, it’s to small, it’s not viable, we need to remove it as soon as possible. She seems to not be a big fan of I’m sorry‘s. The best I got out of her with my tears was a it’s normal that you feel sad. Thanks, I thought so, not everyone has a stone heart like yours. 

There will be no chromosomal testing either. Doctor claims pregnancy isn’t developed enough for that (I thought the sac would have the same chromosomes as the embryo, so could be tested? I guess I’m wrong). 

So the decision is another medical abortion with Cytotec. To be performed at home. Alone. As usual…

I managed to convince the doctor to draw our blood for the RPL testing today. One small victory. Better wait for the results before asking for the referral to the specialist clinic. One step at a time. 

Looking at the drugs on my hands, too many difficult memories come to mind. I try to push them away (and ignore my fear) and focus on what needs to be accomplished. I decided it’s best to do it Friday. Until then, I’ll prepare for it: stock up the fridge, cook some meals, clean the bathroom and pick some movies on Netflix, to distract me in the time after inserting the pills, while waiting for the bleeding to start. Any suggestions? 

On a funnier note, I got the painkillers in suppository form this time (not by choice). I’m becoming an expert in shoving things up my vagina, so why not try the back side too, right?!

The latest obsession 

 

Source: gratisography.com

 
With every loss, I want answers, I want explanations, I want doctors to say why this happened and how to fix it. They don’t offer any reasons why. All they keep repeating is: just bad luck. That makes me especially angry. Isn’t it bad luck when someone gets melanoma? But won’t the doctors run tests and treat it anyways? Isn’t it bad luck when someone has a car accident? But won’t the doctors help this person regardless of their luck? So why is it only with pregnancy loss that “bad luck” is an acceptable diagnosis? I want all tests and all possible treatments available. I want, no, I need to know I’m giving my babies their best chance. 

I think I know the reason doctors believe it’s enough to say “just bad luck” regarding pregnancy loss. It’s because they follow it with a “just try again”. They can’t say just try again to someone with melanoma or whom has had a car accident. What doctors don’t seem to realise though, is that trying again is not so easy. Sure, physically it can be fine. But, at least in my case, I feel that each loss takes away a little piece of my heart and of my soul. And I don’t know what the limit is, before there’s nothing left. I hope I’ll know when to stop before it’s too late, but I’m afraid I won’t see the signs, so desperate I’m to have a living, healthy baby in my arms. 

In my last ultrasound, while I sat across the doctor, hearing she repeat this baby I’m still carrying will not survive, I couldn’t hold my tears. To console me, she reminded us that we still have 6 frozen blastocysts. I know she meant well and I’m grateful for my little embies. But all I could think about at that moment was: I can’t go through this 6 times more! There will be nothing left of myself by the end of it! And that is what most doctors can’t understand, because only those who have felt this kind of heartache understands. 

I know we all hear stories of these very strong women who had 14 miscarriages or even 28 (!!!). I admire their resilience, no doubt, but everyone’s limit is different and as long as you can handle, sure, keep trying. I never thought I could have 4 losses either, so maybe I can do it 6 more times, I don’t know. What I’m certain of is that my soul would suffer, my marriage would suffer, my carrier would suffer. How much suffering is acceptable before it isn’t worth it anymore?

It’s easy to acknowledge that I have had trouble trusting doctors these past years. When they refused to give me answers, I started searching for them myself. I read blogs and articles and scientific papers and whatever I could put my hands on regarding recurrent miscarriage. I sought a second and a third opinion. But since I had one ectopic pregnancy and two missed miscarriages, I didn’t fit the criteria, so only basic testing was done. 

I became obsessed with immunological reasons for recurrent miscarriage and was convinced it was my issue. I still think it can be the issue and I’m hoping I’ll finally get some testing in this area soon. But back then, there’s nothing I could do on my own without a doctors approval on this matter, so I had to turn elsewhere. 

I bought and read “It starts with the egg”, from Rebecca Fett. Cleaning myself and my house of toxins became my new obsession, along with vitamins and supplements. I strictly followed the author’s recommendation of stripping the kitchen off of any plastics. It wasn’t easy, I must say. I also changed all my personal hygiene products and house cleaning products to natural ones. My new mantra became: not put on myself anything I wouldn’t put in myself. Of course, I also followed the suggestions for vitamins and supplements. All of this without the supervision of my doctor. I’m not proud of it (I’m actually ashamed) nor I recommend anyone doing this. I tried asking my doctor which vitamins and supplements could help me, and all they recommended was folic acid. They clearly said there was nothing I could take to improve my eggs’ quality. I simply disagree with that statement. 

All of that was implemented (together with the obvious no alcohol, no caffeine, no exercise) months before this pregnancy was conceived. But it still failed. Not that I’ll go back to the plastics and all that, but I need something new to obsess about. Something to give me hope and a little sense of control over any of this. I know it’s irrational, but if doctors won’t give me that glimpse of “let’s try this new something, maybe it will work”, I go looking for it myself. 

And my latest obsession is MTHFR mutation. I’ve read many blogs and articles connecting it to recurrent miscarriages. I don’t know if I have the gene or not and I don’t think the doctors here will accept my request for testing for it, since studies on this are not yet conclusive. So again, I decided to take measures on my own hands and ordered a personal genome test online (23andme). Regardless of the results, the “treatment” is very simple, so I’ll follow it no matter what. It consists of taking bio-active forms of B-complex vitamins, instead of the usual ones. I’ve already ordered a new pre-natal multi-vitamin with these bio-active substances to substitute the one I’m taking now. 

Rationally thinking, I know probably it won’t help. But if it can’t hurt, I’ll try. And I’ll keep trying until stopping is the only option.