I was a bit older when I finally made the decision to have children. At age 32 I was done with graduate school and in a long-term relationship and the time ‘seemed right’. I had spent a good chunk of my life before then avoiding pregnancy. Growing up as the child of a teenage mother, my Grandparents made it seem that if a man sneezed on you, you could get pregnant. So like most young women — I thought that I could just make motherhood happen whenever I was ready.
Well they say that ‘man plans, God laughs’, right? The first surprise that I faced was that I did not get pregnant right away. Actually it took more than a year. That was a shock to me. Everything I read said that you are under the age of 35, then you need a year of trying before a fertility doctor will think that you have a problem. I waited until it had been more than a year and then started a full battery of tests to find out what was wrong. No particular problem was found. The diagnoses of unexplained infertility was panic-inducing; because there is no particular issue to treat and you are confronted with the fact that you may never have children of your own.
After trying (so) many natural supplements like Vitex and Royal Jelly and Serrapeptase and even progesterone cream; I finally met with the doctor to get a prescription of Clomid. I waited a bit before filling the prescription though. And what would you know? I finally conceived!
This was an amazing time…finally I got the confirmation that my body wasn’t broken. I thought that the hard part was over. Other than a few bouts with nausea and some food aversions, everything was going well. I looked into signing up with a midwifery practice because I wanted to have a natural birth. Such an exciting time!
I made it through the dreaded 1st trimester — the one with all of the morning sickness and high risk of miscarriage. I was acing all of the prenatal appointments. Mentally and physically I was preparing to bring home a baby in about 5 months time.
When I was 15 weeks along, I remember standing in the kitchen and feeling a lot of wetness hit my underwear suddenly. It was very strange….because it wasn’t a gush or a lot. But it did seem to come out of nowhere. Almost as if I lost control of my bladder for like a second. Of course I ran to the bathroom to check things out. No blood. Ok that was good! I had read that pregnancy caused increased blood flow and wetness ‘down there’. So as long as there was no blood…I wasn’t worried.
Later that night, I was woken up out of my sleep by what felt like a charlie horse in my stomach. It was quite painful! Again…ran to the bathroom. No blood. That’s a good thing, right? Hmmm. Maybe this was Braxton Hicks? My 33 year old uterus had never been stretched like this before. Maybe this was normal? I remember drinking water and rubbing my belly…concerned about the pain. But I had suffered from menstrual cramps since I was a pre-teen. This pain wasn’t a contraction. It was just a ball of tightness. It took a while….but I went back to sleep.
That morning I got ready for work as usual. I drove to my office. Opened the car door to get out. As soon as I stood up I felt something that felt like a water balloon being popped in my vagina. A second later my pants were saturated with fluid. I was frantic. I ran inside to let my co-workers know that I was going to the hospital. And that was the beginning a worse reality than unexplained infertility was. Of course I called my maternal care team. A nurse brushed off my concerns over the phone….saying that at 15 weeks, you don’t have much water to lose. That I probably urinated on myself (random side bar – pregnant women hear this a lot; and I always found it to be incredibly dismissive. I had lots of experience peeing up until that point. I would know if I were peeing vs. when I am not). When I reached the hospital, and ultrasound was done and it was confirmed…I had in fact lost all of the water that was around the fetus.
Medical Abortion #1
This all happened so quickly. And I had no idea about what premature rupture of membranes (pPROM) was and certainly not incompetent cervix. It was explained to me that with no fluid around the baby, the chance of the fetus/baby developing normally was low. There was also the risk of me getting an infection due to the sterile environment of the amniotic sack being compromised. I would also need to be on bedrest. I live in Pennsylvania, so at that time I had the option to terminate the pregnancy — which would be considered an abortion, since the fetus was still alive. Sadly due to the lack of fluid, I could actually feel the baby move whereas I couldn’t before. But I still stuck by the decision that termination of the pregnancy would be best.
The very unfortunate thing about the politicizing of the abortion debate, is that it looks at abortion in a very binary way. The truth is, there is a lot of gray area whenever a woman or couple make the choice to terminate a pregnancy. Regardless of whether you believe that a zygote/embryo/fetus has the same rights as a human who has been born and survived that birth; the termination of a pregnancy is one of the safest medical procedures that you can undergo. The emotional aspect of going through an abortion is much harder. Having gone through several of them — I can only imagine how much worse it would be if I had to struggle with logistical challenges to get the procedure done safely.
Next Pregnancy – We Have a Plan Sam
After that first loss, it again took some time (less than a year, but almost) again to conceive. Of course in the meantime, I’m trying to figure out what exactly went wrong with the last pregnancy. The doctors told me it was a fluke — that sometimes these things ‘just happen’. I was told that if I conceived again, I would immediately be considered high risk since I never had a successful live birth. So much for my crunchy, natural birth plan aspirations!
When the pregnancy test popped up positive this time, everything went into high gear. I went through all the tests and was told by my obstetrician that due to my history, I would start meeting with maternal fetal medicine (the ‘high risk’ group) at 16 weeks.
Why 16 weeks? I lost my previous baby at 15 weeks. Shouldn’t they be seeing me from the start? It was then explained to me, like I was a 5 year old who should have known better….that MFM do not consult with women who are less than 16 weeks pregnant. What happened previously was an unexplained fluke. I did mention the incompetent cervix issue — but again, my concerns were brushed away. It was explained that a cervix fails when the baby puts enough pressure on it to fail. A 15 week old fetus is just not that big. MFM will assess my cervix at 16 weeks. And if they feel that it is necessary, then a vaginal cerclage will be placed and the cervix will be sewn shut.
Ok, ok. These people are trained medical professionals. They make a whole heck of a lot more money than I do….I just need to listen to them and do what they say!
At 16 weeks I went in for my first appointment with the MFM group — the folks who would swoop in and save the day and make sure that I deliver a healthy baby. They did my ultrasound. And let me tell you — I most likely hate prenatal ultrasounds due to this experience! It was the classic ‘ok lets take a hundred pictures at different angles….and not say anything…but make perplexed looking faces the entire time’. The ultrasound tech said the dreaded “Ok, I’m going to show these to the doctor, and he’ll talk to you”. My heart sank.
While this pregnancy wasn’t giving me any of the problems that I had noticed with my previous pregnancy, the ultrasound revealed that I was almost fully effaced. I only had 3 mm of cervical length at that point. Nope — that is not a typo. The normal range for cervical length at that stage should be 35-48 mm. The doctor told me that they would need to do a vaginal cerclage immediately. The next day I was in the operating room; tilted in Trendelenburg position to get the pressure off the cervix. After the procedure, the doctor admitted that the amniotic sac had protruded out and he had to push it back in. Although normally, the vaginal cerclage has 85-90% success rate; he didn’t seem to display much confidence and in all honesty, I didn’t have much either.
It Lasted For 3, Terrible Weeks
While I had few issues with the pregnancy prior to the cerclage being placed, things just seemed to snowball afterward. First I lost my mucus plug. The nurse assured me that was ok, and it would grow back. Then I seemed to have gushes of wetness all of the time. I was frequently running to the bathroom and checking myself. Sometimes I saw blood (again, I was told this was ok….since I just had surgery….it was most likely from the cervix, and not the baby); but more often I saw mucus and discharge that started out yellow then changed to green. Everyone around me was hopeful. But I just had an incredible sense of dread.
Then one day at work, in the morning I started to notice a dull tightness in my belly. But it would come and go. I had never gone through contractions before; but I took out a post-it note, and started to write down the time whenever I felt it. Yep — there was a pattern. Every 15 to 20 minutes, I would feel the cramping….then it would go away. At lunchtime I opted to go to the emergency room.
When I was examined the doctor told me she could see that I was contracting and that the cerclage would need to be removed immediately or my cervix would tear. I was 19 weeks I was in labor. Although I was a bit further along in this pregnancy, the prognosis was the same. I was given medication to stop the active labor. I then went in for a D&C to remove the baby and the placenta. This time though, I had the complication of sepsis. That discharge that I had was a sign of interuterine infection and it got into my bloodstream. So not only was I in labor, I felt like I had the worst case of the flu that there ever was.
Looking back I don’t beat myself up to much. I was younger and my personality type is to defer to others who I see as being more accomplished and experienced. However I also see know that my instincts were much more accurate that the ‘expert diagnosis’ that I received. I am very thankful for the incredible community of women who are online and who talk about their incredibly painful experiences in such a public way. I learned more from them than I did from WebMD or any medical journal that often are just giving dry data collected from studies and controlled test. I get that — doctors are trained in the scientific method. They need a clear cause and effect — insurance companies don’t pay them to play around. But as a woman whose entire worth and happiness are on the line — the medical community’s response to miscarriage is just woefully inadequate.