Miscarriage and Loss Remembrance
Strange where those words burrow themselves in. Miscarriage and loss.
I had two miscarriages. Many years ago. Many experiences ago.
My grieving went on long after it made much sense to me. After all, the losses were so early they were barely losses. Right?
They were losses after IUI's (intrauterine inseminations). I knew exactly what day I had been impregnated, exactly how far along I was. I could practically have told you how many cells each embryo had and how they were developing.
I hesitate to write on this sensitive, emotional subject. There is a political aspect to this conversation that is undeniable, given that we have a presidential election a scant 3 weeks from today.
The emotional, spiritual side is unmuddied by the political controversy. For me, I can separate these issues as easily as I open my eyes after a full, restful night's sleep.
I believe in a women's right to choose to have a baby or not to have a baby. That is my belief. I vote with that belief. That is not only my political belief; that is my feminist belief.
And yet. Those pregnancies held my future as I hoped it would be. Those two pregnancies were filled with soft, green grass and blue skies and picnics, holding a baby. Dreams of lighting candles and seeing the lights reflected on my baby's face. Gently holding my baby as I read my favorite books. I breathed into those places of sleeping and waking, knowing that my baby was alive and real and part of my waking life, not just a dream.
Yes, all those dreams and thoughts about an embryo so small that there was never any possibility of survival past living in my uterus.
Positive Pregnancy Test Dreams
While in fertility treatment, after a positive pregnancy test, I dreamt a whole life with my baby, toddler, pre-schooler. I dreamt of life with my child, all the way through college. All in the first several weeks, all while that baby was only a possibility of a baby. And I mourned the loss of that baby, child, and adult when the pregnancy failed. My heart broke with each realization that not every conception or embryo or pregnancy resulted in a baby in my arms.
I mourned the loss of those embryos that did not survive to babyhood.
I still do.
I still know exactly how old those children would have been. When their birthdays were.
I know that the moment I got those positive pregnancy tests that those embryos became babies to me.
Prayers to Those Mourning Recurrent Pregnancy Loss and Miscarriage
My prayers go to all of us who are mourning those losses today. Infant loss, spontaneous miscarriage, recurrent pregnancy loss--this pain has many different names. I am sending you loving thoughts, hoping that comfort finds it's way into your lives, moment by moment.
I hope that you can separate your loss from the political side of pregnancy. In three weeks we elect a president that is being very clear on his position. The issue is not abortion. It's about freedom to choose and reproductive health.
Vice presidential candidate Paul Ryan said in the debate with Vice President Joe Biden that he and Mitt Romney, if elected, would place supreme court justices on the court who would vote against Roe v. Wade.
Please understand that this is not only about abortion. It's also about fertility treatment and the ability to create embryos that create our families. It's about being able to have fertility treatment as a choice at all. If you think I'm exaggerating, please refer back to previous blogs about embyos being granted personhood.
I support a woman choosing. Choosing to have a family. And choosing not to have a family. Her choice. Not mine.
My choice is to take a few minutes today, two decades later, to sit quietly and remember the pregnancies that I lost. The embryos that didn't mature into the young men or women that I dreamed of. I will say a prayer of love and gratitude.
For all of us.
When Becoming Pregnant is Not the Hardest Part
Infertility is not always about becoming pregnant. Sometimes that's the easy part. Sometimes it's the easier part. Sometimes the hard part is staying pregnant.
It is it's own special, horrific pain to miscarry the baby that was so dearly wanted and planned for. Our hopes and dreams for our babies often begin the moment we receive our first positive pregnancy test.
When infertility and miscarriage loss has not been present in our lives, many of us assume it will all just go well. That we get pregnant and nine months later, we have our babies.
If you've had a pregnancy loss, you know it doesn't always go that way.
If you've had a loss, how do you get through the next pregnancy successfully?
Luckily, most losses do not predict a future of losses.
Let me repeat that a different way.
Very frequently, if you have had a miscarriage, you will go on to have a successful pregnancy.
Re-read that please.
After a Miscarriage, Odds are Favorable for Successful Pregnancy
If you have had a miscarriage, the odds are very much in your favor that you can successfully carry another pregnancy to term and hold that baby. Yet another way to say it.
A few things to ask your health care provider before becoming pregnant again:
Was there a specific reason that the miscarriage occurred (often it is unknown)?
Is there a way to prevent that from happening again (often there was nothing that could have been done)?
How long should you wait before trying again (whether trying to conceive on your own or in fertility treatment cycles)?
Is there any genetic testing that should be done on either partner to prevent another miscarriage?
Is there any testing that could be done on an embryo to prevent another miscarriage (CCS, short for Comprehensive Chromosonal Screening, examines all of the chromosomes and allows you to know that the embryo or embryos are normal)?
Can they recommend a mental health professional or support group to help you with the grief process that occurs after a miscarriage?
You know that having another baby will not replace the baby you lost. I know that too, personally, having had two miscarriages. We cannot replace one baby with another, that's a given. We can go on, though, and have a successful pregnancy and have a family that is cherished for the living beings that exist in it.
Finding a way to get past that point in your pregnancy where you lost a baby is very challenging. Most of us don't relax until we have reached a new marker and have progressed farther. Many of us don't feel completely comfortable until the baby is moving and we can feel it.
What We Know About Miscarriage
What we do know about miscarriage is that it's never easy, whether a carefully planned pregnancy or a delightful surprise. It rips your heart open and makes you look inside.
Have the courage to look, you will find more strength than you imagined, more than enough healing powers to move on and enough love to support all of your efforts to create your family.
You do not have to do this alone. Lisa Tuttle, PhD, here at RMACT, is a wonderful resource, whether to see her personally or to be in a pregnancy loss support group.
Miscarriage and Pregnancy Loss
Miscarriage, losing a wanted pregnancy, no matter how early, is a loss.
Whether you are five weeks, five months or five minutes, when a pregnancy ends before a baby arrives, it hurts.
It hurts terribly.
And hearing well meant comments that hurt even more can make any one of us shrink back into ourselves.
We know we may get pregnant again and have a baby.
That doesn't make this loss less painful or sad.
We know that the pregnancy may never have had a chance of surviving to become a healthy child.
That doesn't make having our pregnancy end feel any better.
We have our own beliefs about God and/or a higher power that may be shaken to it's very core or strengthened beyond what we could ever have believed. And with all due respect, those are our beliefs.
The Right to Grieve, The Right to Recover
No matter what anyone tells you, you have the right to grieve a pregnancy loss--however you may need to.
It may be a ritual. A letter written to your unborn child. It may be that you plant something. It may be that you start a scholarship fund.
It may be that you cry for a long time or frequently.
Let yourself grieve. Find loved ones that can help. Find a mental health professional, like RMACT's clinical psychologist Lisa Tuttle, PhD, that can help support you through your grief.
Please let us know what we can do to support you.
We are here.
Infertility and loss.
Where do you feel it most significantly?
For me, it popped up in unexpected places and in ways that I felt unprepared for.
When my father died, it was sudden. It was in the middle of infertility treatment, right after a miscarriage. I felt like I was carrying the weight of the world on my shoulders.
Several years later, still in treatment, still no success, another miscarriage later, I got leveled by infertility fall out again.
My mother was moving and deciding what to bring with her, what to give to each of her daughters and what to get rid of.
And there I was. Looking at china and stemware and wondering if I would ever have a child to hand down things to. A child to keep my grandmother's beloved things, that child's great grandmother.
Was this the end of my family lineage? My family's history? My family?
And it brought up my father's death again. Of course it did.
For the grandfather that my children, who did not exist, would never know. I grieved for the loss of relationship that could not exist between my father and my children that I still hoped for. I grieved again and again, for what could not be.
China, stemware, death and infertility. It all got very intertwined for me. It felt almost impossible to separate out one from the other. Crying over my father and over the beautiful glasses that my grandmother so lovingly took care of.
I was spared some of the horror stories that I heard from my friends. My mother was kind, as were my sisters. There was no conversation about who would inherit these things from us. No conversation that these beautiful heirlooms should go to someone else who could pass them down, keep them in the family.
And so I grieved new layers of the loss of my father. New layers of the loss of two pregnancies. New layers of infertility, life and death.
With each layer of grieving, there was some relief. Just the smallest of lifting of sadness.
I brought those beautiful things home. I put them where I could see them every day. As my grandmother taught me, I did not save them for special occasions, I used them often. I enjoyed them and loved them and they brought joyful memories of my grandmother.
I inherited much more than material things during that time. I inherited love, tenderness and compassion.
Infertility opened my eyes to what I had in my life, not just what I did not have in my life.
And every time I forgot, I looked at the sun streaming in and sending rainbows all over the room from my grandmother, my mother and my sisters.
Today, Tally Jacobs, an important and treasured member of the RMACT team writes about her experience with twins.Here's what she had to say:
When I first heard that I was having twins, I was thrilled. And maybe a bit relieved. The numerous failed IUI cycles meant nothing. The needles, the early morning monitoring, the awkward explanations to my bosses about missed work travel and meetings – it was all absolutely insignificant. The miscarriage? Practically out of my memory (at least for a moment).
I had learned earlier that I was pregnant (“very pregnant” according to the doctor), and the feeling was absolute elation. Now that I knew I was having twins, there was no question that my precious child would know the joy of a sibling.
I have two sisters, and they are among the most important relationships in my life. I always envisioned passing on this love to my own children, but failed attempts to get pregnant left a lingering feeling that maybe I should just be lucky enough to have one child. So the news about twins sent me flying.
Later I realized that along with being elated, I was also being naïve. Through education about twins and the common complications that arrive with multiple gestations, I realized why they call it a “high risk pregnancy.” These gestations can pose serious threats, including preterm labor, premature birth, low birth weight, gestational diabetes and preeclampsia. The babies can also have long-term disabilities such as mental retardation, cerebral palsy, and vision and hearing loss.
I was lucky. My pregnancy was beautiful, magical. My two daughters, now two and a half years old, are treasures. They delight me with their candid observations; they amaze me daily with new things they have learned; they incite laughter and share tender, loving moments with each other, me and my husband. And now that they have a younger brother, I see their nurturing personalities from another perspective.
Because of these blessings, I feel a need to show support for others who have not been so lucky. On April 30, I will be a part of the RMA of CT team at the annual March of Dimes walk. I hope you will join us. After all, fertility treatment is not just about pregnancies. It is about healthy pregnancies.
Please visit the RMACT's March of Dimes team website.
We don’t want to be pregnant. We don’t want perfect eggs or perfect embryos or perfect cycles.
What we want are babies in our arms.
When miscarriages are experienced, we don’t necessarily enjoy the next pregnancy. Even after we pass the time of our previous miscarriage, we don’t go on to enjoy the pregnancy. As one of my Fertile Yoga students said this weekend, she’s just waiting for the other shoe to drop.
When we undergo fertility treatment, we know that sometimes it’s successful and sometimes it’s not. Pregnancy rates vary from infertility program to infertility program; you can check on the SART (Society for Reproductive Technology) website to see what they are for the programs in your area. And while we understand that sometimes fertility treatment doesn’t work, we don’t really understand it, especially with IVF (In vitro fertilization).
With IVF, we know that we are transferring fertilized, dividing embryos back to the uterus. Sometimes we literally see the cells dividing, under the microscope at our programs. We know that they are alive and well and functioning just as they are supposed to, to become babies and children.
So really what happens is that each IVF cycle becomes a loss. A miscarriage. While no pregnancy test has come back positive, we know that egg and sperm had met, the egg had fertilized and that there was an embryo dividing and alive.
And when that pregnancy test comes back negative, we feel a loss. That embryo is no longer alive, no longer has the potential of the baby we are dreaming of. If we’ve had positive pregnancy test results that have ended before our baby is born, believing in the positive results next time because even more challenging.
So if you’ve been struggling with infertility, been in treatment, had positive pregnancy tests and then find yourself unable to enjoy the positive test, give yourself a break. The anxiety of “will it work better this time?” can be nearly insurmountable. The inability to feel happy actually makes perfect sense. Especially to a heart that has been wounded by infertility.
So maybe the best advice that I can give you is that if you are not jumping for joy with a positive pregnancy test, especially with past losses, you are not alone. And it is ok. Perhaps at some point, you will be able to enjoy the pregnancy.
If not? Perhaps the very worst, if you do experience a healthy pregnancy that you feel anxious through? Nine months later, the pregnancy will be over and you will enjoy your baby.
And that would be a happy enough ending for most of us.
In case you are trying for your second or third child, read on. Secondary infertility is more common than you may realize.
Today is the medical information, tomorrow will take a look at some of the rest of it. Including the feelings of guilt that you even want a second one when you are lucky enough to have a first. I've been talking to a lot of women about that lately. It is powerful, this urge for our families. How did guilt get attached to such a healthy, instinctual urge?
Taken directly from Reproductive Medicine Associates of CT website:
Statistically, secondary infertility is more common than primary infertility. More than three million Americans are dealing with secondary infertility, which occurs when a couple has difficulty conceiving or carrying a pregnancy to term after successfully having one or more children without medical assistance. Secondary infertility can also cause repeated miscarriages (defined as two or more) in women who have already carried a pregnancy to term.
It is estimated that approximately 20% of women experience secondary infertility at some point in their lifetime and that secondary infertility is responsible for six out of every ten cases of infertility, making it more common than many people realize. Couples experiencing secondary infertility may feel especially frustrated and confused since they’ve already accomplished at least one successful pregnancy and may feel that they’ve “proven” their fertility.
One of the main causes of secondary fertility is also one of the most natural and inevitable: bodies change over time. Like primary infertility, secondary infertility can also result from a variety of hormonal, environmental, immunological and physiological causes:
- A natural, age-related decline in fertility
- A decline in sperm counts in men
- Development of irregular menstrual cycles in women
- Surgery, including C-section, that has led to tubal damage
- Body trauma
- Complications with a previous delivery
- A new partner
- Weight gain
- Too large a gap between the first and second pregnancy
Whatever the cause, there are viable solutions for treating secondary infertility. Unfortunately, couples with the condition are often less likely to seek treatment.
At RMACT, we work with each patient individually to create a comprehensive and custom fertility treatment plan that incorporates a medical approach with complementary care services like support groups, individual and couples counseling, yoga classes, acupuncture, and nutritional advice.
As promised, read below to hear from Dr. Cynthia Murdock about one of the scariest situations while dealing with infertility-
If I had to choose one single problem which causes the most stress and anxiety among our patients, I would say that it is bleeding in early pregnancy. The official medical terminology for this is first trimester bleeding. Nothing is worse than working so hard to achieve a pregnancy only to discover that you are bleeding. The first thought that enters everyone’s mind is “I am losing this pregnancy”.
All bleeding should be evaluated with a blood test to check estrogen and progesterone levels, and an ultrasound to rule out any bleeding in the uterus. Most often when the bleeding is light we may not find a reason for the bleeding, but luckily most light bleeding episodes are limited to 1-2 days. Common recommendations are abstinence from sexual intercourse. In some cases of heavy bleeding we may ask you to decrease your activity level, but there is no evidence that this will prevent a miscarriage.
Luckily we have some positive news on this front. First of all, approximately 25% of all women have bleeding in the first trimester of pregnancy. A recent large study of over 4,000 women revealed that of the 25% of women who have bleeding , only 8% have heavy bleeding (defined as more than a normal menstrual bleed). The majority of women (92%) who have bleeding, have only light bleeding(less than a menstrual period) or spotting. The good news is that women with only light bleeding or spotting are at no increased risk for a pregnancy loss. The not-so-good news is that women who experience heavy bleeding have a 3-fold increase in the risk of miscarriage. The most important messages that we can take home from this study are that first trimester bleeding is common, and that greater than 90% of women with first trimester bleeding are at no increased risk for a miscarriage.
Remember bleeding is common, but luckily most of the time it poses no risk to the pregnancy. Call your nurse so you can be evaluated but don’t panic!
Dr. Cynthia Murdock
Dr. Murdock earned a BA in biology at Cornell University and an MD at Creighton University School of Medicine where she graduated magna cum laude. She completed her residency at Creighton University Medical Center where she was named Berlex Best Teaching Resident. In 2003 she completed a fellowship in Reproductive Endocrinology and Infertility at the National Institutes of Health.
An experienced researcher, Dr. Murdock has contributed to numerous peer-reviewed studies and presented at several of the most prestigious conferences in the field of reproductive medicine. The focus of much of her research has been on estrogen receptors, hypothalamic neuron function, and precocious puberty.
Dr. Murdock is a member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility, as well as a Fellow of the American College of Obstetrics and Gynecology.
Dr. Murdock was previously an assistant clinical professor at Creighton University School of Medicine and a staff physician with Reproductive Health Specialists at Nebraska Methodist Hospital. She has also served as an Assistant Professor of OB-GYN at the National Naval Medical Center and Walter Reed Army Medical Center.
Dr. Murdock is now a staff physician and a fertility specialist in Reproductive Medicine at RMACT. She is board-certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility.
An infertility poem I wanted to share with you. I hope that you find something helpful or comforting or loving in it.... yes, it's about loss, it's also about hope and love.
This year, I grew a garden
I tilled the soil and pulled the weeds
I raised the beds and laid the seeds
before the ground would harden
I mixed the clay with fertile dirt
worked the ground till my bones hurt
I tended to little seeds
and out of dirt they sprouted bright
soaking in the water, nutrients and light
and I could feel my heart beat
I delighted in the miracle
that God and I could conspire
to make a garden grow
I think I became obsessed
Secretly planting through the night
a butterfly garden to the left
a water garden to the right
and I wasn’t finished yet
I planted bushes here and there
I even planted trees, banana and pear
I was a gardener this spring
basil, berries, melons, cilantro
cucumbers, corn and little tomatoes
fragrant, sweet and pretty things
for surely if my hands can do all of this
then my belly deserved nature’s kiss
As Autumn slowly takes over
The harvest moon has come and gone
my heart beat is not quite as strong
My stride’s a little slower
My tomatoes vines are turning brown
And I can’t pick my knees up off the ground
The air this morning was cold
My lush gardens have wilted away
butterflies didn’t visit them today
The pain in my stomach is getting strong
And I am losing hope in the garden inside
I don’t know where to go, whom to confide
This year I built a garden
I watched it bloom and fade
But I could not grow one in me
My seedlings could not be saved
I tried my best to build good soil
but no amount of tilling, no amount of toil
Could make my little garden grow
From the inside out
Will I grow a garden next year?
Right now, I feel such doubt
I doubt and I cry
I cover my face and hide
Though my heart is broken
I will not stop my stride
I will continue to till the soil
I will pull away the weeds
I will feed the ground with compost
And nurture every seed
I will fill my garden with water
And sun from up above
But above all things
I will give my garden love
One day a bean will sprout
And he will beam so bright
soaking in the water, nutrients and light
he will feel my heart beat
and take in all the love I give
As God and I will conspire
to make a baby live
If you have gotten pregnant, (either on your own, or through infertility treatment), have experienced the despair of losing a much wanted pregnancy, and then conceived again, then you know the emotional difficulties of the next cycle in which you try to conceive.
When you've experienced a miscarriage loss, being pregnant again can make you feel vulnerable and downright scared. When do you know that everything is all right? When can you relax and feel secure that the pregnancy is progressing normally and in a healthy way? When can you enjoy knowing that you are pregnant?
If you have experienced recurrent pregnancy loss, than you have lost at least two consecutive pregnancies after having heard a heartbeat. That is the clinical definition of recurrent pregnancy loss. There are many of us out there that have miscarried more than one pregnancy, not consecutively, not hearing a heartbeat each time. Either way, these losses are wearing on us emotionally and physically.
Either way, knowing that everything's ok is a very different animal. Spotting or staining becomes a source of anxiety, fear and worry. Every twinge is that possibility that this is where the pregnancy stops being ok. Every twinge that you don't feel is the possibility that now is when you will lose this pregnancy as you lost the others. It may feel very trying to be around other happily pregnant women, who seem almost blissfully unaware of what could happen, what has happened to you. You may feel isolated as you don't fit in with women who are still struggling to conceive nor do you feel that you fit in with women who are pregnant.
The feeling of joy is elusive at best in these situations. The feeling of relief may come late, very late, much later and sometimes not at all, depending on how late your pregnancy losses were. This is normal! I rarely use exclamation points, but if you are like me and felt that there was something wrong with you because you couldn't enjoy a pregnancy, I want you to know that this is normal. Normal, normal, normal.
A few suggestions, perhaps?
Most important, create community. Our program (RMACT) has a specific support group run by Dr. Lisa Tuttle (clinical psychologist), on recurrent miscarriage and pregnancy loss. An entire group of women, led by a compassionate mental health professional to help you process your losses, help you enjoy the pregnancy you are experiencing or help prepare you for your next pregnancy. There are other places as well that you can find support, I will post those sites for you as a resource later in the day. Check back.
Sometimes creating a ritual can be helpful as well. A good bye to the babies that you have lost. Perhaps a letter written. Perhaps a tree planted. Some way of acknowledging the hopes that you had for the babies that were not born, but still loved by you.
Tomorrow's blog will continue on this theme of loss, with a look towards hope and birth. In every loss that we experience, there is a season to grieve and there is a time to move on. Those losses don't disappear, not by any means, but they do become the fabric of our lives, an experience that we process, absorb and still continue to live our lives.
I know exactly how old my children would have been that I miscarried. It's not a conscious thought, figuring out the years, just part of who I am. It was a long time ago; they are still part of who I am. I am a healthy, strong woman. And yes, I know how old my babies would be, as you probably will.
Twenty one in July, nineteen in September.