I really wanted medical management of my miscarriage, i.e., to take medication to speed it along. I wound up not having that option, since my indicators last week were not great, but also not totally inconsistent with a healthy pregnancy. Since my doctors weren’t sure, they didn’t want to intervene with medication or surgery (a decision I certainly understand and agree with), which meant that I wound up undergoing a slow-motion miscarriage as, over the course of the week, I slowly went from spotting to bleeding to passing tissue and knew that it was over. An ultrasound this morning confirmed that my body passed the tissue on its own (even though I am still bleeding), so I have officially miscarried. Gravida 3, para 1.
The strange thing about going through a slow-motion miscarriage is that you can’t just curl up at home with a pint of Ben & Jerry’s and wait for it to pass. I mean, I guess you could (perks of the flexibility of an academic job?), but mine has gone on for at least a week, and that would require more pints of Ben & Jerry’s than I am really comfortable consuming. So, as a result, I wound up doing a lot of things that I never imagined I might do while having a miscarriage:
- Having a miscarriage during research meetings with my students and postdoc
- Having a miscarriage while talking with my department chair
- Having a miscarriage while writing an invited major review article on recent advances in my field
- Having a miscarriage while sitting on the grass and listening to a student folk music concert with my toddler
- Having a miscarriage at my department’s end-of-year party
- Having a miscarriage while baking cookies and playing board games with my old college roommate, visiting from New York City
- Having a miscarriage during an ice cream fundraiser for my son’s daycare
I mean, on the one hand, if you have to have a slow-motion miscarriage, many of these things are quite pleasant ways to pass an otherwise depressing time. On the other hand, I’ve felt weirdly disconnected from my life this week, and it’s bizarre to be engaged in some other activity and then have the intrusive thought “wow, isn’t it weird that I’m doing this while having a miscarriage?” It also feels strange, and somehow dishonest, to interact with other people when they have no idea that you’re having a miscarriage during the interaction — but not quite enough that I really felt like telling them about it (I did tell the two close friends who happened to call this week, and my visiting college roommate).
It’s also frustrating because my son seems to be old enough now that people feel comfortable asking me if we’re planning to have another baby. Twice this week alone, I got the question, and not from people that I’m particularly close to. I wanted to yell at them that I was having a miscarriage, and they really shouldn’t ask questions about people’s reproductive plans (or at least point them to this amusing flow chart). Instead, I just gave my stock answer of “we’ll see!”
One thing I found both disturbing and reassuring this week was a recent study on 2nd and 3rd trimester loss that was published in 2016. I wasn’t aware of it until this week, since it wasn’t published yet when I was scouring the literature after we lost our daughter in September 2014. I thought it was such a great study that I emailed the author to thank her for doing the work, particularly since there seems to be so little research on 2nd trimester loss. You can read the full article here, but these are the two main takeaways for me:
- Second and third trimester pregnancy losses are strongly correlated, indicating similar etiologies. Once you have had a 2nd or 3rd trimester loss (including before 20 weeks), you are about an order of magnitude more likely than a typical woman to have another one. The overall probability is about 4%, with recurrence more likely if the cause of your first loss was placental or maternal, and less likely if the cause was fetal or unexplained. (This was the disturbing part — my first loss was placental/maternal, which puts me in the higher risk category of ~8% recurrence. I sort of knew that already, but this was the first time I’d seen the probabilities broken down in that way.)
- First trimester miscarriage is not correlated with 2nd or 3rd trimester loss, including recurrent 2nd or 3rd trimester loss. Roughly a quarter of previous pregnancies ended in first-trimester loss for all the women in the study, regardless of the number of previous 2nd or 3rd trimester losses, which is not significantly higher than the general population. (This was the reassuring part — it makes it more likely that my current miscarriage was just run-of-the-mill bad luck.)
So, anyway, here I am, just waiting again. Waiting for the bleeding to taper off, waiting for my cycles to reestablish themselves, waiting to see if we can get pregnant on our own again. The OBGYN had me make a follow-up appointment for August, mostly as a chance to check in and come up with a plan if necessary. She half-suggested that I could go for an infertility evaluation at the local big state hospital system if I wanted, but since I’m already being followed by an RE at the other major hospital system in the state I figured it wasn’t necessary, at least not yet. As I discussed with her, while it’s great that we spontaneously conceived (and so quickly!), it does make it hard to know how long to wait before going back to the RE again. I did put in a note through the electronic messaging system to my RE to update her about this pregnancy and ask if she had any suggestions moving forward, and her one suggestion was: stop breastfeeding. I’m not quite ready to do that yet, and it seems pointless to go back to her before I am. So I guess the plan is to wait a few months, see what my cycles are up to, and then reevaluate. I think I’m OK with that plan for now.