Slow-Motion Miscarriage

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.

20 thoughts on “Slow-Motion Miscarriage

  1. jwhitworth7

    I’m so sorry you’re going through this. On one hand I can totally see where medical intervention days/weeks ago would have been preferred to get it over with and on the other hand I can see why you appreciated their advice to wait it out. I remember having the same thought when I went through my chemical pregnancy. I had a positive pregnancy test two days before and then started bleeding at work and thinking it was so weird I just kept going on about my day at school. It would be unnerving to have people ask about conceiving again while you’re going through this miscarriage. It seems like people’s filter goes out the window when it comes to pregnancy related topics. Thank you for the link to the article. I’m interested in reading it. And while it’s so frustrating it is helpful to know that first trimester loss isn’t connected to 2nd or 3rd (I often asked this after the chemical and missed miscarriage after Oliver). It is kinda hard to accept that it’s just bad luck especially after what we’ve been through s I think your plan to try again on your own is totally reasonable. And I’m curious as to why your RE continues to advocate for stopping breastfeeding. Luke self weaned a few weeks into this pregnancy and I was told that there was a risk of preterm labor due to nipple stimulation causing uterine contractions but have never been told there is a reason to stop early on besides the fact it’s hard on your body (but what isn’t?) I’m wishing you the best of luck in the coming weeks and months. And I appreciate you updating us. You’ve been on my mind.

    1. lyra211 Post author

      Thank you — it’s so good to hear from you, especially since I know you understand in such a deep way everything I’ve been going through (although of course I wish you didn’t have to go through it!). Isn’t it so weird to be going through a miscarriage at work? Possibly TMI, but I passed the pregnancy tissue at work this morning (finally), and it was totally bizarre knowing that my colleague was just a few feet away (his office is right next to the bathroom) and knowing that I’ll always remember that I flushed my pregnancy at work — so weird, right?!?!

      As for the breastfeeding, I think it’s primarily because of my history of irregular cycles, since breastfeeding can cause irregular cycles too — so I guess that if I’m breastfeeding, she can’t tell if my cycles are irregular because of breastfeeding, or because of some hormonal imbalance that she should try to correct? It has never been clear to me whether irregular cycles cause problems or only indicate problems, but I know that she has suggested “tweaking” my cycles in the past as a way to increase the likelihood of pregnancy. I think I’m a little unusual in that even though my cycles are irregular, I ovulate very consistently — often irregular cycles indicate problems with ovulation, but I’ve never NOT ovulated during a cycle that I’ve been tracking (and I’ve tracked a lot of cycles at this point!). So, I’m really not sure whether irregular cycles, particularly if they’re due to breastfeeding, are actually a problem if I’m still ovulating, but apparently my RE thinks so. She also said there’s maybe some evidence that prolactin can cause the lining of the uterus to be suboptimal, making it difficult for an egg to implant. Again, that didn’t seem to be my problem, since the egg implanted but just didn’t develop into an embryo, but what do I know? Also, women get pregnant while breastfeeding all the time! I guess the idea is that if I’m already in some sort of suboptimal state, breastfeeding might be worse for me than for a typical woman who doesn’t already have issues with irregular cycles? As you can tell, it’s not totally clear to me either! But anyway, that’s what she said: that I should stop breastfeeding because (1) it can cause irregular cycles, and (2) it can affect the lining of the uterus and possibly make it more difficult for an egg to implant.

      1. jwhitworth7

        Oh I’m so sorry you’ve had to go through this especially at work. It is so odd to think about.

        As far as breastfeeding. I agree with you. It seems like if you’re ovulating then BF shouldn’t be an issue right away. I mean despite the miscarriage you did get pregnant with implantation which I’ve always been told is the hardest part. And yes SO many women get pregnant while BF and those that don’t/can’t usually aren’t ovulating due to BF. I do think it’s good news that even though you have irregular cycles you have ovulated when tracking. After all that’s how pregnancy happens right? Again I’m thinking about you. Wishing you the best!

  2. theskyandback

    I am so sorry about all of this. I just caught up on everything. Seriously? I think you’ve met your quota for pregnancy loss already. The Universe needs to call the clue phone. So unfair. Seriously, though, I wish I could give you a huge hug. Sending love from here.

    1. lyra211 Post author

      Ha ha… call the clue phone… I like it! Thanks so much for your good thoughts. Hopefully we’ll be able to move on with a healthy pregnancy soon. It’s lovely to hear from you.

  3. RJ

    I’m so sorry you are going through this. Sending you lots of love. I did all mine medically and I commend you for going about your day while you’re miscarrying.

    1. RJ

      I accidentally hit send before I was finished, sorry! I have a hard time with people who ask about having more kids even though I know the question is innocent. It irks me that my personal life is the topic of “light conversation”. I also find that research very intriguing. Thank you for sharing. Hugs during this difficult time.

      1. lyra211 Post author

        The thing that surprises me about these questions is that I often get them from other women of childbearing age. So I think you’re right that they’re “innocent” questions, in the sense that they are probably coming from women who have never experienced pregnancy loss or infertility — they are “innocent” about how heartbreaking the childbearing years can be for some women, because pregnancy just works for them and they’ve never known it any other way. Wouldn’t it be nice to just get pregnant and have a baby when you want to? Anyway, it’s lovely to hear from you, and hope all is well!

  4. My Perfect Breakdown

    I am so sorry. There is something exceptionally cruel and odd about having a miscarriage while having to go about your daily life in public.
    I’m hoping your done with the worst of the physical loss. Sending my love, as always.

  5. Meiko

    I’m really sorry that this is happening to you. I hope you can have some closure soon.
    Unfortunately I can relate very well, having gone through a similar ordeal three times (two miscarriages and one ectopic). For the first miscarriage I stayed home from work for a few days and it was actually the worst (psychologically) because I had nothing else to occupy my day and I was wallowing in my sadness. For the second I just popped some pain medication and went on as usual, sitting on committees, giving a presentation at a workshop etc. In some sense it was better to have a distraction and to be reminded that I have another life outside of my fertility issues. Of course, it depends on whether you’re in serious physical pain or not. But it’s the unpredictability of the whole process that is very stressful- I was always worried that I would start gushing blood in the middle of a meeting etc.
    I agree that it’s very weird that no one knows what is happening. The ectopic happened the same week in which I won a small local prize. My colleagues probably thought that I was very ungrateful because I acted super-cranky when they congratulated me.

    1. lyra211 Post author

      Ugh, I’m so sorry to hear about everything you have been through as well. But I’m glad you found your way to the blog, even if it’s a set of sad experiences that brought you here. It sounds like maybe you’re in academia as well?

      I definitely relate to the awful psychology of staying home during/after a loss — after my 18-week loss (found out on a Thursday, delivered on Friday), I stayed home through Monday, but then was back in the office by Tuesday, mostly because I couldn’t stand sitting at home anymore thinking about the fact that our daughter was gone. I agree that the work and the reminder that you have a life outside of pregnancy loss are therapeutic — they certainly were for me as well, both that first time and this time. But I also hear your point about the unpredictability of being at work while undergoing a miscarriage. Fortunately this happened to be not only during my sabbatical but also during exam/senior week when our department is a ghost town, but I still worried about randomly starting to gush blood at an inopportune moment. Fortunately it was not so bad, and the major tissue passage happened at a fine time when I was just working alone in my office. I guess there are worse work environments to have a miscarriage in!

      Oh, wow, the discord of winning a prize the week that you have an ectopic pregnancy… that must have been very difficult to deal with! I was also unjustifiably cranky with a colleague this week and felt bad about it afterwards. Hopefully they know us well enough the rest of the time that they can just write it off as an anomaly and move on.

      1. Meiko

        An 18-week loss must be really heartbreaking. I suppose it’s an experience you can’t imagine facing until unfortunately you find yourself in the middle of it and have to cope somehow.

        And yes, I am also in academia. In fact I have been reading your blog for a couple of years, probably – I found it through xykademiqz. But I’ve never left a comment, sorry!

  6. marmomae

    Waiting is the worst. I’m ectopic waiting for my HCGs to get to zero, doesn’t matter what you’re waiting for either way it sucks. However sometimes work is an easier place to escape.

    1. lyra211 Post author

      Ugh, I’m so sorry about your ectopic pregnancy… that’s awful, and also a terrible waiting game. I hope your numbers come down quickly and that you are able to move on soon!

    1. lyra211 Post author

      Thank you. It’s finally over (as far as I can tell!), so at least we are able to start picking up the pieces and moving on. Despite having it drag out for a couple of weeks, it really, really wasn’t as bad as our 2nd trimester loss, either physically or emotionally — just, with all of the circumstances being different this time around, it feels like a more minor setback than a disaster. We’re mostly just impatient to get on with trying again. I so appreciate all your good wishes.

  7. hopingforatakehome

    I’m just getting back to reading and writing after being away on a trip with an internet break. I was hoping that you were going to have a unicorn experience and that somehow it would work out even when most signs were pointing that it wasn’t. I am so sorry this wasn’t the case.

    1. lyra211 Post author

      Heh… thanks. I really had no hope for a unicorn, although I appreciate that you had hopes for me. 🙂 Sucks that it dragged out, but it didn’t take too long in the end. Back to the waiting game!


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