Tag Archives: pregnancy after loss

So long, pregnancy #4

We had our 6-week ultrasound today for pregnancy #4.  It did not go well.  There wasn’t much of anything to see — a bunch of irregular lumps that might have been bleeds and might have been products of conception but no gestational sac, yolk sac, or fetal pole.  The OB gave me the option of waiting and coming back in a week for another ultrasound, but admitted that she thought there was basically no chance that it was a viable pregnancy, so she gave me a prescription for misoprostol to take this weekend.

I knew, going in.  I’d had some extremely light spotting on and off, and zero pregnancy symptoms.  Even with the encouraging betas last week, I’ve been pregnant enough times now that I just knew something was off.  I usually get stretchy round-ligament-type feelings, and I’d gotten them the week after the positive HPT, but then they tapered off.  I’d had some tenderness while nursing, and it tapered off too.  But even though I expected it, it’s not much easier to deal with.

I just feel the overwhelming weight of needing to (1) get through this miscarriage, (2) go through the whole long process of trying to conceive again, and (3) going through another anxious pregnancy where I’ll be freaking out at every stage.  It just feels like too much right now.  But there’s no getting around step 1 — my only hope is that it won’t drag out too long (like it has the other two times, says my pessimistic self).  I can’t say I’m really looking forward to step 2 either — I just hope that awful ovulation pain doesn’t come back.  And while step 3 is a necessary mile marker on the way to the goal of having another living child, I’m really not looking forward to it either.  I’m just so tired of everything conception- and pregnancy- and miscarriage-related.  God, I can’t wait for this phase of my life to be over.

The other set of decisions I’m having to make is how aggressive to be with follow-up.  I put in a call to my RE’s office this afternoon, although I haven’t seen them in 8 months so I don’t know if they’ll get back to me quickly or have me come in for an appointment before they’ll talk to me.  I need to decide whether or not I want to ask for testing of the products of conception, for example (probably, since I always think that more data are better).  I had a lot of testing after the 2nd-trimester loss of our daughter, but I will probably make an appointment with the RPL clinic at my RE’s office for a consultation to make sure there’s no other testing they recommend (they encourage consultations after two consecutive losses).  For example, it seems like it wouldn’t hurt to have my thyroid and some other things checked again, since they haven’t been checked in several years.  My guess is that everything will come back normal, and they’ll just tell me to quit breastfeeding and send me on my way, but you never know.  My OB did tell me she’d recommend progesterone next time as a precaution (the RE had me on it for my pregnancy with my son, so I’m no stranger to it).

Breastfeeding is a whole other can of worms.  I know that it probably makes sense to wean before we try again.  While there’s no really good evidence, there’s circumstantial evidence that it can lead to difficulties with implantation, and so it seems like a sensible step to take now that my son is 20 months old.  But… he doesn’t want to wean, and I don’t want to wean, and the whole idea is just making me feel a lot more miserable.  It’s like, on top of dealing with dead baby #3, I now have to face the prospect of making my one living baby miserable and bringing an end to one of the few things that has gone perfectly right during my reproductive years — depriving myself of a beautiful part of my relationship with my son just on the off chance that it might help me not kill another baby.  It’s just not fair, dammit.

Well, as many of the readers of this blog know all too well, even with recurrent losses the odds are still reasonably good (though not great) that next time will be a success, so probably the main thing to do is just move on with getting un-pregnant and then trying to get pregnant again.  I can only hope that it will go quickly and not drag out for another eternity.

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Pregnancy #4

So, remember how I said in my last post that I was just getting my period on Wednesday?  I was pretty sure, because it was the day my period was due, and I was cramping and I think spotting a little.  But then, it just… stopped.  My period never started.  This morning I took a test, and, yup. Pregnancy number 4.

But with cramping and spotting (which has mostly stopped), so, yeah.  I’m not counting any chicks just yet.

But at least for today, I’m pregnant again!  End of June sounds like a nice time to have a baby. Kind of in the same way that the moon Europa sounds like a nice place to visit.  (They both seem very far away and hypothetical at the moment.)

Here we go again!  Wish me luck!

Still Trying… With Some Perspective

After four cycles of trying, still no luck.  I know that especially since my tubes are crap this is still well within the range of normal, but I’m starting to contemplate when to go back to the RE.  The decision is complicated by the fact that my ovulation pain reached new heights of awful this month and sent me back to my OBGYN basically asking “This is not normal, right? Is there anything I can do about it?”

To give you an idea, this month for five days leading up to ovulation I experienced pressure and abdominal pain.  For the ~2 days around ovulation, everything hurt.  It hurt to sit down, it hurt to walk, it hurt to have sex (which is just adding insult to injury), and the pain was so bad that it woke me up in the middle of the night.  I mean, I know some level of ovulation pain is normal, but this just seems beyond normal.  I had brought up ovulation pain at my last annual visit and my doctor brushed it off, but it was so bad this month that I decided to go back.  So I made an appointment, which wound up being with their midwife who I haven’t met before (I thought someone told me she had retired, but apparently she’s back).

I ran through my symptoms and she basically said that she’d be happy to order an ultrasound but didn’t think she’d see anything — I agreed that she was probably right, particularly since I just had two ultrasounds in May/June during my miscarriage, which also didn’t show anything weird about my ovaries.  She said it’s probably either endometriosis or adhesions — I know I have some scarring from the first pregnancy when we lost our daughter at 18 weeks and I developed an infection that I later found out had scarred my fallopian tubes (worse on the left than the right, which is probably why my two subsequent pregnancies have both been on the right).  She said that there’s basically nothing they can do about those things: “Well, I mean, there’s surgery, but…” she said with a little laugh.  I was sitting there thinking: why are you laughing about surgery?  It was as though she thought it was ridiculous that I might consider surgery for pain bad enough that it affects me for a whole week of every month and wakes me up in the middle of the night.  I mean, that’s bad, right?  So the upshot of the appointment was that I declined another ultrasound, and she told me that my best option was going back to the RE — she thought maybe another HSG would help break up some of the adhesions and relieve the pain a little (which sounds sketchy to me, but what do I know?).  I left totally down in the dumps, wondering when I can finally put this phase of life behind me, because it’s just so unrelentingly awful (except for my son, who is the best thing in the Universe, which is the only reason I am willing to keep putting myself through this crap to try to have another one).

Fast forward two weeks to today, and my period arrives.  I’m feeling like crap, thinking I’ll never get pregnant again, or if I do, the baby will probably die again.  Then I had a meeting with our colloquium speaker.

This colloquium speaker and I have known each other on and off through meetings, talks, and conferences for a number of years.  I think we have sort of a little mutual admiration society going on. I remember meeting her for the first time when she was a grad student and I was visiting her university as a postdoc to give the colloquium.  She had just had a baby a few weeks before, but came to campus specifically to meet with me.  I was equally as interested in her science as in what it was like to have a newborn — we had a ton to talk about.  She just seemed so put together, was doing such awesome science, was interested in science education, was thoughtful, and appeared to be super-mom on top of it.  My career was a little farther ahead than hers, but she was a little older because she’s a non-traditional student who started her PhD a little later in life.  So, we kept tabs on each other a bit, as we both bounced around and wound up in our dream jobs as physical scientists at liberal arts colleges only an hour’s drive apart in New England. I started my job four years before she did, which means that she just started her job in January of this year.  I had a kid about three years after she had her first.  She invited me up to give a colloquium her first semester on campus, and this semester I invited her down to give a colloquium at our campus.  Today she’s visiting, and we started off our meeting with the usual excited back-and-forth about what we’re both up to — how her first year of teaching is going, how my approach to tenure material submission is going, etc.  Then, she changed the subject.  She mentioned that she was 22 weeks pregnant.  I congratulated her, quite genuinely, but couldn’t help feeling a small pang of self-pity that she was pregnant and I had just gotten my period for the fourth time after miscarrying, seven months into the journey to conceive our second living child.

But then, she kept going.  She remembered a conversation we’d had a while ago — she had shared that she had two miscarriages in a row, and I had shared about the loss of our daughter in the second trimester.  Well, it turns out that two weeks ago, at their 20 week anatomy scan, she got some bad news that their baby is much smaller than expected.  She is in that heartbreaking waiting phase where they’re trying to figure out how bad it is and whether they will be able to make it to viability, but there is much talk of early delivery and long NICU stays and potential long-term health issues.  Apparently they can’t yet tell whether it’s a placental issue or a chromosomal issue, but neither outlook is good.  She won’t know more until her next ultrasound in two weeks, but she’s been thinking a lot about how to handle it.  She wanted to know if I had any advice based on what I’d been through before (with weirdly similar timing relative to my tenure clock — we are truly living parallel lives in some ways).

My eyes immediately filled with tears for her.  And I silently kicked myself for allowing that earlier pang of self-pity.  It was an important reminder that we never, ever know what other pregnant women are going through, even when it looks from the outside like everything is perfect.  Advice.  What advice do I have?  None, really.  I don’t think I handled my 2nd trimester loss particularly well, but I also don’t think there is a good way to handle it.  I told her a few things:

  • Please accept offers of help.  I didn’t and I made things unnecessarily difficult for myself.  This is a huge life event, and it’s a small fraction of your time on the tenure clock and your life overall, so be kind to yourself while it’s happening.
  • If doing work feels therapeutic to you, go with it.  I couldn’t function for my own sake while I was going through our loss, but I could force myself to function for my students’ sake.  So if it feels right to work, work.  If it doesn’t, don’t.  You need to do whatever you can to get through this.
  • She wanted to know if I had thoughts about when she should tell her department — should she tell them soon so they could plan for the possibility that she might need to take medical leave?  I don’t know if this is the right answer, but I said no.  She doesn’t know what will happen.  Possibly nothing will happen, and she’ll be able to get through the rest of the semester without any issues.  Nobody can plan for this right now, so she has no responsibility to tell other people if she doesn’t want to.  They will figure it out.  They will not blame her for not telling them the news sooner.  There is really nothing to tell right now other than that her baby is sick and she doesn’t know what’s going to happen.  I advised her to wait until she knows what she needs so that she can ask for what she needs.  Unless she wants them to know for emotional support purposes, but my experience was that people really don’t understand pregnancy loss, especially in the second trimester, and having everyone know is often just a higher emotional load to deal with.

That was pretty much all I could think of.  I also told her that I am so, so sorry, and that I am here to help or if she just wants to talk — I told her that when our daughter died, I was just desperate to talk to people who had had second trimester losses, especially those who had gone on to have healthy pregnancies afterward, so if she has the same desire I am absolutely here for her.  I just wish she didn’t have to go through it, especially not this tortuous period of not knowing what’s going to happen.  She sounds pretty pessimistic about having a healthy baby at the end, but I will be hoping upon hope that it’s another case of unreliable ultrasound and that everything will be fine.

These childbearing years are the hardest thing I’ve ever been through, and it breaks my heart the more I learn how awful they are for so many women.  I wish there were a better way.  I wish it were easier.  I wish people talked about it more and were better at supporting each other through it.  I wish we could just wish children into our lives.  When they do come, they’re amazing, but it doesn’t seem like we should have to endure so much suffering to get there.  I will be holding this friend in my thoughts, and checking in with her in two weeks to see if she needs anything after their next ultrasound.

Day 3 labs and my dad’s memorial service

I swear I’m not as much of a grumpy gus in real life as I am on my blog, but I sure do feel like I have plenty to be grumpy about these days.  I thought I had left most of the bitterness of pregnancy loss and infertility behind me, but we’re now six months and one miscarriage into trying to conceive our second living child and I just today saw the second pregnancy announcement from a friend/acquaintance who is five months pregnant (which is how pregnant I would be right now if I hadn’t miscarried), and my dad’s memorial service was last Saturday, and we’re heading into midterm season which is no more fun as a professor than it was as a student, and I am GRUMPY about it all.

As part of the conversation with my OB about how to go forward with trying to conceive after my miscarriage in May, she offered to repeat my Day 3 labs, which I haven’t had done since before my daughter was conceived — I figured that if they were normal, I’d be more comfortable trying on our own a little longer, but if they indicated low reserve I’d want to head back to the RE sooner rather than later.  The results came back this week, and my FSH and estradiol are both normal (8.8 and 49, respectively).  My FSH was 8 before, so things don’t seem to have changed much there (although I do always worry about inter-cycle variability).  My AMH was a bit on the high side — good for egg quantity/quality, but apparently a potential indicator of cysts or PCOS.  Which makes total sense to me, because it seems like every time I get an ultrasound someone tells me I have a cyst and they’ll “keep an eye on it” and then they never do and then I mention it whenever they do another ultrasound and they’re like, “oh, huh, you do have a cyst… well, it looks normal, but we’ll keep an eye on it,” and then nothing happens.  I also wonder if my borderline high AMH levels are related to the fact that I get wicked ovulation pain these days — I don’t even really need OPKs anymore, because I can tell 2-3 days before the OPK turns positive that I’m starting to ovulate, and by the time I get to ovulation day it hurts to sit down.  Anyway, who knows?  My OB mostly just brushed it off (I didn’t actually get to talk to her; she left a message and said to call if I had questions and I haven’t gotten around to it).  But at least my eggs aren’t rotten, which was my main concern.  So that leaves us in purgatory of trying and trying and wondering when to go back to the RE.  I think I’ll probably wait it out until January — that would be seven cycles of trying post-miscarriage (since it took me >2 months to get my period back after the miscarriage), 10 months since we started trying after our son was born, and it would also be past the window of inconvenient due date timing (since I’m planning to submit my tenure materials next November).  Seems like a good time to step up our efforts.

In the meantime, I held my dad’s memorial service last Saturday.  It was so strange.  I still don’t really believe that he’s dead.  Most of the family got together, and it was nice to see everyone.  In a way, it was one of the more pleasant family funerals since nobody was really all that sad, since nobody was really that close to my dad — sounds weird to say it that way, but it’s the silver lining of my dad’s depressing life during which he worked hard to alienate himself from pretty much everyone in the family.  My uncle is a minister, and he planned most of the service.  He did a nice job — told some stories about my dad that were funny but didn’t totally whitewash the seedier sides of his personality.  It’s got to be disconcerting for my uncle that he’s now led funeral services for his parents and two of his three siblings, but you’d never know it from the way he was up there talking and laughing and playing Grateful Dead songs (which my dad definitely would have appreciated).  My son, S, was the star of the show, if that’s a thing that one can be at a funeral.  He was dancing along to the Grateful Dead songs, peeking over my shoulder at a family friend and saying “Boo!” during the service, and when I got up to give the eulogy he held out his arms yelling “Mama, mama, mama!” until I just picked him up and let him sit on my hip while I spoke and he tried to disassemble the microphone.

I had some really nice moments with my dad’s old friends who told me stories about the good old days when my dad was actually a functional human being and did some really important welfare reform work — like, welfare reform that influenced policy decisions across many states and also the platform for one presidential campaign that my dad worked on.  It was all before I was 5 years old, so I don’t really have any memories of those days, but it was nice to hear about how he used to be really driven and dedicated to helping other people.  I don’t know what happened — part of it was being diagnosed with Multiple Sclerosis, although that’s clearly not all of it.  As I mentioned before, there were drugs and alcohol and abuse involved, and I’m pretty sure there were some undiagnosed mental health issues too.  Not depression/anxiety so much as narcissistic personality disorder with perhaps a touch of sociopath, if I may armchair-diagnose my deceased father.  Anyway, it was good to hear his friends remember how he used to be, and to hear stories about him that I hadn’t heard before.  Since he died a lot of my sadness has been related to the empty life he led, particularly towards the end (I won’t elaborate on some of the things I found while cleaning out his apartment, but they were incredibly depressing) and so it was nice to hear that there were other parts of his life that were more fulfilling than the parts that I had the front row seats for.

So, that’s where we are now.  Making arrangements for the funeral and my dad’s affairs has been eating up my life since he died ~3 weeks ago, and with traveling back home on the weekends and my phone ringing off the hook I’ve been very behind on work and it’s been very stressful.  I’ve still got a stack of grading to be done, but I’m keeping up on the essentials, and now I finally feel like I might have a tiny hope of catching up — not that any academic is ever truly caught up, but at least I hopefully won’t feel that I’m constantly dropping balls and letting people down.

One sort of interesting thing that happened this week is that on Monday I was apologizing to one of my masters students for not answering an email that he had sent on Friday — I said that I didn’t want to play the sad card, but I did want to explain that my father’s funeral was Saturday so I just didn’t look at my email all weekend.  He said, “Wait, your father’s funeral?!” and I realized I hadn’t actually told him that my father had died, even though it had come up with all the other members of my group at one point or another.  But after that student found out, nice things started happening all week — the grad students in our department all signed a sympathy card for me and chipped in on a gift certificate to a local restaurant, and then “the students” brought surprise baked goods to our research group meeting today.  When I walked in and said, “Well, this is nice!  What’s the occasion?” they said, “We just wanted to do something nice since you do so much for us,” and it just about collapsed me into a weeping puddle of goo right then and there!  I have strong suspicions that this masters student who found out late goaded the other students into action — it fits his personality, and he’s a non-traditional older student, already married, so he’s significantly more mature than the other students in our program.  But it is clear that all the other students eagerly piled on once someone initiated, and I am grateful to all the students in our program — and my research group — for their kindness this week.  Even though it’s a little awkward, it’s nice to be treated like a human with feelings and shown a bit of appreciation occasionally (not that that’s why I do what I do, but it’s still nice when it happens!), and at a time like this it means even more than it otherwise would.  Our tiny department has all the pros and cons of small town living, but the way people support each other is one of the biggest pros there is.

Back on the Roller Coaster

It has now been two full months, or about 9 weeks, since my (2nd) miscarriage.  I’ve honestly been pretty numb to it all… except the last few days.

It’s a very different experience, having a 1st trimester loss after (1) a previous 2nd trimester loss, and (2) the birth of a living child.  Everyone’s experience of grief is different, and I know that if I hadn’t experienced those two key events in my life, this event would have been much, much harder for me to process.  As it is, I’ve mostly just been able to write it off as bad luck.  This is my 1 in 4 pregnancies that probably had some chromosomal defect that my body rejected.  We’ll move on and try again.  That’s that.

Until the last few days.

I’ve had highly significant ovulation pain every cycle since the birth of my son, so I’ve been able to tell pretty clearly when I’m ovulating.  I knew that I had ovulated about two weeks ago.  But as the days ticked by and my period didn’t arrive, I started feeling that roller coaster of TTC emotions that I remember so well.  It’s like there’s a constant subprocess looping in the back of my brain:

Could I be pregnant?  It’s too early to tell.  I could take a test!  No, that’s a waste of money — if I still don’t have my period by Monday, then I’ll be pretty sure and I can just take the test to confirm.  Let’s google when your period returns after a miscarriage.  Mine sure seems late!  But I think I know when I ovulated, and that was less than two weeks ago.  Let’s google about getting pregnant before you get your period after a miscarriage.  It’s a thing that happens to people!  But it probably won’t happen to me, because we don’t tend to get pregnant easily.  But we did this last time.  But I really shouldn’t get my hopes up.  Chances are I’m not pregnant.  But could I be pregnant?

And repeat, with increasing intensity, for three days.  UGH.

I won’t keep you hanging any longer — I got my period yesterday.  I’m not pregnant.  I didn’t really think I was.  But boy, did I hope!  I was so mad at myself for hoping, too — or really, for caring so much.  It was so nice after my son was born to just not obsess about my cycle endlessly, and I’m annoyed that now I’m back to doing it even though I really don’t want to.  I guess it’s a good thing that I got my period, since it hopefully means my hormones are back to normal (or my body’s best approximation thereof) and now we can really start TTC again in earnest.  But it’s also a reminder of just how much time it’s taken to go through this miscarriage — this is my first period since March.  Four months of lost time, and another lost baby (albeit a very small one).

Well, I knew that getting pregnant again was likely to be a long haul, so it’s good that we started trying early.  And we’re still in the zone of inconvenient timing relative to my tenure clock, so from that perspective it’s OK if this takes another 6 months or so.  Just not much more than that, please.  I’m not sure I can handle the emotional roller coaster for another two years.

Hopefully the approaching onslaught of teaching and advising and committees and meetings will distract me from the TTC roller coaster.  Hopefully I can just turn that subprocess down to a dull roar in the back of my mind while we keep pushing on with our quest for another living child.  Hopefully it won’t eat up too many more years of our lives and hopefully there won’t be too much more disappointment and heartbreak to come.  Hopefully it’ll be a smooth journey and another uneventful pregnancy.  That’s a lot to hope for, but hopefully at least some of my hopes will come to pass.

Talking about Family Planning with Students

Last week the senior faculty member in my department hosted his annual 4th of July barbecue for our department — all the faculty, their families, and all the students who are here doing research for the summer were invited.  It was quite a crew (for a liberal arts college), with 30 or more people hanging out in his backyard, munching hot dogs and (veggie) burgers, and splashing in the pool.  It was a beautiful day with some really great people, and I love that my department is such a welcoming and family-friendly place (this is one of several regular events throughout the year at which partners and children are explicitly encouraged to attend).

I was sitting on the grass with my son on my lap.  He was contemplatively munching on a veggie burger.  We were surrounded by students.  They were commenting on how much he’s grown since the last time they saw him, how long his hair is (it’s in these amazing platinum-blond ringlets right now since we haven’t cut it yet), asking what new things he can do, etc.  Then, one student busted out with “Are you going to have more kids?”

I gave my stock response: “We’ll see!”

Another (perceptive) student said: “It sounds like maybe you say that a lot.”

I laughed and said, “You’re right!  A lot of people are curious.  Almost as much now as when my husband and I first got married and we got lots of questions about when we were going to have kids.”

Another student said, “It’s kind of a personal question, isn’t it?”

I said, “Yes, it’s personal.”

The student who asked in the first place apologized.  I told her I didn’t mind, that I was also very curious about things like that when I was her age.

It was a brief twinge of discomfort in an otherwise lovely day.  I kept turning it over in my head.  I almost wanted to tell them why it was personal — to tell them about the daughter we lost before our son was born, or the fact that I’ve been pregnant three times with only my son to show for it, but I didn’t want to spoil the festive mood.  On the other hand, I feel that we generally do our young people a disservice by being so closed-mouthed about the realities of pregnancy loss and infertility.  I teach my students lots of things, and sometimes they learn from me whether I want them to or not — I know that the students have been keenly interested in my life since I revealed that I was pregnant with S (the students were also keenly interested when I was pregnant with his big sister, although that generation has all graduated by now).  I also know that for all the young women, I am the sole example they have of a female professor in our field, which can feel like a heavy responsibility.  I want them to be encouraged by my example, not daunted.  But I also want to prepare them for challenges they are likely to face.  There were about 8 students sitting with me on the grass during this conversation — odds are that several of them will experience miscarriage sometime in their lives, and probably one of them will experience infertility.  Is it better to prepare them, or to let them find out for themselves?  I made a choice in the moment, a choice that felt right to me at the time, but I could imagine having handled it a different way.

For now, I educated them that asking questions about fertility plans is personal.  I’ll save the conversation about pregnancy loss for another time.

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.