Archive for Miscarriage

Managing the Holidays without Baby

Here in the US, we are coming up on another Thanksgiving, and for those of you coming to this site right now, thanks is not something you may feel like giving.

Before I say anything else, I want to assure you: That’s just fine. You don’t have to feel thankful. You don’t have to count your blessings every single moment. You can, when you need, grieve for the holiday you thought you would have, either glowing and pregnant, enduring jokes about eating for two, or with that new baby, walking into relative’s home to the exclamations over the new family member.

Do not feel you have to save face. Do not feel you have to hide how you feel. And if your family gathering involves pregnant women or new babies, this may be the year to volunteer in the kitchen. I always start cutting onions if I can’t control myself, for the concentration and the excuse for tears.

If you find yourself in a tough situation, look around for a sympathetic relative. Maybe it will be the boys, and you can run off with them to watch a football game rather than fuss over the small children. Maybe it will be a forgotten aunt. Take time to really get to know her this year.

Don’t expect that everyone is going to understand. Your sister-in-law might feel slighted if you don’t want to hold her newborn. Walking out of the room during a discussion of what to name a baby might cause a little stir.

SO WHAT.

Try not to get into any confrontations about it. Just smile and make a simple excuse. Plan ahead so you can bow out of uncomfortable moments gracefully by maybe preparing some complicated dish of your own.

Your years will come.  Have faith in that. And while you’re washing dishes or stuck watching UT beat the Aggies, think ahead to that, to your turn, and even if your family thinks you are being dramatic or over emotional, they are your family. You were born into it, and your future babies will be too. Love them even if they don’t understand.

Your next pregnancy: To tell or not to tell

One of the scariest parts of getting pregnant after a miscarriage is the fear that it might happen again. It permeates everything, and can be so strong that seeing that positive home pregnancy test may fill you with dread rather than joy.

Hopefully you have a good understanding doctor in your corner (if not, FIND one, ask your friends for recommendations) and a supportive partner.

But still, as the nausea starts to hit and you consider whether or not you can get away with leaving your pants unbuttoned, you wonder–should I tell anyone I am pregnant?

The first impulse is to keep it to yourself. Your conversations about the loss might have been too terrible and painful to consider going through again. Maybe you feel like a failure (though you shouldn’t) or worry you will be judged.

It’s natural for us to want to hunker down with our pain, fight it alone, and try to keep the glossy outside world separate from our grief. Maintaining a zone where you don’t have to think about a loss, where you can escape it for a few hours, is a legitimate reason to keep the information from coworkers or bosses.

But I do think you should reconsider not telling friends and family. Imagine yourself, 25 years down the line, with a daughter in your position. Would you not want to know? To hopefully offer some sort of ear, if not concrete help?

I know some of us have parents who are less than helpful. Our partner’s parents may be worse. But I am a big believer in pain shared being pain halved, and if you don’t let anyone know you are pregnant, then no one can help you in your dark days.

I also want you to consider this: if you knew you only had two weeks to spend with someone you loved–how would you want it to be spent? In secret, in shadow, just between you? It’s possible, and if so, then keeping the knowledge private might be the way to go.

But if you want hope, joy, and happiness to suffuse what time you might have, then let it all out. Greet this new baby into the world with all your heart, make memories, make scrapbook pages, and make a mini-life. You are not going to feel worse because you did this. Your heart cannot hurt any more than it will if you kept it a secret. But you will have had that happiness, and certainly those moments make the pregnancy worth it, no matter how it ends.

I understand the need to hide it. If you read my journal you’ll find I felt exactly the same way the second time around. But in hindsight, and that is what I share with you, I am glad I wasn’t able to contain it and told everyone. Because when the bleeding started, when the tests were abnormal, when I had to be on bedrest, crying, sure another baby would be lost, I had help. I had books, I had phone calls, I had caring. And me and that baby were surrounded with love, and that’s the best way to go out of this world.

Book Review: Miscarriage, Medicine & Miracles

Miscarriage, Medicine & Miracles: Everything You Need to Know about Miscarriage by Bruce Young, MD, and Amy Zavatto is the newest medical-based book on pregnancy loss. Other types of books focus on psychology, grieving, or anecdotes of women’s stories, but this is a very traditional doctor-to-patient manual.

I am always glad to find a book that is up to date and comprehensive, the best sort of resource for a woman who is ready to sit down and read, hoping to find a stronghold in what has felt like a freefall so that she can begin the search for answers.

Overall, this book delivered. The section on myths (and why luncheon meat does not cause miscarriage) made me want to leap up and shout, “Finally!” So many women, with their pregnancy manuals in hand, will apply the warnings about tuna and hair dye and hot tubs retroactively, certain that they caused their losses. Young clearly defines the line between a theoretical health risk and a serious miscarriage cause.

The book contains all the classic elements: signs of an impending loss, common causes, treatments, and thoughts on prevention. It has a nicely expanded section on the impact of health conditions that can complicate a pregnancy. Some of the stories were out-and-out riveting, including patient histories where one twin was failing and they had to make a careful decision on when to deliver for the safety of both, and the harrowing case of a woman with kidney disease trying to delay the birth so her baby would survive, even though she was risking death herself.

I would recommend this book, but I have some very sharp criticisms. I almost flung the book across the room in horror the moment I opened the Table of Contents.

I’m not sure who thought glib chapter titles such as “scarred and scared” for scar tissue or “misplaced trust” for ectopic was a good idea, but let me be clear: miscarriage is not and will never be funny. Do not try to be clever or use flip word play to women who are in real pain.

This happened again in the myths section. Young calmly talks about how working out, having sex, and caring for your other children are perfectly safe activities. Then, inexplicably, he gets cute, saying that because of the association between night work and an increased risk of miscarriage, “…You can work very hard, only not at night!”

Is that supposed to be funny? Are all the women who have evening shifts, nurses and factory workers and 911 operators, supposed to read that and think—I killed my baby? Once again I sat the book down and reflected on whether or not I could recommend it.

I am not a fan of the “I’m the doctor know-all” style, nor the way Dr.Young starts off each chapter by describing the physical characteristics (overweight, blonde, tall) of the woman whose case he is about to explain, but this is the most recent book that covers what many of you want to know—the how, the why, and the what next.

Since it does its job efficiently most of the time, I will, with some reservation, say, yes, I can recommend it to you. But don’t read it when you’re upset. Take up this book when you are ready to plod through some of the insensitive writing to get at the heart of the research and information.

More about Miscarriage, Medicine & Miracles

The Problem of Early Detection Pregnancy Tests

During research for my book Facing Miscarriage, I stumbled across an article in the British news source, The Telegraph, talking about a “panic” that spread across the UK when early detection home pregnant tests first became available a few years ago.

I didn’t find any similar articles in US papers, but it’s easy to see why the new home pregnancy tests could cause a flurry of concern.

Old-style tests, manufactured prior to 2004, typically looked for a pregnancy hormone level of 50-100 mIU/ml and were not effective until the day a woman missed her period, on average, about 14 days post fertilization. This is when the baby is well implanted and the miscarriage rate is expected to be between 8 and 20 percent.

The new tests, however, detect the hormone at 20 mIU/ml. This is within a day or two of implantation, more like 9-10 days after fertilization.

Since the advent of early sonography, we’ve known that a huge number of fertilized eggs either never implant at all, or attempt implantation and fail. This number varies depending on who you ask, but is always frighteningly high — between 50 and 75 percent.

For many moms, working so hard to achieve pregnancy and the family of their dreams, this is a terrible and sad loss. The emotional pain in getting their period after seeing a positive pregnancy test is often strong and frightening.

These early losses, however, almost never indicate a problem that needs treatment. The fusing of the egg and sperm’s genetic material is tricky and often goes awry, either misaligning or dividing improperly in early cell growth. When the egg with chromosomal errors bumps against the uterus, the body will start the implantation process. This sets off the manufacture of pregnancy hormone, but often, the lining rejects the egg. In this case, the woman’s body will register a fleeting rise in pregnancy hormone even though the baby could not implant and grow. The new tests are so sensitive as to catch the temporary rise.

This early chromosomal rejection has no bearing on the health of the mother or her ability to carry children to term. The rush of hospital visits by distressed moms causes extra upset and frustration. They often find they are simply turned away. Others might be subjected to invasive and unnecessary tests. The problem amplifies — moms want their babies to be recognized from conception, and health care providers want to maintain a simplicity in diagnosis and treatment of clinically recognized pregnancy and miscarriage.

As I write what I hope to be the newest book about miscarriage and how to get through it, I will address the issue of the new definition of miscarriage. Do we adjust our statistics and scare women with the real figure — that over half of their pregnancies will be lost before week 5? And how do we decide when a woman actually needs intervention for recurring miscarriages? Do early losses simply “not count” anymore? I do wish sites like this one that advocate super-early testing also include a reminder of how common an early loss can be.

Perhaps we will rewrite the rules based on our early detection of pregnancies, creating a hierarchy of risk based on gestational age. But the rules will be for treatment and clinical relevance only. Our babies are our babies, whether at 16 cells or fully formed in our waiting arms.

Eliza & Her Angel

 

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Many of you know my younger daughter Elizabeth was once part of a set of twins. I lost one of the babies when my water broke on that sac at 10 weeks. It was a harrowing experience as I was on an airplane, only two hours into a 12-hour flight between Switzerland and the US.

After a tense week, we finally saw Elizabeth’s heart beat, and the other sac collapsed and got out of the way. I had no further complications to her pregnancy, other than the usual stuck position and required c-section.

A few days ago, after taking Elizabeth’s hair out of braids, she said, “I have angel hair!” So we took her picture holding a baby doll, which I later replaced with an image of herself as a baby.

There isn’t a sweeter guardian angel than Emma Hope, Elizabeth’s twin, and no better way to portray them than with a sister who once shared her womb.

This image is available at RedBubble for a keepsake card or a little poster for baby’s room, if you also have a guardian angel who will watch over you or your other children. It includes the very common phrase you will see repeatedly on grief sites, miscarriage tickers, and signatures, “Some people dream of angels…I held one in my arms.”

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