Miscarriage: The Silent Sorrow

Miscarriage: The Silent Sorrow
If there's a recurring theme in miscarriage, it's that it seems nobody wants to hear about it or understands your loss.
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Every time I turn around another glamorous celebrity is expecting a baby. Waiting in the supermarket checkout line, I’m inundated with photographs of gorgeous supermodels, actresses and pop stars in their eighth or ninth month of pregnancy, often wearing bikinis or slinky evening gowns, looking happier than ever. Pregnancy is sexy and beautiful. Not only that, but having a baby, the media will have us believe, is easy to combine with a busy career – just look at Tina Fey, Amy Poehler, Beyonce. And age is no longer a barrier; many of today’s pregnant celebrities are in their 30s or 40s. Carla Bruni, the 44-year-old Italian singer and supermodel married to French Prime Minister Nicolas Sarkozy, just had a baby. 

For those of us who have experienced multiple miscarriages, or even just one loss of a baby, all the attention bestowed on women who are successfully pregnant is a painful reminder of our devastating loss. And it’s a silent sorrow; nobody talks about miscarriages. Pregnancy makes the news; maternity is fashionable and chic. But no one wants to hear about the babies that didn’t make it and the pregnant women who never got to become mothers. 

Even infertility is more talked-about than miscarriage. We read and hear about research studies linking infertility to various environmental factors. Many popular remedies claim to help infertile couples conceive: acupuncture, herbal medicine, meditation, yoga. And there are support groups, where infertile couples can get sympathy and advice on how to conceive. Not being able to conceive is, of course, a serious problem for some couples and comes with its share of heartbreaks and sadness. But miscarriages are devastating both physically and emotionally because the mind and body have begun preparations for a life that, for unexplained reasons, dies. It is not the absence of life but the miraculous creation of life and then that little life’s mysterious termination. 

My first miscarriage was a near-fatal medical emergency. I don’t remember much after going into shock, dully aware that I was bleeding to death and would never see my husband again. I woke up in an ambulance with an IV in my arm, sirens blaring as we rushed to the ER. I went home that night, in a fairly stable but weakened condition, but it took me nearly a year to recover physically and emotionally. And truthfully, although I recovered physically, I will never fully heal emotionally. The pain remains, and every day I have to try to get used to it.

I hadn’t told anyone that I was pregnant, but since the hemorrhaging started in the middle of my workday, I couldn’t keep it a secret from my co-workers. Everyone was incredibly sympathetic and comforting. But what really surprised me was how many women told me they had also experienced a miscarriage, two miscarriages, or more. Or that their mothers, friends, wives, sisters, had miscarried. In fact, everyone I spoke with about my miscarriage revealed that either they or someone they knew had experienced one or more. Apparently, they are not all that uncommon.

My doctor rattled off the statistics. Women under 35 have about a 15% chance of miscarriage. Women 35-45 have a 20-35% chance of miscarriage. Women over 45 can have up to a 50% chance of miscarriage. A woman who has had a previous miscarriage has a 25% chance of having another. How then, I wondered, does this combine with the other risks, such as being over 45? Does that mean a 75% chance of miscarriage? “It can,” said my doctor. That “can” is the big unknown.

My question, and the one that no one has been able to answer, is why? Why do miscarriages occur and why had it happened to me, to us, to our baby? What made the baby die?

The doctor shrugged. “We don’t know.”

One co-worker ignorantly suggested that perhaps I had been doing something while pregnant that had caused the miscarriage. It was all that yoga or swimming or working out at the gym or walking to work and back. Or it was because I’m a vegetarian (I haven’t eaten meat for over thirty years, and believe it or not I’m extremely healthy), or because I drink coffee. My doctor assured me miscarriage had nothing to do with what I was or wasn’t doing -- practicing yoga or drinking coffee or not eating meat. Women all over the world continue to lead active, hard-working, physically and mentally stressful lives and millions of babies are being born each day. I could be fairly certain that I had not caused the miscarriage.

Furthermore, after tissue analysis of the fetal material, I discovered that the embryo had terminated at the beginning, after the first or second cell division. There were no little fingers and toes, no spinal column, no brain, no little baby developing for the eleven weeks that I had remained pregnant. It had died right away, indicating a chromosomal abnormality. Whatever that abnormality was, it could not sustain life and, graciously, instead of developing into a mutant, the life terminated. 

And yet, tragically - and my doctor tells me this is very common, this is normal - my body continued to be pregnant. For almost three moths my body continued along, happily doing all the right things to support a healthy pregnancy: painful, heavy breasts getting bigger every day, nausea, fatigue, unusual cravings for pickled herring and smoked Gouda, hypersensitivity to smells, and unusual fatigue. I would curl up on the sofa in the evenings, listening to the trees rustling in the autumn wind, ready to hunker down for the winter, protective of this new little miracle inside of me. I prepared for it. I bought sensible shoes for my widening feet; I bought new, larger bras and oversized sweaters. I was pregnant.

But it was all an illusion created by my mind and hormones. My body stayed pregnant because it didn’t know yet that the little miracle had left us long before I even got the first positive pregnancy test.

Somewhere, perhaps on a nature show on TV, I learned that mother panda bears will cradle their dead newborn cub for days. The mother bear keeps the poor infant corpse close to her, snuggled in her thick black and white fur. Does the mother panda know her baby is dead? Or maybe, like my body, she really doesn’t know, and it takes a while for the awful truth to hit. And when the truth hit me and I started bleeding, I was bleeding to death.

My second pregnancy was an unplanned, and a bit of an unwelcome surprise. I had already accepted our decision not to try again to become pregnant, since the risks - miscarriage, Down’s syndrome, spina bifida - were so high for someone my age. I was forty-five, we had basically given up hope of having a baby, and we were at peace with that. Most of our friends have kids and we decided it was okay to be a good aunt and uncle to them. But then there it was, two lines on the test stick. I tried a different brand of pregnancy test, and there it was again, this time, with a plus instead of a minus. I went through four at-home tests in all before calling my doctor and arranging an emergency visit the following day. Yes, she assured me, I was pregnant.

I was more cautious this time around. I also now had a doctor more experienced in older women and high-risk pregnancies than the one I’d seen during my first pregnancy. That was me - an older woman, a high-risk pregnancy. The label reminded me of the vibrant, creative teenagers I had worked with in detention homes, who were called “at-risk youth.”  Watch out for us: high-risk, at-risk; so dangerous and risky.

Given my age and my past near-death miscarriage, my doctor advised an ultrasound at nine weeks. We’d see if there was any cardiac activity, any heartbeat. If so, there was a baby developing, great. We’d take it from there, step-by-step, high risk and all. A multitude of subsequent tests would be able to detect birth defects, other abnormalities, and we’d make decisions when the time came. And if there was no heartbeat, no baby, no life, well then we’d go right in for a D and C and avoid the possible complications that had almost killed me the first time. And that would be that.

The thing about pregnancy, as anyone who has ever been pregnant knows because it hits you like a slap in the face the moment you find out, is that it is a one-way road. There is no turning back. Your body will move forward on this road and this road will either end in birth or in death. As delighted as a couple may be upon discovering that their joyful amorous activities have resulted in the miracle of life, there is also the sobering realization that this situation cannot be undone. It will move forward, and one way or another something completely enormous will happen no matter what. 

As I watched the fuzzy images on the screen, craning my head to see what was happening while the radiologist meticulously searched around my uterus with the ultrasound scanner, I was not surprised. There was nothing. There was no heartbeat. No life, no baby. How many of you who are reading this now, I wonder, are reminded of and will remember forever the sound of that verdict. No heartbeat. 

Well, that’s it then, I thought. Let’s get this D and C over with. We did, and it was relatively easy. A little cramping and bleeding, and in a few weeks I was pretty much back to normal. Back to my usual self, small breasts, no nausea. I cleaned out the fridge and threw away the pickled herring and smoked Gouda.

But, years later, I still wonder why. Why did it die, and why did it die at the very beginning?  Whose chromosomes were abnormal?  Was it my husband’s? Was it because he had played out in the fields as a child while DDT trucks sprayed the Midwestern landscape?  Or was it all the tuna he’d eaten, canned tuna full of mercury we didn’t know about back then. Or maybe it was my abnormal chromosome, because I had eaten fresh produce in Europe in the summer of 1986, right after the accident at Chernobyl. 

We don’t know. My doctor doesn’t know. No one knows.

Time has passed and my husband and I have come to terms with not producing children. But the loss I feel at having felt the tiny possibility of a life forming inside me and then having it die is constant, and I still don’t know how to cope with it. On the one hand, I want people to know I have experienced this physical and emotional devastation. I want to wear a sign saying “Baby died, devastated.” It was like that when my parents died, too. I wanted people to know, because I couldn’t possibly act normal, yet I often couldn’t talk about it, or didn’t want to. With my miscarriages there is the same conflict: I want others to know, yet there’s no real way to talk about it without feeling like I’m revealing too much personal information. And if I am able to mention it, I’m often not prepared for people’s reactions. “I’m so sorry for your loss,” they say, and “I hope you take time to grieve.” And I can only say “thank you,” rather than the more truthful “actually, instead of taking time to grieve I’m going into full-swing workaholic mode because that’s how I cope with pain.” I especially do not want to hear the well-meaning “Do the doctors know what’s wrong? Do they know why you can’t stay pregnant?” “The real question,” I want to say, is “why did my body stay pregnant for over two months when the baby died on day one?”

Our good friends Sonia and Ben (not their real names) recently experienced their third miscarriage. Over dinner the other night, Ben said to us, “You know what it is I’m having trouble with?  It’s how to deal with other people’s view of us as a childless couple. Some people think it’s tragic and that our lives must be empty without children. Other people think we’re irresponsible and immature, prancing around having a fun, carefree life while they slog away at the chores of parenthood.”

It’s true. Most outside observers probably have no idea why we have no children. Here’s another situation in which wearing a sign would be useful: “Multiple miscarriages, hence no kids.”  And unlike infertility, which can often be treated through artificial insemination or other methods, miscarriages cannot be predicted or prevented. All we can do is read up on statistics, which we can then interpret as likelihood. We can keep trying, which is physically and emotionally exhausting, or we can walk that line between acceptance and giving up.

Of course, there is adoption. But that is costly, and requires an extensive process of evaluation and judgment. Both the cost and the process, I am told, are well worth it. Many of our friends have adopted children and they all assure us that it is a wonderful, joyous and rewarding venture. My husband and I have not ruled out that option but we aren’t ready to embark on that journey right now. Neither are Sonia and Ben, and in the meantime, as Ben wondered aloud for all of us, how do we handle the opinions of people who view us, the childless couples, with a combination of envy, pity and, possibly for some, scorn?

In my grandmother’s day, her sister, married and childless, was considered dirty, evil and un-Christian for not bearing children. With no explanation as to why she remained childless, she was viewed in our family as the black sheep, a sinner of sorts. I can only wonder what silent grief she bore her whole life.

In the end, I only hope that people who have children will think twice when wondering why some of us don’t have children. It’s not always due to a choice to remain carefree and to avoid responsibility. Nor is it always the tragedy of our lives. We grow to accept it. And even for those of us for whom it is the tragedy of our lives, still, we grow to accept it. We have to.

I wish, however, that miscarriages were not so secret, that they could be talked about without embarrassment, without judgment, without a sense of having spoken about something inappropriate and vaguely gory. Miscarriages are so very common, and they are so difficult to go through. But as with so many of life’s challenges, we must move on.

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