October 15 is National Pregnancy and Infant Loss Remembrance Day. Sadly, early pregnancy loss — also known as miscarriage — is all too common. About 20% of recognizable pregnancies end in a miscarriage. If you have not experienced a miscarriage, you most likely know someone who has. I am one of the women who have suffered that loss.
After 3 years of actively trying to conceive, my first pregnancy ended up in a miscarriage. It was not a surprising outcome and yet, I was heartbroken. As an obstetrician, I knew the statistics about miscarriage inside and out. I was well aware that the chances of a miscarriage increase with advanced maternal age. I knew that at my age, my risk of a miscarriage were upwards of 30%. I had counseled numerous women experiencing this loss, consoled them during this precarious time and re-assured them that it wasn’t their fault and that most likely their next pregnancy would be normal.
When I learned I was pregnant, I was cautiously optimistic. I first showed an unmistaken outward sign of joy during my ultrasound at 5 weeks of gestation. I unintentionally let out a cry of pure elation and, frankly, relief when I saw that little round structure called a yoke. It was still too early to see the actual embryo, but this finding was reassuring that the pregnancy was inside my uterus with the potential to be viable. Although most pregnancies are located in the uterus, I often have to counsel women that their highly-desired pregnancy is extra-uterine and that it has the potential to be dangerous to their own lives. This is called an ectopic pregnancy and it is a pregnancy that should not go forward.
At my subsequent ultrasound, we saw a fetal pole and what seemed to be a heartbeat. I felt reassured and decided to have a formal ultrasound to date my pregnancy. Until now, I had been performing these scans myself. I could not bear the idea of being diagnosed with a failed pregnancy by one of my physician colleagues. The process of getting pregnant had been too long and quite emotional at times.
At my formal ultrasound, the sonographer who knew me well looked worried. We both could see a small line that looked like a fetal pole, but did not observe a heartbeat. By this time, the heart of the embryo should have been beating recognizably fast. My own heart sank. My husband, who is not in medicine, looked lost. He held my hand with a bit more force than he likely intended to do. I tried to keep my emotions in check as I explained to him the concerning ultrasound findings.
At the time, I was completing my last year of a Maternal-Fetal Medicine fellowship. My attending came in to scan me and verify the findings. He told us that the embryo was measuring small and the heartbeat was slow. He tried to reassure us that there was still a chance, albeit small, that the pregnancy would go forward and be normal. We left the office with the plan to return in one week for a repeat ultrasound to see if the pregnancy had grown appropriately and if the heart rate was normal. A normal fetal heart rate is between 120 and 160 beats per minute.
My husband and I prayed hard that week for a miracle. He kept reassuring me that everything was going to be okay. Unlike him, I was one of the experts in the field of obstetrics. Intellectually, I knew that the odds of a normal pregnancy were not in our favor. Emotionally, I hoped my doctor’s mind would be proven wrong. Still, I prayed that if the pregnancy was not going to be viable, we’d find out sooner than later because later would be more devastating.
This latter prayer was answered; on my next ultrasound, there was no heartbeat. I was diagnosed with a missed abortion.
I felt an incredible sense of loss and my chest felt the suffocation brought upon an intense pain. The stress of the uncertainty of the past few weeks hit me like a brick and I could no longer keep the emotions bottled up. I had witnessed this reaction in so many of my patients before. I hid myself in one of the offices and cried as I waited for the prescription for misoprostol, a medication I would take later that day to help evacuate my uterus. I managed to put myself together to walk out of the building without appearing obviously distraught to the staff who worked with me and the patients seated in the waiting room.
That afternoon, my husband held my hand through the intense cramps and heavy vaginal bleeding, expected side effects of the misoprostol. He refused to leave me as the more offensive gastrointestinal side effects kicked in. In the mist of my abdominal pain and bloating, briefly relieved by the passing of putrid flatulence, a part of me felt sorry for him. In all of my years of counseling patients about the side effect of misoprostol, I don’t recall how much I had warned them about how awful the farting could get. I thought, “This man truly loves me!” I kept a can of air freshener by my side and sprayed it vigorously over and over again hoping to mask the rodent smell of loss. Hours later, I finally passed the pregnancy. As I flushed the toilet, part of me felt that I was flushing our hope and dream of having our own child.
Within a few days of passing the pregnancy, I was back at the university hospital campus performing prenatal ultrasound scans in women whose fertility luck seemed to be better than mine. I never felt bitter. I never felt jealous. I shared their joy even as my heart healed from my miscarriage. I wished them well and hoped they would never experience the pain I did.
The bloating persisted for days after the miscarriage. One of my patients looked at my belly and congratulated me on being pregnant. I tried to give her a smile, but the fleeting sadness in my eyes may have betrayed me. I responded, “Thank you! But, I am not pregnant. My belly is just big.” As her physician, I could not reveal to her that I had experienced a recent pregnancy loss. In fact, few of my friends and family knew of the ordeal I had gone through.
My husband and I had affectionately named the embryo “Ovo Strelol,” which means fried egg in Cape Verdean Criolo because of the appearance of the yoke sac in the first ultrasound. We felt that Ovo Strelod existed, albeit briefly, for a reason and that we needed to honor that experience and find a way to commemorate it.
Weeks later, when perusing the garden section of a hardware store, we knew exactly what to do when we saw a row of beautiful fruit trees. Neither one of us had ever planted a fruit tree before. We bought a pear tree and struggled to dig a whole big enough to accommodate it in our backyard. The terrain was filled with big rocks that were hard to remove.
I wrongly feared that the terrain and my uterus were similarly hostile to life. It is not uncommon for women who experience a miscarriage to think that there is something wrong with them. Some blame themselves. Some experience true depression. Luckily, I my sorrow did not become pathologic.
I surrounded the tree with fertilizer with the hopes that it would not die. After a loss, I needed to experience and celebrate life. My husband and I were told not to expect the tree to bear fruits for another 3 years. We were willing to nurture the tree and wait for it to reproduce when the time came.
To our surprise, one lovely spring day, one year after we planted the tree, we saw these beautiful little round buds hiding in between luscious green leaves. We couldn’t believe our eyes at first. The tree was full of little pears! My heart filled with joy and I said a prayer for Ovo Strelod.
Around that same time, we found out that I was pregnant again. As I write this, I am 24 weeks pregnant. A couple of days ago, I ate the first pear from our tree of hope. It was not the most perfect or the most delicious pear I have eaten. But, it brought me the most gladness to my heart and soul.
The experience of a miscarriage has thought me to appreciate and celebrate this current pregnancy that much more. I also have a deeper degree of empathy for my patients who experience pregnancy loss and a higher level of joy for those who are pregnant after such loss. I have lived their pain. I have felt their bliss. I recognize their fears. I understand their hopes.
My experience of a miscarriage allows me to be a stronger and yet softer doctor to my patients.