November 30, 2004

Help Through the Heartbreak ; The Devastation of Miscarriage is Eased By the Support of Those Who Have Experienced Loss, Too. About a Quarter of All Pregnancies End in Miscarriage, but Couples Mourn Largely in Silence.

There is a secret society of women, silently ready to help. They are where the real information about miscarriage hides, and one day, if you need to know, they will reveal themselves to you in doctors' offices, at work or in your circle of friends, and your secret mourning will pass into their repository, too.

On Sept. 28, I became a member. My first pregnancy was found dead at 8 1/2 weeks. The heart stopped beating days before, quietly, without fanfare. We can't know exactly when. This is common. Miscarriage is not always the sudden, bloody, decisive process I'd seen in movies. It can be stunning in its slowness.

It all started with a speck of red blood, nothing more. I was 6 1/ 2 weeks along, and privately proud of my proofs of pregnancy: fatigue, headaches and a warm, buzzing feeling. We were really doing this.

Spots of blood can mean nothing, the nurse at my OB-GYN's office said. But just to be safe, come in for a checkup. I put down the phone and sobbed and pleaded with my body. In hindsight, I think I was showing the baby how much I wanted it. I didn't believe I'd lose it.

Why would I? My general doctor had said the odds of a miscarriage were so small that I shouldn't worry about it. Now, as my OB-GYN squinted at the ultrasound screen, she said a quarter of all pregnancies end in miscarriage. What?

That was my first realization that miscarriage is not uncommon, it's unspeakable. It is too malignant to bring up at the start of a pregnancy, too intimate to discuss when it happens, too surreal afterward. It is dark territory to avoid or escape, not explore.

I went to the doctor that day shaken but confident. I told my partner, Patrick, not to leave work to join me. When my OB-GYN turned the ultrasound screen toward me, I was in awe.

There was my curled-up little creature, the size of a raspberry. No screen has ever been so powerful.

But the doctor was squinting, and what I saw sat coldly still. It showed no heartbeat, she said. A wave of horror went through me. I was about to understand that the death of a fetus varies, like a live death. It can come all at once, or you can wait for it. You can miss it entirely.

This could be nothing, the doctor said. It could be too early to detect a heartbeat on this machine. I went home and sat on my porch. The blossoms dangling from my fuchsia basket were pink, but at the soil, the branches were brown. The outside didn't seem to know that the inside was dying. Was the same happening to me?

Two slow days and two blood tests later, the pregnancy looked to have a 50-50 chance. A faint sparkle on the ultrasound represented a tiny beating, but my hormone levels had not risen quite enough. More waiting.

As miscarriage came into view, so did the secret society. Unprompted, the OB-GYN nurse blurted out that she'd lost her baby at 10 weeks. I could ask her anything, she said.

The rest of my life was distant and blurry. I had become precisely what I dislike - a woman obsessed with pregnancy, a monomaniac. To match the baby's chances, I had equal parts hope and fear that left me a jittery, divided mess. Was this what it was to be a mother?

There is nothing you can do to hurt or help this, the doctor insisted. Most of the time, it's genetic. When the egg and sperm come together, they join genes, and if any information is discarded, the pregnancy reaches a point where it doesn't have directions anymore. It is lost. You lose it.

I didn't believe a word of that, and then I did. I pushed away the stress I could control, and then I tortured myself on Internet pregnancy chat rooms. I inhaled vitamins and fruits and vegetables, and then I angrily switched to junk food. It felt like drowning, alternating between floating and flailing.

Four days later, when I could finally get back to the almighty screen, the heartbeat that was supposed to be 120 to 160 beats per minute pulsed about once per second. The being that had somehow become our whole world was limping to survive. All the doctor could say was, come back in a week.

Patrick and I slowed to a limp, too. Time dragged, but sometimes it felt like we wished it would stop. Was the heart still beating? Would it stop today? I recruited perspective to block the dread and panic. Equanimity was in order, after all. Other people were getting terminal cancer diagnoses.

If this dies, you can try again, the doctor and nurses said. One miscarriage does not signal fertility problems. How dare you, I thought. This is my baby. Its birthday is May 7, 2005, right next to Mother's Day. Don't you see how hard it's working to live?

On a deeper level, I scolded myself instead. Can't you protect this child? What kind of mother can you be? And, rationally, I repeated: This is a fetus, not a baby. Let go.

There never was another drop of blood. One by one, my pregnancy symptoms disappeared. Everything, awfully, returned to normal.

We wanted to hang on to our tiny hope, but, raw and tired as the final appointment approached, we found we couldn't afford it. Patrick held my hand as I looked away from the screen. There's no heartbeat, the doctor said. I know, I said flatly. I felt partly dead, and I was.

As the doctor flew into clinical mode, I stared at the floor. There would be no public ritual, but there would be a private one. Her recitation of our three choices sounded almost priestly.

We could wait for the body to expel the pregnancy. But this has been a long limbo, so I don't recommend that, she said. It can take weeks. I've seen women in here a month after this moment, still waiting for their bodies to get the death notice, she said.

There's a pill you can use to stimulate the expulsion, she said. Most of the time, it works the next morning. Occasionally, you have to repeat it. The third option is dilation of the cervix, then vacuuming of the uterus through a straw. This is called a D&C. It's the same procedure as an abortion. You can opt for local or general anesthesia.

No more waiting. No hearing the suction. Goodbye, sleep, and then gone.

As the surgery nurse walked me into the bright room that afternoon, she told me quietly about her miscarriage.

She stroked my arm as anesthesia dripped into my IV, and I cried into sleep.

When I awoke, I heard someone crying. I looked around, but it was me. A nurse came and whispered in my ear. Don't worry, she said, that happens a lot with this procedure.

It's as though my body knew to mourn before my mind could tell it.

My physical recovery was easy. Two days after the D&C, I told a few people at work. Their own miscarriage stories felt like hugs. Patrick said it's like a cult you don't know about, until you're in it. One man told me his wife - or should he say the both of them, he still wasn't sure - had three. A woman my age said she'd had a routine 10-week checkup followed by a 16-week visit that revealed the baby had died in the 10th week. After her D&C, she passed large, painful blood clots not unlike giving birth. Her husband fell into depression and started smoking. They didn't try again for more than a year. (Physically, doctors say you can start after one post-D&C period.)

Patrick and I don't know what we'll do next.

Right now, I'm trying to grasp the mysterious dimensions of the loss, and to understand how the pregnancy swallowed me whole. With respect for those who feel differently, even if I am luckier next time, I will not stamp out this chapter with a "now I have a healthy baby" happy ending. This happened.

Millions of women miscarry babies every year. We might seem invisible, but we aren't mute. I like to think we're a little like superheroes.

You will find us if you need us.

- - -

Jen Graves: 253-597-8568

[email protected]