On Love, Hope and Loss

broken-heartWe didn’t expect infertility since our firstborn was no issue: quick conception, relatively easy pregnancy, home birth. We were considerably fortunate. So, even though I was a bit older, technically “advanced maternal age,” I didn’t expect any issues, since I was still as regular as clockwork.

After a year of trying for a second baby, we conceded we were going to need a specialist to figure out why nothing was working. An initial exam late summer of 2016 revealed a polyp, acting as a natural IUD. This would have been a welcome diagnosis had we felt done growing our family. But I didn’t feel done with one child.

I underwent surgery in the fall to remove the polyp and check the rest of my reproductive anatomy. Upon waking from anesthesia, in the sleepy haze, I found out that our doctor also found some serious blockages in my tubes. He sent us home to try for a few months; if nothing happened by the new year, we should schedule a “next steps” discussion.

We were getting ready to schedule that appointment when I suddenly noticed I felt tired and sore — like falling-asleep-in-my-dinner tired. Since I had bought early detection pregnancy test strips in bulk, I thought there was no harm in taking one.

Four tests later, I couldn’t deny that it really was positive. And it was confirmed by a blood test the next day. For a moment, we really thought this was our miracle. A second blood test 2 days later revealed it was not to be, however, as hCG and progesterone were already dropping. It was very early, and I thought I had braced myself against hoping too hard, but still I found myself mourning the loss about a week later, more strongly than my initial disappointment.

We tried again the next month, even though I thought it was unlikely that we’d get a consecutive positive, especially after 2 years of negative tests. But the universe saw clear to give us another chance at life. And after a week and a half of blood tests and rising numbers, this seemed like the real deal. Each night I fell asleep with my hands cradling my abdomen, willing this baby to grow, strong and healthy, into the safety of love flowing from the palms of my hands.

Still, I hesitated to try to think about the future, knowing there was still so much that could go wrong at not quite 6 weeks along. I worried at the the possibility of an ectopic pregnancy — with my mostly-blocked tubes, it seemed logical that tiny sperm could easily get up, but getting that much larger blastocyst down to the uterus to implant in a viable location, rather than the tubes, seemed more daunting. But my husband, who said he knew it was early and wasn’t going to get too hopeful, was also asking questions like “Would we use the same midwife?” I didn’t know how to process such disparate thoughts coming from him.

I was stuck between two worlds: one of putting positive intentions out into the world, and yet trying not to be too emotionally attached.

Finally came the day that we should be able to see something on ultrasound. I was nervous and guarded. Still at the back of my mind was the possibility of an ectopic pregnancy.

We paused for a moment of good intention before starting the ultrasound. The first thing my doctor saw on the screen was a small something in my uterus. It was much too small for calculated gestational age to be something viable. Were my ovulation/conception dates possibly off, he pondered. Then he scanned around. Something else stood out. It was larger. Location wasn’t clear because of the angle. Was it the next follicle readying? Inconclusive. Was it an embryo in the tube? Inconclusive. Was it an embryo very high in the uterus? Inconclusive. Did it have high bloodflow to it? Inconclusive. We discussed that he’d seen enough in his career that falls outside the norms that he wanted to give it a chance… but we also needed to be prepared for the possibility of an ectopic pregnancy. In my heart I knew I still had to give this pregnancy a chance.

That was on a Thursday. Then came the impossible waiting game. Would I make it to my next appointment on Monday, or would we be making an emergency drive to the hospital in the interim? This question consumed me every moment. Every twinge I felt: Was this the moment I needed to spring into action, or just normal body stuff? Every time I ate, I made a mental record of the time, in case I would need to provide that info for pre-op. As someone who generally trusts my body, this was a hard purgatory to sit in. But I would have done it forever for even the slightest possibility that this was a viable pregnancy.

Generally, I was looking for the symptom of sharp excruciating pain on one side, an indication that a Fallopian tube was exceeding the limits of elasticity to hold a growing embryo. Other symptoms to look for were: heavy bleeding, pain radiating to my shoulder, lightheadedness or dizziness.

On Saturday, I woke up to use the bathroom. Then I walked back to bed. I generally felt a feeling of fullness/pressure in my abdomen. No pain. No signs of bleeding. But when I got back in bed, I felt lightheaded and dizzy, and my ears were ringing and pounding like a freight train in my head. My husband was at work, so he was my first contact. But I still wasn’t having pain, so I didn’t know if this was “it.” I contacted my doctor. He said it sounded like time to go to the ER.

Then the nausea started. (Side note, a child’s potty basin make great emesis basin.) My husband made it home. He helped me to the car, where I blacked out for a moment. How did it get so bad, so quickly, without intense pain? I struggled to maintain consciousness in the car and in triage.

The ER staff worked quickly to get fluids into me to bring my blood pressure up. Thank you nurse Lindsey; calm, steady, but clearly working with purpose and against a clock she seemed to know too well.

My doctor arrived at some point among the chaos. I just remember the sense of relief at seeing a familiar face and feeling I would be ok now that he was there and in charge. He was still wondering if it could be something else because of the lack of unilateral pain, but an ultrasound confirmed fluid in my abdomen. But I no longer had to worry about wasting precious time convincing a stranger that what I was experiencing was likely an atypical presentation of an ectopic pregnancy. I later found out that while I was being prepped for surgery, my doctor predicted to my husband that it was likely this rare presentation: instead of the embryo implanting in the middle of the tube, it was likely implanted in the tube right at the junction with the uterus. There, there is no stretch, just a sudden blowout when the embryo gets too big.

First symptom at 8 am, and I was in the operating room at 10 am. And then I was waking up in post-op. I don’t remember much. People were swirling about. I couldn’t open my eyes. My post-op nurse was Esther, whose face I never saw, but I felt her strength and experience through her voice, as she firmly gave directions.

Eventually I was wheeled to my room. My husband was there, a welcome familiar voice. Through a dry mouth and sore throat, I remember asking him if the surgery was the right decision. “Oh yes,” he said. There was no longer any question. They had pulled 2 liters of blood from my abdomen during surgery and I was given the first of 2 units of blood.

Have I mentioned that I use humor to help me? This is what my detached tube looks like in my mind.

Have I mentioned that I use humor to help me? This is what my detached tube looks like in my mind.

The embryo had been implanted as my doctor predicted. It had been so close to the uterus. But so close might as well have been a million miles away. There is no viability for an ectopic, no matter how close to the uterus. My baby was gone at 5 weeks 6 days. And my tube is flapping in the breeze, cauterized and detached from my uterus.

I spent [only!] the next 26 hours in a hospital room, trying to shake the fog and exhaustion, and wondering how long it would take for the pain to subside. How could 4 little holes cause so much pain and burning? I finally realized that it probably wasn’t so much the incision sites that were uncomfortable — there was a lot they had to do inside — and with all those tools moving around so quickly, it was probably a lot like being a human pinball machine. Thank you nurse Nicole for your kindness and patience throughout the night. You knew exactly what I needed, even though I didn’t. And then you stayed past your shift change to make sure my transfusion went smoothly.

I’ve been healing. As my physical healing has progressed, it has given way to working through the grief of the loss, anxiety, and to the fear of how close I was to losing my own life. And also gratitude.

I’m taking several pieces of wisdom away from my experience:

Grieving the loss and being grateful for my life are not mutually exclusive. Just because I am sad about the loss of our baby doesn’t mean I have forgotten to appreciate what’s around me. Towards the end of my first week home, when I was able to move around, I marveled in all the many beautiful things around me: bright sun and blue sky and the perfect temperature and breeze; my daughter’s sweet face, big eyes, and tender hugs; my husband, my rock for 18 years; the love of family; good friends who stopped by with hugs and have been so helpful and supportive these last few months, and who don’t judge me for using humor to get through tough times; my cats, who took turns snuggling with me to help my heart heal.

My body is amazing. I no longer care that it isn’t some magazine’s idea of perfection. The reality is that this body is stronger than I ever could have imagined, and it continues to show me that every day. It is resilient and capable.

From this point onward, I need to embrace who I am, without apology. This won’t be easy for me, but I shouldn’t be ashamed to put as much love and compassion out into the world as possible.

Having healthcare support that you trust can make all the difference. Unfortunately, for many people, finding this is a privilege. I truly believe it should be a right. You should be part of your own healthcare team, not forced to be a bystander. I can’t thank my doctors enough. My primary care is someone I truly believe cares more about her patients than policy, and she respects us and provides collaborative care. And my fertility specialist — well, he didn’t have to come in on a weekend, a holiday weekend no less — he could have easily said to go to the nearest ER. But he showed up, and I have no doubt his quick action saved my life. Later, told us that he was glad to do it, because as much as he loves reproductive medicine, he originally thought he wanted to be a trauma surgeon because he liked the action. In a situation like this, you really want the doc who really likes working in that high-pressure environment. Thank you Dr. Simckes for all your support: your expertise, your words of wisdom and humor, giving me my life back. No words will ever be enough to thank you.

I cannot feel guilty about mourning my losses. I have tried to will myself to get over this more quickly. There’s been guilt associated, feeling like I perhaps am indulging and grieving something that I don’t have a right to. That I already have a child, when others struggling with infertility are still hoping for even one child in their lives. That I know other who have suffered losses much further along. That I know many who have had many more losses, etc. But there’s no formula for the amount of grief one should experience, like if you were x weeks along, have had y pregnancy/infant losses in the past, and z number of children already, then your allotted amount of grief = A.

I have an even deeper appreciation for how much support families need in their journey. Not all journeys look like we hope or expect them to. And that means that the support families need, whenever they need it, is important.

Please make sure you know the risk factors for an ectopic pregnancy. And if you think there’s even a slight possibility, please make sure that you are followed by an OB very closely during your first trimester. According to the Mayo Clinic, risk factors include:

  • Previous ectopic pregnancy. If you’ve had one ectopic pregnancy, you’re more likely to have another.
  • Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are caused by gonorrhea or chlamydia.
  • Fertility issues. Some research suggests an association between difficulties with fertility — as well as use of fertility drugs — and ectopic pregnancy.
  • Structural concerns. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy.
  • Contraceptive choice. Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it’s more likely to be ectopic. The same goes for pregnancy after tubal ligation — a permanent method of birth control commonly known as “having your tubes tied.” Although pregnancy after tubal ligation is rare, if it happens, it’s more likely to be ectopic.
  • Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. And the more you smoke, the greater the risk.

One final note: To all those who are grieving in your path to parenthood or to expand your family, I honor your journey and feelings, and hold space for you. You may or may not want to talk about it, but either way you need not feel alone in your journey.

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About Becca Marshall

Becca is a postpartum doula and a CLC (Certified Lactation Counselor), offering in-home, customized support for babies and families. She also teaches Pump Prep, a class designed specifically for those who need to pump. She has been with Purple Lotus Doulas since 2013.

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