Tuesday, January 1, 2013

Remembering our loss of Little Owl

Almost two months ago, I left off with Crunchy Husband and I celebrating the coming of a new baby and not-so-much celebrating the woes of the 1st Trimester.  About a month ago, about a week into what we thought was my 2nd Trimester, we discovered the worst news any expecting parent could face.... we had lost the baby.  I am just now coming to complete terms with this as we try to healthily grieve and move on.  Luckily, CH and I have an extremely strong marriage.  We have been through a lot together, so while this experience has shaken our individual well-beings and fortitude, it has not shaken our marriage.  One bit.  And that, in itself is truly a Christmas miracle.

What happened?  Well, I'm still trying to figure that out, and with my scientific mind, I couldn't take "We may never know" as a valid reason.  What follows is what I do know, now.

We experienced what is called a "missed miscarriage" or "missed abortion".  This happens, usually later in the 1st Trimester and early 2nd Trimester and is common in the periods before women may have what is called a "still birth", where the baby may be "born" but technically has died in the womb, usually some time before.

We found out this news on December 3rd.  I was supposed to be 13 1/2 weeks pregnant and going in for a routine ultrasound to perform a nuchal fold transparency test.  It basically measures the baby's skin around the back of the neck, which can be an indicator of genetic abnormalities, such as Downs Syndrome.  I was excited to get to see our baby again, and super excited because it would have been the first time CH would have seen the heartbeat.  He had to work the day I had my 1st ultrasound where we found out I was 6 weeks 5 days and saw the heartbeat.  I was also excited because it seemed like the 1st Trimester nausea and vomiting had finally eased up.  Little did I know, that wasn't completely normal.

Instead of seeing our Little Owl with a beating heart and moving around in response to the ultrasound probe moving on my belly.  We saw Little Owl just curled up there,  not moving, no heartbeat.  You could tell there was something amiss, and the ultrasound tech and her doctor supervisor quickly hurried out of the room, while asking me if I could go pee.  Trying to think the best, I thought maybe my bladder being full was the reason the baby wasn't moving or maybe we weren't getting a good picture.  I came back from the bathroom, and it was several more minutes before the ultrasound tech and supervisor came back in.  They lubed my belly up again and tried a second time.  Still no heartbeat.  Still no movement.  And the baby was measuring small for its supposed gestational age.  The baby had died almost 2 weeks ago.

I went into hysterics.  I was bawling.  I vomited several times into the exam room trash can.  Nothing my husband or my mother could do comforted me.  It was the pain I have ever felt.  In my entire life.  It felt as though some monster had reached into my body, into my soul, and had grabbed it, crushing it with its claws and wrenching it into pieces until there was nothing left.

After I had calmed down some, they lead me to another exam room.  My OB, usually a bouncing humorous man with a Jersey accent who has practiced obstetrics for 42 years, was solemn.  The first thing he said to me was "Shit.  Just shit.  There is no good to come out of this. None."  He held my hand as my husband sat on the examination table with me, trying to comfort me.  He explained that something was wrong with the baby that had caused it to pass away and that we may never know.  He told me there were three options (1) Watchful waiting for a natural miscarriage.  (2) Misoprostol, a NSAID that would cause me to go into contractions and miscarry at home.  (3) Dialation and Cutterage (D&C) to abort (miscarry) the baby by medical means.  With the third option, he told me, at least we could do pathology and genetic testing on the baby to see if we could pinpoint what may have been wrong.  He talked to me about grieving.  How it was natural.  How he would have thought I wasn't human had I not reacted the way I did.  How he would know if I was grieving too much or for too long because he would be with me every step of the way.  That it wasn't our faults.  That he wanted me to make a list of every single stupid reason I came up with for why it could have happened and bring it for my next appointment so he could tell me I was absolutely wrong.  And then he hugged me and held me for almost too long and told me that we would all get through it together and that I would try again and have a successful, healthy pregnancy.

But first, I had to go downstairs for pre-admission bloodwork and confirmation of declining hCG levels.  There was a huge congregation of people waiting on bloodwork in the laboratory waiting room.  With tears still streaming down my face, I filled out a form and waited to be seated.  A woman walked into the room with her newborn baby cooing and crying.  I lost it.  I started sobbing and my husband tried to shield me.  A saw the admission specialists whispering to a nurse.  She walked over to the door and called my name.  When I walked into the lab, she took my hand, led me over to her station and gave me a big hug.  "I'm so incredibly sorry.  Please, can I get you anything?  A cup of water?  A cold compress?"  All I could do is nod and she almost had to physically place me in the chair because I was so numb to my surrounds.  But all I could think was.. "I just lost my baby, and this complete stranger cares.  She just literally helped me wipe my tears away.  She actually cares that I just lost my baby"  You don't think about healthcare professionals actually CARE for you and your emotions.  That they have done things so many times that they are numb robots that automatically have a set reaction to every situation.  From this experience, I can tell you that is absolutely false.

I went home.  I went into my office to write an email to people at work letting them know everything was okay but it would be a few days before I could return to work.  In my office chair, I found our Little Owl.  Not our baby, but the stuffed Little Owl my husband had bought for our baby.  I had put it there before we left for the ultrasound to get it out of the way for my mom, who was sleeping in our guest room/office.  I held it and couldn't let it go for the first day, and my husband and I crawled into bed together.  We held each other and the stuffed version of our Little Owl.  We asked why.  We prayed.  We hoped for the future.  I cried.  He solemnly comforted me, always being the rock he always is, and that at that time, I didn't know if I wanted him to be.  We slept for hours.  We woke up, cried some more, talked some more, sometimes napped some more.  My mother made us something to eat, and I choked it down because I wasn't hungry, but I knew I needed strength and had to go on.

After I could handle being out of bed.  I frantically researched.  Google. Babycenter. American Pregnancy. PubMed.  I researched missed miscarriages and their causes.  I researched my medical options for miscarrying.  I found out that the 1st option was entirely unlikely to happen on its own at this late stage, and that what would likely happen is that I would start hemorrhaging and have to have an emergency D&C anyway.  With the 2nd option, I read the horror stories of women who also hemorrhaged, had excruciating contractions, and then had to face their failed pregnancy in the face.  By staring at their dead baby, at this point the size of a peach, in the toilet, sac and all.  Ultimately, a lot of these women still had to undergo an emergency D&C because all the "products of conception" were not removed and the left over tissue caused an intrauterine infection, which can lead to scarring and sterility.

I knew my choice was clear.  Although it is not the "natural" choice, I chose a D&C because (1) I am a scientist.  I know the risks.  I know there is a reason these procedures were originally developed.  It was not to abort babies of mothers that wanted a choice in their reproduction.  It was to SAVE the lives of mothers who didn't have a choice in whether their baby lived or died.  (2) I wanted to know, if at all possible, what had caused our Little Owl's demise.  (3) The sooner we put Little Owl to rest, the sooner I could heal, both physically and emotionally.  Carrying around my dead son or daughter around with me 24/7 was getting to be more than I could bear.

My OB, understanding the stages of grief and the realism that I probably had not come to terms with accepting that Little Owl had died, scheduled a second ultrasound to confirm death of the fetus on another ultrasound machine, several days later.  Through the denial, I came up with all kinds of reasons.  The ultrasound machine was broken.  The ultrasound tech had accidentally pulled up someone else's still frame.  The ultrasound was too quick to be able to get the probe in the right angle.  The baby was asleep.  The baby is just small for its gestational age.  On and on and on....On December 6th, I went in to the ultrasound and got a good hard look at the reality.  The baby was even smaller, right along with how many days had passed because they shrink at the same rate they grow.  The ultrasound tech was a resident that was under my OB.  She took as much time as I needed.  She explained all the markers.  She moved the probe in different angles so I could be sure it was MY baby I was seeing inside MY body.  She asked me what I wanted to do.  I told her I wanted a D&C.  She told me that was pretty much the only option I had being this far along and that I made the right decision.  That they tell people they have those other 2 options when really, they don't, and they're putting themselves and their future reproductive and possibly mental health at risk.

I was scheduled for a D&C the next morning.  My mother, my husband and I went straight up to the maternity ward.  They put me in a beautiful, large room.  It was almost completely quiet.  No babies crying.  No dinging of the celebratory birth chime.  Just nurses coming in and out prepping me for my surgery, and a visit from a dear friend who has been there for me during both the ups and downs of the pregnancy. Talking about theirs and others experiences with miscarriage.  Their later triumphs.  Assuring me that all would be well, during the surgery and after.  The nurses started my IV and put me on a high dose of antibiotic.  It was fresh out of the fridge and so cold it made my arm hurt.  My nurse, Tamara, rubbed my arm to warm it up, covered it in hot blankets, and diluted my antibiotic with saline so my arm wouldn't hurt so bad.  We even laughed about bubbles in the IV and how much it takes for an embolism and every time I saw a big one, she would try to flick it into smaller bubbles so I wouldn't worry so much.  She was by my side through the whole thing, and assured me she would be with me during the whole surgery and my recovery.

They wheeled me back to the OR and had me switch onto the operating table.  The anesthesiologist came in to start me on my "twilight" anesthesia.  I would be awake for the surgery and responsive in case they needed me to push, but I shouldn't remember anything.  For the most part, I didn't, except little snips of the OR, the OB surgeon, and the rest of the OR staff, including Tamara, standing there, watching, waiting, assisting, making sure I was okay, occasionally holding my hand.  But I remember them telling me the surgery was over, they told me my baby had been delivered.  They asked if I wanted cytogenetics.  My speech was so slurred they couldn't understand me and had to ask me again after I had recovered, but luckily they also didn't hear me ask "Is my Little Owl a boy or a girl?"  Although the cytogenetics did tell us what happened to the baby, I still don't know the answer to that question because I haven't asked it again.

I recovered extremely quickly.  The anesthesia wore off ask I was being wheeled back into my room.  My mom and husband were waiting there.  After I woke up, they took out my catheter and let me go to the bathroom.  My nurse commented that she had never seen someone get up so quickly and be steady on their feet.  She covered me up with hot blankets and got me some hot tea and asked if I would like something to eat.  After I ate, she told me I could stay as long as I liked and go home when I was ready.  I was ready.  I wanted to leave it all behind.

We stopped by the pharmacy and picked up my medications, a heavy-duty 600mg ibuprofen and methylergonovine, a medication that would help my uterus shrink back down and help me deliver any remaining tissue from the surgery.  The recovery went pretty well, I slept most of the next two days, partially out of depression, mostly from the ibuprofen making me drowsy.  My mom was extremely helpful with cleaning up my house and making sure I ate.  After a few days, I thought I was okay to return to work.  I wasn't.  Physically, it was painful for me to sit or stand for too long.  Emotionally, I couldn't handle knowing that everyone wanted to know what happened, and I couldn't even begin to tell them in any amount of detail.  Although I am usually very open with people about all the joys and trials in my life, I couldn't stomach being open just yet.  I just wanted to be in my shell.  By myself.  Maybe occasionally accompanied by my husband.  Just us. Just me.  With my Little Owl stuffed animal I had bought for our baby.  Our baby who had lived inside of me, but who would never live in the outside world.

I went for a check-up with my OB about 10 days later.  He did some more grief counseling.  He checked to make sure everything was back to "normal", and he told me we could start trying again after my first anovulatory cycle because I am a late ovulator (otherwise it would have been two cycles).  Just when I thought I had healed, I returned to work, although briefly, and I began to hope for future pregnancies.  That's when I got the phone call.  The cytogenetics had come back.

Receiving the results opened new wounds.  Knowing there was nothing I could have done gave me a strange peace.  The OB surgeon recommended waiting three months to conceive again.  This would give us time to be seen by a genetic counselor in the High Risk Obstetrics unit.  To my husband and I, it didn't make sense to wait.  Knowing how ovulation works from a scientific standpoint, I knew waiting did not decrease our chances of another miscarriage.  In fact, the next dominant egg was likely going to be defect-free.  Our OB who had practiced for 42 years knew there was not a single significant medical reason for waiting more than one normal cycle.  In fact, waiting too long can increase the chances of another miscarriage.  So, we are trying again.  Because right now, it feels like it is the only way we see fit to heal.

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